Handwashing: It’s Important! Dr. Eric Strand Health November 9, 2021 Everyone’s making a pretty big stink out of hand washing these days. I mean, sure social distancing, but come on… handwashing and Covid-19? Well, basically, if you consider how many things you touch in a day. From door handles to bathroom faucet knobs, toilet handles and lids to counter tops, car keys, and even cell phones. That’s a LOT of touching. When you add to that list the number of things that everyone else has man-handled (or a woman, if you are one), the ‘touches’ add up to an intense amount of germ spreading possibilities. Yesterday (March 29th, 2020) the World Health Organization published a description of the particle sizes of the most likely transmission routes of the Novel Coronavirus, also known as Covid-19. They defined particle sizes in the respiratory mode of transmission as “droplet transmission” and “airborne transmission”, differing only in the sizes of the particles(1). In this case, size matters! For the purpose of this discussion, we’re going to be talking about micrometers. A micrometer (μm) is one thousandth of a millimeter (0.001 mm), or one millionth of a meter (1 x 10-6 m) (2). Apparently, Size Matters. When someone sneezes or coughs you get the bigger chunks, defined as droplets. These droplets are considered to be somewhere between five and ten μm. With sneezing or coughing, sometimes you can even see the spray as it leaves the offending mouth hole. These potentially microbe-laden droplets are fairly heavy and fall quickly to surfaces, objects, and other people nearby. Basically, anything within 1-2 meters (roughly 6-7 feet) is getting a pretty thick dusting from an un-blocked cough or sneeze. You may have seen some people coughing into their elbow or quickly pulling up the inside of their hoodie. That’s great for reducing primary droplet transmission, but then they go to scratch or rub their face; now those creepy-crawly bugs are all over their hand. Still, an elbow is better if you’re out in public (why on earth are you out in public?). Just remember to sanitize/wash your hands frequently after touching or handling objects that aren’t yours. Image from the National Institute of Allergy and Infectious Diseases (NIAID). Image captured and color-enhanced at the NIAID Integrated Research Facility (IRF) in Fort Detrick, Maryland. Flickr The second description is of the smaller, more difficult to see ‘airborne’ droplets. These are mega-tiny: think spider-web-silk-strand small, or half-the-thickness-of-sandwich-cellophane small! This is what’s left behind in the vapor trail of someone else’s breathing. This is the stuff that can supposedly hang around for hours in the air. Think about this… have you ever walked by someone smoking and gotten a nice lung full of their secondhand exhalation? You can smell it, right? Maybe even taste it? Tobacco smoke is roughly 0.7 to 1.0 μm in lung vapor (3); the airborne pathogen we are talking about here are described as anything smaller than 5 μm up to 10 μm. If you can smell tobacco smoke being exhaled from 15 feet away with a light breeze, you could just as easily be walking through a nice fat puff of virus. Time to close the Florida beaches! The last mode of transmission described is the age-old family-fun fecal-oral route. That’s right, kids and kittens… poop in your mouth. How did it get there? Well, unless you’ve got some fetishes we need to discuss, or continue to eat at the taco truck that gives you the trots every week, then it gets there on your hands. Either you, or someone you know, love, or bumped into didn’t do you the ultimate bro-solid of washing their hands for a good 20 seconds with soap and warm water before you shook their hand, or touched the door handle, the toilet flush handle, the top of the office Keurig, or any number of keypads at the grocery store checkout kiosk. You touched it, then directly touched your mouth, or touched food and then put that in your mouth. You fed yourself poop. That’s how it got there. The reality is, if you got poop in your mouth it’s more than likely your own since according to a recent poll of 24,000 US adults, at least 4 in 10 adults don’t wash their hands every time after using the restroom (4).This means that almost 60% of people claim to wash their hands after using the bathroom. Still, 40% say they don’t always? That’s pretty gross, right? But, since we’re talking about the flu, and specifically Covid-19, if you haven’t been around anyone coughing or sneezing lately, you may have actually gotten a little bit of Uncle Biff’s poo on your hand, which you then put into your mouth with that last bit of Cheetos® dust. If there IS a silver lining, the CDC doesn’t think this mode of transmission is actually a thing (1). They only found some of the virus in one stool sample of the ones they looked at, and to date, there have been no confirmed cases of fecal-oral transmission of Covid-19. Not even in Italy! The bad news? You’re still probably getting some poop in your mouth from unwashed hands touching things and then touching your face or food. This isn’t just a ‘right now’ thing, it should be an always thing. You can also help out greatly by following a few simple rules for living in polite society: cough or sneeze into a paper towel, disposable tissue, or elbow; put on fresh clothes daily; shower or bathe at least once every day. For more on Covid-19, the flu, and proper handwashing, here’s some interesting links: For a GREAT breakdown of the believed pathophysiology of Covid-19, follow this link to watch Armando Hasudungan on YouTube. If you want to watch an amazing doctor discount the quickly mounting rumors about Covid-19: Doctor Mike Here’s a spectacular video on YouTube showing how quick and easy germs can spread by just one or two people being infected and not washing their hands: https://www.youtube.com/watch?v=I5-dI74zxPg For the basics of hand washing: https://www.cdc.gov/handwashing/when-how-handwashing.html The initial WHO publication on modes of infection: https://reliefweb.int/report/world/modes-transmission-virus-causing-covid-19-implications-ipc-precaution-recommendations Links to references: (1) https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations (2) https://en.wikipedia.org/wiki/Micrometre (3) https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-019-0970-9 (4) https://today.yougov.com/topics/lifestyle/articles-reports/2020/01/30/hand-washing-soap-poll-survey Reference Links to Images Used: (1) Sneeze Guy (2) Cov-2 (covid-19) Click here to see original posting by Dr. Strand on March 31, 2020.