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Mental and Interpersonal Hygiene in Response to the Coronavirus Pandemic

March 09, 2020
Ron Manderscheid
By Ron Manderscheid, Executive Director, NACBHDD and NARMH
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

The international coronavirus crisis continues to grow. As of Sunday, there have been about 110,000 known cases in 79 countries, and nearly 4,000 persons have died. Just released research from Harvard University concludes that the mortality rate is about 15 persons per 1,000 infected, under the assumption that only about half of those infected actually are ever identified as cases.

In the U.S., as of Sunday, there have been more than 400 cases in 34 states, and 19 persons have died. Great uncertainty also exists about the future course of the infection in the US, which is leading to disruptions in business, travel and the stock market.

More testing kits will become available in the U.S. this week, which should help to contain and control the disease. However, many more testing kits are needed.

Clearly, this period of great uncertainty can lead to fear and, in some cases, panic. For our behavioral health field, these emotional states can have very detrimental consequences.

In the workplace, three principal employee reactions to fear and panic are possible: paralysis, hyperactivity and routine functioning. Based on observations during previous national crises, each of the first two groups could represent from 10% to 15% of workers, and the third category, 70 to 80% of workers. Making every effort to reduce uncertainty can forestall these reactions. Also, increased interpersonal support can be important when employees do experience either paralysis or hyperactivity.

Persons with mental or substance use conditions are particularly vulnerable to such stress responses in the presence of uncertainty and threat. We need to have much more interpersonal contact with consumers during this period, even if only via social media, and also much stronger interpersonal support to forestall crisis situations.

Finally, I would like to present some interpersonal hygiene recommendations from James Robb, MD, one of the first molecular virologists to work on coronaviruses:

  1. No handshaking! Use a fist bump, slight bow, elbow bump, etc.
  2. Use ONLY your knuckle to touch light switches. elevator buttons, etc. Lift the gasoline dispenser with a paper towel or use a disposable glove.
  3. Open doors with your closed fist or hip. Do not grasp the handle with your hand, unless there is no other way to open the door. This is especially important on bathroom and post office/commercial doors.
  4. Use disinfectant wipes at stores when they are available, including wiping the handle and child seat in grocery carts.
  5. Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.
  6. Keep a bottle of sanitizer available at each of your home's entrances, and in your car for use after getting gas or touching other contaminated objects when you can't immediately wash your hands.
  7. If possible, cough or sneeze into a disposable tissue and discard. In the absence of a tissue, use your elbow, but keep in mind the clothing on your elbow will contain infectious virus that can be passed on for up to a week or more.

What I have stocked in preparation for the pandemic spread to the U.S.:

  1. Latex or nitrile latex disposable gloves for use when going shopping, using a gasoline pump, and all other outside activity when you come in contact with contaminated areas. Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you. However, all the surfaces where these droplets land are infectious for about a week on average. Everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces, and you will not be infected unless your unprotected face is directly coughed or sneezed upon. This virus only has cell receptors for lung cells (it only infects your lungs). The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.
  2. Disposable masks to prevent you from touching your nose and/or mouth. Studies show that on average, we touch our nose/mouth 90 times per day without knowing it. This type of contact is the only way this virus can infect you—it is lung-specific. An important note: A mask will not prevent the virus in a direct sneeze from getting into your nose or mouth—it is only to keep you from touching your nose or mouth.
  3. Hand sanitizers that have an alcohol content of at least 60%.
  4. Zinc lozenges, which have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel any “cold-like” symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx.

As this pandemic continues to develop in the U.S., I hope that each of you will pay close attention to both the mental and the interpersonal hygiene concerns being raised by coronavirus.

I will plan future reports as this situation continues to develop.

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