How to Get Gas in your Car Without COVID-19 in your Lungs — and other Thoughts on Quelling the Pandemic
Like all psychiatrists, I first trained as a medical doctor — and married a registered nurse — and today I’m putting on my medical hat to write about Covid-19 and how not to catch it at the gas station and other places.
I recently heard that Iceland has tested a higher percentage of its population for COVID-19 than any other country. Unlike most other countries, Iceland has not only carried out tests on people who are ill; medical authorities there have also tested people at random. Their findings? 50% of people who test positive have no symptoms. When you consider that these symptomless carriers are much more likely to move around and socialize (because they feel well and are not in bed with fever), it seems likely that way more than 50% of COVID-19 infections are transmitted by symptomless people. Some estimate this figure to be around 80%. Even if this figure turns out , after further research, to be too high, there is no doubt that symptomless carriers are very significant in the spread of COVID-19. They are a major reason why it is so hard to control this pandemic: not only is the virus invisible, many of its carriers are also invisible — completely indistinguishable from non-carriers.
And here there is a strange contradiction. We have been told to keep 6 feet away from others (which is good advice of course), and have been given the explanation that this is because a sneeze or cough can project droplets two yards. But most of these symptomless carriers are not coughing or sneezing. So what is happening? One factor, much less often mentioned, is that when we speak we also shower invisible droplets into the air. If you’d like to demonstrate this for yourself, try wetting the palm of your hand, holding your wetted palm in front of you, as far from your face as the length of your arm will allow. Blow toward your hand till you can feel your breath on your hand (this is your direction finder) and now, a few times and with gusto, speak these two words toward your wetted palm: “Party Pooper.” You will almost certainly notice the air from the plosive “P” hitting your hand. This air is laden with moisture increased by the sudden release of your lips to create the “P”.
“P” is the most plosive of the consonants, but other consonants also help fire spittle into the air, some more than others. The point? Healthy-looking, talking people may be inadvertently spraying viruses within invisible droplets of saliva. The other day I was talking to someone outside, making sure I kept a good eight feet apart. Quite suddenly, there was a light gust of wind and, since I was directly downwind from him, I realized that I could be taking in what he was saying rather more literally than I cared to.
Seventy of the first 92 diagnoses of COVID-19 in Massachusetts were tied to one corporate meeting of Biogen employees in Boston in February. Executives from this meetings also unwittingly seeded infections in Indiana, North Carolina, and Tennessee. None of the attendees at this meeting felt ill. It is unlikely they were hugging and kissing — but they did speak to each other, shared a buffet dinner together, and some of them probably shook hands. It is impossible to know in retrospect what percentage of transmission occurred by which route; but while we don’t know this, it’s worth cutting off every route we can — within reason.
But what does “within reason” mean exactly? From a practical point of view, where does all this take us? Understanding how to take care of ourselves depends on two key protective assumptions:
ONE: ASSUME THAT EVERY PERSON CARRIES THE CORONAVIRUS, INCLUDING YOURSELF
Most people will not be carriers, but you have no way of telling. Anyone of us could be a symptomless carrier. Taking distancing precautions — staying at least 6 feet away from all others outside your home — is one very useful way of avoiding playing Russian roulette with germs you cannot see. It is worth adding to this: wear a mask in public — as recommended by the CDC, as used in South Korea’s incredibly effective campaign against the novel coronavirus, and as detested by a lot of people. I include myself in this last category because I just don’t like having something over my nose and mouth. But I am wearing a mask in public. A home-made mask stops flying droplets, discourages you from touching your face, and reminds others not to come too close to you.
TWO: ASSUME THAT EVERY PUBLIC ITEM THAT MAY HAVE BEEN TOUCHED BY OTHERS CARRIES THE CORONAVIRUS
Most items will not be contaminated, of course, but there is no way of telling in advance (or ever). Taking steps to disinfect or keep distance from such objects, is the second main way of avoiding playing a game of Russian roulette with potentially lethal germs you cannot see. Because the virus can survive on shiny surfaces for about three days (though, by two days the virus population is greatly reduced), avoid touching surfaces that people outside your home might have touched, especially door handles, elevator buttons, etc., which have been touched by many different people. Instead, use gloves, or your elbow (less ideal and difficult to use on a round door-handle). Or, if you do touch such surfaces with your bare hands, no worries, just wash your hands or sanitize them.
These two assumptions are indeed protective, but what is not always so clear are the details. “Wash your hand frequently.” How often? And what if you are in your own home, how often then? And what is the best way to protect yourself when going shopping or getting gas?
PLANS FOR THE GAS STATION
Armed with these two very useful protective assumptions, you can work out what you need to do in most circumstances. But it does take some thought in advance. A few weeks ago, my wife and I discussed how to get gas safely. Neither of us is particularly germ adverse, and in many decades of marriage we had never discussed such a thing before. My wife, remembering her experience as a nurse, suggested wearing gloves. I listened. We doctors are generally not nearly so well trained in hygiene as nurses are.
Next day, armed with latex gloves, everything seemed to be going pretty well at the gas station, until I retrieved my credit card from the gas pump and the thought occurred to me: “Oh… any one of the previous 100 users might have breathed or coughed on their credit card… which could therefore be contaminated with COVID-19 virus… and these viruses could have traveled right into the credit card slot, ready to board the next transit vehicle … my credit card! What am I now going to do with my slight-possibility-of-virus-laden credit card which could-perhaps-even-if-unlikely convey a few hundred thousand viruses to me?” I put the credit card on the floor of my trunk — not the best solution. As I said, thinking things through in advance is a really good idea.
GAS STATION PROTOCOL
Next time I was more prepared. Courtesy of my ex-nurse wife, I carried latex gloves, sanitizing wipes, and plastic bags in my car.
At the gas station, I put on my gloves. I decided in advance to use my right hand on the potentially contaminated fuel dispenser and my left hand on my car which is unlikely to be contaminated (since only I touch it — if I had contaminated my own car, it would mean I was already a carrier of the virus).
With my left hand I carried a small plastic bag. With my right hand I inserted my credit card and punched the metal buttons as directed (feeling well-protected by that glove). When I pulled out the credit card, I placed it in the small plastic bag, taking care not to touch the outside of the bag with the credit card. The inside of the bag was now potentially contaminated, but since the outside was uncontaminated, it was safe to put the bag in the car, making sure that I opened the car door with my left (uncontaminated) hand.
I then opened the cap of my car’s fuel tank with my left hand, filled the car with gas using my right hand, and then closed my car’s fuel tank with my left hand. My right hand never touched the car. Yeah, I know, this probably sounds really complicated, but once you do it, it’s easy—just like it’s a lot easier to play a new game than to figure it out from paragraphs of instructions. Also, there are other options, which I’ll come to later.
Now it was time to remove the gloves from my hands before touching the car doors. When I did my internship in surgery, most of the sterile technique was carried out by nurses, but the doctors did have to learn some sterile technique, including how to take off their gloves without contaminating themselves or anyone else. Remembering these simple, useful lessons, I took hold of each glove at the wrist and pulled it off in such a way that the glove turned completely inside-out. I had planned to throw the inside-out gloves into the garbage can, but there was no garbage can. So, I took out another plastic bag and placed the inside-out gloves in the plastic bag.
The two plastic bags and I drove home. I was the driver. At home I took the plastic bag with my credit card to the sink, and washed the credit card and then my hands with soap. And yes, I sang “happy birthday” twice — while thinking that I really must come up with a different 20 second song. Then I threw away the two plastic bags in the plastic-lined garbage can.
This worked for me, but others I’ve spoken to have different variations. You do not need gloves. A good friend of ours douses her credit card with anti-microbial solution immediately after withdrawing it from the machine. She uses the same solution to wipe down any part of the gas-pump she is going to touch and then sanitizes her hands before touching her car. These viruses are quite easily destroyed by soap or sanitizing solutions.
IT IS WORTH IT?
One guy asked me: “Is all that really necessary?” Well, in retrospect, it might not have been necessary because the gas pump I used might not have been contaminated at all, and, even if it was, the virus might not have infected me. You could say it’s not necessary in the same sense that a seat-belt wasn’t necessary if you didn’t have an accident. Though there’s also a difference that makes it harder to appreciate the danger of Covid-19: with a car accident you know when you’ve had one, while with Covid-19 contamination you have no idea for several days (if you get symptoms) or never (if you don’t) — unless you are able to get tested.
From the gas station example, and especially from the two protective assumptions it’s based on (outside your home, everyone and everything they’ve touched might be contaminated), you can work out how, in any situation, you can protect yourself from these invisible particles that can cause so much damage. The more you do it, the easier it becomes. You can make a game of it — finding different ways to outsmart these tiny parcels of deadly information that take over your cells and turn them into virus-creating machines.
PROTECTING YOUR HOME
Thinking through what you decide to do can also help you not do things that are unnecessary. For example, while in our home, my wife and I do not wash our hands more frequently than we normally would. We assume that our home is not contaminated (knowing that if it was, there’s a fair chance that we both would be too) and we do our best to keep it uncontaminated by being stringent after any excursion into potentially contaminated territory (like shops), by washing our hands and the door handle as soon as we come in, and by washing any objects (like shopping) we bring from outside.
Of course, it is possible that someone at home in your family could be a carrier, but physical distancing within a household is not usually advised, unless a member of the household is sick or susceptible to complications from the virus. So long as households are isolated from other households, the spread of the disease can be interrupted.
If you are a family at home, you can think of protecting your home — and you in it — as a unit against the virus. As Social Epidemiologist Malia Jones at the University of Wisconsin put it: “…you should be in a safe harbor with your family.” Therefore, anything that comes into your home from a public source, including you, needs to be cleaned. With mail or cardboard-wrapped parcels, for example, one option is to avoid opening them for 24 hours (because the virus can survive up to 24 hours on cardboard) or, if you need to open it earlier, disinfect it outside, or wear gloves and unwrap it outside. And then wash your hands. An American friend of mine who is staying in Italy (she’s in a locked-down area and not allowed to leave) described going shopping: she goes out with her home-made face-mask and gloves, keeps her distance from everyone, and then, when she returns, washes her hands and every item she has bought.
In thinking through you plans for avoiding Covid-19 and taking action on those plans, you are doing all you can to stop the virus from infecting you and from using you to infect other people. You are not only protecting yourself, you are also contributing to the health of your neighborhood, your country and the whole world!
