By Mike DuBose
In the months since news of Covid-19—which, as I am writing this column, has killed nearly 400,000 people worldwide—first surfaced, misinformation has run rampant. Some people have taken it very seriously, while others have rolled the dice by ignoring social distancing protocols and forgoing protective gear. Regulations pertaining to non-essential businesses and gatherings differ from state to state and even city to city, further adding to the chaos.
As of June 2020, the confusion persists, and it’s unclear when—or how—life will go back to normal. As Joseph Epstein noted in a May 29 Wall Street Journal column, “One of the most infuriating aspects of the coronavirus pandemic is the uncertainty about when it will end. There is much talk about peaks being reached, trajectories leveling off, incidences upward or downward, vaccines in the works, phased reopenings of businesses. But nobody can say with authority when the danger of the virus will be gone, or that it won’t return later with greater virulence.”
There are still more uncertainties about this virus than there are facts, and what we think we know today may change by tomorrow. For example, although we initially thought that healthy young adults and children might be immune to the virus, we have since realized that everyone is at risk! When interviewing physicians, business owners, and consumers for this article, I noted a wide range of perceptions about the coronavirus and the risks involved. Some people—especially those at high risk of dying if they were to contract the virus—were afraid and were staying at home as much as possible, while others felt that the situation had been overblown and traveled without any virus protection. Some were confused by the conflicting information they had heard, trying to figure out if it was safe yet to visit the doctor, dentist, gym, or church. Others were absorbed in conspiracy theories of where the virus came from and were convinced that the government was robbing them of their freedoms by asking them to wear a mask. Still others erroneously thought that they might be protected from infection by herd immunity. (Johns Hopkins University says that “depending how contagious an infection is, usually 70% to 90% of a population needs immunity to achieve herd immunity,” and some models are predicting that more than half of Americans will eventually become infected with the coronavirus, so this is not a reliable strategy.)
Like many trying to understand the virus when warnings first surfaced in early 2020, I initially compared Covid-19 deaths to those caused by the flu, which kills upwards of 80,000 Americans per year. However, as time passed and I further researched emerging Covid-19 information from a wide range of reputable scientists, I realized that they truly don’t compare. Although, like the flu, the coronavirus is deadliest to those aged 65 and older (especially those with underlying medical conditions), it’s significantly more contagious. On average, one person with the coronavirus may transmit the virus to about 3 other people. The Centers for Disease Control and Prevention (CDC) estimates that 35% (or more) of infected people in the US are asymptomatic—they do not have any symptoms and feel healthy—however, they are still able to spread the virus to others, who may not be as fortunate. This helps explain why Covid-19 has spread so quickly throughout our communities.
While 80% of infected individuals may have mild to moderate symptoms, according to the National Institutes of Health (NIH), many older folks are dying because younger, healthier individuals are infecting the more vulnerable. To make matters worse, even those who recover from Covid-19 may experience long-lasting health problems, including chronic fatigue, lung damage, blood clots, heart problems, difficulty breathing, dizziness, loss of smell and taste, and neurological damage.
As I write this column in early June 2020, nearly 7 million coronavirus cases have been confirmed worldwide. In the US alone, nearly 2 million cases have been verified, and 111,000 deaths have been attributed to Covid-19. Greg Hadley reported in a June 7, 2020 State News article that South Carolina has seen about 14,000 known infections and 545 deaths, although DHEC officials estimate that about 95,000 people have likely had the coronavirus since March. Hadley noted, “Some experts and DHEC officials believe the increase in cases could be due to residents moving more in public, a lack of social distancing and residents not wearing masks. Experts have said those factors could lead to later outbreaks.”
High-Risk Populations: As we age, our immune systems find it harder to fight off diseases and infections. Adults age 65 and older are in the greatest danger from contracting serious illnesses, especially coronavirus, and they are more likely to catch them. According to an April 2020 Consumer Reports Health by Hallie Levine, “Older adults are at an increased risk for severe viral and bacterial infections, from the flu to colds to shingles to pneumonia.” Seniors are also more likely to experience potentially deadly complications if infected with coronavirus, including sepsis (an extreme response to infection that can cause tissue damage and organ failure), pneumonia, and acute respiratory distress syndrome, where fluid collects in the lungs.
People with secondary conditions who contract Covid-19 face an increased risk of death. Morbidity rates for people infected with coronavirus who have secondary conditions are: cardiovascular disease, 13%; diabetes, 9%; respiratory disease, 8%; and hypertension, 8% (figures rounded to nearest whole number). The Mayo Clinic recommends that, if you have any of the following medical issues (or are the guardian of anyone who has them, such as a senior or a child), you should take serious precautions to avoid contracting coronavirus: hypertension; obesity; chronic lung, kidney and liver diseases; diabetes; cystic and other types of fibrosis; cardiovascular disease; asthma; COPD; and autoimmune disease. Those who are undergoing cancer treatment are more open to infection because of low white blood cell counts and should also take extra precautions.
Behavioral Risk Factors: The Wall Street Journal published an excellent article in May 2020 by Dr. Maryanne Vandervelde about how to gauge the risks of the coronavirus for you, your family, loved ones, and friends. I have combined her findings with other research to develop the following risk profiles. You can estimate your risk by determining which level corresponds to your behaviors and health conditions.
For your own protection against the coronavirus, it’s wise to follow guidelines based on scientific research from respected health organizations, such as the CDC. The organization recommends that citizens wear a mask when leaving their homes when people are nearby; maintain six feet of social distancing from individuals they do not live with; wash or sanitize their hands frequently, especially when leaving and reentering their homes; avoid touching their faces; refrain from physical contact (hugs, shaking hands, and fist/elbow bumps) with others; and avoid enclosed structures when possible.
Consumers should be aware and cautious. Simply because a business is open doesn’t mean it’s safe to patronize it! Many businesses will place profit ahead of safety for their customers and employees, and some organizations will stumble into reopening without thoroughly researching the dangers, needlessly infecting many others.
When our state of South Carolina went into shelter-in-place mode, my son Joel DuBose and I began researching how we could protect our clients from coronavirus during personal fitness training at the gym, DuBose Fitness (www.dubosefitness.com), that we co-own. While we wanted to reopen as soon as possible, we wanted to do so safely. We knew that research shows that entering enclosed environments with other people (such as houses of worship, gyms, and restaurants) creates a higher risk for infection, and we wanted to reduce that risk as much as possible. We developed new safety procedures based on our research, and after presenting them to the Governor’s Task Force, DuBose Fitness was granted an exemption to reopen in early May. The following are some important research-based precautions we have implemented at DuBose Fitness to limit our risk of coronavirus infection, as well as some personal steps my family and I are taking to protect ourselves.
Staying Away from Groups: According to the CDC, coronavirus is mainly spread through sneezing, coughing, and breathing. Our breath contains very small (sometimes, invisible) respiratory droplets. A person emits 2,600 droplets per second when breathing and talking. When an individual coughs, the number of droplets increases to 30,000, and a sneeze will expel 40,000 droplets racing at a speed of 300 miles per hour! While there is debate amongst scientists, some studies have indicated that Covid-19 can remain in the air as droplets for up to three hours, depending on the ventilation.
Also, it is up for debate how far respiratory droplets can travel. In a recent Business Insider article, William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center, noted that droplets “are usually transmitted within three to six feet, but these droplets can be pushed farther out, sometimes even beyond six feet, if you give the exhalation more energy, with a cough or a sneeze or even singing.” MIT associate professor Lydia Bourouiba, who has studied coughs and sneezes, wrote in a Journal of the American Medicine Association article that "peak exhalation speeds can reach up to 33 to 100 feet per second, creating a cloud that can span approximately 23 to 27 feet." Studies are being conducted to determine if infectious particles floating in the air can be transmitted more than six feet from their source, and if so, how far.
Envision many people—some of whom are infected—in an enclosed area like a church, robustly singing. By the end of the song, hundreds of thousands of invisible respiratory droplets have been flung over the congregation. An infected individual sitting in the back of the church sings along, and the person in the pew in front of him inhales his respiratory droplets, ricocheting the virus forward. By the end of the service, many of the attendees could be exposed!
This example illustrates why it’s so important to avoid enclosed spaces with groups of people in them until a proven treatment method and/or a safe vaccine serum is produced. The concept applies to many other situations. For example, if you eat at a restaurant, do so outside, and only eat at places where servers wear masks. If in a gym, stay away from people who are exercising without a mask.
Social Distancing: Especially now that South Carolina is experiencing a spike in coronavirus cases, it’s advisable to stay home (within reason) and avoid social situations with groups of people, some of whom may be unwitting carriers of the virus. However, there are some businesses—such as personal fitness training—where close proximity to non-family members is unavoidable. At DuBose Fitness, we have implemented social distancing measures to minimize risk: we only allow one person (other than Joel, the personal trainer) in our gym at a time, and we ask customers to sit in their cars until the client before them leaves. The CDC recommends that individuals put at least six feet for social distance between them and others, but we use an expanded spacing parameter due to recent breathing studies that suggest an even greater distance is ideal. Joel stands to the side of the client, not in front, and both he and the customer wear facial masks. We also keep extra face masks handy to provide to customers who may have forgotten theirs.
A significant issue that many organizations, including churches, face is how to bring members into a building with social distancing in mind and how to help them leave in an orderly fashion while discouraging them from congregating indoors in groups (violating the CDC’s suggestion of keeping six feet away from others). One suggestion is to release the group row by row, guiding them to the exit and asking that any socializing be carried out outside. However, a secondary problem will be how to maintain social distancing in inclement weather, when members will be bottled up in a small space.
Disinfecting High-Contact Surfaces: Many contagious viruses—including Covid-19—can live on objects after an infected person touches them. The harder the surface, the longer the virus can live. A study published by the New England Journal of Medicine determined that the coronavirus can live on glass for four days, plastic (like restaurant menus) and stainless steel (such as doorknobs and hand railings) for three days, and cardboard for one day. Although touching objects is not the primary spreader of the coronavirus, according to the CDC, the danger of infection is still present.
Scientists say that a chain of events must occur in order for you to become infected by a surface virus: (1) there must be sufficient viral material on the surface (for example, someone coughing or sneezing into their hand and then touching the surface); (2) you come into physical contact with the material; and (3) you, touch your mouth, eyes, or nose for the virus to enter your throat, where it grows and then travels into your respiratory system. To avoid infection from a surface contaminated with the virus, you must break the chain. You can do this by sanitizing any “touch points” that you may regularly come into contact with after others (i.e. wiping down gas pumps, ATM buttons, and shopping cart handles with disinfectant wipes); regularly washing your hands with liquid soap and water for at least 20 seconds (or using alcohol-based hand sanitizer), especially when you’ve been out in public; and avoiding touching your face. This can be surprisingly difficult, given that the average person touches their face 15 times per hour, according to some studies! To sanitize cell phones, which are high-risk carriers since we touch them so frequently, I recommend purchasing the excellent PhoneSoap UV light sanitizer. The 12” square Hope C+ UV LED sanitizer box, available on Amazon for about $150, is also great for sanitizing facial masks and other larger items.
Businesses should take extra precautions to keep high-contact surfaces clean. At DuBose Fitness, we allocate adequate time between customers to clean and disinfect the machines and any touch points. We use sanitizers with at least 60% ethyl alcohol or 70% isopropyl alcohol (preferably higher) to wipe down equipment to kill the virus. (See epa.gov for a list of disinfectants that the Environmental Protection Agency recommends.) We require all clients to sanitize their hands upon entry and again when leaving, without touching anything. Some cleaning companies have now added Covid-19 disinfection to their list of services, so that may be another option for businesses that involve contact with the public.
Taking Temperatures and Oxygen Levels: Fever is one of top three most common symptoms of Covid-19, according to the WHO. Identifying people with significantly heightened body temperatures (over 101 degrees Fahrenheit) and denying them access to enclosed areas with other people can therefore help stop the spread of the virus. For DuBose Fitness Center, we purchased a professional-grade temperature gun which, when pointed to the forehead, can provide instant readings.
Of course, it can be uncomfortable to require that a person have their temperature taken before entering a public place, but given the surprising amount of people who go out even when sick, we highly recommend it. (One of my doctors had a patient come into their office with a 103-degree fever without telling anyone in advance because she didn’t want to miss her appointment!) Most customers will recognize that the extra precautionary measures are being taken to protect them. Alternatively, organizations like places of worship could ask members to take their own temperatures an hour before scheduled services and stay home if they are abnormal.
Medical experts have also detected that many people who are infected but asymptomatic may have low levels of oxygen, but no other symptoms. A finger oximeter that sells for about $40 on Amazon can provide advanced clues a person may be infected if their blood oxygen readings are less than the 90% threshold.
Requiring Masks: The CDC strongly recommends that everyone wear a face mask when in public around other people. Although wearing a mask can feel claustrophobic, given the knowledge of how Covid-19 can travel in air, it’s clear that the benefits outweigh the discomfort. (In fact, if the mask you have is thick, uncomfortable, and difficult to breathe in, chances are that you have a pretty good one!)
Wearing a mask serves two purposes. First, it protects others from invisible droplets we exhale, and secondly, it prevents us from inhaling virus-carrying droplets expelled by others. There are many types of mask you can wear, ranging from the high-grade, commercially made white ones used by medical staff to colorful homemade masks. Unfortunately, home-sewn masks are usually made of fabric that can allow the virus to pass through the material into your lungs. The best—and most difficult to find—masks are the N95 and KN95 types, which prevent more than 95% of the virus molecules from entering the respiratory system. However, any type of mask is better than none at all!
Ideally, anywhere people gather in an enclosed space (including houses of worship) should ask all attendees to wear surgical masks. These masks only cost $.60 each on Amazon and can prevent the spread of the virus, but they still allow wearers to breathe, speak, and sing. Everyone at DuBose Fitness wears them, and they don’t impede workouts and make our clients feel safer. The catch is that everyone within an enclosed space must wear one to make it work, since these masks have limited capability to prevent the wearer from inhaling the virus.
Using Antimicrobial Materials: For an extra layer of protection, consider replacing some of your hardware at your home or organization with options designed to kill germs. At DuBose Fitness Center, we have replaced the doorknobs with EPA-approved Kwikset Microban products. These doorknobs are antimicrobial, so when a virus or bacteria comes into contact with them, the antimicrobial coating penetrates the cell wall of the microorganism and makes it unable to grow and reproduce. We have also installed Delta faucets with antimicrobial SpotShield protection on our sinks. The doorknobs can be found on Amazon and at Lowes for about $35 per set and, depending upon your desired models, faucet sets run about $100-$150 per sink.
Handling Mail and Package Deliveries with Caution: According to the CDC, postal mail presents a very low risk for contracting coronavirus. However, nearly 3,000 US postal workers have tested positive for Covid-19, according to a June 2020 article by Jennifer Smith, so it is possible that your mail has come into contact with an infected person. To be safe, either let your mail sit for a couple of days before opening or take it out from the envelopes, throw the envelopes away, read your mail, and then wash your hands thoroughly.
Most carriers and shippers have put safety precautions in place for their delivery drivers; however, because of the overwhelming volume of packages, they often contract with third-party individuals in personal cars to deliver packages to businesses and homes. Not all of these drivers are wearing protective gear like masks, and no one can guarantee that they wash their hands regularly. It’s a good idea to stay on the safe side by picking up packages with paper towels (or while wearing gloves) and putting them aside for three days to allow time for the virus to die. Once you have opened a package, immediately discard the packaging and wash or disinfect your hands.
Utilizing UV Lights and HEPA filters: All organizations—especially those with small rooms where people gather, like restaurants—should be aware that their HVAC units could suck in and redistribute coronavirus to their patrons, as studies by Chinese scientists have shown. Consider attaching an air exchange unit, which removes stale air and replaces it with fresh air, to help mitigate the threat.
An even better option is adding ultraviolet (UV) light technology to your HVAC system. The White House Covid-19 Task Force has confirmed UV lights kill the coronavirus, and they also kill other germs, mold, and allergens. Prices vary depending on which unit you choose, but our RGF REME Halo UV system runs about $1,600 (Cassell Brothers in Irmo is an authorized dealer). The unit is installed inside your HVAC’s air blower. If you obtain one of these devices, it is important to keep your HVAC fan in the “ON” position (versus automatic) 24/7 so that the air is actively circulated and viruses are killed by the UV system. If you cannot afford UV HVAC equipment, consider adding HEPA filters like those used in commercial airliners to all air return units (keep the fan in the ON position for these to work as well). A combination of HEPA filters and UV germ sanitizing equipment would be ideal.
For an additional layer of protection, we installed UV germicidal sterilization lights, which radiate through about 600 square feet of air, at DuBose Fitness to kill germs and viruses on the equipment. While not designed for large, open rooms like auditoriums and churches, these units appear to be effective for smaller spaces like offices and restaurant kitchens. They are available for around $200 on Amazon. Commercial units are available for larger spaces, with prices ranging in the thousands of dollars.
The Bottom Line: As Vandervelde explained in the Wall Street Journal, “We are just at the beginning of a steep learning curve about ourselves. We face risks we didn’t imagine a few months ago—and yet taking pleasure in small things is more important than ever. The more we name our fears and desires, make our own decisions about risk, and understand how we got to those choices, the stronger we will emerge from the weirdest of times.” We know that this deadly virus may attack one of us or a loved one at any time. While we don’t want to live in fear, we need to respect the danger we are in and work to understand Covid-19 as much as possible. Let’s join together to protect ourselves and others!
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Visit Mike DuBose’s nonprofit website www.mikedubose.com for 100+ published articles on business, travel, retirement, and personal topics, and health columns written with Surb Guram, MD, as well as a free copy of his book, The Art of Building a Great Business, based on 30 years of experience with the DuBose Family of Companies and 100 bestselling business books he read. Mike is a retired staff member of the University of South Carolina’s graduate school.
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