How can EA local groups reduce likelihood of our members getting COVID-19 or other infectious diseases?
By Linch @ 2020-02-26T16:16 (+23)
Note: I’m not a qualified expert (or an unqualified expert) in epidemiology, public health, or even basic biology. However, this article has been lightly reviewed by more qualified people.
UPDATE 2020/03/08: Since 2020/03/04, all Bay Area EA events will be postponed until further notice. I encourage other event organizers in a similar position (multiple confirmed cases, community transmission, CDC or local equivalents being noticeably slow to act) to do the same.
From a public health perspective, focusing coronavirus prevention efforts on EA local groups doesn’t make much sense. We’re unusually young, likely to be in Western countries, unusually wealthy, etc. However, I think that a) EA group organizers are comparatively well-placed to reduce infection rates at our own events (even if our members are not people who public health professionals will triage) and b) local group organizers plausibly have a special obligation to make sure our members aren’t infected.
Here are 7 core tips for thinking about coronavirus for local group organizers:
- Don’t panic. This will most likely blow over, and it’s not worthwhile to panic anyway. There are large costs (isolation, anxiety) to cancelling normal events.
- Education. Get your fellow group organizers to read this guide as well as the CDC guide for event attendees.
- Encourage self-quarantine. Encourage and applaud members for not attending events if sick, even slightly.
- Handwashing. Teach your attendees and model handwashing well.
- Hand sanitizers. Have hand sanitizers readily accessible and available.
- Strongly discourage handshakes. Encourage the elbow bump or bows instead.
- Wipe down public surfaces if possible. Lysol works for other similar coronaviruses.
You can read a more detailed linked Google Doc I wrote if you’re interested in implementation details, or more hypothetical suggestions that might occasionally be useful for a subset of group organizers.
This article is biased towards a specific region and time (the current situation as of 2020/02/26, with Europe/ North America/ Australasia groups in mind). Local conditions may vary.
The author will like to thank the biosecurity conference Catalyst for inspiring him to write something about COVID-19, Tessa Alexanian and Richard Bruns for an initial review and constructive feedback, and his roommates, fellow Bay Area EA organizers, and Buck Shlegeris for humoring him on this sudden novel coronavirus obsession in the last two days.
willbradshaw @ 2020-02-27T09:56 (+15)
Encourage self-quarantine. Encourage and applaud members for not attending events if sick, even slightly.
To be honest I'd be pretty happy if we created a strong norm against attending events while sick even disregarding COVID-19. Our culture(s) seem to not take this very seriously and this seems really dumb to me.
I've been to multiple biosecurity events where at least one attendee came while ill. It's impressive dedication but probably not net-positive in expectation.
JP Addison @ 2020-02-26T17:50 (+7)
My guess is that putting hand sanitizer conspicuously out near food will be more important than teaching and modeling handwashing.
In general, reading that the WHO prefers sanitizer to handwashing (when your hands aren't visibly dirty) was a really big update for me, because hand sanitizer is so much easier to use.
Linch @ 2020-02-26T18:05 (+3)
I think learning to use hand sanitizer correctly isn't meaningfully different from learning to wash your hands well...and most people fail at both!
tessa @ 2020-02-26T23:00 (+2)
Yeah, most people (including me) don't apply multiple mL of hand sanitizer over every surface of their hands, then rub the hands together until it dries completely (which takes around 20 seconds).
JP Addison @ 2020-02-27T01:21 (+2)
I'd really like to see effectiveness differences between the gold standard and "regular person use".
tessa @ 2020-02-27T04:22 (+2)
If children washing their hand in Spanish daycares looks like "regular person use", then this study found hand sanitizer to be more effective.
(Though I can't tell how much more carefully supervised the children using hand sanitizer were; there's a paragraph that sort of suggests this-"The HSG children were supervised by DCC staff and parents when using the hand sanitizer, and in the case of young children, it was administered by DCC staff and parents. The CG followed usual hand-washing procedures."- and that might explain the whole difference, since it's not that dramatic.)
tessa @ 2020-02-26T23:03 (+2)
Happy to be corrected here, but I think hand sanitizer is recommended by the WHO for healthcare workers because of its strong antibacterial properties, and if you're concerned specifically about viruses you will usually be better off with hand washing.
JP Addison @ 2020-02-27T01:29 (+2)
Very interested in the right answer here. Wikipedia says "90% alcohol rubs are more effective against viruses than most other forms of hand washing." (And I'm hoping it will generalize to the 70% concentration I typically use.) But here's a 2019 article that seems to show weak effectiveness against flu.
tessa @ 2020-02-27T04:27 (+2)
I wish I could look up the source for that 90% quote, but it's from a book from the 1990s. Quoting a press release from ASM about that same 2019 result:
The influenza A virus (IAV) remains infectious in wet mucus from infected patients, even after being exposed to an ethanol-based disinfectant (EBD) for two full minutes... Most studies on EBDs test the disinfectants on mucus that has already dried. When he and his colleagues repeated their experiments using fully dried mucus, they found that hand rubbing inactivated the virus within 30 seconds... Washing hands with an antiseptic soap, they found, deactivated the virus within 30 seconds, regardless of whether the mucus remained wet or had dried.
More alcohol isn't necessarily better- this 2002 CDC Review on Handwashing notes that:
Alcohol solutions containing 60%–95% alcohol are most effective, and higher concentrations are less potent because proteins are not denatured easily in the absence of water.
The tests summarized in that report suggest high efficacy at the 70% concentration for a lot of viruses, included some non-enveloped ones:
Other nonenveloped viruses such as hepatitis A and enteroviruses (e.g., poliovirus) may require 70%–80% alcohol to be reliably inactivated. However, both 70% ethanol and a 62% ethanol foam product with emollients reduced hepatitis A virus titers on whole hands or fingertips more than nonmedicated soap.
[edited to clarify]
So maybe the reason that the CDC recommends handwashing is that healthcare workers are likely to have soiled [ETA: or damp or mucus-covered] hands?
willbradshaw @ 2020-02-27T09:50 (+3)
I might be misunderstanding your meanings here, so please disregard if so, but:
Quoting a press release from ASM about that same 2019 result [...]
TWiV discussed this paper a few weeks ago. I think it's important that the finding is that virus specifically in wet mucus, not just in water generally. Mucus has complicated properties that I think are important here.
So maybe the reason that it's recommended for healthcare workers is that they're likely to have soiled or damp hands?
The WHO recommendation for hand sanitiser is specifically for when hands are not visibly soiled, so I don't think it's this.
tessa @ 2020-02-27T15:18 (+1)
Yeah, edited to clarify a bit. At this point I'm just a bit confused about the CDC recommendation to favour handwashing:
Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
- If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
willbradshaw @ 2020-02-27T22:24 (+2)
Yeah, I'm also unsure about that. I tried to find some NHS guidelines as a third opinion but didn't find any public-facing guidance directly comparing the two. The Mayo Clinic seems to weakly/obliquely recommend washing over sanitiser, but doesn't say why and might just be copying the CDC.
I initially tried washing my hands all the time, and found that I quite quickly developed chapped and painful hands; this quickly went away after I switched to using hand sanitiser in borderline cases. So anyone who wants to follow the CDC over the WHO should make sure they have gentle soap!
willbradshaw @ 2020-02-27T09:51 (+1)
My guess is that putting hand sanitizer conspicuously out near food will be more important than teaching and modeling handwashing.
Sadly I've seen lots of (most?) people at multiple events (including at Catalyst) completely ignore available hand sanitiser, so I don't think this works that well by itself. It might work if the organisers intentionally create common knowledge that guests should use hand sanitiser before touching food, and that not using it is considered defecting.
ofer @ 2020-02-27T05:19 (+5)
Strongly discourage handshakes. Encourage the elbow bump or bows instead.
Is the elbow bump recommended even if people are sneezing/coughing into their elbows?
[EDIT: maybe people should only cough into their left elbow?]
Linch @ 2020-02-27T08:05 (+4)
I'm coming into the conclusion that either finger guns, bows, or some other non-contact solution is better, or if we should give up on discouraging handshakes and instead encourage hand sanitizer immediately after washing hands.
I'm excited to see local groups experiment with trialing different practices and seeing which ones stick.
Handshakes are plausibly one of the more likely ways that infectious diseases spread, so it's worthwhile to look for healthier alternatives.
willbradshaw @ 2020-02-28T14:21 (+1)
Tabarrok likes fist bumps: https://marginalrevolution.com/marginalrevolution/2020/02/all-praise-the-fist-bump.html
Linch @ 2020-02-29T04:32 (+2)
Do you have a sense of what % of badness in handshakes are in fist bumps?
Peter_Hurford @ 2020-03-16T11:55 (+4)
Wow. A lot can change in just eighteen days.
Linch @ 2020-03-16T18:52 (+2)
Tell me about it!
Linch @ 2020-03-05T07:32 (+4)
Update: Other Bay Area EA organizers and I have decided to cancel/postpone all medium (>15 people) and large-scale public events until further notice. I will publish more details later.