3 How to prevent the spread of COVID-19

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Contents

• Objectives
• Preventing the spread of COVID-19
• Screening, testing and contact tracing
• Community lockdown
• Case studies

Objectives

Once you have finished this chapter you should be able to:

1. Describe how the public can prevent the spread of COVID-19.
2. Explain why wearing a cloth mask in public is important.
3. Describe what government can do to prevent the spread of COVID-19.
4. Understand how community screening, testing and tracing are done.
5. Describe community lockdown.

Preventing the spread of COVID-19

Video by the Global Health Media Project made available under a Creative Commons Attribution-NonCommercial-NoDerivatives License

3-1 Is there a vaccine for COVID-19?

Unfortunately, there is no vaccine yet. This means a huge effort must be made to prevent the spread of COVID-19. There is an international effort to produce an effective vaccine against coronavirus as soon as possible. Only when a vaccine is available will immunisation be able to control and finally stop the spread of COVID-19.

3-2 What can the public do to prevent the spread of COVID-19?

There are several things everyone can do to slow down the spread of coronavirus:

• Stay at home.
• Wash hands frequently and thoroughly with soap and running water.
• Use an alcohol-based hand rub or hand spray.
• Cover your mouth with a flexed elbow or tissue when coughing or sneezing.
• Do not touch your face with unwashed hands.
• Clean frequently touched surfaces, such as door handles, phones and computer keyboards, often.
• Keep 1 to 2 metres away from other people (social distancing).
• Wear a non-medical cloth face mask in public places.
• Help to spread correct information about COVID-19.
• Support one another and help to reduce stigma.

3-3 What is thorough handwashing?

Regularly washing both hands well with soap and running water for 20 seconds. Make sure that all surfaces of the hands, fingers and thumbs are washed. Do not wash in a basin. Hands should be thoroughly dried, preferably with a paper towel after washing. Switch off the tap with the used paper towel and place it in a bin. It is safer to use a disposable paper towel than a hand towel.

In the home, school and general workplace environment, hands should be washed before preparing food, after using the toilet, when you have been in a public place, after removing a mask and after handling tissues. Good handwashing is an important way to avoid coronavirus infection. Keep your hands free of coronavirus.

3-4 When is it useful to use an alcohol hand spray?

A 70% alcohol-based hand rub or hand spray (hand sanitiser) can be used, particularly if soap and water are not available. This is especially helpful when entering and leaving a shop or office.

3-5 Why should you cover your mouth when you cough?

This helps prevent the spread of small droplets which may carry coronavirus. Always cover your mouth and nose with your bent elbow or a paper tissue when you cough or sneeze (respiratory hygiene). Place the used tissue in a bin immediately. Do not leave used tissues lying around for someone else to pick up. Never spit in public.

It is the responsibility of everyone to protect others around them as well as to protect themselves. Good handwashing after coughing and handling respiratory secretions (used tissues) is another important way to avoid coronavirus infection.

Keep your droplets to yourself.

3-6 Why should you not touch your face?

Do not touch your face with unwashed hands. If you touch a surface that is contaminated with coronavirus and then you touch your nose or mouth, or rub your eyes, with a hand that has not been washed, you may become infected. If you must rub your nose it is safer to use the back of your hand or your arm.

Try to learn not to touch your face.

3-7 How can frequently touched surfaces be cleaned?

Most frequently touched surfaces such as counter tops, tables, taps and door handles can be cleaned with a soapy cloth followed by disinfection with 70% alcohol spray or wiping down with a diluted 0.1% bleach solution. One part Jik to 4 parts water can also be used at home. Spectacles and cellphones can be wiped down with alcohol-based sanitiser.

3-8 What is social distancing?

Social (physical) distancing means getting no closer than 1 metre, and preferably no closer than 2 metres, to another person, especially if they are coughing. Do not shake hands, touch, hug or kiss other people. Social distancing is important when doing essential shopping or standing in queues. Avoid crowds or social gatherings, especially if they are indoors with poor ventilation. This is an effective way to prevent the spread of coronavirus.

Keep people apart.

3-9 How effective is staying at home?

Restricting the movement of healthy people and families by getting them to stay at home is probably the most effective way of protecting them from coronavirus infection. Staying at home stops the coronavirus from spreading through communities as it prevents people from getting coronavirus from other people.

If in doubt, don’t go out.

3-10 What is self-isolation?

Self-isolation refers to keeping any person with coronavirus infection, or suspected coronavirus infection, alone in their home or room. This will reduce the chance that they will pass on the infection to family members or social contacts. People who are self-isolating must stay at home and away from other people for 14 days. Self-isolation in a room at home or in an isolation facility is an essential step to slow down the spread of the pandemic.

3-11 What is quarantining?

Quarantine means keeping someone who has been in contact with a person with coronavirus infection at home or in a quarantine facility. This allows time to find out if they have been infected with coronavirus or not. Quarantining plays an important role in preventing the spread of coronavirus.

3-12 Is it helpful to wear a non-medical cloth face mask when going out in public?

Wearing a simple cloth (cotton) mask in public will help protect others as it reduces the spread of droplets when one coughs. It may also protect people from breathing in droplets that contain coronavirus. Wearing a cloth mask may help you remember not to touch your face. Many people feel reassured by wearing a cloth face mask.

When in close contact with others, such as in a taxi, food store or at a funeral, a simple cloth mask reduces the risk of an infected person shedding virus into the air. Unfortunately, a mask does not give 100% protection. Only touch the ties and not the material when putting the mask on or taking it off. Wash your hands after removing a mask. Do not share masks.

Cloth masks should be washed daily with soap and hot water, allowed to dry in the sun and ironed after use. It is best if everyone has two cloth masks: one to wash and one to wear.

Until the pandemic is over everyone should wear cloth masks in public.

My mask protects you and your mask protects me.

The public should not use medical masks or N95 respirators (masks) as these are in short supply and must be reserved for health workers.

3-13 Should people wear gloves in public?

No. Like hands, gloves may get contaminated from infected surfaces and can then spread the coronavirus if you touch your face. It is better for the public to wash their hands with soap and running water, or to use 70% alcohol hand spray (hand sanitiser) if soap and running water are not available.

3-14 Why should the public be educated about COVID-19?

It is essential that everyone learns about COVID-19 and how coronavirus is spread. Only then will they understand and practice how to protect themselves, their family and their community. The whole population must become involved in the battle against COVID-19. A better understanding of COVID-19 helps to reduce stigma toward people who are ill with or have recovered from COVID-19.

Information is power.

3-15 What can national governments do to slow the spread of COVID-19?

There are several steps that many governments are taking:

• Screening and testing to prevent potentially infected people entering the country
• Screening and testing anyone with suspected coronavirus infection
• Community screening for COVID-19 and community testing for coronavirus infection
• Tracing people who have been in contact with someone who has COVID-19 (contact tracing)
• Isolating people who have been infected with coronavirus (self-isolation)
• Quarantining people who have had close contact with someone with confirmed COVID-19 (quarantining)
• National regulations to prevent the public mixing with other people (community lockdown)
• Providing information via the media on how to avoid infection
• Promoting or giving the public non-medical cloth face masks to use in crowded spaces
• Supporting the unemployed financially and providing food parcels to the poor.

These efforts are all aimed at flattening the curve.

3-16 What does it mean to flatten the curve?

Without intervention, COVID-19 spreads rapidly through a community, with the number of infected people doubling every 2 to 3 days. Each person with coronavirus usually infects three others. This results in a steep increase in the number of infected people, which places an enormous strain on health services, especially hospital wards and intensive care units. The aim is to reduce the speed at which new people become infected and so decrease the daily number of new infections, which is called flattening the curve. The best methods to flatten the curve are community screening, contact tracing and community testing, together with public lockdown to reduce opportunities for coronavirus transmission.

Screening, testing and contact tracing

3-17 How are people screened for COVID-19?

Screening is usually done door to door in communities at high risk of COVID-19. Screening teams will also be sent to sites where new cases of COVID-19 are being reported.

Community health workers conduct screening by recording the person’s identity details and recent movements, taking a history of cough, fever, sore throat or shortness of breath, and possibly measuring the person’s temperature. A body temperature of 38℃ or more is abnormal. Those suspected of having COVID-19 are sent for testing. Not all people who are screened are also tested.

3-18 What is testing?

Those who are suspected of having COVID-19 are tested by taking a throat or preferably a nose (nasopharyngeal) swab for coronavirus. The swabs are placed in a dry test tube and sent to a laboratory. This can be uncomfortable and can make the person cough. People who have been tested must self-isolate until they get their test result back. Further management is decided when the test results are released.

Mobile testing vans with Xpert machines that can give an answer in 45 minutes can be sent to a testing site which will speed up testing. Management for infected people can then be planned immediately.

3-19 Why is community screening important?

With door-to-door community screening (active surveillance), a large portion of the community is screened for COVID-19. This makes it possible to get a true idea of how many people are ill with COVID-19. An accurate mortality rate for people with COVID-19 can then be calculated. This is especially important for projecting the course of the pandemic and planning for the hospital care of ill patients. It also helps manage the impact of COVID-19 on society and the economy.

Community screening may be extended to many communities (population screening) or even include people from the whole country (national screening). The more screening the better. Only with widespread screening will the COVID-19 pandemic be controlled.

3-20 What is the value of community testing?

If people are tested with swabs for coronavirus, it is possible to find out how many people are infected with coronavirus. Many of them will be well (asymptomatic). Testing helps to assess the accuracy of screening. It also gives the true number of infected individuals. The mortality rate of all infected people (both symptomatic and asymptomatic people) can then be calculated. The frequency of COVID-19 (people who are ill) is much less than the frequency of coronavirus infection (people who are well plus people who are ill). The number of people infected with coronavirus gives a good idea of the risk of the public becoming infected. This helps in deciding when to lift lockdown.

3-21 What is contact tracing?

Contact tracing is looking for all the people who have recently been in contact with someone who is infected with coronavirus. All people who have been in physical contact with the patient in the previous few days should be identified, traced and screened for COVID-19. Due to fear and stigma, some people may be afraid of giving the names of their contacts.

Contact tracing requires the time and effort of many people but is important to find people who are at high risk of incubating coronavirus or of having COVID-19. This is a vitally important part of slowing down the spread of infection. Contacts of people who have tested positive for COVID-19 should be kept at home or sent to a quarantine facility if there is any delay in getting the screening results.

Community lockdown

3-22 What is community lockdown?

With community lockdown everyone must remain at home, not mix with others, and not move around. People can go out of the home only when it is strictly necessary, such as to get food or medicine, or to visit the doctor. A special permit is needed to go anywhere else. This policy of enforced isolation aims to slow the spread of coronavirus and thereby save lives. This is a drastic action as it means people cannot work, which interferes with the civil rights of citizens. However, it is the most effective way of reducing the number of infected individuals until a vaccine against COVID-19 becomes available to all.

With community lockdown, most companies, shops, schools, places of higher learning, meetings, churches, sports clubs and any space where people congregate must be closed. Exceptions include health facilities, family practitioners, a limited number of food stores, banks, fuel stations, and other essential services. This causes severe social and economic disruption, especially for the poor.

With community lockdown there is a greater chance that public health tracing teams can identify infected individuals, trace, screen and test their contacts, and ensure the quarantine of all infected individuals at home or in hospital. This task is expensive and requires many health personnel. However, only by preventing the spread of the virus and tracing contacts can the rapid transmission of coronavirus in a community or population be avoided. Failure to prevent the spread of COVID-19 would be a catastrophe with the potential for huge numbers of deaths, especially amongst the elderly.

3-23 What are the problems with community lockdown?

When people feel frightened, it is normal for them to want to meet and talk to family and friends. This makes being alone or away from family difficult. Being isolated is not natural and causes stress in many people. They may feel sad, scared, angry or very lonely. It is important to keep in contact with family or friends by email or phone. Some important things that people can do to help themselves during lockdown include:

• Do not obsess over television or radio news reports all day and make sure that you only get scientifically correct information.
• Establish a routine, get up and get dressed in the morning, have a good diet, get enough sleep, and do what exercise you can.
• Be creative to fill your time and support others.
• Reduce anxiety by practicing mindfulness and breathing exercises.
• Phone for professional help if you become very anxious or depressed.

Funerals are especially important in all societies. Banning or limiting attendance at funerals is necessary but it can be particularly upsetting. As the body is infectious to others, the coffin may be sealed so the body cannot be viewed by the family.

Community lockdown with contact tracing is often the only way to prevent the rapid nationwide spread of COVID-19. Once the pandemic is under control, a gradual lifting of the lockdown can be started.

3-24 What are the challenges of community lockdown in poor communities?

While community lockdown is possible in communities with a regular income it is especially difficult in a poor community with many people living together in informal housing. Income is often earned on a day-to-day basis, so staying at home means no income and no food. Water in homes for washing hands is often not available. The need to get fresh air, sunshine and exercise may be overwhelming. Poor people often need to buy food every day which involves moving around and standing in crowded queues regularly.

With the threat of urban lockdown many people flee to rural areas. This leads to further spread of COVID-19. It is important to implement a community lockdown to slow down the spread of coronavirus, but the socioeconomic consequences can be severe.

Case study 1

Thapelo wants to protect his family from COVID-19. When a community health worker visits the home to screen the family, he asks whether they should wear masks when going to the shop.

1. How can wearing a face mask help protect Thapelo and his family?

Everyone should wear a cloth (cotton) mask when in a public space, especially in crowded areas such as taxis or shops. Wearing a mask reduces the number of droplets you spray into the air if you cough or sneeze. This protects other people from breathing in coronavirus. If they wear a mask it will protect you. So, if everyone wears a mask, we will all protect one another.

2. What type of mask should the public wear?

A non-medical cloth face mask. These are easy to make out of three layers of cotton material, such as an old sheet. The public should not wear medical masks or N95 respirators as these are in short supply and must be reserved for health workers.

3. Is handwashing important if Thapelo does not have water in his home?

Washing hands well with soap and running water helps prevent the spread of coronavirus. This is particularly important after taking off your mask and when you return home after being in a public place. Perhaps Thapelo could get a drum of water for their house. If not, they could buy 70% alcohol hand spray to use if water is not available. The family should learn not to touch their faces.

4. Is it safe to cough into a handkerchief?

No. Either cough into your elbow or into a tissue to prevent spraying coronavirus into the air. This is important in a room or in a public space. Place the tissue into a bin after using it and then wash your hands with soap and running water or spray your hands with 70% alcohol hand sanitiser.

Case study 2

During lockdown, a schoolteacher is speaking to her learners using Skype on her cellphone. She says that staying at home and social distancing are important to protect yourself. One learner asks about screening, testing and contact tracing as his home has been visited by a community health team.

1. Is staying at home during lockdown important if it is so difficult?

Staying at home is the best way of protecting yourself from coronavirus. It is important to support your family and friends and to help them to stay at home.

2. Do you understand what social distancing means?

During the COVID-19 pandemic, it is important not to get close to or touch other people. If you keep more than 1 to 2 metres away from anyone who coughs, the droplets should fall to the ground and not reach you.

3. Can touching surfaces in a shop or taxi be dangerous?

If someone coughs into their hand and then touches a surface such as a tabletop or door handle, they can leave coronavirus on that surface. If you touch the same place and then touch your face you can become infected.

4. Is screening the same as testing?

No. Screening is done by asking a list of questions such as whether you have had a cough, sore throat, or fever. In many communities, health workers go door to door screening people. This helps to identify people who probably have COVID-19 and need to be tested. People are tested for coronavirus infection by taking a throat or nose swab which is sent to a local or mobile laboratory.

5. What is contact tracing?

If someone has COVID-19, or is well but has coronavirus infection, the people they have met in the last few days may also become infected. These contacts need to be found so that they can also be screened and tested. This is an important way of preventing spread of COVID-19 in a community.

It is important that the learners understand about these steps to control the spread of COVID-19. Then they are more likely to stay at home, be aware of touching contaminated surfaces, and maintain social distancing.