Even with some states judiciously re-opening for limited business, I don’t think we are ever getting back to the previous “normal,” at least not until next year, if at all. Of course, there are some states that seem to be recklessly re-opening at all costs, placing the economy squarely above public health. So, for this month’s column, I’m removing my food and wine hat and getting back to what pays the bills in the Tatsumoto abode and putting my health care worker hat back on.
The Careful Balancing Act
I fully understand the current impact that COVID-19 is having on the economy. Unemployment rates have soared, and are at the country’s worst since the Great Depression. Many states have been bogged down by masses of unemployed for close to two months, compounded by many state offices having employees work from home. I know there are many workers who haven’t even seen their first unemployment check. And the situation won’t be improving anytime soon.
Even with businesses slowly opening, many will be operating with just the minimum skeleton crew, so everyone won’t be back to work immediately. Even if businesses are given the green light, how many shoppers and diners are likely to re-patronize these businesses in the way they did before the pandemic? I miss my local watering hole, Vino Italian Tapas and Wine Bar, as well as Tanuki Sushi, but I’m probably not jumping back into the fray, as the dining experience itself would be surreal at best, with other tables seated six feet away, along with the constant cleansing of tables between table turns. We’ll probably continue to order take-out on a regular basis to support our favorite establishments, but actual sit-down dining will be placed on hold for the short-term.
And it’s not just for personal reasons, even though I’m just below the high-risk age cut-off and have several medical conditions that place me just below high risk. I still have an 85-year-old mother who definitely is high risk and the last thing I want to do is unwittingly transmit COVID-19 to Mom.
The first, second and third measures to reduce the risk for COVID-19 infection is washing your hands properly, and as often as possible. Get that lather nice and soapy and scrub the fingertips, between the fingers and the palm for at least 20 seconds — sing “Happy Birthday” to yourself (silently or out loud) twice. And even if you wash your hands often, get in the habit of NOT touching your face! You can wash your hands for 100 seconds, but if you touch a surface that still has viable virus particles, then rub your eyes or touch your mouth or nose, those virus particles now have an entry point through your mucus membranes to initiate the infection.
I engaged in the “no touch” behavior when I first worked in retail pharmacy 20 years ago, as any virus infection, including the ubiquitous common cold, is primarily passed hand-to-mouth. You touch that patient’s insurance card or paper prescription (which many patients placed in their mouth while searching for their insurance card) then either rub your eyes or mouth and voila! Those same viruses that the patient saw the doctor for now are in your system.
And if you can’t wash your hands with soap and water for 20 seconds, use an alcohol-based gel to temporarily disinfect your hands. Since most alcohol-based gels like Purell are probably in short supply, I created my own using a recipe from the United States Pharmacopeia. I am a pharmacist, after all.
Their recipe was for creating 10 liters of alcohol gel, which was a lot more than is needed for personal use, so I scaled back my measurements. For starters, while the minimum ethyl alcohol (the same alcohol in adult beverages) required is 60 percent (Purell is 70 percent), most experts recommend an 80 percent ethyl alcohol gel. That’s why homemade gels using Tito’s vodka fall far short of the recommended alcohol level as even pure vodka is usually just 43 percent alcohol.
My recipe also uses a “beverage” that you usually find at liquor stores, but it’s either Everclear or Clear Springs grain alcohol, which is 190 proof or 95 percent ethyl alcohol. Though they’re sold at liquor stores, they’re not really produced for plain consumption — and while I do have bottles in my home, I use it to make either limoncello or to rinse out decanters.
80-plus Percent Ethyl Alcohol Cleanser
7 ounces 190 proof grain alcohol
2 tsp 3 percent hydrogen peroxide
Enough glycerin to make eight ounces of liquid total
Mix the liquids until the glycerin “dissolves” into the alcohol and peroxide mixture. I use an empty eight ounce Dawn dishwashing container and leave it upright in the beverage holder of my vehicle and use it whenever washing my hands with soap and water isn’t practical or available (leaving the gas station or supermarket).
This solution is a lot more runny than Purell gel, so don’t forcefully squeeze the bottle when using this sanitizer.
For starters, let me clear the air on personal mask use. The purpose of wearing them is primarily used to prevent the wearer from spreading viral particles to other people in close proximity. Because most masks used in public are either basic surgical masks, cloth masks or masks enhanced with PM 2.5 filters, they prevent the spread of viral particles if the mask wearer coughs, sneezes or even simply speaks — yes, speaking causes the propulsion of air from your lungs and those minute vapor particles carry viruses.
But don’t surgical masks prevent you from inhaling viruses (since surgeons use them in the operating room)? While they can reduce the wearer from inhaling infectious agents, they don’t make a complete seal around the nose and mouth, and their primary utility is to prevent the surgeon from passing infectious agents to the patient who has their sterile body parts cut open. Even masks with the PM 2.5 filters are primarily meant to prevent the wearer from inhaling particles 2.5 microns or larger, which are typically pollutants like smog, car exhaust and chemicals. COVID-19 is one of the larger viral particles, and it’s still only 0.12 microns in size, which easily can pass through a 2.5-micron filter.
Because a fair number of COVID-19 patients exhibit no symptoms at all, requiring mask use for everyone reduces the chances that one of those asymptomatic patients will spread the infection into the general public.
But what about reducing your chances of infection? The only mask that reduces the wearers chances of inhaling viral particles are the N95 or KN95 masks. Both block 95 percent of particles 0.3 microns or larger, with the N95 meeting American Centers for Disease Control and Prevention and National Institute for Occupational Safety and Health standards and the KN95 meeting China’s standards. But didn’t I just say COVID-19 particles are just 0.12 microns? Yes, but the viral particles invariably float through the air on water vapor or dust particles, which are usually larger than 0.3 microns and electrostatic fibers in these masks tend to bind even particles smaller than 0.3 microns. However, these are the masks that frontline health care providers need and are in very short supply in most hospitals. Ideally, each mask should be used for an individual patient encounter, but many nurses are using a single mask for their whole eight-to-12-hour-shift due to the supply shortage.
What About the
This is my personal professional opinion, so take it anyway you want, but I’m not really hopefully that a COVID-19 vaccine will be the cure-all, end-all of COVID-19. For starters, it takes quite awhile for any new vaccine to hit the market. First, you have to make sure it’s safe in a small population, then you see if it’s possibly effective in that population. Then you have to do randomized trials in a larger population for both safety and efficacy. If you attain statistical significance that it’s efficacious and the potential side effects don’t outweigh the benefits, finally, it can be produced and marketed. Just the testing alone, even if a beneficial vaccine is created, places mass immunization into next year at the earliest — not when the usual flu season begins in a few months.
Secondly, COVID-19 comes from the corona family of viruses, many of which are the causes for the common cold. And like most people, I’ve had a case of the common cold many times in my life, because virtually all of us never develop immunity to this family of viruses.
Even if a vaccine is produced, different vaccinations have different abilities to produce immunogenic responses with varying durations of that response. For instance, the Pneumovax provides 60 percent protection on the lower end, and up to 100 percent protection with the Tetanus vaccination. And it’s widely accepted that contracting the disease provides a greater response and immunity than the vaccination alone. As a personal example, I contracted chickenpox some 46 years ago and still have high titers of antibodies to the varicella-zoster virus, whereas Zostavax only provides guaranteed disease protection against shingles for about 10 years.
Since we’re finding patients who were COVID-19 positive and had symptom resolution two to three weeks later with an accompanying negative test, only to test positive again a month or so later, I’m not sure how effective a vaccine will be for long lasting COVID-19 protection.
The New Normal
So, the new normal will probably include frequent hand washing and/or alcohol gelling, as well as more frequent mask use. I also see the educational system eventually moving to more online teaching and training, especially at the college and high school level. And I hope people realize that it’s not just simply about trying not to get infected with the virus, but it is also about trying not to infect others …
The Gochiso Gourmet is a column on food, wine and healthy eating. Ryan Tatsumoto is a graduate of both the University of Hawai‘i and UC San Francisco. He is a clinical pharmacist during the day and a budding chef/recipe developer/wine taster at night. He writes from Kane‘ohe, HI and can be reached at email@example.com. Views expressed in the preceding column are not necessarily those of the Nichi Bei Weekly.