15-07-2021

tHursDAy, July 15, 2021
5
The pandemic habit that should be kept
JAnE E. BroDy
After a year of obsessive 20-second hand-washings
every time I touched something from outside my
home, I think I should have stocked up on hand
cream, not toilet paper, at the start of the pandemic.
It was certainly not a good time for CVS to
discontinue my favorite product, Healthy Hands
lotion, which could have kept my skin from
resembling sandpaper these many months.
Nonetheless, I don't regret this habit that, along
with consistent mask-wearing and social distancing,
helped me remain hale and hearty while waves of
Covid-19 ravaged New York City. Not only did I stay
free of the coronavirus, I never even got a sniffle
despite daily outdoor exercise and dog walks and a
stubborn refusal to let others do my grocery
shopping.
Now, with many people seeming to have caught a
cold in recent weeks as we get back into the world
and drop our guard, it's a good reminder that we
shouldn't drop the hand-washing habits we learned
during the pandemic.
On average, our hands come into contact with
many hundreds of surfaces a day, exposing them to
hundreds of thousands of microorganisms.
Fortunately, most are innocuous. Still, given that we
touch our faces about 16 or more times an hour,
without proper hand hygiene, we risk the chance of
introducing a not-so-harmless infectious organism,
including the Delta variant of the coronavirus, into
our mouths, noses or eyes.
Last year, the Centers for Disease Control and
Prevention and just about every public health
specialist emphasized repeatedly that handwashing
with soap and water for at least 20 seconds,
or using an alcohol-based hand sanitizer when soap
and water are unavailable, is the first line of defense
against the spread of Covid-19.
The agency recommends using clean running
water (warm or cold), plain soap (not antibacterial),
lathering up, then rubbing hands together, front
and back and between fingers. After the 20-second
lather, rinse hands well to remove dirt and germs
and minimize irritation. Then either air-dry for 20
seconds or use a clean towel to dry them; wet hands
are vectors for transferring germs.
Before Covid and the resulting reminders at every
turn of the importance of good hand hygiene,
American hand-washing habits left much to be
desired. In an online survey of 1,000 nationally
representative members of American adults in
2012, 71 percent of respondents said they washed
their hands "regularly," whatever that may mean
As we get back into the world and the germs that inhabit it, we shouldn't drop the hand-washing
habits so many us adopted in the Covid era.
Photo Gracia lam
(maybe only once a day!). Fifty-eight percent said
they'd seen others leave a restroom without
washing; more than half said they did not wash after
being on public transportation, using shared
equipment or handling money, and 39 percent
(most likely a gross underestimate, based on
personal observation) admitted to not washing after
they sneezed, coughed or blew their nose.
Even health care workers have not always been
diligent. A team from Britain and Australia reported
in the Journal of Clinical Nursing last year that "as
nurses, we are aware that hand-washing has not
always been taken as seriously as it should, with
compliance and adherence in clinical settings far
from optimal over time." According to multiple
reports from different countries, before Covid,
compliance with hand-hygiene guidelines among
nurses averaged only 40 percent, the team noted.
"Although this is a simple and lifesaving task, it is
not, regrettably, always undertaken," they wrote.
They urged that the current attention to handwashing
prompted by Covid-19 be continued
throughout communities, as well as among health
care professionals, "once the pandemic is over."
Washing one's hands after using the bathroom is a
universal recommendation, for good reasons. It's
been shown to reduce the incidence of diarrhea by
as much as 40 percent. The coronavirus can be
transferred through stool, and a single gram of
human feces can contain a trillion germs.
Chances are your parents and teachers taught you
to wash your hands before eating. I often recall an
amusing interchange I witnessed at a friend's house
years ago. When she called her 4-year-old son in for
supper and told him to wash his hands, he went
straight to the kitchen sink. "Not there, in the
bathroom," the exasperated mom said, to which the
boy replied, "Is this a sink, or isn't it?"
The Jewish tradition calls for hand-washing
before the blessing that starts a meal, and during
the Passover Seder, hands are washed twice: once
before eating the bitter vegetable dipped in salt
water and again before blessing the matzo. The
Talmud states: "Any food that is dipped into a liquid
requires washing of the hands before it is eaten"
because the liquid could become contaminated and
transfer a noxious organism to the food.
Muslims, who are told they must be clean before
presenting themselves to God, also perform ritual
hand-washing. Each hand (among other body
parts) is supposed to be washed three times before
prayers.
Surgeons, however, most likely win the handwashing
award these days. Surgical gloves did not
exist when the 19th century surgeon Joseph Lister,
whose name was co-opted by the product Listerine,
demonstrated that preoperative disinfection was
the key to preventing infections in surgical wounds.
Hand-washing with soap and warm water, often
with a brush, for five minutes became an accepted
protocol at the end of the 1800s.
However, the introduction of sterile gloves did not
render thorough hand cleansing by surgeons
irrelevant. After surgery, some 18 percent of gloves
have been shown to have tiny punctures that are not
noticed by surgeons more than 80 percent of the
time. And when an operation lasts two hours, more
than a third of the surgeons' gloves are likely to have
holes.
Thus, anyone likely to touch the surgical field is
supposed to scrub up to the elbows and under every
fingernail for five minutes to reduce the risk of
contamination. The goal is to eliminate
microorganisms that inhabit the hands and inhibit
the growth of bacteria under the surgeon's gloves.
Surgeons are taught to use warm water, which
enhances the effectiveness of soap. They're told to
avoid very hot water because it removes protective
fatty acids from the skin, a good lesson for us all.
In an Op-Ed in March on "The Neurology of
Handwashing" in Medpage Today, Dr. James
Santiago Grisolia of Scripps Mercy Hospital in San
Diego described hand-washing as a kind of
neurological sedative. "Washing the hands
resonates deeply within our brain, sounding deep
notes of acting with care and integrity in a dirty,
sometimes dangerous world," he wrote.
To minimize the tedium of watching the clock or
counting to 20 every time you wash your hands,
experts suggested singing the Happy Birthday song
all the way through twice to achieve full ablution.
However, Dr. Grisolia, citing a Covid-19 baby bust
and the fact that in less than a year the pandemic
spread throughout the world, suggested that a more
timely mantra might be to sing the chorus to "It's a
Small World (After All)."
Giving careto adult children
struggling with mental health
the CDC said the more transmissible and lethal variant is spreading rapidly in communities
with low vaccination rates.
Photo: Bryan
Scientists give clue ondelta
variant of coronavirus
APoorvA MAnDAvilli
The Delta variant of the coronavirus
can evade antibodies that target
certain parts of the virus, according
to a new study published on
Thursday in Nature. The findings
provide an explanation for
diminished effectiveness of the
vaccines against Delta, compared
with other variants.
The variant, first identified in India,
is believed to be about 60 percent
more contagious than Alpha, the
version of the virus that thrashed
Britain and much of Europe earlier
this year, and perhaps twice as
contagious as the original
coronavirus. The Delta variant is now
driving outbreaks among
unvaccinated populations in
countries like Malaysia, Portugal,
Indonesia and Australia.
Delta is also now the dominant
variant in the United States.
Infections in the country had
plateaued at their lowest levels since
early in the pandemic, though the
numbers may be rising. Still,
hospitalizations and deaths related to
the virus have continued a steep
plunge. That's partly because of
relatively high vaccination rates: 48
percent of Americans are fully
vaccinated, and 55 percent have
received at least one dose.
But the new study found that Delta
was barely sensitive to one dose of
vaccine, confirming previous
research that suggested that the
variant can partly evade the immune
system - although to a lesser degree
than Beta, the variant first identified
in South Africa.
French researchers tested how well
antibodies produced by natural
infection and by coronavirus vaccines
neutralize the Alpha, Beta and Delta
variants, as well as a reference
variant similar to the original version
of the virus.
The researchers looked at blood
samples from 103 people who had
been infected with the coronavirus.
Delta was much less sensitive than
Alpha to samples from unvaccinated
people in this group, the study found.
One dose of vaccine significantly
boosted the sensitivity, suggesting
that people who have recovered from
Covid-19 still need to be vaccinated to
fend off some variants.
The team also analyzed samples
from 59 people after they had
received the first and second doses of
the AstraZeneca or Pfizer-BioNTech
vaccines.
Blood samples from just 10 percent
of people immunized with one dose
of the AstraZeneca or the Pfizer-
BioNTech vaccines were able to
neutralize the Delta and Beta variants
in laboratory experiments. But a
second dose boosted that number to
95 percent. There was no major
difference in the levels of antibodies
elicited by the two vaccines.
"A single dose of Pfizer or
AstraZeneca was either poorly or not
at all efficient against Beta and Delta
variants," the researchers concluded.
Data from Israel and Britain broadly
support this finding, although those
studies suggest that one dose of
vaccine is still enough to prevent
hospitalization or death from the
virus.
The Delta variant also did not
respond to bamlanivimab, the
monoclonal antibody made by Eli
Lilly, according to the new study.
Fortunately, three other monoclonal
antibodies tested in the study
retained their effectiveness against
the variant.
In April, citing the rise of variants
resistant to bamlanivimab, the U.S.
Food and Drug Administration
revoked the emergency use
authorization for its use as a single
treatment in treating Covid-19
patients.
JuliE HAlPErt
Katie Bradeen of Colorado Springs, Colo.,
began to worry about her 20-year-old
son, Ryan, when he came home for
Christmas break of 2020. She said he had
a "gray demeanor" and "he seemed to be
in slow motion."
Though Mr. Bradeen was on campus
for his sophomore year of college, the
social distancing and virtual classes
during the pandemic were challenging,
especially for him as a theater major. The
winter of 2021 "was even more difficult
and excruciating than the fall 2020
semester," he said.
His mother didn't think he'd be open to
a face-to face conversation, so she left a
note on his pillow, written on pink heart
stationery. She said she wouldn't pry, but
was "available to listen anytime he
wants." Mr. Bradeen said that he had
been wanting to get counseling for a
while but his mom's raising the issue
made him feel he had the "thumbs up."
He started therapy early in 2021, and his
mother said she can already see the
difference; there's "more laughter and
jokes, less grumpiness."
Many parents like Ms. Bradeen were
navigating the sticky territory of how to
help young adults with mental health
issues long before Covid-19. But the
pandemic brought greater challenges,
taxing already-vulnerable young adults
even more.
Data from May 26 to June 7 from the
Centers for Diseases Control and
Prevention's Household Pulse Survey
shows that 43.6 percent of adults 18 to 29
experienced symptoms of an anxiety or
depressive disorder in the previous seven
days. The National Center for Health
Statistics partnered with the Census
Bureau on the survey questions, which
are based on self-reporting and are not a
clinical diagnosis; the data are weighted
to be nationally representative.
The American Psychological
Association's 2020 Stress in America
survey found that 34 percent of those 18
to 23 said their mental health has
worsened compared with before the
pandemic, a number higher than any
other generation. Risa Garon, a licensed
clinical social worker in Silver Spring,
Md., and executive director of the
National Family Resiliency Center, has
seen in her practice that the pandemic
has caused many young adults to lose
"the rhythm of living," she said.
Even before the pandemic, many
young people struggled with major
student loan debt, overall economic
uncertainties and unrealistic
expectations of success from social
media, Ms. Garon said. Then Covid-19
hit, with its mandated isolation
disrupting friendships and romantic
relationships. It doesn't always go as well
as it did for Ms. Bradeen and her son. Ms.
Garon said it can be common for adult
children in her practice to brush off a
parent's suggestion that they need help.
David Palmiter, a professor at
Marywood University with a private
practice in Clarks Summit, Pa., and
author of the book "Working Parents,
Thriving Families: 10 Strategies That
Make a Difference," said that if a parent
tries to intervene the wrong way, it could
"drive a wedge in the relationship with
the child."
But there are effective strategies that
can at least open the door to a young
adult receiving help if parents see signs
that their child is struggling.If children
aren't local, Dr. Palmiter said, parents
could arrange a weekly phone call or
FaceTime and wait to establish that
connection before broaching the subject
of getting help.
Ms. Garon said that if parents fear that
a young adult may be suicidal or likely to
harm others, it would be appropriate to
act immediately and call 9-1-1.Parents
should avoid the temptation to lecture,
which comes across as criticism and may
shut down communication, Dr. Palmiter
said. Instead, he suggested a sequence he
called "pain, empathy, question." Start by
asking questions that help parents
understand how the young adult is
hurting, with language like: "How's your
mood these days? You're doing so
much."
The next step, empathy, can promote
more open sharing. If a child complains
that their boss is yelling at them all the
time, don't step in and try to problem
solve. Instead, say, "It's terrible to go into
work and be yelled at when you're
working as hard as you are. I'm sorry
you're experiencing that." Then the
parent can raise the issue of getting
support.
If this does not lead to a child being
more open to help, he said don't fight it.
Instead say, "If you ever change your
mind, I'd be happy to partner with you in
thinking about possible solutions."
Laura Dollinger, of Beaver, Pa., tried
this approach. She began to worry about
the mental state of her daughter Emily
after two distressing events: the breakup
with her boyfriend in November of 2018
and the loss of one of her best friends in a
car accident in February 2019. A straight-
A student, Emily, now 19, said that she
began to push "people away, slept a lot,
skipped classes, and made friends with
people who filled their own voids with
unhealthy things." Concerned about her
daughter, Ms. Dollinger got a
recommendation for a good therapist.
"My mom presented it in a
nonthreatening way; I knew she cared
about me and loved me," Emily Dollinger
said. She took the recommendation and
said her counselor helped her to develop
healthy coping skills, which she used in
dealing with a recent breakup. The
difference therapy made "was night and
day," Laura Dollinger said.
Expert advice on how to gently offer help and compassion.
Photo:
Andrea D'Aquino