Back to work in the new normal

On the eve of returning to work for non-essential economic activities (and where teleworking is not an option), which were suspended in Spain on March 30, 2020 due to the current pandemic of the SARS-Cov-2 coronavirus, we are going to touch an issue where there is no consensus among experts today: the use of masks. Anyway, we go step by step.

As the InstitNational uto of Allergy and Infectious Diseases of the USA (1), the coronavirus is a broad family of viruses responsible for causing mild to moderate respiratory diseases, such as the common cold. Most circulate among animals such as pigs, camels, bats, and cats. But sometimes they “jump” humans.

Of the seven known coronaviruses that can make people sick, three of them have emerged in the last two decades, causing major pathologies and many deaths:

SARS-CoVThis coronavirus appeared in November 2002 in China, causing severe or severe acute respiratory syndrome (SARS) and disappearing in 2004.MERS-CoV (2): appeared in 2012 in Saudi Arabia, causing Middle East respiratory syndrome (MERS) and often triggers outbreaks. Scientific data point to dromedaries as a reservoir for MERS-CoV and an animal source of human infection, but the specific role of dromedaries and what exactly the routes of transmission are are unknown.COVID-2: we know this one. Its acronym comes from the English Severe Acute Respiratory Syndrome Coronavirus 2. Also called 2019n-CoV (2019 novel coronavirus), it appears in China in December 2019, being responsible for the infectious disease called COVID-19 (Coronavirus Disease-2019). It is declared a pandemic by the WHO on March 11, 2020.

This new virus is so recent that, obviously, there is no information about it prior to November 2019. But, from the first cases, the investigations have not stopped and, little by little, we are learning more data about SARS-CoV -2. In fact, today's advanced technology means that information arrives instantly from one end of the planet to another. Unfortunately, this has its downside and that is that misinformation has the same advantage.

Hoaxes, "fake news" and other half-truths, create confusion, ignorance and terrible knowledge about a reality that we still have much to know. In Spain, for example, we have colleagues from cursed.es (3), which are a non-profit medium that, as they say on their website, their purpose is to provide citizens with "tools so that they do not strain you." From the beginning they have been updating and debunking hoaxes about the coronavirus and currently they have cleared 690 hoaxes (4).

In order to stop them and understand the little truth we know about COVID-19, we must turn to scientific evidence. So get to work!

In any contagious disease, we have to know how it is transmitted.  In the case of the transmission of SARS-CoV-2 (5), the virus is found in respiratory droplets (diameter ≥ 5-10 µm) that come out of the mouth or nose when coughing or sneezing, even when talking, of an infected patient (with or without symptoms). If these viruses reach the mucosa (mouth or nose) or conjunctiva (eyes) of a person, they can become infected.

It might be because:

Direct transmission: when being in close contact (less than 1 meter) with an infected patient and these respiratory droplets reach the mucosa. This is why it is drop insulation.Indirect transmission: by fomites. These virally loaded droplets can be on surfaces or objects (from hours to days, depending on the material), and if a person touches them and then touches their face, they are at risk of infection. This is why it is contact isolation.

Air transmission? There may be, in specific circumstances and places where procedures are performed or treatments are administered that can generate aerosols (droplet nuclei with a diameter <5 µm, which can remain in the air for prolonged periods and reach people who are more than one meter away). The techniques that can generate aerosols are:

Drug delivery by nebulization Endotracheal intubation Open aspiration Bronchoscopy Manual ventilation prior to intubation Turning the patient to the prone position Disconnection of the patient from a ventilator Noninvasive positive pressure ventilation Tracheostomy Cardiopulmonary resuscitation (Recommendations on CPR in a patient with COVID19 here!Sputum induction techniques.