Handwashing, Masks, and Social Distancing Are Here to Stay

Georgia’s Hartsfield-Jackson Atlanta International Airport has a terminal where domestic and international flights often comingle.

I average well over 100 flight segments a year and could navigate many airport hubs like Atlanta’s without paying much attention. You see a lot of the world’s people in a large airport, and I distinctly remember departing a flight at Hartsfield one ordinary, early fall day in 2019 and looking to my left, where a longhaul plane was departing with the majority of its passengers wearing masks. It was a stark difference from everyone else in the terminal, not wearing any masks at all, many of whom began rubbernecking when they strolled by one of the mask-wearers.

“WHAT’S WRONG WITH THEM?”

As a trained health care professional, I knew these passengers were wearing masks largely to protect those around them, as well as for some smaller measure of self-protection. I also knew that most of them were coming from a region of the world that was well into its influenza season and where mask-wearing is seasonally commonplace. Yet, if those domestic passersby had thought bubbles, they most likely would have read, “I wonder what’s wrong with them?” or “Do they all have cancer?” or “That’s weird and uncomfortable.” I remember thinking to myself at that moment that the United States would never be able to adopt the same basic public health prevention behaviors as other places in the world. Cultural norms are some of the most powerful forces in nature, and I did not think we had it in us as Americans to wear masks.

SARS-COV HELPED BUILD AND REINFORCE INFECTION CONTROL BEHAVIORS IN ASIA

The first widely known and publicized outbreak of severe acute respiratory syndrome coronavirus (SARS-CoV) occurred in 2003, with about 8000 people being infected and just under 800 perishing.¹ Despite spreading to many other countries, including the United States, containment strategies were effective, and nearly all the deaths were concentrated in eastern Asia. By many accounts, the SARS virus had a strong effect on the psyche of many Asian nations. Mask wearing is now commonplace during outbreaks, and awareness of infection control measures is high.

FAMILY AWARENESS GROWS, IMMUNOCOMPROMISED PATIENTS REJOICE

Prior to the coronavirus disease 2019 (COVID-19) pandemic, most Americans would not have thought twice about toughing out a cold or influenza and getting together with family or friends, perhaps even at a bar or movie theater. Although influenza kills tens of thousands of Americans every year, we gave nary a thought to our own contagious effects on others. Those of us who felt like traveling, traveled. Those who wanted to go to work went to work. Immunocompromised patients tended not to self-identify by wearing N95 masks regularly in public and generally socially distanced themselves during outbreaks without most of us noticing. Those days are over. COVID-19 is top of mind and likely will be for the foreseeable future, even after the current pandemic abates.

MASKS GOING MAINSTREAM, LIKELY TO BECOME A BEST PRACTICE

What used to be limited to individuals who were susceptible to infections and the occasional principled provider is now mainstream behavior. The evidence is in: Masks save lives. They reduce morbidity, mortality, and likely economic and social ruin. Much like handwashing before it, when it comes to mask wearing, glancing in the rearview mirror will be cringeworthy. Can you imagine never washing your hands before performing surgery or preparing food or after using the restroom?

It has only been about a century and a half since handwashing became a recommended hygiene practice. And even now, many do not do a good job. (When prompted by a sign, 97% of women wash their hands in public restrooms versus just 35% of men.)² Nobody really questions the importance of handwashing. Will it be likewise for mask wearing?

BUSINESSES ARE ALSO CHANGING ATTITUDES AND STRATEGY

Businesses of all types have now been forced to assess infection control in the workplace, and it is making them rethink many aspects of health, wellness, and productivity. With so much of the country working from home and a forthcoming grand natural experiment with a potentially suppressed influenza season, owing to measures taken to prevent COVID-19 spread, human resource departments and managers alike are conversing with their subordinates about sickness generally.

WORKING WHILE SICK IS NO LONGER FASHIONABLE

Everyone takes “stay home if you are sick” seriously now. This has not always been the case. Pharmacists are notorious for toughing out illness to keep pharmacies staffed, believing that the business must remain open to serve the community despite a little cough or sniffle. I remember working as a floater during the “roaring” 2000s

when we were at the height of the pharmacist shortage and calling in sick caused a shock wave. Frantic, panic-stricken supervisors were calling to beg for shift coverage. It was hard not to adopt a culture of “toughing it out.” But along with a pharmacist surplus, COVID-19 has changed that, and we are now aware not only of the importance of our own health but of the effects and risk we may place on others.

IT’S NOT ABOUT ME, IT’S ABOUT YOU

Here is the big change in mindset that will result from this godforsaken pandemic—–awareness and conscious thinking about those around us who could get infected if we are careless. We still have large swaths of the population who have not got the memo that conventional mask wearing is principally about others around us. We have not seen in our lifetimes a disease with both a high asymptomatic spread rate and a relatively high mortality rate. COVID-19 has forced us to think differently about infection control.

WHEN RESTAURANTS HAD SMOKING SECTIONS

Some of us are old enough to remember smoking sections in restaurants. They are hard to find now, but I waited tables in those sections when I was in college, and nobody wanted to sit next to those areas. Why? For the same reason we do not have a peeing section in a pool: smoke spreads, and so do coronavirus and many other preventable diseases.

EXPECT COUNSELING ON MASKS, HANDWASHING, AND SOCIAL DISTANCING TO BE BEST PRACTICE

With mounting evidence emanating from unprecedented volumes of new studies and epidemiological data, and ongoing natural experimentation related to COVID-19 spread,³ it is highly likely that health care professionals will be enlisted to communicate infection control measures to the public and to their own patients, pharmacies and pharmacists included, as a standard of practice. There is no sense in waiting. If you have not done so already, start advising patients to distance themselves socially, wash their hands, and wear masks. Explain the “why,” the “how,” and the “when.”

And men: Goodness gracious, wash your hands!

Troy Trygstad, PharmD, PhD, MBA, is the vice president of pharmacy provider partnerships for Community Care of North Carolina, which works collaboratively with more than 1800 medical practices to serve more than 1.6 million Medicaid, Medicare, commercially insured, and uninsured patients. He received his PharmD and MBA degrees from Drake University and his PhD in pharmaceutical outcomes and policy from the University of North Carolina at Chapel Hill. He also serves on the board of directors for the American Pharmacists Association Foundation and the Pharmacy Quality Alliance.

REFERENCES

• SARS basics fact sheet. CDC. Updated December 6, 2017. Accessed November 1, 2020. https://www.cdc.gov/sars/about/fs-sars.html
• Johnson HD, Sholcosky D, Gabello K, Ragni R, Ogonosky N. Sex differences in public restroom handwashing behavior associated with visual behavior prompts. Percept Mot Skills. 2003;97(3 pt 1):805-810. doi:10.2466/pms.2003.97.3.805
• Peeples L. Face masks: what the data say. Nature. October 6, 2020. Accessed November 1, 2020. https://www.nature.com/articles/d41586-020-02801-8