It’s time we had the talk. I’m banking on all of you already knowing that babies come from storks. Although this is good advice on preventing STDs, I’d like to focus on the TD part: transmitted disease.

A pathogen is a bacterium, virus, or other microorganism (fungi, protozoa, and worms) that can cause disease. Infectious diseases are caused by pathogens that can spread from one person to another. Zoonotic diseases are caused by pathogens that can be spread from animals to humans and cause disease. The treatment depends on the kind of pathogen. For example: antibiotics ONLY work on bacterial infections; taking antibiotics for a viral infection is taking a knife to a gun fight. Here’s why:

The difference between viruses and bacteria:

Well, there’s a lot, but what you need to know is that bacteria are living organisms; viruses are not. If you’d like to know what must be present in order to be classified as living, look up “the seven characteristics of life”. Anyway, bacteria check all seven of those boxes. Viruses, on the other hand, must have a host cell to grow and reproduce. That means that, outside of a host, viruses are dormant (all function suspended indefinitely; like a battery, if you will) while bacteria are business as usual. Bacteria can even work together as a team. They’re tiny critters. Now: both bacteria and viruses are invisible to the naked eye, but bacteria are HUGE compared to viruses. The smallest bacteria is 0.4 microns. The largest virus is 0.025 microns. That means that the wimpiest bacteria is 16 times the size of the beefiest virus. To put that in perspective, the track you ran on in high school is a 1/4 mile oval. One time around that track and you’ve passed a virus. 15 more times (3 3/4 miles), and you’ve finally passed the bacteria beside it. The super impressive thing about viruses is (in case you haven’t connected the dots yet): they’re dormant until they have a living host. Bacteria are living hosts. That means… you guessed it! Viruses can infect a bacteria. Like tiny soulless drones. YIKES.

If you only take one thing away from this article, it should be this: antibiotics, such as Zithromax, do absolutely nothing to viruses. I can’t stress how important this is. Taking antibiotics when you have a viral infection will only upset your stomach and possibly give you a yeast infection because antibiotics only kill bacteria, and a lot of the bacteria in our bodies do good things like help with digestion and eat excess yeast. Taking an antibiotic to kill a virus is essentially using a bug spray as a weed killer; not only will it not kill the weeds, it’ll kill the bugs that would normally eat the weeds and then you’ve got MORE WEEDS.

I know. Rumor has it that Zithromax and Plaquenil makes you immune to COVID19, STDs, and hurt feelings and if you take them together you’ll be a better dancer. This is simply not true (NONE OF IT). Hydroxychloroquinine, brand name Plaquenil, is a first line drug to treat and prevent malaria (a protozoal parasite – NOT a virus) that is spread through mosquito bites primarily in tropic and subtropic climates. Plaquenil is also used to treat inflammation in some autoimmune disorders. A secondary infection is an infection that occurs 1. during or after treatment of a primary infection (the yeast infection caused by the antibiotics killing the bacteria that keep the yeast in check), and/or 2. during a change and or/weakening of the immune system. Bacterial pneumonia is a secondary infection that can be caused by COVID19. This is the only time the one-two combo of those particular drugs is warranted. Otherwise, taking them will just create a superbug (ie: MRSA), and create a shortage of medicine that helps people with Lupus and the like (autoimmune disorders).

The way these things are spread:

This is also known as the routes of transmission. Basically, the ways they can move from one human to another and declare their independence like we did from England back in 1776:

1. Aerosol. The pathogen is contained in aerosolized droplets and enters its next victim while hanging out and floating around in the air.
2. Direct contact. The pathogen enters it’s new person through mucous membranes (these are the places that aren’t covered by regular skin – eyes, ears, nose, mouth, genitals) and also through breaks in your regular skin (cuts, tears, hangnails, etc.) from the mucous membrane of it’s original person.
3. Oral. This one is obvious. Don’t eat it, chew on it, or lick it. Not even if you found it. The five second rule doesn’t even apply here.
4. Fomite. This one’s important; it’s a lot like direct contact but there’s something else involved in the meantime. Sure, you didn’t lick you neighbor’s nose. But that doesn’t matter if they opened your door after they wiped it on their hand, then you run out to give them the eggs they forgot, then you lick the peanut butter and jelly from your sandwich off your fingers on your way back inside. You just licked your neighbor’s nose without the awkwardness or the police getting involved. This one is why you can’t return underwear if it doesn’t fit.
5. Vector borne. The pathogen moves from host to host via living shuttle. The fleas and ticks. The bubonic plague was born.

In the hospital, there are three different levels of precautions to limit the movement of a pathogen based on presenting symptoms. That said, the creed we live by (quite literally) is “treat everybody like they have everything” (aka: standard precautions). Here are the three levels of infection control and prevention (the steps you take in addition to standard precautions):

• Contact precautions. Used with known or suspected diseases spread through direct or indirect contact. These are the yucks. Gown and gloves (ie: draining abscesses, head lice).
• Droplet precautions. Known or suspected pathogen spread by droplets. A surgical mask when within three feet of the person (ie: pertussis and influenza. Six feet for smallpox).
• Airborne precautions. This one adds a N-95 mask/respirator and keep the person in a negative pressure room if one is available (ie: tuberculosis and measles). Positive pressure rooms use air vents to push clean air into a room and push pathogens away from the occupant, ie: someone that is immunocompromised (on chemotherapy, for example). In a negative pressure room, the air is pulled *through* them via the vents, filtered, then blown out of the building. This helps keep the airborne pathogens out of the building sort of like the good-hair-day-ruining air curtains at Big Box stores help keep the climate controlled air inside. One of the ways we beat the Spanish Flu back in 1918 was outdoor hospitals. Sharing air vents makes things complicated. Everybody had their very own positive AND negative pressure tent by default, with the added sanitization of the UV light from the sun.

We give every provider the heads up about what kind of suspected or confirmed pathogen is present by placing a laminated sign outside the closed door that says either Contact Isolation, Droplet Isolation, or Airborne Isolation. Sometimes it’s okay to put a label on it. There is a subtle but distinct difference between infringing on someone’s rights and protecting yourself and others from cooties. Even though I cried myself into dehydration, I highly recommend watching the movie “Five Feet Apart”. It’s about two teens with Cystic Fibrosis (not an infectious disease. Look it up in your Funk and Wagnalls if you’re curious) that meet and fall in love in the hospital. Their romance is built around staying at least five feet away from each other at all times – a feat they undertake in a creative way: “holding hands” by each holding one end of a pool stick between them at all times. I think they came up with the idea with the best of intentions; the misleading part is that five feet is enough (when the standard is six or more). Go into it knowing that and it brings a lot of things about infectious disease home.

What exactly is the novel COVID19, then?

Coronaviruses have been around for like, ever. Chances are, we’ve all had one at some point. They’re not a singular virus but rather a family of viruses that usually cause mild to moderate upper respiratory tract illnesses; the biggest example is the common cold. You read correctly: the common cold is a coronavirus. Novel means that it is a new strain of a coronavirus that had not been previously identified in humans. COVID-19 differentiates this particular pandemic from other coronaviruses in that it is new, and it emerged in 2019. It’s different because the time from infection to symptomatic can be up to 14 days (this is the incubation period; for the common cold it is 1 to 3 days). This means you could have it and be spreading it for up to two weeks without knowing it. That’s a BIG margin. The other major difference is severity. Because it’s a new strain, we don’t have specific immunity to it. This is important because it means COVID19 is much easier to spread from person to person, and also because our bodies don’t know how to tackle it (meaning the symptoms hit much harder).

Hand hygiene, masks, and “don’t touch your face”: without the method, you’ve just got madness.

Everybody knows that the best way to flatten the curve is with masks and good hand hygiene. But: if you don’t know the how’s and why’s, they’re a far cry from the Idiot’s Guide to Not Getting COVID19. Heres the skinny:

It’s not just your face you shouldn’t touch.

Not in a biblical sense; in a common sense. I was absolutely riveted (like, on the edge of my seat kind of consumed) during anatomy, physiology, pathophysiology, and microbiology classes. Sure, I’ve forgotten a lot of the specifics I learned, but the dots connected and the bigger picture still remains in my hard drive (the nickname I gave to my central nervous system. Because I’m a NERD.). I’ll simplify this as best I can as most people glaze over about 1.5 minutes in when I strike up a conversation about it (because I’m also a socially awkward DORK.). I get palpitations when someone says, “we should hang out”. I don’t even understand what that *means*. When I hear that suggestion, this is what I picture:

This is some basic information you need to know about how to intelligently defend yourself against pathogens. If you’re lucky, your body has soldiers already in place to defend its territory. There are three major branches of your armed forces:

• Cellular barriers. These soldiers are your skin and your mucous membranes (cells that secrete mucous which serves to lubricate and protect by trapping pathogens). They’re your frontline defense to prevent the enemy from breaching your perimeter.
• Mechanical defenses. Urine, tears, shedders, and sweepers. These appointed officials are the Marshalls, the Rangers, and the Citizenship and Immigration Service. They nab the intruders, the trespassers, and the interlopers and remove them.
• Microbiome. Beneficial resident bacteria that live on your skin, respiratory tract, GI tract, and genitourinary tract. These guys are the vigilantes and the one’s that put the bad guys under citizens arrest. They take up the space and use the resources. They’re the shoulder-to-shoulder general admission ticket holders that already ate all the hot dogs and drank all the beer.

Hand hygiene is mostly washing your hands and using hand sanitizer. What they don’t tell you is that you should clean and cover the cuts and scrapes on your hands and you definitely shouldn’t pull that hangnail down to the bone when you’re bored. That’s ripping a hole in your armed forces (also known as skin integrity. You basically lowered the drawbridge for the pathogens to walk straight in.). The other thing to consider with hand hygiene is your fingernails. They can create a cave for the little bastards to hide in. Unless you’re on a network TV drama getting bad relationship advice from another surgeon while you’re both scrubbing from the elbows down with a chlorohexadine or betadine sponge brush and fingernail scraper, you should cut the white part of your nail off and smooth everything down and forgo the acrylics. Singing “Happy Birthday” twice in the back 9 bathroom of the mall just isn’t going to cut it. This will make more sense after you read the “hand washing” section below.

“But I JUST washed my hands!!!!”

IDGAF. When’s the last time you sanitized your cellphone? Your door knobs? Your toilet handle? Your frickin’ STEERING WHEEL? Exactly. Good for you for leaving your shoes outside when you got home from the grocery store. BUT: it doesn’t count because you forgot the grocery list and snuck through the house to grab it after you left the convenient store with them on. Now your baby is crawling through your invisible path of destruction and babies put their hands in their mouth. That’s right: your kid just licked the convenient store floor. Seriously. This crud can live on surfaces for DAYS. Literally.

Hand sanitizer is alcohol based and should be 60-95% alcohol. It kills a broad spectrum of pathogens by drying them out. It is important to note that it only effects the pathogens already on your hands. It does NOT kill any that may get on your hands after you have used it. It’s not a cape and it’s not an invisibility cloak. Once you’ve touched something, REAPPLY.

Hand washing is the gold standard for clean hands. Even more than hand sanitizer. Washing your hands using soap and water for 20 seconds doesn’t kill the pathogens, it removes them entirely. If you sing “happy birthday”, “row row row your boat”, or the ABC song twice, that’s about 20 seconds. Thats how long it takes to wash the yuck off your hands.

Gloves can prevent the pathogens from getting on your hands in the first place. What they don’t prevent is pathogens from getting on the GLOVES. Then you use your gloved hand to answer your phone. If you do this, you’ve missed the point of gloves. Maybe think of disposable gloves as used condoms from now on. You’re welcome.

Masks provide a physical barrier against pathogens. It’s really, really hard for pathogens to turn corners. That means *anything* covering your mouth and nose is better than nothing. Bonus: masks also work both ways: if someone sneezes, the pathogen will have a real hard time rounding the corners to get in your nose or mouth. They’re not heat-seeking missiles. If YOU sneeze, it stops most, if not all, of the cloud of mayhem you just imparted. What about the “don’t touch your face” thing? We’ve already discussed ways these things can get into your body. If you think about it, your face (your head, really) contains a lot of those ways. Your nose. Your mouth. Your ears. Your eyes. Those are all holes in your skin. Without going into intimate detail, consider your underwear the mask for the other holes in your skin and WASH YO DAMN NASTY HANDS BEFORE YOU TOUCH YOURS OR ANYBODY ELSE’S. My point: the second way masks help prevent transmittable diseases is they remind you to keep your grubby hands off your face. If used correctly, they can be psychological barriers to protect you from yourself. Thirsty? Gotta move the mask. Hungry? Gotta move the mask. Tear open a package with your teeth? Gotta move the mask. Need to do karaoke? Gotta move the mask. Bite your nails and suck your thumb? Gotta move the mask. Just be careful how and when you do it. If you use the palms of your hands to wipe the mask off your face, you just wasted a mask and an otherwise perfectly good human being.

Much love to all y’all. Stay safe.