ABC For COVID-19 Prevention?

A sign that reads, "NOT TODAY #COVID-19". This is Social Distancing, a critical component in the fight against COVID-19 infections.

 

INTRODUCTION

The COVID-19 pandemic that started in Wuhan, China in December 2019, is spreading like wildfire in many countries. It is causing morbidity and mortality on a scale never seen in modern times.

As is the case with many viral infections, there is no cure for COVID-19. There is also as yet, no vaccine for the disease. The disease is highly contagious and carries a mortality much higher than that of the common cold or even influenza.

COVID-19 is much more contagious, is spreading faster, and is a lot deadlier than the other concurrent viral pandemic, HIV. Preventing or delaying the infection of individuals and communities, and controlling the spread of SARS-CoV-2, the virus that causes COVID-19, is key in the world-wide fight.

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HISTORICAL BACKGROUND

For decades, the world, under the leadership of the World Health Organisation (WHO), has been using the “ABC” algorithm for HIV prevention. The advice went, and still goes:

A – Abstain from intercourse OR

B – Be faithful to one partner OR

C – Condomise (if A or B impractical)

POSSIBLE USE

Because the above approach has been taught so extensively throughout the world, for so many decades, wouldn’t it be wise to ride on the success of that campaign, and to modify it a bit to teach the prevention of COVID-19 infection?

The ABC strategy was very successful in Developed Countries, which are the ones currently bearing the brunt of COVID-19. But the strategy was still somewhat successful in Developing Countries, with the biggest success story being that of Uganda.

MODIFICATION

The ABC strategy could, in the case of COVID-19, be used to summarise the recommended Public Health measures. ALL of these measures must be practised in order to prevent infection. But it seems people, especially less educated ones, cannot grasp them fully, or they forget, or they simply don’t have the willpower to practise the preventive measures consistently.

WHAT ABC STANDS FOR IN THE CONTEXT OF COVID-19

The difference, to reiterate, is that people have to practise all of A, B, and C, and not choose one of them as in HIV prevention.

A – Abstain from Social Contact AND

B – Be faithful                                AND

C – Coughing and sneezing etiquette

In detail:

* Abstain from Social Contact

This is also called Social Distancing. It is clear from COVID-19 prevalence patterns, and from the failures and successes of different countries or regions, that a lot of human contact promotes the spread of COVID-19 infection. Isolated continents, countries, or towns have less incidence and prevalence, while overcrowded areas and tourist hotspots have suffered immensely.

Lesotho, Southern Africa. A country with mostly a sparse population, and a tourism industry that has almost died in the past quarter-century, after the changes in the surrounding South Africa. Lesotho will, if ever, be one of the last countries on Earth, to record a COVID-19 case.
Lesotho, Southern Africa. A country with mostly a sparse population, and a tourism industry that has almost died in the past quarter-century, after the changes in the surrounding South Africa. Lesotho will, if ever, be one of the last countries on Earth, to record a COVID-19 case.

 

This fact is best demonstrated by African countries. Countries that delayed instituting quarantine measures and travel restrictions, also happen to be the ones with the highest (air) traffic connections with other continents. These are the countries with the highest number of confirmed COVID-19 cases in Africa.

Also, globally, countries that have been strict in enforcing quarantine measures, are faring much better than liberal ones. This will forever be a Public Health dilemma – the slippery area of democracy and human rights.

People are taught to abstain from handshakes, hugs, kisses and other day-to-day social interactions. There should at all times be a distance between persons, of at least one to two (1-2) metres. Talking should also be minimised, being limited to essential talk as much as possible.

Individuals who feel unwell with flu or cold symptoms, or any unexplained (febrile) illness, should self isolate for two weeks. But the public must also take responsibility to avoid contact with sick people. Lessons should by now have been learnt from HIV and AIDS, in terms of friends and relatives nursing the sick.

In the first two months of the epidemic, it was thought that SARS-CoV-2 was not an airborne infection. But the scientific evidence has suggested otherwise, and the possibility of airborne infection has been accepted.

Reports are emerging, of people acquiring COVID-19 infection from choral singing. All these social activities have to be avoided, especially those that are done en masse (more than 50 people; some guidelines even say 10). At-risk people, being the elderly, people with diabetes, heart disease or other underlying conditions, etc, have to take the greatest care.

* Be faithful to handwashing, sanitisers, no-touch techniques, face masks, gloves, good nutrition, etc. SARS-CoV-2 settles on surfaces, surviving for varying numbers of hours, and gets transferred to the next person when they touch the surface. They then transfer the infection into their bodies by touching their faces, especially the mouth, nose or eyes.

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It is important to avoid touching or leaning against surfaces in public places. Gloves are helpful for people whose work involves touching bank notes, lot of paperwork from the public, and so on.

Masks are now recommended for anyone who is at risk of inhaling the virus or transmitting it, and not just for the sick or Healthworkers.

Frequent, THOROUGH handwashing of at least 20 seconds, or the use of an alcohol-based sanitiser with at least 60% alcohol content, cannot be overemphasized.

But BEING FAITHFUL to all of the measures under this bullet is key. And unfortunately from observations, a lot of people practice these measures inconsistently, partially, or wrongly.

Examples include people who wear masks, but lift them off (in crowded places) to talk to others. Or those who use improperly-constituted sanitisers. Or those who wear gloves but go on to touch their faces with the gloves, or touch different people with the same pair of gloves (e.g. Healthcare Workers).

It is very important to also know that the exterior surface of worn masks should never be touched, as it could be carrying germs including SARS-CoV-2. Proper technique of removing the worn masks and gloves has to be learnt and taught.

* Coughing and sneezing etiquette.

A woman covering her nose with a handkerchief during sneezing.
The mouth and nose should be covered with a cloth or tissue paper during coughing and sneezing. Otherwise, cough or sneeze into the elbow (not hand).

 

This has unfortunately for many decades, been practised the wrong way. And it is difficult to undo the longstanding malpractices.

Traditionally, the fraction of the world’s population that knows it has to cover their mouths and noses, is used to coughing or sneezing into their hands. To teach them to do this into a handkerchief / cloth or disposable tissue paper, their elbows or shoulders, will take months or years to achieve.  Meantime COVID-19 is spreading by the day.

Poverty and other challenges also mean that disposable tissue paper ends up being pocketed after use.

CONCLUSION

The ABC approach of prevention that is traditionally used for HIV, could be modified and used to teach the prevention of the unfolding COVID-19 infection across the globe. This could bring about, easier memorisation of the preventive armamentarium, and help improve consistency, which is currently lacking.

REFERENCES

1. Lekhanya, T. “Who’s Failing Whom – ABC Or Us?” Public Eye, 9 Dec 2005

2. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17050-5/fulltext

3. https://www.medicalnewstoday.com/articles/coronaviruses-how-long-can-they-survive-on-surfaces?utm_source=facebook&utm_medium=social&utm_campaign=owned&utm_term=covid&utm_content=2020-03-13

4. https://www.cnbc.com/2020/03/16/who-considers-airborne-precautions-for-medical-staff-after-study-shows-coronavirus-can-survive-in-air.html

5. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

6. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks/

7. Read, R. “Church Practice Turns Fatal. Airborne Coronavirus Strongly Suspected.” LA Times, 30 March 2020

8. https://www.who.int/

9. https://www.cdc.gov/

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6 Replies to “ABC For COVID-19 Prevention?”

  1. Hey nice article you have there, your thoughts are indeed invaluable. Thanks for contributing your quota towards the curtailment of this dreaded pandemic disease. Since the virus stays in surfaces for sometime, it is advisable to have a frequent hand wash, use hand sanitizer always, avoid touching your face with unwashed hands, all this can also help in the prevention

  2. Thank you Teboho for this ingenious way of communicating to others on the benefits of staying healthy! The A-B-C method enumerated by you brings a lot of simplicity into maintaining healthy standards and helping to reduce the spread of COVID-19.

    With your kind permission, I would like to use this same analogy in helping the younger ones better understand safety. Like you rightly pointed out, poverty may prevent many from accessing disposable tissue. Let us keep encouraging one another to stick to the ABC guide for preventing COVID-19.

    1. Hi Israel,

      Thanks for your contribution.

      Glad that you found the article good and empowering.

      Please go ahead and help the younger generation.

      Regards!

  3. Thanks for such an educational post. ABC regarding the new crown virus can be applied faster, given the decades of experience with HIV. Today HIV does not reduce you from the comfort of life. With just one pill a day, you can live normally. I hope we get to live normally with the new coronavirus as well.

    1. Hi Carmen,

      Thanks so very much! 😊

      HIV has been successfully reduced from the big monster it used to be. So surely the lessons learnt should be applied to this unfolding tragedy?

      Warmest wishes.

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