DR. ELIZABETH ALLEMANN, MD

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4/7/2020

Social Distancing Rules

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Honestly, it feels a little bit like the conversations we have around safer sex.  Who have you been around?  And who have they been around?  And can't I make this thing I want to do with you safe enough that we can break the rules? 

The First Rule of Social Distancing = Essential Activities ONLY
Stay home.  Anything you do in your home, in your yard, and with your household members is good.  Walking outside in a public space (or on private land with permission) by yourself or with other members of your household is also fine.  

Getting food, medicine, essential household items, and health care are considered essential activities.  It is best to do that with minimal contact. Use curbside pickup or delivery for groceries or other consumer products.  Take out (stay outside) or delivery is the only option for prepared food.  Reschedule routine health care visits or do them by phone or video conferencing.  Ask if labs, X-rays, ultrasounds or other studies can be rescheduled. Rarely, folks will need emergency home repairs, will need to sign papers, will need to make a larger purchase like a car or an appliance. Limit this to the essentials and be creative about reducing your time in a building you don't live in and contact with anyone not in your household (even at a distance). 

Only Household Members.

Whatever contact, even distant, you have is to be with members of your household only. Some folks have gotten clever and decided to make one household out of two and agreed to limit ALL their contact to just the members who live in those two households.  This doesn't work if someone  leaving the house to go interact with others on a regular basis, like for work or is going into stores to get supplies. 

Wash your hands. 

After using the restroom of course, before eating. Before and during food preparation.  Before and after touching shared surfaces. Use soap and water.  No need for antibacterial soap. A second choice (not as good as soap) is alcohol-based hand sanitizer with 60-70% ethyl or isopropyl alcohol. Stronger isn't more effective.  Avoid touching your face. 

Cover your coughs and sneezes.  

Wear a mask. If you need to cough or sneeze while wearing the mask, lower your face, use a tissue or catch it with your elbow.  
A mask will reduce (but not eliminate) the amount of aerosols you spread into the air.  If you have an infection, it will reduce the amount of virus that floats in the air for hours after you pass through a space.  
No mask works as well as staying out of the space in the first place.  Talking, laughing, and singing all seem to increase the amount of aerosols and droplets you send out.  

Distance= 2 meters of distance determines our existance
If you have already determined that your errand is essential AND that you can't do it without crossing paths with others, THEN please make every effort to stay 6 feet (2 meters) away from everyone else.  Current recommendations advise that  you cover your mouth and nose with a mask, wash your hands, use hand sanitizer, don't touch anything you don't have to,  and get your business done quickly so you can return home. 

Intentionally getting together socially and staying 6 feet away or wearing a mask is NOT on the current guidelines.  Taking a walk with a friend but staying 6 feet away?  NOPE.  Having a neighbor over to garden outside?  NOPE.  Having friends over for a campfire?  NOPE.  Having a community work day to pick up trash/pull out invasive?  NOPE.  Stopping by to see your grandchildren and sitting out in the driveway 6 feet or more apart? NOPE.  Why?  because none of these things fits into the above definition of essential activities.  And they all include folks who aren't in your household. 

Clean surfaces. 
Use the same soap for wiping down surfaces and objects.   For surfaces a third choice is bleach, 10% solution   Stronger doesn't work better.  Do not apply bleach to your skin. We have all read about how long the virus lives on various surfaces--from a few hours to a few days.  If someone outside of your household has touched a surface, it's wise to either leave it alone for a day or two or wipe it down with soap and water, alcohol, or a dilute bleach solution.  As you do this, remember that the PRIMARY way SARS Co2 is spread is by respiratory droplets and aerosols.  The most important things seems to be to stay out of buildings that you don't live in.  High exposure folks like health care workers and emergency responders should probably launder their clothes on returning home and shower before touching other people or surfaces.  We don't know if there is any benefit in doing that after a trip to the store.  There is no need to even consider that if you picked up curbside or had your items delivered. 

  
Everyone has to make their own best decisions of course.  Each person knows what is essential for themselves.  We are all in this together.  We are being asked to do the really hard things so that hospital workers and emergency responders don't have to do so many horrific things.  

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    Elizabeth Alleman, MD is a family physician, acupuncturist practicing and pondering in central Missouri

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