SARS-CoV-2 is an airborne biosafety level 3 human pathogen. It is neither mild nor over.
As a lung transplant recipient, Tony is highly aware of the realities of acute, end-stage organ failure, ECMO and ICU visits as well as living with a serious chronic illness. He takes COVID very seriously as none of these are situations you want to find yourself in, especially when you can prevent them by taking simple actions.
This page outlines his COVID protection policy and procedures.
Risk Assessment & The Precautionary Principle
Precautionary Principle: This states that in the absence of data, it is best to err on the side of caution in our decisions and behaviours.
In the case of COVID, the numbers cited above mean that as individuals we need to assume that any person we come into contact with is currently infected and respond from there. The precautionary principle also means that we need assume that an infection will result in a negative outcome as there is no way currently to predict individual outcomes from a COVID infection.
In the absence of reliable or transparent COVID information from public health authorities, we now rely on ad hoc associations of physicians and scientists who are providing data and advice on:
- Bi-weekly COVID prevalence forecasts for Canada and each province. These can be found at COVID-19 Resources Canada’s “Hazard Index” page. Click on the first link in the table of contents to see the dashboard. Learn more about Dr. Moriarty and her infectious disease research lab. Alternately, follow Dr. Tara Moriarty on Twitter.
- Current issues and protections regarding the COVID-19 pandemic in BC. Protect Our Province BC is “a grassroots group of physicians, nurses, health scientists, health policy specialists and community advocates” who volunteer their time to put out public health advice and education for citizens of BC.
- Source Control information about air quality. Individuals to follow include:
- Dr. Jim Rosenthal and Dr. Richard Corsi – Of the Corsi-Rosenthal box fame – this is a DIY air filter that is verified as effective by 3M. Find them on Twitter: @CorsIAQ, @JimRosenthal4.
- Joey Fox, P.Eng, Canadian HVAC Engineer. He provides information on aspects of air quality including standards for mitigating airborne pathogens and calculations for a variety of indoor situations. Find him on Twitter: @joeyfox85 and his website, ‘It’s Airborne‘.
COVID Safety Mitigations
The ‘Swiss Cheese Model’ of risk mitigation shows that no one intervention provides 100% protection. This model is used for many situations, and the diagram below has been created specifically for COVID-19.
Note that there are key ‘slices’ that are the responsibility of public health and government agencies that we are currently missing. As individuals, we can act on the slices labelled ‘personal responsibilities’ and we do have some control over some indoor spaces.
Tony’s COVID policy and procedures are based on this model of risk assessment and mitigation and are outlined below.
COVID Protection Policy and Procedures
Based on the Swiss Cheese Model
This brings us to the actions Tony takes when meeting with clients and entering their living spaces. These policies are also in place for Tony for any indoor space, including medical appointments.
- Physical Distance/Stay Home When Sick:
- SARS-CoV-2 hangs in the air for hours, even after an infected person has left the space. Physical distancing reduces the number of people in a space, so it does help by lowering the potential viral load. Please minimize the number of people in the indoor space while working with Tony. If he is organizing others to come into the space he will stagger times to reduce the number of people inside at any given time.
- Tony has chronic conditions aside from his transplant and so understands that plans may need to be cancelled without warning. This is fine and is preferrable to meeting if you are sick for any reason. The health and safety of all parties comes first. COVID is a bell you can’t ‘unring’. (Evidence is mounting that SARS-CoV-2 persists throughout the body causing damage whether people realize it immediately or not. See this science review article from the John Snow Project.)
- Outside of Tony’s work and medical appointments, our family avoids indoor spaces in general, especially as COVID is circulating unchecked in our communities. We use curbside pickup and delivery whenever possible and enter street-facing retail stores rarely and briefly – always masked and with an Aranet CO2 monitor. (Should COVID levels drop to <3/100K in conjunction with percent positivity <3%, and an R(t)<1 we will revisit this policy.)
- Masking: Tony wears an N95 respirator mask and asks others to use a respirator mask as well. He can provide an N95 if you don’t have one. (K)N95 masks provide both good fit and excellent filter to reduce adding to the airborne viral load in an enclosed space. Medical/surgical masks provide good filter, but the poor fit allows significant aerosol leakage (both in and out). Further, a non fit-tested N95 mask is superior to a medical/surgical mask (Read this AMA article).
- Hand Hygiene/Cough Etiquette: Washing hands is important in reducing the spread of many viruses and bacteria. Hand washing before and after donning/doffing your mask is prudent. Etiquette says to cover a cough or sneeze. When indoors and wearing a mask, keep it on to cough and sneeze – that’s when it’s most needed!
- Avoid Touching Your Face: This is good basic infection prevention advice. In the case of SARS-CoV-2 airborne virus, this is precautionary advice. Our mucous membranes (eyes, nose, mouth) are potential routes of entry so every bit of prevention helps.
- If Crowded, Limit Your Time: The more people breathing in a space, the higher the risk of transmission of an airborne virus. Measuring CO2 levels is a good way to assess the effectiveness of a building’s ventilation. Tony uses an Aranet CO2 monitor for this purpose. If the CO2 levels begin to rise above acceptable levels (800 ppm), he will direct people to open doors and/or windows. Should the CO2 levels become unacceptable (above 1000 ppm), he will ask people to leave and may leave himself, especially when around unmasked people.
- Ventilation, Working Outdoors, Air Filtration: Air quality depends on a variety of factors. Ventilation helps get fresh air into the space and reduces potential viral load. Opening doors and/or windows can have a surprisingly fast effect on lowering the CO2 levels in a space. Similarly, using HEPA or MERV13 (or better) filters in your space will reduce viral load. If you don’t know what kinds of filters are being used in your HVAC system, portable filters should be deployed. Tony will provide a Corsi-Rosenthal box if you don’t have a HEPA or equivalent filter.
- Vaccination: As an organ transplant recipient, Tony is fully vaccinated and boosted but given his immunosuppression medications he may not be one of the patients who mount any immune response from vaccines. The precautionary principle requires him to act as if he is not vaccinated.