By Dr. Rock CJay Positano, Director, Non-surgical Foot and Ankle Service, Hospital for Special Surgery
Life in the time of Covid-19 has definitely revealed many interesting things. A woman speaking to her friend around what appeared to be less than the recommended 6ft away (distances have a wide interpretation these days), pushing her soiled mask up with dirty gloves around every other word in order to prevent the mask from sliding down her condensation beaded face, a man eating a slice of pizza with his soiled gloves, and just general face bandana wearing to name just a few. Whatever perversion it may be one thing remains clear from this global health crisis episode – we (as a people) desperately need to better address the issue of proper health hygiene and surveillance in addition to general global food hygiene practices.
In light of the increased personal protective equipment (ppe) use we are currently experiencing with the Covid-19 outbreak, it has been hard not to notice how people have actually been using their own ppe in public. What initially started out as a somewhat comic activity to do while walking is now turning into a sober reflection of how seemingly impossible it is for the public to, not only comprehend, but use their ppe in the proper way that does not defeat its intended purpose. You cannot just distribute ppe and let the public wander around without proper guidance – even then there is no guarantee the ppe will be used correctly.
Knowing this, the hard fact is that, lamentably, it is untenable to have completely unadulterated ppe use, especially when people already have no concept of proper health hygiene literacy and even then, being fallible humans, there is a great chance that a mental lapse will occur at some point in the course of a day leading to such misuse of the ppe. Trying to figure out what we touched becomes an ontological nightmare that would lead us down a rabbit hole. Also, this classic exercise shines further light on the dilemma – hypothetically imagine having wet paint on your whole person from head to toe for a day and see how many things get marked up or touched throughout the course of a day. Now imagine a whole population doing this. So, saying this naturally begs the question whether is it better to use ppe anyway (than not) or is wearing some ppe better than nothing when you are not using it properly? Either way, if the goal is mitigation of transmission then, for the sake of public health, obviously following some type of uniform protocol is better than not. But at a time when there is so much conflicting information jockeying for attention, this seemingly simple task becomes a herculean effort often ending in mass confusion and, as highlighted earlier, becomes more of an exercise in public creative interpretation.
Instead of shooting for unattainable goals, such as testing every individual before they go back to work, handcuffing our liberties even more to political will instead of thoughtful logic, we should shoot for more thoughtful and manageable goals and long-term ideals – as should have been formulated at the onset of this outbreak (but then the Monday morning quarterback never lost a game). More importantly, we all need to get over the fact that it is incredibly difficult to completely eradicate something of infectious origin (look at the flu or common cold) and we need to just learn how to live with this fact and in addition to finding cures, try to better manage sanitation, health surveillance, and health literacy as best as we can and all get back to work.
The ‘right’ answer still remains, but the underlying dilemma of global health literacy should be seriously considered and reflected upon as we begin transitioning back to ‘normalcy’ or whatever altered reality awaiting us at the coda of this crisis. If anything this episode has taught us, other than the limits of our own sanity, it is that this world (not just the microcosm of New York) needs to take infection control seriously and until the needs of the human health collective are prioritized over any political or economic advantage one country may have over another and transparency and accountability championed, the fate of humanity will forever be at the mercy of silent enemies like Covid-19.