From time to time, we’ll publish excerpts from our new book Beat the Coronavirus here as a public service. Today we’ll publish an excerpt from Chapter 5.
What’s the deal with face masks? Here’s where things stand now. Federal health officials are advising people to wear cloth face masks anytime they leave their house. It’s a recommendation, not a law or order. The guidance states:
CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.
CDC also advises the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.1
For decades, face masks have been a standard part of daily life in many Asian countries during disease outbreaks, but it’s a ritual that’s foreign to most North Americans. That, too, is one of the jarring changes we’re seeing occur almost overnight as a result of the pandemic. The nightly news is now filled with pedestrians walking down city streets wearing masks, something we haven’t really seen in this country since the great flu pandemic of 1918-1919 (see Chapter 12 for more on the Spanish flu).
A few days ago, the Centers for Disease Control and Prevention quietly issued full interim guidance on how schools and other establishments can safely open during the coronavirus/COVID-19 pandemic.
Given that the CDC decided to issue these recommendations to school officials and state governments as part of a fairly dense 60-page PDF, we wanted to put it into a friendlier format.
Here are the CDC recommendations for school reopenings in full:
INTERIM GUIDANCE FOR SCHOOLS AND DAY CAMPS
As communities consider a gradual scale up of activities toward pre-covid-19 operating practices in centers for learning, such as K-12 schools and summer day camps, CDC offers the following recommendations to keep communities safe while resuming peer-to-peer learning and providing crucial support for parents and guardians returning to work.
These recommendations depend on community monitoring to prevent covid-19 from spreading. Communities with low levels of covid-19 spread and those with confidence that the incidence of infection is genuinely low (e.g., communities that remain in low transmission or that have entered Step 2 or 3) may put in place the practices described below as part of a gradual scale up of operations.
All decisions about following these recommendations should be made in collaboration with local health officials and other state and local authorities who can help assess the current level of mitigation needed based on levels of covid-19 community transmission and the capacities of the local public health and health care systems, among other relevant factors. CDC is releasing this interim guidance, laid out in a series of three steps, to inform a gradual scale up of operations.
In case it hasn’t become obvious by now, the Centers for Disease Control and Prevention is increasingly buckling under political pressure to alter its recommendations to the American public — something that has never been done in the history of the agency.
The full guidance was removed from the CDC site after it was briefly published and now consigned to the Internet Archive’s Wayback Machine. We’ve decided to republish the recommendations here for churches, synagogues, houses of worship and other communities of faith interested in getting straight talk from health officials without interference from political leaders.
CDC Interim Guidance for Communities of Faith
CDC offers the following general considerations to help communities of faith discern how best to practice their beliefs while keeping their staff and congregations safe. Millions of Americans embrace worship as an essential part of life. For many faith traditions, gathering together for worship is at the heart of what it means to be a community of faith. But as Americans are now aware, gatherings present a risk for increasing the spread of COVID-19 during this public health emergency.
The Centers for Disease Control and Prevention has offered a new set of guidelines for reopening U.S. businesses and workplaces.
The recommendations chiefly fall into two areas: Administrative controls that change the way people work in an office or workplace, and “engineering controls” that minimize the chance of workers being exposed to the virus.
Of special interest are the recommendations regarding how employees are supposed to change the way they work going forward through the New Normal. Among the key recommendations:
Upon arriving at work, employees should get a temperature and symptom check.
Inside the office, desks should be six feet apart. If that isn’t possible, employers should consider erecting plastic shields around desks.
Seating should be barred in common areas.
Face coverings should be worn at all times.
Recommendations on workplace changes
Here are the CDC’s full recommendations on changes to workplace behavior and interactions because of the coronavirus:
Actively encourage employees who have symptoms of COVID-19 or who have a sick family member at home with COVID-19 to notify their supervisor and stay home.
Employees who appear to have symptoms upon arrival at work or who become sick during the day should immediately be separated from others, provided a face mask if they are not using one, and sent home with instructions and guidance on how to follow-up with their health care professional.
Develop and implement a policy to prevent employees from congregating in groups while waiting for screening, and maintain a 6-foot separation between employees.
Stagger shifts, start times, and break times as feasible to reduce the density of employees in common areas such as screening areas, break rooms, and locker rooms.
Consider posting signs in parking areas and entrances that ask guests and visitors to phone from their cars to inform the administration or security when they reach the facility.
Provide directions for visitors to enter the building at staggered times.
Consider posting signs in parking areas and entrances that ask guests and visitors to wear cloth face coverings if possible, to not enter the building if they are sick, and to stay 6 feet away from employees, if possible.
Follow the Guidance for Cleaning and Disinfecting to develop, follow, and maintain a plan to perform regular cleanings to reduce the risk of people’s exposure to the virus that causes COVID-19 on surfaces.
Routinely clean all frequently touched surfaces in the workplace, such as workstations, keyboards, telephones, handrails, printer/copiers, drinking fountains, and doorknobs.
If hard surfaces are visibly soiled (dirty), clean them using a detergent or soap and water before you disinfect them.
Provide employees with disposable wipes and other cleaning materials so that they can properly wipe down frequently touched surfaces before each use.
Provide employees adequate time to wash their hands and access to soap, clean water, and single use paper towels.
Remind employees to wash their hands often with soap and water for at least 20 seconds. If soap and water are not available, they should use hand sanitizer with at least 60% alcohol.
Establish policies and practices for social distancing:
Remind employees that people may be able to spread COVID-19 even if they do not show symptoms. Consider all close interactions (within 6 feet) with employees, clients, and others as a potential source of exposure.
Prohibit handshaking, hugs, and fist bumps.
Limit use and occupancy of elevators to maintain social distancing of at least 6 feet.
Encourage the use of outdoor seating areas and social distancing for any small group activities such as lunches, breaks, and meetings.
For employees who commute to work using public transportation or ride sharing, consider offering the following support:
If feasible, offer employees incentives to use forms of transportation that minimize close contact with others (e.g., biking, walking, driving or riding by car either alone or with household members).
CDC recommends wearing a cloth face covering as a measure to contain the wearer’s respiratory droplets and help protect their co-workers and members of the general public. Employees should not wear cloth face coverings at work if they have trouble breathing, any inability to tolerate wearing it, or if they are unable to remove it without assistance.
Cloth face coverings are not considered personal protective equipment. They may prevent workers, including those who don’t know they have the virus, from spreading it to others but may not protect the wearers from exposure to the virus that causes COVID-19.
Remind employees and clients that CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain, especially in areas of significant community-based transmission. Wearing a cloth face covering, however, does not replace the need to practice social distancing.
After several days of delay, the Centers for Disease Prevention and Control has issued a set of recommendations and guidelines for reopening large swaths of the nation. The 60-page report, titled CDC Activities and Initiatives Supporting the COVID-19 Response and the President’s Plan for Opening America Up Again,” is here.
From the report:
As businesses and other organizations gradually open after the COVID-19-related slowdown, they will need to consider a variety of measures for keeping people safe. These considerations include practices for scaling up operations, safety actions (e.g., cleaning and disinfection, social distancing), monitoring possible reemergence of illness, and maintaining health operations. …
Widespread community mitigation combined with ongoing containment activities represents both an effective
intervention for limiting the spread of COVID-19 and a serious threat to the economic well-being of the country
and the world.
See pages 45 to 48 for guidance for schools, pages 53 to 56 for guidances for restaurants and bars, and pages 49 to 52 for guidance for employers with high-risk workers.
The report appears to be fairly well crafted if somewhat thin on specifics and passive on enforcement. It seems divorced, however, from the actions being taken at the federal level. Calling for continued community mitigation and containment strategies is all well and good, but if those calls are divorced from supportive measures to implement them, then they’re just words on a page.
Mothers’ Day is coming up. Every year, I feel grateful that I get to make not one but two calls. Big E, my belated father’s only sibling and that “cool, badass aunt,” has always been like a second mother to me and countless other young people she has encountered throughout her life.
I wrote my first column for the New Haven Independent in mid-April about what it is like to be an emergency room doctor during the coronavirus pandemic. Big E was once a newspaper journalist, so I made sure I emailed the article to her.
I am so glad I sent that email. A week later, Big E died from Covid-19.
Her death was not completely unexpected. She was 77 and fighting chronic lung disease and tongue and colon cancer. Though she yearned to return to her townhouse, she was residing in an assisted living facility.
The residents at the facility had been quarantined there for six weeks, unable to leave their rooms. Activities, communal meals and happy hour were all canceled. A free (and curious!) spirit, Big E would occasionally sneak a peek into the hall. Otherwise, she and her co-residents upheld strict Covid precautions.
She, like so many with Covid, was without family but not alone in her final days. Weeks ago, she became frustrated that no doctor would come to her facility, where she was suffering from hugely swollen legs. Always the investigative reporter, she discovered that if she signed up for home hospice, fearless angels in the form of hospice nurses would start weekly in-person visits.
She was eligible for hospice, as there was never a shortage of doctors who thought she had fewer than six months left to live (some of those doctors died years ago!). She was then satisfied that a medical provider bore witness to her pitting, weeping legs. She got a fever, weeks into “this nonsense,” as she called it. She said, “It’s curtains for me,” even before her test came back positive.
A few days later, while speaking to her on the phone, I noted she was having trouble breathing. I asked her if she wanted to go to the hospital. It was hard for her to speak, but I knew if she wanted to go, she would let me know. Big E earned her moniker through her outspoken personality, not her 100-pound physique.
After conferring with her two children, we made the call to send the hospice nurses to Big E’s side to manage her breathing symptoms. Fortunately, a day later, the hospice program arranged for her two children to make a final visit in her facility. Her two children donned personal protective equipment (PPE) and made sure she knew how much they loved her.
In the best case scenario, conversations about end of life wishes occur when there is the luxury of time. However, even with all the time in the world, these conversations can be messy, contradictory and complicated. On multiple occasions over the years, Big E told me that she wanted “to live as long as possible.” But by choice, she had no medical care until age 70.
When she was in the hospital, Big E would often fight with her providers about a blood draw, an X-ray, or a CT scan. She skipped many outpatient follow-up appointments. Her OB-GYN office is still waiting—50 years later—for her to return for her postpartum checkup. When admitted to the hospital for pneumonia this winter, she refused a ventilator even when ICU doctors told her that she might die without it. (That time, she proved them wrong.) She said she wanted to live as long as possible, yet she actively avoided or declined much of the care available to her over many decades.
In her final days, we decided to honor her wishes as expressed by her actions. We debated whether we were honoring her words. After her death, we realized that we also honored her wish to allow her to live “as long as possible.” As a journalist who was always precise with her words, she made sure the words we needed were there all along.
I recommend that everyone start the process of having these difficult conversations with their family members about their wishes. At the very least, everyone should name someone they trust to make decisions for them if they are unable to speak for themselves. Books such as How We Die by former Yale physician Sherwin Nuland and Being Mortal by Atul Gawande are good starting points for us all to get more comfortable talking about death. Covid is making it necessary.
Karen Jubanyik (pictured) is an emergency medicine physician at Yale New Haven Hospital and a faculty member at the Yale School of Medicine. This article originally appeared in the New Haven Independent.
We were able to include only a few of these images in our new book “Beat the Coronavirus,” so we thought we’d share more of these public domain photos here. The parallels between now and 102 years ago are striking!