Coronavirus outbreak bumps hand hygiene compliance

Hand hygiene is a cornerstone of infection control,1,2 yet compliance remains low, averaging 50% across hospitals nationwide.1 Audit and feedback can improve compliance,3 but audits traditionally occur using direct observation, capturing few events and leading to inaccurate measurements.4 To address this, some institutions have implemented automated monitoring.1,4 

Woman washing her hands at the kitchen sink. There are vegetables out of focus in the background.

To further validate hand hygiene compliance measurements from automated monitoring and estimate the upper bound of compliance achievable with such systems, we describe changes in compliance during the COVID-19 pandemic as measured by the automated system at our institution, one of the largest such deployments nationally.

Hand hygiene compliance rate during the COVID-19 pandemic

JAMA Internal Medicine

Sonya Makhni, MD, MBA1,2Craig A. Umscheid, MD, MS1,2,3Jackie Soo, MPH, ScD3Vera Chu, MS, MLS(ASCP)CM4Allison Bartlett, MD, MS2,4,5Emily Landon, MD1,2,4Rachel Marrs, DNP, RN, CIC4

doi:10.1001/jamainternmed.2021.1429

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2779293

Huh? COVID-19 science and the uncertainty dance

My friend Tim Caufield, professor of law at the University of Alberta, the Research Director of its Health Law Institute, and current Canada Research Chair in Health Law and Policy, writes in an op-ed for the Globe and Mail that COVID public health policies have been with us for a year. So has uncertainty. We’ve all lived through twelve months of “huh”? And this has added to the public’s frustration, fatigue, and stress.

In the early weeks and months of the pandemic, there was uncertainty about masks and asymptomatic spread. There was uncertainty about if and when we’d get a vaccine. There was uncertainty about what type of public health policies worked best and were most needed. We have all had to tolerate a lot of ambiguity. And as the vaccines roll out, we are being asked to tolerate even more. (When will I get a vaccine? Which one will I get? And what about the variants?)

For public health communications to be effective, the public must have confidence in the message. And, unfortunately, for some, that confidence isn’t there. A recent study from the University of Calgary explored pandemic communication and found, not surprisingly, that “participants felt that public health messaging to date has been conflicting and at times unclear.”

This perception is understandable. An atmosphere of seemingly relentless uncertainty and confusion has been created by a combination of scientific realities, media practices, some less-than-ideal communication from policy makers, and the spread of misinformation and conspiracy theories.

The science surrounding COVID was – and, for some topics, continues to be – highly uncertain. While a growing body of evidence has emerged around the most contested issues (such as the value of masks and physical distancing strategies), early in the pandemic there wasn’t much that was unequivocal. The science evolved and, as you would hope with any evidence-informed approach, the resulting science advice and recommendations evolved too. But for some, shifting policies, even if appropriate, just added to a sense, rightly or not, of chaos.

In addition, the media has been reporting on the research as it unfolds, including referencing studies that have not yet been peer reviewed. Often the preliminary or uncertain nature of the relevant research is not reported in the media, thus creating a false impression about the actual state of the science – as exemplified by the “hydroxychloroquine works!” debacle (PS, it doesn’t). Perhaps worse, relatively fringe perspectives – such as those pushing the value of “natural herd immunity” – have been given a relatively high profile in both the conventional press and on social media. This can create a false balance (fringe idea vs. broad scientific consensus) that we know can be detrimental to both public discourse and health behaviours.

Despite the frustration that uncertainty can create, the public has a demonstrated preference for honesty about the limits of our knowledge. A recent study from Germany found that “a majority of respondents indicated a preference for open communication of scientific uncertainty in the context of the COVID-19 pandemic.” This finding agrees with other research that has found that when uncertainty is relevant to their lives, the public wants to know about it.

People may want to hear about uncertainty, but will communicating it do more harm than good? Will it just add to an already confused information environment? The data on this point are actually fairly mixed, but recent research exploring the impact of communicating scientific uncertainty found that it either increased perceptions of trust in science or had almost no impact. This is good news. As the authors of one of the studies notes, “this should allow academics and science communicators to be more transparent about the limits of human knowledge.” Other studies have found that being honest about uncertainties in media reports about research can actually boost the perceived credibility of journalists.

And over the long term, honesty about the uncertainties of the evidence used to inform policy seems essential to the maintenance of public trust. For example, being overly dogmatic about a policy or predictive model could hurt the credibility of decision makers if new evidence requires a revision of a past positions.

When possible, public health authorities (or anyone seeking to communicate science) should start with well-defined and well-supported takeaway messages (e.g., please get vaccinated with whatever vaccine is available to and recommended for you!).But then be honest about what is not known (e.g., while vaccines are our best defense, we aren’t sure how long immunity will last).

Depending on the medium used (a social media post, for example, may not be the best venue for a long discourse on methodological challenges), it may also be wise to explain the limits of the research approach (e.g., observational studies can’t prove causation). If there are areas of scientific disagreement, be honest about that too – but be specific about what is being disputed. Often there is broad agreement about the big stuff (e.g., vaccines work!), but academic debate about some details. Often those trying to sow doubt – like those in the anti-vaccine community – will try to weaponize and over-emphasize small academic disagreements. Don’t give them that room.

When communicating about uncertainty it is also important to highlight what is being done to reduce it, such as forthcoming research or new data analysis. This provides a road map forward and invites the public to follow the science as it unfolds. It is also a way to stress that uncertainty is a natural part of the scientific process.

For the public, try not to let the uncertainty kerfuffle distract you from the big picture. Remember that there are many clear knowns. Vaccines, physical distancing, hand washing, masks, and being responsible when symptoms emerge will get us through this pandemic.

Finally, it is also important to take a break from all the uncertainty noise. Studies have shown that the constant consumption of conflicting COVID news can (no surprise here) add to our stress. Put down the phone, back away from the screen, and take ten from “huh?”

Digital media and communication scenarios

It’s not food safety, it has more current relevance to Covid-19, but this paper has some important insights for communicating during an outbreak. The Australian lesson from cornavirus seems to be, go fast, hard.

Expert-lay mass media communication (a phrase I always despised) in public health prevention campaigns has been at the forefront in knowledge dissemination before digital communication gained in momentum.

The advent of digital media has radically changed communicative scenarios and strategies used to actively involve population, for example promoting large-scale change in awareness, behaviour, and attitude. However, research still has not fully documented how digital environments orchestrate different multimodal resources, including, among others, language, still and moving images. Other research gaps deal with understanding how users can be actively engaged in websites and how the identity of participants is projected with reference to their distance from the voice of the expert.

The paper combines linguistic and visual analysis in a multimodal perspective to investigate the interplay of identity and distance in the website and integrated social media of the Centers for Disease Control and Prevention (CDC, https://npin.cdc.gov), an operating component of the Department of Health and Human Services (US).

Linguistic and visual analysis of the Vital Signs monthly reports on campaigns for HIV prevention will focus on the revision of the notion of deixis to see how this has been reconfigured in multimodal environments. Findings show that person, time, and place deixis have been reshaped in digital scenarios with the aim of engaging participants and disseminate knowledge to prompt change in behaviour.

The image, left, shows person deixis, place deixis and time deixis in English.

“The time is now”: A multimodal pragmatic analysis of how identity and distance are indexed in HIV risk communication digital campaigns in US

May 2021

Journal of Pragmatics, vol.177 pg. 82-96

Maria Sindoni

https://doi.org/10.1016/j.pragma.2021.02.012

https://www.sciencedirect.com/science/article/abs/pii/S0378216621000680

The art of persuasion hasn’t changed in 2,000 years and applies to coronavirus

Carmine Galloof wrote in the Harvard Business Review last year that ideas are the currency of the twenty-first century. The ability to persuade, to change hearts and minds, is perhaps the single greatest skill that will give you a competitive edge in the knowledge economy — an age where ideas matter more than ever.

More than 2,000 years ago Aristotle outlined a formula on how to master the art of persuasion in his work Rhetoric. A summary of Galloof’s article appears below.

1) Ethos or “Character”

Aristotle believed that if a speaker’s actions didn’t back their words, they would lose credibility, and ultimately, weaken their argument.

2) Logos or “Reason”

Once ethos is established, it’s time to make a logical appeal to reason. Use data, evidence, and facts to form a rational argument.

3) Pathos or “Emotion”

According to Aristotle, persuasion cannot occur in the absence of emotion. People are moved to action by how a speaker makes them feel. Aristotle believed the best way to transfer emotion from one person to another is through the rhetorical device of storytelling. More than 2,000 years later, neuroscientists have found  his thesis accurate. Studies have found that narratives trigger a rush of neurochemicals in the brain, notably oxytocin, the “moral molecule” that connects people on a deeper, emotional level.

4) Metaphor

Aristotle believed that metaphor gives language its verbal beauty. “To be a master of metaphor is the greatest thing by far,” he wrote. When you use a metaphor or analogy to compare a new idea to something that is familiar to your audience, it clarifies your idea by turning the abstract into something concrete.

Those who master the metaphor have the ability to turn words into images that help others gain a clearer understanding of  their ideas — but more importantly, remember and share them. It is a powerful tool to have.

5) Brevity

Here again, Aristotle was ahead of his time. “Aristotle had discovered that there are fairly universal limits to the amount of information which any human can absorb and retain,” writes Kings College professor Edith Hall in Aristotle’s Way. “When it comes to persuasion, less is always more.”

Brevity is a crucial element in making a persuasive speech. An argument, Aristotle said, should be expressed “as compactly and in as few words as possible.” He also observed that the opening of a person’s speech is the most important since “attention slackens everywhere else rather than at the beginning.” The lesson here is: start with your strongest point.

Sorta like journalism.

Facebook deletes celebrity chef wannabe Pete Evans’s Instagram account over repeated coronavirus and vaccine misinformation

ABC (the Australian one) reports celebrity chef wannabe Pete Evans (right, exactly as shown) has been permanently booted off Instagram for sharing misinformation about coronavirus and vaccines.

Pete Evans’s Facebook page was removed last year, but he continued posting misinformation on Instagram, which Facebook owns

Facebook last week expanded the list of false claims it will remove, adding more about coronavirus and the vaccines.

The company no longer tolerates false claims the virus is man-made, that the disease is safer than the vaccine, that vaccines are toxic, dangerous, or cause autism

Facebook confirmed it deleted Mr Evans’s account on the popular picture-sharing platform on Wednesday.

The account had hundreds of thousands of followers.

Celebrity chefs are just so full of bad food safety information (except for Alton Brown).

“We removed Pete Evans’s account for repeatedly sharing debunked claims about the coronavirus or vaccines,” the company said in a statement.

“We don’t allow anyone to share misinformation about COVID-19 that could lead to imminent physical harm or about COVID-19 vaccines that have been debunked by public health experts.”

Mr Evans’s Facebook page was removed in December, but he continued to share misinformation through Instagram, which is also owned by Facebook.

Facebook had earlier removed several of the chef’s Instagram posts for violating its policies on misinformation.

Facebook’s COVID-19 and vaccine misinformation policies were updated last week, with the company vowing to crack down on false claims.

Mr Evans was a judge on My Kitchen Rules between 2010 and 2020.

He has repeatedly made posts opposing COVID-19 vaccines and masks, shared discredited coronavirus cures, and claimed in a podcast that the coronavirus is a hoax.

Mr Evans regularly used his Instagram account to cast doubt on official information about COVID-19, vaccines, and other parts of mainstream science.

His company was fined more than $25,000 by the Therapeutic Goods Administration (TGA) in April after he promoted a device called a “BioCharger” on a Facebook live stream, claiming it could be used in relation to coronavirus.

The TGA said the claim had “no apparent foundation”.

Mr Evans announced last week he would run for federal parliament, standing as a Senate candidate for a fringe party set up by former One Nation senator Rod Culleton.

Who knows, he may get some votes: On Saturday more that 1,000 clogged roads in downtown Brisbane to protest against the vaccine as the first inoculations were conducted in the federal capital of Canberra. Vaccines begin Monday in Brisbane.

As a risk communication dude, I am however concerned with the approach being taken by the Australian Capital Territory to win over anti-vaxxers. The Canberra Times reports the ACT government will launch a major public information campaign as part of efforts to counter anti-vaccination messages amid concern vaccination rates could be affected by misinformation. Flyers making false and misleading claims about vaccines have been distributed to households in Canberra in recent days, prompting renewed calls for people to stop undermining public health information.

On Saturday, about 150 people, including some affiliated with far-right groups, gathered near the Carillon on the shores of Lake Burley Griffin to protest mandatory vaccinations – despite no such initiative being proposed.

Ms Stephen-Smith said, “We aim to provide informative, trustworthy and up-to-date advice to the community so they understand the risks of COVID-19, our responsibilities in helping to reduce these risks and where to access healthcare services.

“As the vaccine program rolls out, we will be ramping up our public health information campaign. This will focus on educating Canberrans about the COVID-19 vaccine, where and when they can access it and how they can find factual and reliable information.”

It’s a leader’s duty to inform rather than educate. Further, the proposal reeks of a failed risk communication strategy: If I could only get that one person or group to change their minds, conflict will be removed. By focusing on vaccine opponents, leaders are not paying enough attention to vaccine proponents and the essence of good science. But I’ll let Jimmy Kimmel explain from 2015:

30 Helens and most of 635 epidemiologists agree: Stay at home for Thanksgiving

Thanksgiving is my favorite holiday, both the Canadian, in early October, and the American, today, the last Thursday in November.

The U.S. Centers for Disease Control (CDC) has finally found a consistent voice and has recommendations to make #Thanksgiving safer. Bring your own food and drinks, stay at least 6 feet apart, and wash your hands often. Choose outdoor or well-ventilated spaces.

Most importantly, CDC and others strongly recommend to celebrate only with those you live with, and use virtual gatherings with others (I am exceedingly thankful for the electronic toys we have to help weather the pandemic; 1918 and the Spanish flu would have really sucked).

Of course, the current White House occupant is planning on hosting several parties throughout the holidays. Please ignore Trump et al. and listen to the science.

To that end, the N.Y. Times surveyed 635 epidemiologists and found that most are staying at home, and that those who are gathering with family or friends are taking precautions or rethinking their holiday rituals altogether.

Enjoy your Thanksgiving my American friends and colleagues, and be thankful that someone will live with you.

Australia has somewhat enviable statistics related to this pandemic and the lesson that America is only beginning to grasp is this: go fast, go hard and go smart to limit the spread of coronavirus or any illness.

Proper handwashing requires proper tools: Soap vs. COVID-19

I don’t like the militarization of terms to discuss foodborne or other bugs. The bugs are there, be cool, take steps to reduce risk.

UNSW academics have released a 3D visualisation of soap destroying the coronavirus to remind Australians that simply washing your hands can help stem the pandemic.

(There is nothing simple about handwashing when almost all public restrooms contain blow-dryers instead of paper towels and have controlled water flow rates that would dislodge nothing. It is the friction that helps reduce microbial loads on hands, which is why hospitals are over-flowing with paper towel dispensers.)

Soap counts too.

There’s too much self-aggrandizing in the PR piece, below, but it has pretty pictures.

This scientifically accurate simulation — a collaboration between UNSW Art & Design and UNSW Science — shows soap acting on contaminated skin covered with tiny coronavirus particles.

“With the threat of the second wave upon us, simple hygiene is something everyone can do to prevent the spread of the virus,” UNSW Science’s Professor Pall Thordarson said.

“Soap can destroy the virus on your skin.”

The simulation uses a cinematic approach and evocative animation to deliver a message that’s accessible to adults and children.

“One of the very few pieces of good news about this virus is that it’s actually very fragile — if you wash your hands with soap, the whole virus basically collapses like a house of cards,” Professor Thordarson said.

The simulation was created by UNSW’s 3D Visualisation Aesthetics Lab, which explores arts- and design-led visualisations of complex scientific and biomedical data. The Lab creates immersive platforms that play out scientific phenomena, such as drug interactions with cancerous cells or interactive personalised scans of strokes to help patients understand their treatment.

“3D visualisations make complex science comprehensible. The creative industries are in a unique position to be able to offer these kinds of innovative educational simulations,” said Associate Professor John McGhee who created the simulation with UNSW 3D Visualisation Aesthetics Lab post-doctoral researcher Dr Andrew Lilja.

What is deep cleaning and how does it work?

It’s a phrase that is bandied about whenever there is an outbreak of foodborne or other microbiological thingies: We didn’t just clean, we did a deep clean.

Sexual connotations aside, what does a deep clean actually mean?

Andrew Brown of The Canberra Times had a go at the subject of deep clean.

While cleaning normally focuses on removing visible signs of mess through vacuuming, dusting and wiping things down, deep cleaning goes one step further.

Deep cleaning involves the use of disinfectant and other chemicals to remove any traces of germs and viruses, including coronavirus.

Part of deep cleaning also involves wiping down every surface in a venue, regardless of whether it has come into direct contact with an infected person or not.

A particular focus is high-frequency touch points, such as light switches, door handles, taps and areas like computer terminals or communal kitchens in office spaces. While high-grade disinfectants are used as part of deep cleaning, other chemicals can also help to remove traces of the virus.

Anthony Bailey, ACT Education Directorate senior director of school cleaning services, said a fine-mist spray was also used as part of deep cleaning efforts in Canberra schools.

“With the fine-mist spray, the chemical settles in areas you can’t normally reach,” Mr Bailey said.

“It’s unlikely people are touching those surfaces, but it’s all about elimination.

One of the ACT’s schools, Lyneham High School, required deep cleaning in March after a student attended the campus while potentially contagious with coronavirus.

Mr Bailey said swab tests of surfaces for traces of coronavirus were also carried out before students and staff members could re-enter the school.

One of the main ways coronavirus has been able to spread is through being picked up by humans after they come into contact with the virus on surfaces. Research is being carried out in a number of places on how long exactly the virus can linger on surfaces and lead to further infections.

Early findings have determined strains of COVID-19 can stay alive for several hours or even days, depending on the type of surface it lands on.

According to a recent study from the New England Journal of Medicine, the virus can last for four hours on copper surfaces, while it can stay on cardboard or paper for 24 hours and up to three days on plastic and stainless steel.

A similar study published in The Lancet had slightly different findings, with the virus lasting for three hours on tissue paper, while traces were still detected on cloth and wooden materials for two days.

Associate professor at the Australian National University medical school, Sanjaya Senanayake, said the Lancet study also found the virus could stay on surfaces such as surgical masks for up to one week after they were worn.

“The two studies were slightly different in the types of materials that were used, but clearly the virus can survive on surfaces for some time,” associate professor Senanayake said.

“Maybe after half an hour on a surface, there’s a lot more virus on it, and therefore people are more likely to be infected if they come into contact.

“By the seventh day, the virus might still be around on surfaces, but may not be enough to cause an infection.”

At its core, deep cleaning is about attacking the virus at every possible location it could be in a building.

However, for a virus that’s devastated nations around the world and locked down cities across Australia, associate professor Senanayake said COVID-19 was remarkably easy to kill.

“It’s an enveloped virus, meaning it’s got an outer covering and it’s very susceptible to things,” he said.

“Despite it being this terrible thing that’s caused a pandemic, it’s easy to kill with things like standard detergents as well as soap and water.”

Using things like detergents might be enough to kill off the virus, but associate professor Senanayake said using just disinfectant or chemicals on their own might not have the desired effect.

“If you put just disinfectant on those areas, some of the virus particles might be able to hide,” he said.

“Surfaces should be cleaned with detergent first and then disinfected after that with something like 70 per cent alcohol or bleach.”

It should also be noted that any cleaning of surfaces suspected of having traces of coronavirus should be done with personal protection, such as a mask.

Speed at the sound of lonliness

I’m still troubled the world lost such a gifted and incisive songwriter as John Prine to coronavirus.

And I’m lonely, because I live downstairs.

Social distancing and “stay-at-home” orders are essential to contain the coronavirus outbreak (COVID-19), but there is concern that these measures will increase feelings of loneliness, particularly in vulnerable groups. The present study examined change in loneliness in response to the social restriction measures taken to control the coronavirus spread.

A nationwide sample of American adults (N 1,545; 45% women; ages 18 to 98, M 53.68, SD 15.63) was assessed on three occasions: in late January/early February 2020 (before the outbreak), in late March (during the President’s initial “15 Days to Slow the Spread” campaign), and in late April (during the “stay-at-home” policies of most states). Contrary to expectations, there were no significant mean-level changes in loneliness across the three assessments (d .04, p .05). In fact, respondents perceived increased support from others over the follow-up period (d .19, p .01). Older adults reported less loneliness overall compared to younger age groups but had an increase in loneliness during the acute phase of the outbreak (d .14, p.05). Their loneliness, however, leveled off after the issuance of stay

Trajectory of loneliness in response to COVID-19, 2020

American Psychological Association

Martina Luchetti, Ji Hyun Lee, Damaris Aschwanden, Amanda Sesker, Jason E. Strickhouser, Antonio Terracciano, and Angelina R. Sutin

http://dx.doi.org/10.1037/amp0000690

Oh, Missouri: Summer camp virus outbreak raises safety questions

Looks like I picked the wrong week to send my 5 daughters to summer camp.

They’re over that now but Missouri leaders knew the risk of convening thousands of kids at summer camps across the state during a pandemic, the state’s top health official said, and insisted that camp organizers have plans in place to keep an outbreak from happening.

The outbreak happened anyway.

An overnight summer camp in rural southwestern Missouri has seen scores of campers, counselors and staff infected with the coronavirus, the local health department revealed this week, raising questions about the ability to keep kids safe at what is a rite of childhood for many.

Missouri is one of several states to report outbreaks at summer camps. The Kanakuk camp near Branson ended up sending its teenage campers home. On Friday, the local health department announced 49 positive cases of the COVID-19 virus at the camp. By Monday, the number had jumped to 82.

Some states, like Oregon, New York, New Jersey and Connecticut, closed summer camps this year, and many camps elsewhere have voluntarily canceled programs. But other camps are plowing ahead, hoping that precautions like social distancing, masks and requiring children to quarantine before coming to camp will quell the risk. Other states where outbreaks have been reported have included Texas, Georgia, North Carolina and Tennessee.