Re: Fwd: fecal ID of COVID (fwd)

[robert <http://dummy.us.eu.org/robert>]

 > From: Noelle <http://dummy.us.eu.org/noelleg>
 > Date: Mon, 16 Mar 2020 11:03:14 -0700 (PDT)
 >
 > Another good reason to cook your own food.

Guess you can't just eat salad all the time.

 >  > From: Elizabeth Sarmiento <http://www.gmail.com/~elizabethsarmientoolson>
 >  > Date: Mon, 16 Mar 2020 10:54:53 -0700
 >  > To: Smart Yards Co-op <http://www.gmail.com/~smartyardscoop>
 >  > 
 >  > Dear friends,
 >  > 
 >  > Forwarding this informative note from my friend Amy Adams, a Dr. involved
 >  > with the Coronavirus work.
 >  > 
 >  > Please stay healthy.
 >  > 
 >  > Love,
 >  > Elizabeth
 >  > 
 >  > ---------- Forwarded message ---------
 >  > From: Amy Adams <http://www.post.harvard.edu/~amy_adams>
 >  > Date: Sun, Mar 15, 2020 at 3:48 PM
 >  > Subject: Fwd: fecal ID of COVID
 >  > To: Adams, Amy E. MD <http://www.pamf.org/~adamsa5>
 >  > 
 >  > Hello Friends, Colleagues--
 >  > Time is precious-I'm getting this out to those I think can pass
 >  > it along widely. Many of you I've seen recently, some not for
 >  > years. I will simply say I hope you are dealing with our
 >  > difficult times as best as you can.
 >  > 
 >  > I am an MD/PhD -a practicing physician with a background in
 >  > molecular biology. Below is some critical information that may
 >  > affect your hygiene, behavior and choices for food (and who
 >  > prepares it) in the coming weeks as well as your reasons for
 >  > seeking medical care/guidance regarding symptoms you may have
 >  > related to COVID-19.
 >  > 
 >  > Physicians have already stated that some with COVID-19 may
 >  > experience GI symptoms. How or why was postulated, but not
 >  > initially totally clear. Two recent studies from China show that
 >  > there is likely fecal-oral transmission of COVID-19. I posted
 >  > the link to a Medpage Today article below, but there are many
 >  > news sources. So much news is happening right now, the
 >  > importance of something like this can be easy to miss. If you've
 >  > not yet heard of this, I think it is critical to share
 >  > widely. Some already had a sense this may be the case, but this
 >  > brings scientific proof to the table. The data presented in the
 >  > first paper is strong. It was a well run study, published in the
 >  > top US GI journal, Gastroenterology. In their study of 75
 >  > patients, it was detected in the feces in 50%. While we don't
 >  > yet know what % of total cases spread via this route, since this
 >  > was a small study, we have to suspect some do and it is telling
 >  > that the second referenced paper in the article, notes that the
 >  > 1st US case in Seattle had GI symptoms and loose stool for
 >  > several days at his time of hospitalization and COVID was also
 >  > found in his stool.  What does this mean in lay terms: COVID is
 >  > seen primarily as a respiratory illness akin to cold or
 >  > flu-person coughs, either hits face of someone nearby or goes on
 >  > hand and then hand touches a surface. Advice=Stay away from
 >  > someone coughing as droplets could get on your mouth, nose,
 >  > face. They might put hand on doorknob, banister, etc. so wash
 >  > hands when in any place another may have touched.  All are true,
 >  > all excellent advice- but also what is likely happening--an ill
 >  > person touches something "else" on one's body (when using the
 >  > restroom), then touches a surface or a food or utensil etc. I
 >  > don't think these data change decisions and recommendations for
 >  > our personal hygiene habits. Washing hands thoroughly has always
 >  > been recommended. Contamination of surfaces becomes more
 >  > important and says double down on washing your hands and other
 >  > surfaces that could be contaminated. Knowing for this additional
 >  > source of tranmission may change the way you think of 2 other
 >  > behaviors, since you don't know if others are doing that washing
 >  > too.  1) How fastidious you are in cleanliness and habits in
 >  > your bathroom, esp if someone in home is ill with COVID and
 >  > other is not. Separate restroom likely important where possible
 >  > or at least lid down with flush, careful cleaning habits of bath
 >  > surfaces, etc. Public restroom hygiene-- sink, stall door, main
 >  > door etc. must be considered. We all know of lots of other GI
 >  > bugs that come from the bathroom, so this is not a big change.
 >  > 
 >  > 2) Your food choices and where you get your food and how it is
 >  > prepared (e/g takeout vs home prep) is likely more
 >  > important. Think of E. Coli outbreaks and lettuce. Sliced deli
 >  > items that can't be washed and that are handled by others comes
 >  > to mind, delivered restaurant cold food with heavy assembly, but
 >  > there are many others. As time goes on, this virus will be
 >  > fairly wide spread and we need to think of it contaminating all
 >  > areas of the food transport service even on surfaces - cans,
 >  > boxes etc at the grocery and must clean appropriately before
 >  > opening. The more people that process or touch food, the more
 >  > the risk goes up. We may not need to avoid all fresh food, but
 >  > really need to be thoughtful. Soap/water washing and high heat
 >  > kill this virus. Items like onions and cabbage can have outer
 >  > areas carefully peeled. Carrots, apples can be washed with
 >  > soap/water then peeled. Things like broccoli, cauliflower likely
 >  > best steamed. Spinach-eat steamed not as a salad. Berries can't
 >  > be washed - avoid them or cook/stew.  And so on. The more
 >  > control you have over your own food preparation the better.
 >  > 
 >  > This issue is of particular concern to me is when I started
 >  > thinking of what food would be brought to an elderly friend
 >  > who's social distancing to try to avoid getting ill from
 >  > COVID-19. Things that have minimum handling prep such as
 >  > commercial frozen dinner that can be heated in the oven or a
 >  > single serve cup of apple sauce, canned vegi to be heated (corn)
 >  > seem like good choices.  While it seems nicer, a salad with
 >  > berries and your homemade deli meat/cheese sandwich is likely
 >  > NOT what you want to bring them. I can see a few bad choices
 >  > made during a mass effort to get food out to help a town's
 >  > elderly ill, turning into a source of contamination if not done
 >  > thoughtfully.  I think of a food handler (say in a nursing home)
 >  > who preps fresh food and either works when ill, doesn't know
 >  > they're ill yet, or is the only one least ill to do the job when
 >  > this thing escalates. Again, the more control you have over your
 >  > own food preparation and serving the better.
 >  > 
 >  > I will leave it to your imagination as to if fecal-oral
 >  > transmission strengthens or weakens the argument that kids are a
 >  > major source of community infection and if their crowding
 >  > together (say in schools) might accelerate spread through the
 >  > community and as to if it is good that we are now majorly
 >  > closing schools to encourage social distancing. Below is the
 >  > link to the article which has both a summary of the findings and
 >  > discussion by leading experts on the significance of this mode
 >  > of transmission. We must err on the side of caution as to how
 >  > much a role this plays in spreading disease=we've no time for
 >  > more detailed trials, though each week more data will come out
 >  > from our colleagues in Asia. I hope your passing this
 >  > information along may help some of our ill and elderly better
 >  > weather this terrible storm. Again, please circulate widely via
 >  > your contacts and SM channels- Facebook, Twitter etc. I feel
 >  > this can't be emphasized enough.
 >  > https://www.medpagetoday.com/infectiousdisease/covid19/85315
 >  > 
 >  > My apologies if I do not respond immediately to you.  You don't
 >  > need to write back -- everyone is very busy right now--just
 >  > read, understand and forward on or summarize as you see
 >  > fit. Just get the info our to the lay public however you can.
 >  > Today, finally, we have adequate tests available.  We've been
 >  > running a mobile respiratory screening clinic at many of our
 >  > sites since last week. We are headed towards an unprecedented
 >  > time in health care and the world-and we've no time to waste.
 >  > 
 >  > With kindest regards--
 >  > 
 >  > Amy E. Adams, MD/PhD
 >  > ++++++++++++++++++++++++++++
 >  > My email address will sometimes change.  Please always use my permanent,
 >  > forwarding email,
 >  > http://www.post.harvard.edu/~amy_adams
 >  > 

 >  > "If the world is to be healed through human efforts, I am
 >  > convinced it will be by ordinary people, people whose love for
 >  > this life is even greater than their fear."  ~ Joanna Macy