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Is this a real vaccine?

Once again, I'm pressed to stray from the fictional format that I set out for this blog, and I apologize for that, but recent social media discourse has prompted me to add a short educational piece.  What follows is an explanation of how vaccines work, and how the mRNA vaccines in particular work, in what is (hopefully) friendly language. I was asked by a friend if I thought the COVID-19 vaccines really were in line with the traditional definition of vaccines, and I found myself producing what, in social media terms, would be considered a very lengthy response, but probably is pretty appropriate in blog terms. Don't bail, please. It's user-friendly (and you ARE a user. We're talking use of the immune system here). The human immune system is amazingly complex, and a semester college course can’t come anywhere near providing a full understanding of it, so I’ll be hard pressed to offer a full explanation here and now, but the nutshell is this: When a foreign thing enters t

The Air is Not Your Enemy - A Commentary

[Warning: This post strays from the typical fictional format on this blog.]



I am an ER physician in Jacksonville, FL.

I learned a few days ago that a top health official in New Zealand was reprimanded for taking his family to the beach. He did this after orders had been given to stay home and strict social distancing had been mandated. This was not his only offense - he was also reported to have been seen riding his mountain bike. New Zealand's outbreak has so far appeared to be reasonably contained, and this is very commendable, but I'd like to take a minute to think about this.

Social distancing works. The less contact we have with other people, the less the novel-coronavirus can spread.

But why is social distancing helpful?

The recommendation to keep six feet of distance between people comes from studies that have investigated the radius of droplet spread that occurs when an infected person coughs, sneezes or talks. The droplet leaves the infected person's mouth or nose, travels a few inches or feet away, then drifts down onto a surrounding surface where it can remain infectious for varying amounts of time depending on the type of material on which it alights. Transmission typically takes place when a person in close proximity either directly inhales droplets before they land, or touches a surface on which they have deposited and then takes that same hand to their own mouth, eyes or nose.

If you are indoors, these droplets may land on the floor. Unless you randomly decide to do a handstand or take a nap on the floor, these particular droplets pose no significant risk to you. And if you are outdoors? Now the droplets will land on pavement, sidewalk, grass, dirt, or sand, where they will disperse or fall into nooks and crannies. Even if you did an immediate handstand, righted yourself and rubbed your fingertips against your itchy nose, the likelihood of recovering an infectious dose would be exceedingly small. Virus particles cannot reproduce without the machinery of our cells, so they can’t grow in the dirt like mold can, they simply degrade. Now add in UV light, which is known to degrade viruses, including the coronavirus, winds, ocean waves, etc., which further degrade and disperse the particles, and our chances of infection go down from negligible to minuscule.

This leads us to the logical conclusion that the outdoors is not dangerous. The air is not teeming with virus, and you cannot get infected from simply walking on the beach, even barefoot. During Spring Break. In Fort Lauderdale.

Why, then, was this New Zealand official punished for riding his mountain bike? By it's very nature, bicycling demands social distance. Even if you drift within six feet of another biker, as long as you are moving, winds will whisk away any potentially infectious bits of spittle that you may inadvertently let loose.

Likewise, a trip to the beach is not inherently dangerous to anyone. It is fair to presume that this New Zealand health official is routinely in close proximity to the members of his immediate family, and that when they obey the rules and stay home, they repetitively touch the same surfaces, and maybe, even, touch each other. Moving this small group to the outdoor setting on an open beachfront, with plenty of UV light (which, as already mentioned, destroys the infectivity of coronavirus) and the ability to choose an appropriate space to keep the family group out of direct contact with others, is not only safe to do, but healthy for the body and mind. 

Images of hordes of young people enjoying spring break while packed onto the beach in South Florida, falling over each other, dancing and partying, seemed to give the world the idea that this is a typical beach day around the globe. Cries of "close the beaches!" sprung up everywhere. A more logical cry would have been "close the party beaches!" Wide stretches of sandy oceanfront, sans parties, are actually a great area for solitary, socially distanced activities that can be carried out with absolutely no risk to anyone. Surfing, like  bicycling, is a naturally solitary activity. People are capable of walking and running on neighborhood streets without encroaching on the safe space of those around them, so why is this not okay on the beach?

Florida is now under a stay home order, permitting essential business to continue operations and individuals to continue essential activities (consistent with social distancing guidelines) such as walking, biking, hiking, fishing, hunting, running or swimming. Predictions are that Florida will experience more infections and deaths than areas that instituted stay at home policies sooner, but the point is to limit contact with other people as much as possible. Prohibiting outdoor, properly distanced activities can only serve to feed into the anxiety, stress, and fear that is rampant among the human population as a result of the coronavirus itself as well as the extreme measures that have been undertaken to control it. Lost wages, lost jobs, social isolation, uncertainty about our economic future and fear of illness and death are taking huge tolls.

Although the New Zealand government no doubt has public well-being in mind when restricting the citizens from outdoor activities, it doesn't make sense when viewed from the standpoint of what they need to be protected from.  After a month of closure, I am thrilled that our beaches and parks are now reopening for appropriate, socially distanced activities.

My advice, as an ER physician, as fearful if not more than any of you, is to GO OUTSIDE. Go for a walk or a run, ride your mountain bike or any other bike that you have, go surfing, take a hike, go fishing, get on your paddle board, or meet your personal trainer at a nearby park. 

Just please, don’t be afraid of the outdoors. It is not your enemy. The air is not your enemy. 

Your enemy can be defeated by responsible social distancing and rigorous hand hygiene. 

Do that. And behave when you go to the beach so you don't ruin it for the rest of us.

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