Ariane Davison: I’m doing very well. I’ve got a whole bunch of infection prevention strategies that are within my family. So I’ve been schooling my husband and my kids, even though my daughter’s only 3, about hand-washing and making sure that high traffic surfaces like your front door and your car handles, elevator buttons — that even though she’s 3 — that she doesn’t touch her face. So we’re just doing our best and also trying to get that kind of information, just really simple information to people that can hopefully try and reduce some of this frenetic chaos and just the panic that we’re now seeing globally.

Lau: Absolutely, and I think the best medicine right now is information. Your article — ‘Face masks do’s and don’ts,’ let’s get right to it. Now, in Asia, wearing face masks is a social norm. In the West, where I’m reporting from now, it’s not. In fact, in the U.S. it’s being recommended that you don’t wear face masks unless you’re sick. So who’s right? Which is it?

Davison: It’s a little bit of both. If you look at a lot of items, just basic items that you use for protection in life — one that even comes to my mind is the use of home pregnancy tests or even contraceptives, things like condoms, as much as it might sound very, very basic — it’s about the way that you use them. If you use them correctly and according to instructions, then they actually provide the efficacy and the protection that’s offered on the box or in the instructions.

If you wear a surgical face mask correctly or an N95 respirator or FFP2 — they have different names, but basically an N95 respirator — if you wear those two items correctly, and just with a little bit of training, and there’s not a lot of training that you need to read about how to wear them, they actually do protect you. The biggest issue that we’re facing at the moment is supply. And globally, there just doesn’t seem to be enough supply of either of those items, whether it be in Hong Kong, or Australia.

I’ve traveled to New York since January, even in January, there were no basic face masks available in normal stores, pharmacies, Target, Walgreens, CVS. They were not available in January. And we’re seeing through the media that even hospitals and health care systems, nurses and doctors at the front line, airport workers, that they just simply don’t have access to clean face masks. They’re basically a single use item. And at the moment, the world just was not prepared for the number of masks that could be used and could be implemented to reduce the transmission of Covid-19.

Lau: So the fact is people who need it don’t have access to it. Worse yet, those on the front line, like doctors, health care workers, nurses, are struggling with limited supply. So for the rest of the regular population, I guess that’s the rest of us outside the system here who are still in relatively good health, knock on wood, and we don’t have access to day-of-use face masks. What should we do?

Davison: So, I can give you an example. In my family and through work, I’ve managed just to get a handful of surgical face masks and one or two N95 respirators. I’ve got them tucked into my suitcase and I’ve got them packed, not in my handbag at the moment because I’m currently in Sydney, but at the moment, it’s becoming kind of critical [because] the cases are skyrocketing in all of these places. So the focus has gone off China and it’s gone to Italy, of course, and Europe and now the USA and the cases are skyrocketing.

And the unfortunate thing is, is a lot of social behavior that’s coming in just simply out of fear. And people are exposing themselves unnecessarily to situations like panic buying at Costco or Wal-Mart, going to the supermarket and queuing up together very closely, face to face, cheek to cheek. There’s quite a lot of aggression as well. So you’ve got people who are pretty much in each other’s faces. And now we really don’t know who could potentially be infected, who could be a carrier.

That’s actually another very important thing is the carrier status that a lot of people have. So a lot of people of middle age, young age and children can be carriers of Covid-19 and they can spread it. It’s called R0, and that’s the number of people that you could potentially spread this to if you’re infectious. That can be up to two to three people. So you’ve got people in this panic going up to places and putting themselves at risk or in harm’s way potentially, going and doing panic buying in close proximity. I’ve been watching people and there’s pretty much no infection prevention strategies.

People really don’t seem to be adhering to social distancing as much as people are panic buying. And I’ve heard that not just the supermarkets are empty, but the local electronic stores where they sell fridges and freezers. The freezers are now out of stock because people are buying secondary freezers to stockpile food. However, their daily life doesn’t seem to be changing. People still seem to be at cafes and going to restaurants.

It seems to me to be a little bit, unlike Hong Kong, a little bit of ignorance and a little bit of entitlement that ‘this thing can’t get me.’ And that is a real shame. I don’t see people applying any of the hand hygiene alcohol gels that they’ve bought or stockpiled. A lot of people are buying antimicrobial and antiviral hand wipes, but I don’t see them using them. So at the moment, while people are actually in a position to have these items, they’re not actually choosing to use them. And this is really the time where we do need to use those kinds of strategies and those kinds of products.

Lau: So, say we do have to go out, and we are going shopping on an average day. What should we be doing? Explain how you go about your day and all the things that you do. Just walk us through.

Davison: I apply 10 years worth of laboratory training in biohazard labs to my daily life, which is something I never really thought I would have to do. But I’m very grateful that I do that. I treat my hands like they are extensions of myself, but like they’re tools. So they’re not things that I would ever scratch my eyes with or touch my face with.

Unfortunately, you watch the general public and a lot of people pick their nose or they rub the nose. Once you leave the house, your hands should not touch your face. If you need to blow your nose, you should get two tissues. Blow your nose and throw that away. But still, don’t touch your face. If you have an alcohol hand gel after you blow your nose in a tissue and throw it away, then you should use some hand gel.

Before you go to the supermarket, I always grab one of the hygiene wipes that most supermarkets make available. When you first walk through the front door. Most recently, even down here in Sydney, those wipes that you usually save for supermarket trolleys are completely empty. I’m not sure if people are stealing them because that’s also been a big issue too. But you should wipe down your trolley, the trolley handles that you use. You should go and do your shopping, put all the items in your shopping trolley, but still don’t touch your face. Pay for your items, you touch coins and you touch money—and this is actually a very big thing.

Coins, particularly in a lot of clinical studies, have been shown to be a breeding ground. And both viruses and actually some really nasty bacteria can stay alive on coins for days and days and days. So as soon as you take your money back, or your coins and you put it back into your wallet, your hands have now got an increased burden again by the time you get home and you’ve touched your car handles, you’ve now transmitted all the things you’ve been touching onto your car door handles, onto your steering wheel and onto your front door. There’s no need to panic, there’s no need to worry about that if you haven’t touched your face. All you need to do when you go home is wash your hands again.

If you have an emergency situation, say for me after I touch coins and put all my money away, I handle my hands straightaway and preferably I’m using a wipe. There’s a lot of antimicrobial, antiviral hand wipes that have got the same kind of substances in them that also inactivate pathogens. But you get that added extra benefit and bonus of having a mechanical wipe as well because when junk and and just that sticky feeling, when that builds up on your hands, alcohol hand gels won’t necessarily penetrate that because we also have a lot of natural oils on our hands that really grab on to [the bacteria]. They won’t grow on our hands, but it’s kind of hard to get rid of them.

So if you could use the hand wipes, the antimicrobial hand wipes after touching things like coins, that’s the closest thing to a good wash. It’s one step above just plain alcohol hand gel. And then once you get home, give your hands a really good wash. Don’t forget your wrists. Don’t forget your thumbs. Don’t forget to take off your rings as well. A lot of people don’t take off their jewelry, they don’t take off their rings when they wash their hands. And that’s a really great place for really nasty things to sit underneath your jewelry.

So once you get home, wash your hands really well. Give your front door a wipe down, give you the handles on your car a really good wipe down. Even give your steering wheel a good wipe down. Just really think about the places that your hands have touched and just go and give them a really, really good wipe down with some wipes. Soap and water does work very well just to remove things, but it won’t kill or inactivate things. But there’s really only a handful of hotspot places in our homes and in our cars and at the supermarket where we really need to make a big effort to make sure that they’re clean during this Covid-19 outbreak.

Lau: Here in the United States, we’re already getting instructions to quarantine and social distance in counties across America. Schools are closed now, restaurants have been asked to reduce capacity and even shut down. Broadway is shut down. Everybody is getting ready to hunker down as they stay here in the U.S. So social distancing — what’s a good rule in your mind with your vast clinical experiences? Should we just, unfortunately still keep our distance from friends and relatives outside our family home for now?

Davison: In the short term, I think that is a concept that would work. But the unfortunate thing is, human nature is going to trump fear after a relatively short period of time. There’s been quite a lot of studies on the impact of loneliness and depression, as humans we’re built to connect. So for short periods of time, like a few days or maybe a week, I think you’d find that most people would be able to adhere to self-quarantining at home. And this probably dovetails with the hoarding and panic buying that we’re seeing, because the advice from my understanding is to buy enough food and supplies for two weeks.

Now, that’s great. But if you look at the way that the cases have been exponentially rising, and this is just quite normal according to the laws of epidemiology, the cases have been skyrocketing in the U.S. and also in Europe. But more recently in the U.S. I’m really surprised to see that even though social distancing has been recommended, but buying for two weeks in some places has also been recommended. So right there in these equivalent of mass gatherings, there are going to be big cluster outbreaks and contributions to a way larger, exponentially greater number of cases that could probably be preventable.

Social distancing does work, but it doesn’t work on its own. There’s a lot of clinical studies and clinical trials about that, too. Usually you have to implement rigorous hand hygiene with social distancing. Ideally with some kind of mask usage if you have access to find or use a mask. Practically, no hugging, no kissing, no friendly kissing on the cheek. Definitely none of that. There’s no need really to touch anyone at the moment. No handshakes. I even don’t understand the idea of elbow-elbow bumping because we’re also being told to sneeze into our elbows. So that to me seems to be a little bit of a juxtaposition of concepts.

There’s really just no need to touch anyone at the moment. I would say, if possible, stand about one to one-and-a-half meters away from somebody. But again, these are really nice ideas on paper. But when you get flung out into the community and this goes back to Hong Kong, where it’s almost impossible in Hong Kong to be able to maintain that kind of distance from people because of our population density.

Lau: Well the cities are the biggest concerns right now, especially across the globe, frankly. It’s those cluster cities where people are living on top of each other that are seeing a wider spread.

Davison: I was watching the news yesterday and I saw images from O’Hare Airport and my brain as an epidemiologist in my younger years and a virologist and an immunologist, I just looked at the scenes from O’Hare and you can just see the knock-on effect of if there was just one or two people in that situation. The proximity of people to each other was literally cheek to cheek, face to face. That just that single event in and of itself could lead to innumerable numbers of cases. And there were no face masks to be seen. None at all.

To me, it’s a very interesting, stigmatized concept — wearing masks. I’ve even heard down here in Australia and I’ve also heard through some of my medically trained [acquaintances] and people here in health care venture capital in the U.S., that really masks are only worn by Asians. And to me, when something is a respiratory pathogen that is coming out of people’s mouths, it’s just common sense that you should try and cover your mouth.

The original article that I wrote for Forkast was just about using a proper mask and not relying or having faith on a homemade mask or dodgy mask or something that was made from kitchen supplies or an allergy mask. But when you’ve got really large numbers in a gathering now, one misplaced, really wet, snotty sneeze could potentially infect 20, 30 or 40 people around you.

So it would be great to see some kind of face protection being implemented in the United States. I have seen it being done in Italy. If you look at footage coming out of Italy, most people now seem to have embraced the face mask or respirator use. This is just the general public as they line up for supermarkets, or go about doing their shopping even though they’re in complete lock down.

Lau: Well, the problem here is you just can’t find any. You can’t find any on delivery on Amazon. You can’t find any in the stores. It’s not even a thing really to be well-stocked in pharmacies. It’s just not a thing. And you make a great point that Asians are comfortable wearing masks because this all happened in their lifetime 17 years ago under SARS. And that entire continent was trained to combat it, and luckily, it was not something that was spread widely around the globe. In this case, it has been. But it’s as if entire generations really on that continent just saw the effect and the impact of SARS, and over the past decade have essentially been trained to wash hands and to wear masks when people are sick. It is a thing.

Well, it seems like that cat is out of the bag. It’s not coming back. Face masks for 350 million plus people in the United States is impossible. And so social distancing, and you’re absolutely right about flying right now, even panic flying or panic shopping. That is a great point about exposing ourselves to whatever’s out there, because we don’t know over the next two weeks as cases start to show themselves. We have no idea. You’re absolutely right. The other peculiar thing that I’ve noticed is spring breakers—spring break, very popular here in the United States. College kids, they’re partying like everything is fine. Or maybe like it’s the end of the world.

Davison: Like it’s 1999.

Lau: Like it’s 1999. Either way, it’s extremely dangerous. What are the threats there?

Davison: The threats there are from an epidemiological point of view. You’ve got kids who are in close confines who are now very likely to be sharing drinks with each other, doing what spring breakers do, and kissing and cuddling and all those kinds of things. It is pretty much irrefutable that there will be enough small numbers of cases or individuals who are Covid-19 positive, who aren’t showing any symptoms, and they will spread it to each other.

But the biggest issue with that is the impact of Covid-19 on young people and even neonates, babies, young people, middle aged people. The impact of this coronavirus on those age groups is minimal. It’s the equivalent of a cold, but it’s transmissibility is quite high. And the people that we should be caring about or that they should be thinking about as opposed to — I mean, teenagers generally are quite an entitled group. They always feel that things are never going to hurt them. They drive recklessly. They drive at high speeds. They drink too much. They just do what kids do.

But the thing is, it will affect their grandparents. And I’m pretty sure that if you ask most young people of school age or university age, it’s a love that most kids have. It’s just a very special relationship that most kids of that age have with their grandparents. So they need to be thinking about their grandparents because they’ll very easily transmit this to them. Anyone who’s over 70, I think that the fatality rate goes up to over 10%. If you’re over 80, it can head up towards 20 to 30%. It’s really those age groups, the aged care groups are actually really, really terrified right now and justifiably so.

Lau: And finally, Dr. Davison, you and I have children, they’re now 3 years old, and they’re probably better experts than I am at my age now at washing their hands. How do you keep a little one who’s curious and spirited and running around not to touch their face?

Davison: That’s a really difficult one, Angie, and if you could crack that one, let me know. But I think I’ve held my daughter the equivalent of a hostage a few times by just grabbing her forearms, particularly at the supermarket, when she has a fondness for, I’m not going to say licking, but almost putting a face on the conveyor belt, and I almost have a meltdown at the moment when that happens. But I just grab her hands and I carry her with me at all times.

I kind of feel like I’m armed and dangerous. In my back pocket I’ve got some hand gel and in my other pocket, if I don’t have antimicrobial wet wipes, I’ve just got plain tissues and I’ll put a little bit of hand gel onto a tissue if it’s desperate, because I think that at some point we’re gonna have to come up with ways that we can create our own wet wipes or things like that, so that if we are out in the community, we can still go to some decent effort to try and sanitize our hands. So I’ll just grab her hands and I’ll wipe her hands and I’ll try and explain to her why I’m doing it, and it is something that can make people sick, and we have to be careful, so don’t touch your hands. That’s the best that I can do.

I don’t believe that this will go away in the next couple of months. I think we’re going to be living through this probably until the end of summer in the U.S., at least we might see a curtailing of it around the end of summer in the U.S., but the likelihood is up to 80% that someone in all of our families is going to be diagnosed positive with Covid-19, so we just have to do the best that we can do to not contract it in the first place.

Have a little bit of an altruistic perspective and look after the people around us. Look after the community and our grandparents and the elderly. There is no such thing as herd immunity, which is something I’ve been reading in the news lately, because the herd immunity only applies to a situation where vaccination has been possible. So there is no herd immunity and there’s no data yet on once you’ve had Covid-19 once if you have protective immunity against it the second time, should you be reinfected. We just don’t know a lot about it in that way yet.

Lau: So, this started as an article about face masks, but I think we’ve gone way past that. And now it’s just mitigation. Wash your hands. Stay at home and stay well.

Davison: Stay well, and I really implore everyone, particularly in the United States, where we’re saying it’s the newest place to really be hit, just some order, some politeness. Give people space around you. I think items will be available, the U.S. as well as Australia produces so much of their own industry, whether it’s commercial industry, whether it’s to do with consumables or the food industry, it will be okay and food will be available and all those items we need will be available. So the best thing we can do is just go out and be a decent citizen while we’re trying to manage this.

Lau: Amen, and in this digital age we have the greatest resource right now at our fingertips — each other, and we safely share as much information and knowledge as possible.

Dr. Davison, thank you for sharing your expertise and knowledge with us and my best to you and your family and everyone out there listening right now. I’m Angie Lau, Editor-in-Chief of Forkast.News, stay healthy, stay safe. Until the next time.