About three-quarters of Americans have been ordered to stay home during this global pandemic, and that number grows weekly. In particular, people 60 and older, who are at greater risk of serious illness from the novel coronavirus (COVID-19), are urged to leave the house as little as possible.
But how safe are our homes, especially if you live with another person who may be coming in contact with the virus? How, and when, do we disinfect surfaces? How risky is bringing in the mail or groceries?
“There’s a lot we still don’t know,” says Karen Hoffmann, a registered nurse and the immediate past president of the Association for Professionals in Infection Control and Epidemiology. Hoffmann is on the faculty of the University of North Carolina School of Medicine in Chapel Hill and a contractor on infection prevention with the Centers for Medicare and Medicaid Services.
“We don’t know why some people get sicker than others,” Hoffmann continues. “What we do know is that it’s [the coronavirus] more infectious than the flu, but not as infectious as measles. It’s a droplet-spread organism. The longest incubation period is fourteen days, with a five-to-seven-day average. If you have no signs or symptoms in that time and you haven’t gone anywhere, you have very little to worry about.”
Make a Plan to Stay Virus-Free
To do all you can to protect yourself and others from the virus in your home, Hoffmann suggests, begin by making a plan. Which doors do you usually go through to enter your home and what surfaces do you most often touch? In addition, think about how you would isolate a family member who tests positive for the virus, just in case.
Hoffmann and other experts stress that it’s important to look to authoritative sources, both to keep our homes safe and to avoid wasting time and money. The Centers for Disease Control and Prevention (CDC), the World Health Organization and your local public health agency are among the most reliable sources of information.
Frequent handwashing and keeping a 6-foot distance from others outside the home really are, by far, the two most important preventative measures.
“There’s a lot we still don’t know. We don’t know why some people get sicker than others.”
“We have to be reasonable and put [the disease risk] into perspective and make the best use of our time and resources,” says Dr. Manoj Jain, an infectious disease physician who serves on the faculty of the Emory University School of Medicine in Atlanta and advises Memphis authorities, among other public officials, on the control of COVID-19.
Social distancing is the single most important factor that determines the epidemic curve, Jain says. Along with that, wash your hands for 20 seconds with soap and water at least 10 times a day, or whenever you come in contact with anyone or anything from the outside.
For now, the CDC advises only wearing masks when you leave the house if you have the virus or have similar symptoms. But that recommendation is under review and may soon change.
If a Family Member in Your Home Has COVID-19
If someone in your family whom you live with does test positive for the coronavirus (or presumably has it), you need to move into isolation mode, even if the person has no symptoms. If it all possible, have the person stay in another room for up to 14 days, including the use of a separate bathroom, if available, as far from others as possible. If you don’t have an extra bedroom, use any separate area that can be closed off, such as the basement.
“If you don’t have a separate room, that does get more difficult,” says Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases and professor of preventive medicine and infectious diseases at the Vanderbilt University School of Medicine in Nashville. “It’s not easy to sleep on a sofa. You have to do the best you can. Every home can’t be turned into a hospital.”
If you don’t have a separate room, some experts have suggested hanging plastic as a barrier, as is being done in some grocery stores. Although it’s not clear this is effective, Hoffmann says “any barrier does help.”
At mealtimes, leave their food outside the room on a tray.
Both the infected person and others in the household should wear a mask when near each other, according to the World Health Organization. If the infected person is too sick to wear a mask, it’s critical that the caregiver wear a mask.
If you have no masks, improvise with a towel or scarf, but just know it won’t be as effective. “It’s really controversial about homemade masks,” says Hoffmann. If made of fabric, “they tend to get moist and can harbor more organisms.”
If the person with the coronavirus feels well enough, they should clean their toilet and bathroom sink after every use. If they are too ill to clean it themselves, limit the healthy people’s exposure to the virus by cleaning less frequently.
Use gloves to handle the infected person’s laundry, although it’s fine to wash your clothes and theirs together. Daily linen changes are not necessary for the isolated person — it’s far more important that you keep your distance.
“This is now a hug- and kiss-free zone,” says Schaffner. “No matter how much you’d like to give them a hug and reassure them, you really shouldn’t do that.”
Plan for an Emergency
If the person is sick from COVID-19, you need to ask the health provider ahead of time what to do if they take a turn for the worse. Find out whom to call, 24 hours a day and on weekends, and where to go if your family member is having trouble breathing. Don’t wait for an emergency to have a plan in place.
Watch for these warning signs that the person needs medical attention immediately:
- Difficulty breathing or shortness of breath
- Persistent pain or pressure in the chest
- New confusion or inability to rouse from sleep
- Bluish lips or face
At the end of the day, we need to be realistic about our efforts to protect ourselves and our family members. “We can’t be perfect and we can’t put our home and ourselves in an autoclave (sterilization machine),” says Schaffner. “We have to do our best in trying to reduce our risk. There will be compromises.”
How Cautious Should We Be?
Jain, although healthy himself, is in a high-risk group. He sees patients with infectious diseases, his wife sees patients as a rehab doctor and their daughter works in an emergency department. In addition, his in-laws, who are older and thus more vulnerable, live with them.
“We can’t be perfect and we can’t put our home and ourselves in an autoclave. We have to do our best in trying to reduce our risk. There will be compromise.”
“We’re all at risk,” he says. “So, my wife and I sleep in separate rooms. We all maintain six feet between us in the house. My in-laws don’t eat dinner with us, and we are not commonly in the same room at the same time with them.”
But for those who are healthy and have not knowingly been exposed to the virus, you don’t have to take such extreme measures.
“Couples can be together,” says Jain. “If one is out and about in the community a lot and not using any form of mask or protection, then keeping a distance [inside the house] may be a good idea. That’s not a CDC recommendation per se, but it would be prudent.”
What About Food From the Outside?
One thing that this virus has revealed is individual differences in tolerating risk. “There are more and less fastidious people,” says Schaffner. “The very fastidious will wipe off every can of string beans that comes into the house. God bless you. You have to choose at what level you are comfortable.”
Regarding food shopping, Hoffman — who is in a high-risk group herself — says: “I don’t do anything more with groceries than I typically do.” She deems packaged food from the grocery to be safe. “The virus is dying the longer it’s out of the body, depending on the temperature and humidity,” she says.
Even if a supermarket employee had the virus and sneezed on a box of Cheerios, the virus would not likely still be infectious by the time a person who bought that box had a bowl of cereal.
With strict handwashing as soon as you enter your home and after you’ve handled anything from the outside, you should be safe. COVID-19 is not a food-borne illness and the virus does not thrive on the surface of food.
As for carryout food, Schaffner says, again, it depends how fastidious you are. In his household, he and his wife stand six feet away from the delivery person and avert their faces, to avoid a rogue cough or sneeze. His wife wipes off the pizza box. He does not. Both of them dispose of the box and wash their hands before eating the pie.
“There’s no right way,” he says. “It’s what you’re comfortable with.”
The same goes for the mail, the newspaper and packages. Based on studies of SARS, another type of coronavirus, COVID-19 may live up to 24 hours on cardboard and up to three days on stainless steel and plastic.
If you’re concerned about the mail, set it aside for a day or don a pair of gloves and throw out the envelopes after opening. Likewise, you can either wipe down the plastic sleeve of a newspaper and recycle or leave the plastic outside for a few days. Regardless, wash your hands before and after reading the paper.
What About Surfaces in the Home?
If you live with someone else or if you have been out of the house, it’s a good idea to wipe down frequently-used surfaces once or twice a day.
Any kind of commercial disinfectant is fine. “They all work the same,” says Schaffner. “The virus is very fragile.” A brief swipe should kill it. Focus on doorknobs, light switches, refrigerator and stove handles, faucets, kitchen counters, phones, TV remotes, bathroom sinks and toilet seats and flush handles.
If you can’t find commercial disinfectant, use diluted bleach. The CDC recommends five tablespoons per gallon of water (or four teaspoons per quart of water). Use gloves to protect your hands from bleach. And in a pinch, use soapy water, although not on your cell phone or computer monitor where it might leave a film.
Schaffner suggests that each person use separate hand towels, even if you’re both healthy.
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