Gearing Up During the Coronavirus Pandemic

Great article! I was actually going to ask about opinions on how long the virus sticks to surfaces. Things have changed since I read stuff last week.

I found an image yesterday from Medscape, which says 4-5 days on paper. Nothing about cardboard. (no idea how good Medscape is). Most packages have packing slips inside. I currently have a box of mail sitting in my hall, not touching it for awhile.

I’d originally heard it didn’t live as long on porous materials but new data seems to contradict that. Then the story about them finding it in the cruise ships after 17 days!

Diane

Thanks! The thing about finding it in the cruise ship after 17 days is they found RNA, not active virus. CNBC misreported that and then later changed the article. I haven’t heard about it surviving on paper that long, I sure hope that isn’t the case.

There are many different reports about the virus’s viability on surfaces and there’s a lot we don’t know yet, but WebMD’s FAQ seems to align with what I’ve heard from several other sources:

How long does this coronavirus live on surfaces or outside of the body?

A new study found that SARS-CoV-2 (the official name of the new coronavirus that causes COVID-19) may last for a few hours or several days on surfaces and several hours in the air under experimental conditions. The study found it can last up to 4 hours on copper, up to 24 hours on cardboard, and up to 2 to 3 days on plastic and stainless steel. The study shows that it may be possible to transmit the infection by touching a contaminated surface or by breathing it from the air, but does not prove that air transmission actually happens under real-world circumstances. Using a simple disinfectant on all reachable surfaces is a good idea.

I don’t believe it was CNBC that did the misreporting. The CDC document that first mentioned it has also been updated Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020 | MMWR

And I can’t find any confirmation that just because only RNA was found that the virus was necessarily inactive. AFAIK, current testing is only designed to detect the virus RNA. One would have to do a Petri dish lab analysis to then decide whether the virus was still active.

Perhaps some more important info about how long the virus is detectable on surfaces:

Machamer: What’s getting a lot of press and is presented out of context is that the virus can last on plastic for 72 hours—which sounds really scary. But what’s more important is the amount of the virus that remains. It’s less than 0.1% of the starting virus material. Infection is theoretically possible but unlikely at the levels remaining after a few days. People need to know this.

And here is the original study that this information was based on:

https://www.nejm.org/doi/full/10.1056/NEJMc2004973

Thanks for those updates! I obviously read the article soon after it was posted. Comments did ask how viable it was, but I never saw solid answers.

There is a video floating around about how to disinfect your groceries, and he says it can last “a long time” in the freezer.

Diane

Yes, the virus degrades on surfaces over time, but as Dr. Machamer said, infection is still theoretically possible during that period. And unfortunately, due to a lack of testing, we don’t have a clear picture of how many are or have been infected, much less how they were infected. Also, there are mixed opinions on this. I’m remaining on the side of caution. Granted, you’re still likely much safer picking up a package from your doorstep than walking into a crowded store.

We recently had a brownbag with our chief physician here on campus so he could show interested faculty some recent coronavirus data and results. When talking about contamination, he reminded us that these tests are usually conducted under lab conditions. Your parcel, however, sitting out on your porch, exposed to sunshine (UV) and wind, varying temperature and humidity fortunately makes it very hard for a virus to survive in its ‘functioning’ state. He made a strong point about how although current scientific data cannot rule out transmission via contaminated materials, this does not mean it is likely or in fact happens at all. Consequently, the WHO and CDC are both working under the assumption that the main spread vector is airborne infection. Therefore, covering your sneezes and coughs, keeping a distance, not touching your face, and frequently washing your hands are the most efficient safeguards.

One thing I don’t quite understand. If WHO and CDC see airborne infection as the most likely, why are they pushing hand-washing and disinfecting of surfaces so hard? I’m all in favor of an overabundance of caution, but it seems odd to suggest that you have to be careful about what you touch, and it would be good if you would wipe down frequently touched surfaces, but then to say “Oh, none of that really matters with mail or packages.”

Airborne virus lands on surfaces and continue to survive. People touch those surfaces and transfer the virus to their mucus membranes (eyes, nose, mouth). Infected people cough into their hands and touch surfaces leaving virus. Infected people touch their face then touch surfaces. Virus is found in fecal matter, public bathrooms are a major hazard. Just flushing the toilet disperses virus around the room. Every single surface in a bathroom needs to be sanitized frequently.

You are more likely to become infected by touching a contaminated surface and then rubbing your eyes than breathing in aerosolized virus from an infected person in close proximity breathing. Or droplets from a cough or sneeze.

Just keep washing your hands and cleaning those frequently touched surfaces. Avoid close contact with others.

Open the box, remove the items, dispose of the box where it can sit for a few days. Sanitize the items and surfaces and wash your hands thoroughly. Do not touch your face during the entire process. These boxes are in hot trucks and the humidity is rising as well. Sitting on a front step in direct sunlight will likely kill the virus.

But yeah, you’ll be fine. Just don’t lick the boxes.

I’m far from an expert here, but my impression is that hand washing is primarily to protect others. Of course if you continue to touch your face, you’ll probably also be interested in making sure your own hands are as clean as possible. My limited understanding is that the virus survives far better on our skin (and has much better chances of uptake) that it does outside or on surfaces of materials. Plus, I assume it highly depends on the exact situation. There’s a difference between a parcel touched by a dozen people exposed to all kinds of environmental conditions and an indoor elevator button touched by hundreds a day.

Ultimately, I gather to the extent of our limited knowledge, this is largely a game of probability. A 5% chance is not nothing, but it’s still more than an order of magnitude smaller than something with an 70% probability. If you have to choose (and you do), you tell people to concern themselves with the 70% scenario.

I think the whole mask issue is similar. Healthcare workers simply have other risks (and different training) than somebody like I does. The recommendations to them only seem to contradict those for the general population if we ignore that.

Quote of the day!

Reminded me of this:

Same here.

No, sorry, sunlight absolutely will not kill the virus. A UV-C light will, as I explained in my piece for The Prepared, but there are a lot of ifs, ands, and buts that go along with that.

I highly recommend this video w/Dr. David Price, who is in the thick of Covid. Please watch the whole thing. It is a bit long and there is important info throughout. Informative and somewat hopeful if people “follow the rules”.
Dr. David Price, Cornell Weill Medical Center, NYC about Covid

I’ve updated this article in light of a WebMD article I found that claims that coronavirus can live on some surfaces, like ceramic, glass, and paper, for up to five days.

Oh boy. I should be segregating my quarantined mail.

Diane

I have heard conflicting claims regarding the length of time this particular virus can live on different surfaces which is both frustrating and potentially dangerous if someone misinterprets safety in handling a particular item.

I am a senior with underlying medical conditions so I need to be especially cautious.

The few times I have had to go out for medical appointments in the past two weeks my routine is to take nitrile gloves with me. I put them on as soon as I get out of my vehicle and then dispose of them as soon as I am about to re-enter my vehicle.

I treat everything as if the virus can live on it for a long time - at least the five day time frame that gets mentioned frequently. I consider anything that I come in contact with as having the virus living on it. I have been told more than once I am overreacting but personally, I would much sooner overreact than perhaps not survive a SARS-CoV-2 infection.

I readily admit I am not a trusting fan of information at WebMD so I was in a critical mindset before reading the article. That said, to clarify the WebMD article regarding paper, the specific claim is:

“The length of time varies. Some strains of coronavirus live for only a few minutes on paper, while others live for up to 5 days.”

Another aspect of the WebMD article that concerns me is the wide range of time ascribed to different smooth surfaces. For example, it suggests the virus could last for 5 days on a metal doorknob but 2-3 days on a refrigerator or only 2-8 hours on a soda can. Without some linked-to science to back up those disparate numbers I assume it can live on all smooth surfaces for 5 days minimum.

I live alone and had to shop for groceries myself recently. I did a pretty big grocery shop, spending about $300 in an effort to not have to leave my house for a couple more weeks unless I absolutely have to for a medical reason. I chose to deal with my groceries by following this Public Service Announcement

It took me a little extra time following the PSA to ensure everything I brought into my house was disinfected and safe but it removed any subsequent anxiety I might have experienced.

I encountered an interesting effect of Amazon’s shipping prioritization. I decided to order a cold brew coffee brewer, since I won’t be going out to get my usual coffee for the foreseeable future. I ordered it on 3/27 and they said I could get it 4/23, just under four weeks.

But the coffee grounds for it I could have had delivered 3/29.

Not caring about getting it that fast, I opted for a later delivery that would get me $3 of digital credit.

The most frustrating thing about being on the front lines of this pandemic is the lack of solid information. Since the WebMD article didn’t reference any scientific papers, it’s impossible to know what the source material said.

They were careful to say that it wasn’t relevant to SARS-CoV-2 specifically, but “other coronaviruses.” That’s a wide-open field: there are many coronaviruses with varying characteristics. I have also seen papers that have been interpreted as saying the virus can “live” on surfaces when, in fact, researchers were only able to find and amplify specific RNA fragments using PCR, which is an extraordinarily sensitive test. There are bare-DNA viruses, but this ain’t one. It’s not infectious without its protein coat, lipid jacket, and an assortment of proteins embedded in the lipid layer. Even mild disinfectants (the EPA even lists one that is simply salt water) or soaps can denature the surface proteins and/or disrupt the lipid layer, “killing” the virus.

So was someone able to culture live virus on human cells from a sample taken from a surface after five days? Possibly, but I’m scanning a huge number of scientific papers on the topic every day, and I haven’t seen that referenced – and it would be newsworthy.

So the answer remains “we don’t know.” That’s actually the answer to most important questions we ask about SARS-CoV-2 at this point. But one answer we do have is that soap and water will render the virus non-infectious, and is particularly efficacious on hard, smooth surfaces.

In case people wonder how this is handled in the medical world, or at least my medical world, I’m wearing scrubs and a white coat at work for the first time in a couple of decades. I enter the house through the laundry room, where I remove my clothes and don a robe (so I don’t scare the children). I put the clothes directly into the washer on a sanitizing cycle with bleach, I leave my shoes and equipment in the laundry room, and walk straight to the shower. Once showered, I re-enter the laundry room with alcohol swabs and clean off my wallet, phone, and key fob. I have shoes designated for work/community and they stay in the laundry room.

I probably wash my hands 20-30 times a day when I’m staying home with my teens, even more if I’m out seeing patients (increasingly rare as we convert to telemedicine). I wander around the house with a spray bottle of disinfectant (usually isopropanol) and spray keyboards, chair backs and armrests, light switches, table tops, doorknobs, and the like several times throughout the day. (Unless you have a lot of knowledge, don’t spray switches and keyboards but wipe them down with a cloth or paper towel sprayed with disinfectant.) I’m probably overdoing it, as I’m not one of the real heroes working in an ER or ambulance, but it really isn’t that hard and is probably quite effective. When packages arrive, they go to the laundry room where I spray them with 70% isopropyl alcohol, open them, disinfect the contents, carry the packaging to the outdoor bins, then come back in and wash my hands (again!) before bringing the treasures into the house.

I’m going on too long, but I’d like to mention one other thing: masks. I have a pet theory that one of the more important aspects of wearing a mask is that it provides immediate feedback when you start to touch your face. I have enough surgical training that I do a pretty good (not perfect!) job of keeping my hands off my itchy nose and eyes, but for a lot of people a mask can really help as a reminder – and that might be as important as catching some respiratory droplets. I know there are reasons to save masks for frontline workers, but if you really cannot control your face-touching it might be a thing that could help.

In summary, since we don’t know how long the virus actually can survive on inert surfaces, just disinfect everything whenever you can and perhaps worry a little less about when you can skip it.

Hope this is a bit helpful.

–(“if you have to ask, it’s dirty”)Ron

Here is the latest article from the Wash.Post.
Seems about right to me.
Don’t panic about shopping, getting delivery or accepting packages

What is your opinion regarding the home made masks that seem to be proliferating? Not necessarily as something that can protect directly against the virus but as you say, somewhat of a preventative measure to better control face touching.

My concern with masks is they arguably give a false sense of security against the virus but they sure might be excellent as reminders to keep our hands and fingers away from our faces.

I started to address that, but felt as though I’d already gone on far too long. The story of what masks will and won’t do is nuanced and I probably couldn’t do the telling of it justice, but I will say that I think homemade fabric masks serve a valuable purpose. You’re quite correct that if they (or even N95 masks or full respirators) make people feel invulnerable, then they’ll do more harm than good. Most folks, though, seem to understand that they’re just part of the solution and that wearing a mask doesn’t obviate the need to maintain social distance, disinfect surfaces, and wash your hands. Honestly, the role of masks for the general public is probably limited (though “we don’t really know yet” applies here as well), but they probably help a bit, and I would rather people in the community wear fabric or home-made masks and leave the N95’s and respirators to EMTs and ER personnel while there is a shortage.

Agreed, pretty much along the lines of what we recommended in the article:

You can leave that cardboard package at your door for a few hours — or bring it inside and leave it right inside your door, then wash your hands again. If you’re still concerned there was any virus on the package, you could wipe down the exterior with a disinfectant, or open it outdoors and put the packaging in the recycling can. (Then wash your hands again.)

But there’s also no harm in additional caution, especially for people like @papagordie who are more at risk. One behavior does not need to fit all cases.

The following is our protocol I wrote that constitutes “no contact” for the purposes of knowing our “no contact” duration (where violating any of these conditions, sets the “no contact” duration to zero) – in theory, this should enable us to know that, after 2-3 no-contact weeks, we’re not a risk to ourselves or others (and could visit with anyone else of the same status):
[Writing this, I felt like I was back gathering requirements for what would become a specification from which software would be developed!]

• we will confine ourselves to the house and yard

• no visitors will enter the house or get within 6 feet of us in the yard

• interacting with a “came to our door” visitor will be through the closed glass front door

• for parcel/mail/newspaper/grocery/whatever deliveries:

• if supplying an item to be picked up, while any people remain at least 2 meters away, it will be placed outside for retrieval (after we’ve retreated behind the glass door)

• when dealing with deliveries and delivered items up to the point that they have been completely unpackaged and wiped (more info below), disposable “rubber”/nitrile gloves will be worn, the gloves will be disposed of in a garbage-bagged quarantine container and hands will be washed immediately after removing the disposable gloves and before touching any surfaces with hands or wrists

• goods will be transported to the quarantine and wipe-down areas in a manner that prevents contaminating any non-gloved surface along the way (e.g., packages will be touched and will touch only by gloved-hand surfaces and there will be no unopened doors in the transport path)

• for deliveries that require a signature, one of the following will apply:

  • the delivery person will sign on our behalf then leave the item(s) on the front step

  • the signature-device will be placed on the front step and the delivery person will move back at least 2 meters, after which the signature will be provided, the signee will retreat behind the glass front door, the delivery person will retrieve the signature device and leave the parcel on the step and, when the delivery person has retreated, the delivered item will be retrieved

• deliveries containing non-perishable goods will be placed in a quarantine area and marked with their end-of-quarantine date (using a marker that remains in the quarantine area)

• the quarantine durations are 2 or 4 days: 2 days for soft-surfaced goods (e.g., cardboard boxes) and 4 days for hard/glossy surfaced goods (e.g., plastic/fiber envelopes/bags, letters with glossy-window insets, cans/bottles/etc.)

• the end of quarantine date is the day after the day the quarantine duration has passed

• perishable delivered goods that require refrigeration will be moved into the quarantine area and, from that location, completely unpackaged and placed in a wipe-down area where (i.e., all non-packaging/non-trash items to be retained will be placed in the wipe-down area)

• a newly quarantined item will be placed in the quarantine area such that it never touches/contaminates a previously quarantined item – if the delivery frequency is high, this may require additional or larger quarantine area(s)

• when delivered goods are unpackaged, they will be unpackaged completely … i.e., all packaging will be removed to reveal/extract all individual items (down to the final-level packaging in the case of perishable/food items)

• completely unpackaged items that have a hard/glossy surface that have been quarantined for only 2 days (i.e., were delivered in a soft-surfaced package and not initially unpackaged), will be placed in the quarantine area for an additional 2 days and marked with their end-of-quarantine date

• when delivered goods are unpackaged, the unpacking process will be performed in a manner that does not cause the packages to shed dust or packaging particles into the air (if in doubt, the packaging will be sprayed with an appropriate liquid disinfectant – e.g., 70% isopropyl alcohol and water mixture, i.e., we use 99% isopropyl mixed down to 70%)

• completely unpackaged goods that have completed their quarantine will be placed in a wipe-down area

• completely unpackaged perishable goods, after being wiped down, will be placed in a quarantine container (e.g., disposable bags, fridge drawers, isolated shelf, etc.), marked with their end-of-quarantine date and refrigerated for the remainder of their quarantine period

• items that have completed their quarantine duration and were placed in the wipe-down area will be put into service after being wiped using a cloth moistened with an appropriate disinfectant/cleaner (in our case, it’s a 70% isopropyl alcohol and water mixture)

• a freed-up quarantine area will be spayed or wiped down with disinfectant after being freed up and prior to being re-used

• the wipe-down area will, itself, be sprayed or wiped down with disinfectant after completing the wipe-down of a collection of items

• smaller packaging materials will be disposed of in the garbage-bagged quarantine container and larger packaging materials will be placed in an appropriate quarantine area (ideally, outside) for later disposal/recycling, after they have completed their quarantine duration

Here’s a pathologist arguing we should indeed all start wearing masks. He points out we’ll touch our mouth/nose less and he claims we’ll lower the number of droplets we spew towards others. He also shows a recent paper claiming diluting the virus concentration increases your odds to not contract it even when exposed. But he does encourage using bandanas instead of masks now urgently needed by professional healthcare workers.