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Developing New Habits and Self-Care Protocols with Covid 19 Specifically in Mind.

The following is a list of considerations and research that my family and I utilize every day as a matter of daily virus prevention protocol. The following considerations stem from my background as a Emergency Medical Technician, Nursing Student, a CNA and as a currently licensed Medical Massage Therapist. More importantly I am sharing these steps as a concerned Juneau community member and mom of two. I hope many of you are already implementing these steps.

Medical disclaimer: Please keep in mind that I am not a virologist, doctor or a pandemic specialist.

Self-Care Protocols

Steps for Evidence-Based Self-Care for the prevention and containment of viral infection.

1. Minimize Contact! Stay Home. Several leading physicians, including the Prime Minister of New Zealand have stated that it would be better "if we acted like we are already infected and worked strictly to reduce our viral transmission and rate of infection."

This is the mindset I reinforce everyday with my family. As a family we no longer share skin to skin contact, kiss or cuddle. That said after 10 days my youngest who just turned 19 started to have a meltdown from the overwhelm - so hugs over coats with faces turned away helped to reassure. Being this strict will most likely be impossible with younger children – work the best that you can washing hands and noses frequently.

Of course, my eldest who is 21 (the age group who think and act like they are invincible) went out to a friend’s house to share a few beers and sharpen skis. When he returned, I met him at the door. He laughed and asked if he now had to go through TSA. I laughed back still blocking the door way and said “Why yes you do Young Man”! He had to immediately wash all his clothes and have a shower without touching anything in the house. Yep! That actually happened!

My children’s half-sister was staying with us as her mom was in 14 day travel isolation, so we worked on creating nutritious meals to boost immune systems all around. And to lighten the mood - each day we head outside for long walks along one of our many trails by the ocean. Other times are spent laughing and joking and sharing creative art work – which is really really enjoyable and an opportunity to discover one another again. So, make sure to balance all of your hard work for decontamination with love, joy and an emphasis on education. We are so lucky that we live in such a beautiful place with easy access to plenty of trails and rocky beaches.

2. *Isolation: My children’s father, Alan McPherson works at Juneau's Bartlett Hospital, as an Emergency Room Physician, has already been in direct contact with both moderate and severe Covid positive patients. It is important to stress that members of the Juneau community have already been medevac’d out of Juneau for Covid-related illness.

Concerned for our safety, the dad no longer stays at the house and between shifts has been camping in the back of his van or and staying at my son’s place which they have switched in order to isolate the dad from the rest of us. When he needs something from the house, we leave it at the end of the porch which is about 10 feet from the door. The kids all come out to speak to him, but they stay by the door. They all miss him and are quietly concerned for him and I can tell these quick visits cheer everyone up, including their dad.

3. Developing new consistent hygiene protocols: these include new daily household cleaning habits and health centered protocols as a the first step in protecting your home and your family.

4. Surfaces: clean all surfaces daily especially plastic and stainless steel items as the virus can be viable on these surfaces for up to 3 days. This includes laptops, cell phones, all hand held electronics and their electrical cords including head phones. Every morning I get up early and whip down every surface from counters to chairs, pianos, door jams and doors, electronics, bathrooms before my family gets up with a soapy bleach solution and this helps me feel like my family gets off to a good start. My children see the difference and it sets the pace and tone for the rest of the day.

5. Correct Hand Washing: So, as you may now know, Covid 19 cultures has been found in the nose, throat and eyes and stool. For these reasons alone basic hand washing is not enough! Correct evidence-based hand washing is of vital importance. Correct hand washing has been established on evidenced based protocols as follows: (I keep these protocols posted on the mirrors in the bathrooms :)

6. Using Lotion: keep hand lotion right by your soap dispensers. You have probably noticed that your hands are starting to dry out from your increased hand washing. We need to prevent this as those micro fissures in your skin increases the surface area and offers too many nooks and - crannies for the micron sized virus to attach to. Applying lotion after each wash will keep your hands supple, prevent drying out and even serve as a protective barrier.

5. Use gloves: use latex or nitrile gloves to touch all publicly used surfaces such as cash, grocery cart handles, ATM machines and gas nozzles. In the past we have taken these community surfaces for granted, but it is time to change and develop new habits. Also remember to use rubber gloves for vigorous household cleaning. This simple step will protect your hands from the effects of these harsher chemicals. Consider also using rubber gloves to do the laundry - this will keep any build up of virus on everyone's garments off of you.

6. Wear face masks: Bartlett physicians are stressing the importance of wearing a mask before going into any public place outside your home. Wearing a face mask, even a homemade droplet face mask can partially protect others from your exhaled droplets – what is essential is keeping everyone safe - by wearing a droplet mask we are keeping our droplets to ourselves and protecting anyone we come in contact with. In this way we protect one another! wearing a mask may help keep your hands off of your mouth until you can wash them. When other people see you wearing a mask they will start thinking more seriously themselves.

The more people who wear masks the better this will be for everyone as we can suppress the rate of transmission. Vladimir Zdimal, PHd Head of Dept of Chemistry and Aerosol Physics at Czech Technical University submitted this statement: “Population wide use of masks is essential for the suppression of this virus. A simple homemade mask can capture 95-100% of personal micro-droplets.” The mandatory use of masks and gloves in the Czech Republic may be the main determining difference in lower infection rates compared to other countries around the world today.

7. Manage for respiratory health - symptoms or no symptoms:

- As we all now know, Covid -19 is a virus that can cause or develop into a severe or fatal obstruction of the respiratory pathway. This results in the buildup of thick mucus and fluid that blocks the alveoli or specialized lung cells from absorbing and transferring oxygen into the bloodstream for circulation to the heart and brain. Safe guarding against this buildup of thick mucus maybe mitigated by staying well hydrated and getting plenty of fresh air and exercise. So consider a minimum of 2-4 liters of fluid a day.

Drink lots and lots of hot liquids like tea, soup. Consider sipping warm water with lemon every few minutes to keep your throat moist and wear a scarf to keep that glands of your throat warm and protected from cold air. If you have a dry cough go to bed with a hot water bottle on your chest, the heat may help loosen the muscles and tissue of your chest and keep the fluid of the lungs from building up and thickening - this simple step may help to decrease the viruses proliferation and assist your body in coping with infection.

8. **Respiratory safety - respiratory safety begins with your mouth so brushing your teeth becomes very important, brush your teeth every time after a meal, on waking up and/or every time your throat feels sore or scratchy. Be sure to brush your tongue and the back of your throat as well. Using a soft bristled toothbrush will prevent creating lesions in your mouth or gums from frequent brushing. Be thorough but not obsessive. And like every dental hygienist will say - don't forget to floss! “Good oral hygiene can protect you from the germs in your mouth leading to infections. Brush your teeth at least twice daily and see your dentist at least every six months.” American Lung Association.

*Consider using or adding charcoal toothpowder, purchased at Fred Meyers or on Amazon, to your daily regime especially first thing in the morning, especially if you have a sore throat. The activated charcoal may bind with the surface of the virus and help to clear it out of your mouth more effectively. Mix with water or tooth paste before putting into your mouth as you will want to avoid inhaling charcoal dust into your lungs. I use charcoal toothpowder only when I have a sore throat - repetitive or obsessive use of charcoal maybe to abrasive for tooth enamel as some sources indicate.

9. Gargle - with antiseptic solution such as Listerine Ultracare mouth wash, or warm diluted vinegar with added drops of either hydrogen peroxide, baking soda, salt or lemon water daily and especially if you have a sore throat. Wear a scarf to protect your throat against the cold air and use a scarf or mask to cough or sneeze into as this is more effective for catching and containing droplets than coughing just into your arm pit. Wash these items daily or more depending on the amount and degree of coughing/sneezing you are involved in.

10. Sore Throat: If you develop a sore throat address it immediately even if it is just scratchy! Use all of the steps mentioned above and each time no matter how many times a day as together these steps may help to decrease your potential rate of infection and may delay or even prevent the virus from multiplying and moving from your throat into your lungs. Preventing the virus from colonizing the lungs is your first line of defense. Be strict in your self-care regime and do not delay your efforts.

11. Viral load - is the number of copies of viral RNA per 1 milliliter of blood which indicates the percentage of virus in your bloodstream, or more simply, the percentage of covid virus in 1 ml of blood. To reduce our personal accumulative viral load, transmission and the number of times we are likely to be re-infected with each encounter, we have to be committed to reducing the number of likely ways we can be infected, as well as, the number of virus that are on the surface of our clothes, skin, hair. Then we have to manage for the virus that have already entered into our mouth, throat, nose and eyes by reducing the rate of infection with excellent oral hygiene, by including exercise that elevates our core temperature, protecting the glands in the throat from getting cold with a scarf and boosting our immune system with essential vitamins and mineral with fresh veggies and fruit and supplementation.

For those who like to geek out here are two easy, excellent videos from the CDC on the most recent epidemiology and pathophysiology of this novel virus.

12. What viruses attach to: skin, hair and clothing: for this specific reason bathe or shower daily, and change and wash your clothes every day. If you have long hair wear it up and out of your face. If you have a beard or mustache you may consider remaining clean shaven if possible – this will reduce risk of providing the virus more surfaces to attach to near your mouth. After each trip out to any of the stores leave most of the packaging material outside your house while using gloves. Once inside your house immediately shower and wash the clothes you were wearing, only then unpack the groceries.

13. Inhaled Irritants: Be extremely careful around anything that is an inhaled irritant – solvents, dust, hairspray – Your Lungs First! Every breath counts.

And don’t smoke anything! If you smoke quit!

15. Consistently limit all contact - to just family, staying home except for trips outside for fresh air like to Eaglecrest or a hiking trail. Limit all trips to public places like stores for basics, essentials and fresh fruit &veggies, to just 1 time every 2 weeks.

16. Shopping strategies: *Utilize systems like Fred Meyer’s app to pre-order goods and use their convenient drive-up service – the first 3 trips are free and only $4.50 after that, I believe. Avoid stores that do not have excellent safety protocols in place. Stores that seem to be doing a wonderful and conscientious job at sanitizing are Costco, Foodland, Fred Meyers, Joanne’s and Home Depot.

17. Shopping Safety Protocol: before getting out of your car put on a face mask, include a hat with bill to keep your hair off your face and put on latex or nitrile gloves. Wear glasses if you have them. Leave your wallet in the car and take only your membership card and credit card. Stop using cash. Paper money is a huge vector. Bring in your own bags and pack your own groceries for the teller. Try not to touch your face the entire time, including your eyes.

When you have made your purchase, put your bagged groceries in the back of your vehicle. Remove your gloves first - inside out like a medical provider and place in a garbage bag and then seal, take off your hat and your mask. Wipe your mask off with a disposable wipe inside first then outside before putting your mask in a protective bag. If you have a fabric mask wash it after each use.

After each trip out to any of the stores leave most of the packaging material outside your house while using gloves. Once inside your house immediately shower and wash the clothes you were wearing, only then unpack the groceries. Don’t be concerned with any looks or reactions, or comments anyone may make. As time goes on more and more people will be dressed like you. Remember you are establishing safety protocols and you setting an excellent example while protecting yourself, your family and your community. “Population wide use of masks is essential for the suppression of this virus. A simple homemade mask can capture 95-100% of personal microdroplets.” Vladimir Zdimal, PHd Head of Dept of Chemistry and Aerosol Physics at Czech Technical University.

18. Plenty of Fresh air, Sunshine and exercise: Being outdoors is 100% safe. First and foremost, please get outside and GET SOME SUN... whatever you do, please DON'T stay locked up inside your house...that's the WORST thing you can do for your immune system right now. You can still get outside and stay safe all while significantly boosting your immune system. You will NOT catch coronavirus by breathing outdoor air. The virus only concentrates in indoor areas when you're around people who are already infected and coughing. You need to get outside and get some fresh air and sunshine (while still staying away from crowds).

Now that we're in early April, most areas in North America and Europe are getting warmer and sunnier, and getting sun on your skin is the biggest thing you can do to boost your immune system right now. The aspect of vitamin D production in your skin from sun exposure is just one aspect of how sunshine boosts your immune system. There are other reasons too, such as how the sun improves your mood, serotonin, balances hormones, etc. It's also important to note that getting vitamin D from sun exposure on your skin is thought to be significantly more beneficial for your immune system than a supplement.

Stay safe, wear your mask and stay tuned for more in the next few weeks on:

1. how to boost your immune system against viral reproduction and

2. how to prepare a muster kit.

Let's make Wearing Masks not only Safe, but Cool! Jazz your Mask up with Art! And See you outside!

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