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Mitigating risk of COVID-19 while indoors

So much of our discussions these days are around mitigating risk.  We are comparing dangers of social gatherings and grocery stores.  We are discussing safety of bringing kids back to school.  A concept that is central to this discussion is sanitization.  

Before we can decide how to clean, we have to consider how the virus is spread.  

Is the SARS-CoV2 virus airborne?

- There is not a consensus.  Experts agree we should assume it is aerosol when considering sanitation.

What is the difference between airborne and droplets?

- Airborne - These are very small aerosol particles ( smaller than 5 microns) that can spread with talking and breathing.  This means we should be concerned that these particles stay in the air and can be transmitted over longer distances. Furthermore, these aerosols can accumulate overtime in enclosed spaces and increase the risk of transmission.

Droplet - These are heavier particles that are spread through coughing and sneezing. It is presumed they travel approximately 6 ft and drop to the floor.  Moreover, most people turn away when they cough or sneeze (as opposed to talking and breathing).

Some studies are showing positive COVID tests in air samples and some are not.  There is controversy whether some of these samples were taken close enough to a patient that they are actually droplets. A study in Nebraska ICU isolation rooms found SARS-CoV2 viral particles  in the air but these particles were not infectious in cell culture.

On July 9th, the WHO reports no definitive answer to this question.  The possibility of airborne SARS-CoV2 particles can not be ruled out.  

It is important for our society to be aware of these concerns and make good choices when sharing space.  We have made many changes to the office to ensure it is a safe space for patients to be seen for necessary exams that will keep them healthy and out of the Emergency Department.  We will continue to utilize telehealth visits whenever appropriate.  We are limiting visitors to the space to only patients and occasional colleague visits.  In fact, you might notice a large STOP sign on our front door to limit random visitors.  You'd be surprised how many of these we still see.

The following are additional changes to Fulcrum Family Health to decrease the risk of COVID-19 transmission.

1) Removal of all cloth seating.

2) Daily comprehensive clean and weekly deep clean

3) New patient interviews conducted via phone or telehealth allowing for limited time in the office for exams and procedures only.

4) Symptom and temperature screens as well and hand sanitization on arrival.

5) Cleaning between patients with hypochlorous acid (HOCl) and electrostatic fogger machine (see below).

6) Good air flow with window fans to exhaust air and keep circulation strong

7) HEPA/UVC filter 

Will a HEPA filter stop COVID-19?

- The jury is still out on this one.  The SARS-CoV2 virus is approximately 0.125 microns which is too small for a HEPA filter.  We know that it travels on respiratory droplets/aerosol which vary in size depending on their source.

- HEPA filters are believed to filter at 0.3 microns and above.  A NASA study suggests most HEPA filters are highly effective at 0.01 microns.  HEPA filters are used by physicians in a PAPR as an alternative to N95 masks.

- Again, it is unclear whether a HEPA filter will be protective but we are adding them to the office for safe measure.  We will continue to enforce a mandatory mask and hand washing policy.

What is hypochlorous acid? (I have no stake in any of these companies)

- Hypochlorous acid (HOCl) is a strong disinfectant that reliably kills viruses and bacterial by breaking open their cell walls.  Don't let the word "acid" fool you.  This is a non-toxic and can be touched directly and used around children.  

- This liquid is made by salt and water then adding an electrical current.  It is optional to add vinegar (this doesn't appear to change its effectiveness).  There are commercial devices where you can make your own HOCl.  This technology is being used by many dental offices.

- The company Force of Nature utilizes this technology and sells an at-home kit.  

- This cleaner can be added to an electrostatic fogger and used as an effective method to clean a room easily.

- This non-toxic method of cleaning saves time and countless wipes/spray bottles.  It is a great choice for schools, daycares and any indoor space.

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