A COVID-19 Update from Dora Anne Mills, MD, MPH
It’s hard to imagine what we would have thought a year ago if we had a crystal ball and caught a glimpse of our lives today! Information has evolved so quickly, and we’ve had to pivot and adapt to unheard of new habits. I get a lot of questions about everyday living during the pandemic, e.g. when is it fine to not mask, am I eating in restaurants, etc. I’m going to try to answer some of these by taking you through my typical weekday.
In the morning shortly after rising, I answer several screening questions via an app on my smartphone. It asks me if I’ve traveled out of state if I’ve been in contact with anyone who has COVID if I have one or more symptoms. If I answer them all negatively, a “cleared” sign is texted to me. I need to show that “cleared” sign whenever entering a MaineHealth facility. It is good for about 20 hours.
Before I leave for work, I pick out my mask for the day, usually one that matches my outfit. The clean ones now take up their own drawer, similar to the drawers that hold socks and underwear. At the end of the day, my mask will be thrown into the laundry pile.
The masks I like the best are those that have two stretchy bands that go around my head. That way, when I don’t need the mask on (e.g. when I’m alone in my enclosed office with the door shut), the mask is around my neck, looking a bit like a small scarf. It’s easily accessible; I just need to pull it up if someone walks into my office or if I step out. I find the masks with ear loops make the skin around my ears sore and my ears stand out. I like the masks with toggles, but my hair gets caught in them.
Besides showing Jim at the front desk my smartphone with the words “cleared” on it when I enter work, I use my car keys, elbow, and/or shoulder to open the doors and press the elevator buttons. You may ask why I take these precautions if the major transmission with COVID is through the air, not from fomites. You’re right. But I do take precautions around commonly touched items such as door handles and elevator buttons. I try to not touch those directly with my hands, and if I do, I wash or sanitize them afterward.
I work in the office every weekday. Although we in senior management rarely meet in-person and almost always meet virtually (e.g. via zoom), we are still on the same floor and are able to easily find each other for ad hoc discussions pertaining to the many daily decisions related to the pandemic that must be made. We are masked unless we’re alone in our offices. Our policy is when we’re around each other we’re masked and at least 6 feet from each other. We eat lunch alone in our offices, and we don’t have communal food anymore. The good news – maybe I won’t put on the winter holiday pounds this year!
At the end of the day, a couple of times a week I call a local restaurant and order take out, then pick it up curbside on my way home. I didn’t eat out this frequently before the pandemic, but I want to do what I can to help keep our hospitality industry open.
Although I used to enjoy eating with my young adult son, with the winter surge, we try to stay masked, distanced, and eat at different times or in different rooms. He works at a public school and tutors elementary school children who cannot always mask or keep distanced. He is masked and wears a face shield at work. But because we’re both around others at work, with disease rates rising, we are now even more careful than a month ago. We still enjoy talking with each other, but do so now sitting at least six feet across the living room from each other while masked.
In the common area of my condo, I open the windows frequently to improve ventilation, though that is going to have to be less frequent with the cold weather upon us. I just bought an air purifier recommended by Consumer Reports. While it’s unclear how effective these machines are, living in fairly close quarters with someone working on the frontlines, I thought it was worth the investment.
With only one bathroom, I rearranged everything there last March as the pandemic swept toward us. At that time, three of us lived there, including my teenage daughter, who was a senior in high school. I took all of the towels and toiletries out of the bathroom. I gave each of us a small cubby in the hallway with a container for one’s own towels and toiletries. That way, we can pick up what we need and take it into the bathroom, and then leave it in the cubby afterward. Gone is the toothbrush holder beside the sink with all of our toothbrushes and a shared tube of toothpaste. Gone are hairbrushes piled onto the counter. Gone are towels hanging on hooks and racks, including a small hand towel beside the sink. There is a roll of paper towels in case someone forgets to bring their hand towel from the cubby. There is also some bleach spray I wipe the faucets and toilet handle with a couple of times per day, and clean all of the commonly used surfaces with daily. I’ve gotten used to using products like crème and a hairbrush in my bedroom. With limited ways to ventilate the bathroom and two to three of us sharing it, I try to spend as little time there as possible.
What happens when I’m filling up my car with gas? First, I rarely gas up my car, since it turns out with zoom meetings, I’m not on the road like I used to be. I keep paper towels and alcohol-based hand sanitizer in my car. When I gas up, I use my keys to push the buttons at the pump. I also have a metal piece that is on my key ring that I bought from a convenience store months ago. It’s got a less jagged end to it than car keys, making it easier to push elevator and gas pump buttons. I take a doubled-up piece of paper towel that is big enough to fit into the palm of my hand. I use it like a glove with the gas pump. If I were to use gloves, I’d be throwing them away afterward. Throwing the equivalent of two pieces of paper towels away instead seems better.
I am commonly asked if I go out in public. Everyone needs to make their own decisions based on their personal tolerance for risk. My decision has been that I’ve not eaten at an indoor restaurant, or attended an indoor movie or other indoor theater event since before the pandemic. There are higher risks in these settings than I’m not willing to take, especially since people may not be masked and they’re indoors. With that said, I ate at outdoor restaurants three times last summer and attended several drive-in movies and outdoor drive-in concerts. As mentioned, I commonly order takeout or home delivery from restaurants.
his summer I occasionally went into stores, but am now trying to do less of that because of the surge. The good news is that stores are generally well-ventilated and people are hopefully masked. I am fortunate to live where there are home delivery and curbside pickup options, so I’m taking advantage of them. Over the last three weeks, I can think of two times I have been inside a store, and each was for a very brief errand. Otherwise, I order ahead and pick up at curbside.
As careful as I try to be and so much of these habits are now just that – habits – I am by far not perfect. I find myself with lapses now and then. For instance, a friend came to visit recently, and we ended up sitting and talking for too long, mostly masked and 6 feet away but unmasked briefly while drinking coffee. It was probably fine in the summer when we were outside. But now we’re inside. I’m trying to get used to the transition. I realized after the friend left that if she or I had been infected, we could have easily transmitted the virus to the other, given that we were inside, 6 feet from each other, and intermittently unmasked while sipping coffee. I could have at least thrown open the windows and turned up the heat in order to increase the ventilation. This was a while ago, so we’re in the clear. But it was a wakeup call that even sitting together as we did in the summer is not safe, and especially if we’re inside. And after all, the virus doesn’t take a break just because we’re unmasked while eating or drinking.
My more common lapse is that I have a longstanding habit of touching my eyes. The more I try not to touch my eyes, the itchier they become. I’m getting better at it, for instance, I try to use a tissue when touching my eyes. But I do catch myself at least once a day using my fingers to rub or scratch around my eyes. The mucous membranes of the eyes, nose, and mouth are major entry points for the virus. This is one reason I am fairly careful around commonly touched fomites.
The great news is that vaccine is on its way. I could not be more excited, as I’m eager to get back together with loved ones and ditch some of these habits. However, there are some habits I’ll probably keep – attending at least some meetings virtually versus driving so much (good for the environment too), avoiding frequently touched surfaces, storing people’s toiletries separately, not sharing toothpaste. And there are other habits I may keep, depending on the circumstances. For instance, as eager as I am to ditch the masks, knowing how effective they are, I may want to wear one in a crowded setting during flu season.
Although we don’t have a crystal ball to sneak a peak for a year from now, if the preliminary efficacy and safety data for the emerging vaccines hold up, next year’s Thanksgiving week will be much more normal. It will be most interesting to look back then and see how we’ve changed, what pandemic habits we’ve eagerly ditched, and which ones we decide to keep. I look forward to that, as I am sure all of you are as well.Dora Anne Mills, MD, MPH, FAAP, Chief Health Improvement Officer, MaineHealth