What can we do to minimize risk

[annaraven]

I live in an area with two international airports. I fully expect, at some point, to have an ebola carrier come to our area. And given the news, I also expect them to wander around and potentially leave sweat or sneeze on public items.

What kind of basic precautions can we start practicing now (aside from wearing gloves and an N95 mask which we probably wouldn't until/unless we hear of it actually being in the are) in order to minimize our risk if it does come here? What protocol would you recommend? (I already wash my hands regularly and try to avoid touching my face.)

For example - going grocery shopping.

Are the alcohol-based hand sanitizers actually worthwhile in helping minimize the risk of picking it up, say, on a shopping cart? Is wiping the shopping cart handle with one of those alcohol wipes likely to be useful? Is using hand-sanitizer on my hands after shopping, before getting in the car a good idea? Would the combination be helpful or a waste of time? I'm not a big fan of the alcohol-based sanitizers, strongly preferring plain soap and water regularly, but some situations that just isn't possible to do.

Does alcohol even work on ebola?

What about shoes? Would it be a good idea to start entering from the mudroom and switch to slippers there and leave the shoes outside the home? I heard someone say they were going to wipe their shoes with alcohol - would that be even useful?

Just curious what do you consider a reasonable protocol for the average layperson given that a "mildly symptomatic but non-febrile" carrier could be wandering around in public for a couple days before going for diagnosis?

[Redcass]

Re: What can we do to minimize risk

Ok, firstly, to address your alcohol gel question. The CDC says this:

Use a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus) to disinfect environmental surfaces in rooms of patients with suspected or confirmed Ebola virus infection. Although there are no products with specific label claims against the Ebola virus, enveloped viruses such as Ebola are susceptible to a broad range of hospital disinfectants used to disinfect hard, non-porous surfaces. In contrast, non-enveloped viruses are more resistant to disinfectants. As a precaution, selection of a disinfectant product with a higher potency than what is normally required for an enveloped virus is being recommended at this time. EPA-registered hospital disinfectants with label claims against non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) are broadly antiviral and capable of inactivating both enveloped and non-enveloped viruses.
http://www.cdc.gov/vhf/ebola/hcp/env...bile=nocontent

So, basically, if it kills an enveloped virus, it will most likely kill Ebola (since it too is enveloped), but to be on the safe side, go with something that kills non-enveloped virus (like EV-D68).

Here is a good run down of all the major disinfectant types and what they kill:

http://caenvironmentalmanagement.com...%2010%2012.pdf

For everyday out and about, something like Lysol wipes would be fine. If you really want to carry a heavy hitter, use a commercially premixed bleach solution or one you mix yourself. You could also use hospital grade bleach towels (like dispatch).

I personally wipe down my carts but honestly, I am more concerned with EV-D68 and flu than I am Ebola, since I have a 5, 3, and 9 mo old. I also have atopic dermatitis on my hands and usually have cracked, open skin (which is why I also love my nitrile gloves)! I did, however, leave my shoes on the porch after grocery shopping one night, as I had to walk perilously close to a pile of vomit on the way to my car. Cleaned the soles with bleach. Again, not so much for ebola, but other things.
If you feel more comfortable leaving your shoes in the mud room, why not? It really all comes down to a personal level of comfort and security. Just remember if they are by chance contaminated, you must doff them properly or else you just contaminated yourself. It has been noted that the more complicated a procedure, the more chance of error.

I hope the disinfectant info helps some. I am the crazy disinfectant lady, much to the chagrin of my family

[Sharky]

Re: What can we do to minimize risk

At this stage, it's probably not worth the effort to do much more to protect yourself against Ebola than against the flu or other viral diseases. From the research I've done, my best guess is that Ebola is transmissible via droplets or aerosols. In most public places, that would require being within 3 feet of an infected person. Fomites (surfaces) are a possible risk, but probably relatively low unless the viral load or exposure level was high.

One of my kids had a very high risk of respiratory problems when he was young. His doc told us that there was a chance he would get pneumonia, and if he did, there was a good chance it would kill him. We took the doc seriously, and did what we could. Here's a summary of the basic protocol we developed, which I think is applicable for Ebola as well, at least at the moment:

1. Try to stay at least 3 to 4 feet away from others when in public. Avoid crowds.
2. Stay aware of the people around you. If we saw someone sneezing or coughing at the grocery, for example, we would move to a different aisle or line.
3. Wear long-sleeved clothes in public, and use the end of the sleeve to open doors or when touching other objects that are likely to have been handled by others.
4. Avoid public bathrooms except in "emergencies". If needed, keep exposure as short as possible, and wipe-down all contact surfaces. (Definitely not easy with kids).
5. Carry alcohol and/or other antiseptic wipes and hand sanitizer whenever we went out, and used them on public surfaces and/or our hands.
6. Be sure to wash hands before a meal. Not a casual quick wash, but a serious one including plenty of physical movement / friction for at least 60 seconds (learned to count it out). Prefer soap and hot water. If in public when eating, then use wipes or equivalent.
7. Avoid touching your face in public (takes some practice!).
8. Take shoes off before coming back in the house, and special treatment for the long-sleeved outerwear.
9. Keep our immune systems strong with a good diet, supplements, and so on.
10. Wipe down shared phones before using them.
11. Ask potential visitors if they're unwell, and avoid seeing them while they are.
12. Buy meat only from the most reliable butcher we could find.
13. Avoid fast food places like the plague.

There was a period where we also did a light dilute bleach rinse of all fruits and veggies from the market.

We never used masks or gloves. They have their place, but I don't think masks are very effective against many viruses, and gloves present a problem when you take them off, and also have disposal issues/risks.

If I thought the level of risk was more substantial, I might change the above somewhat -- maybe use waterproof boots when going out and a bleach rinse on return, try to restrict the kids more in terms of visitors, outings, and so on, ratcheting up as needed based on the severity of the outbreak.

[zincfinger]

Re: What can we do to minimize risk

To that excellent list I would add:

14) do not eat from salad bars or buffet
15) when risk level is high in your area, try to do shopping and other crowd exposure activities during "off hours" early AM Saturday or Sunday etc when fewer people are there

ON A PERSONAL LEVEL:

If you smoke, STOP SMOKING IMMEDIATELY (don't wait until Ebola gets to your area)

Lung damage is one of the mechanisms Ebola uses to kill. When your oxygen supply becomes insufficient it greatly exacerbates ALL of the other killing effects.

Smoking seriously damages lung tissue and seriously impairs its function (AND resistance to disease) long before symptoms become evident to the smoker. As soon as you stop the lungs start to slowly recover. If you wait until you catch the disease, stopping at that point will still be helpful (smoke causes a lot of immediate damage) but you won't have time for the cumulative benefit.

And, of course, there are many other very strong health benefits from not smoking as well.

WHEN EBOLA GETS TO YOUR AREA:

Do not take NSAIDS (aspirin etc) nor products containing them, for ANY reason. Those who survive Ebola all have strong inflammatory reactions (of the type that NSAIDs strongly suppress) early on. If you happen to be taking NSAIDs for other reasons at the time you are infected and especially if you take them for early symptoms not suspected to be Ebola, your chances of survival are probably seriously impaired.

Maintain good hydration at all times: this includes taking in good sources of electrolytes as well as adequate liquids. Fruits are very good, anything high in potassium. Salty foods are a poor option: we tend to get too much sodium anyway. Potassium and calcium are the ones likely to be in short supply.

Inadequate electrolytes result in dehydration in spite of otherwise adequate liquid intake. Your body MUST maintain homestatis (osmotic etc balance) in the blood or you die quickly. To absorb water taken in it must balance the water with electrolytes to prevent serious and potentially fatal disruption of homeostasis. It there are not sufficient electrolytes the water will not be absorbed.

If you have any disease or condition that tends to dehydrate (diarrheal disease, fever, diabetes, Crohn's disease, intense exercise, etc) it is especially important to maintain hydration. "Oral rehydration salts"*1 should be kept on hand (if you get Ebola you will need 40 litres/quarts or more to (hopefully) get thru it) and used as appropriate for anything that might cause dehydration. MSF has indicated that maintaining good hydration is very effective in fighting the disease. (maintaining good hydration means keeping it optimal, not merely correcting dehydration after it becomes evident).

Stay well rested at all times. (probably the most difficult measure of all in our severely exploitive and hypercompetitive society) Your condition at the time you are exposed or infected strongly affects your chances of survival.

Eat a healthy diet. Good nutritional status and balance give you essential tools to fight disease.

Do not drink more than very moderate amounts of alcohol. More tends to dehydrate. Large amounts stress your detoxification systems, making you more vulnerable to diseases.

GOOD PREPARATION MEANS FAR MORE THAN MERELY STOCKING UP ON ESSENTIAL SUPPLIES.


*1 read the "oral rehydration therapy" section in Wikipedia.

[JJackson]

Re: What can we do to minimize risk

Wear gloves when ever you go out. Any kind you like not for barrier protection but because it makes you think every time you would otherwise unconsciously touch your face. Wash your hands every time you come in. Make it a habit.

[annaraven]

Re: What can we do to minimize risk

Ok, firstly, to address your alcohol gel question. The CDC says this:

Use a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus) to disinfect environmental surfaces in rooms of patients with suspected or confirmed Ebola virus infection. Although there are no products with specific label claims against the Ebola virus, enveloped viruses such as Ebola are susceptible to a broad range of hospital disinfectants used to disinfect hard, non-porous surfaces. In contrast, non-enveloped viruses are more resistant to disinfectants. As a precaution, selection of a disinfectant product with a higher potency than what is normally required for an enveloped virus is being recommended at this time. EPA-registered hospital disinfectants with label claims against non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) are broadly antiviral and capable of inactivating both enveloped and non-enveloped viruses.
http://www.cdc.gov/vhf/ebola/hcp/env...bile=nocontent

So, basically, if it kills an enveloped virus, it will most likely kill Ebola (since it too is enveloped), but to be on the safe side, go with something that kills non-enveloped virus (like EV-D68).

Here is a good run down of all the major disinfectant types and what they kill:

http://caenvironmentalmanagement.com...%2010%2012.pdf

For everyday out and about, something like Lysol wipes would be fine. If you really want to carry a heavy hitter, use a commercially premixed bleach solution or one you mix yourself. You could also use hospital grade bleach towels (like dispatch).

I personally wipe down my carts but honestly, I am more concerned with EV-D68 and flu than I am Ebola, since I have a 5, 3, and 9 mo old. I also have atopic dermatitis on my hands and usually have cracked, open skin (which is why I also love my nitrile gloves)! I did, however, leave my shoes on the porch after grocery shopping one night, as I had to walk perilously close to a pile of vomit on the way to my car. Cleaned the soles with bleach. Again, not so much for ebola, but other things.
If you feel more comfortable leaving your shoes in the mud room, why not? It really all comes down to a personal level of comfort and security. Just remember if they are by chance contaminated, you must doff them properly or else you just contaminated yourself. It has been noted that the more complicated a procedure, the more chance of error.

I hope the disinfectant info helps some. I am the crazy disinfectant lady, much to the chagrin of my family

This is great info. Thanks! And my husband is amusedly tolerant of my interest in this whole thing.