Andrea Amelse knows hand-washing.
For eight years, she’s been washing her hands pretty much every time she passes a sink. When she’s near a bottle of antibacterial gel, she uses it.
She makes a point of avoiding people with contagious illnesses, even though it can be uncomfortable to ask to work from home or miss a date with friends. And she makes sure she gets plenty of sleep, not always easy at 25.
Amelse was diagnosed in 2012 with lupus, an autoimmune disease that makes her vulnerable to infections. She has since developed pulmonary arterial hypertension, a condition that requires intravenous therapy via a central line to her heart.
Both illnesses place her at a heightened risk for viral and bacterial illnesses. So she has adapted as a matter of survival, taking to heart longstanding axioms on what constitutes good hygiene.
As the highly contagious new coronavirus continues its spread, a lot of people probably could learn a thing or two from Amelse and the millions of other Americans with weakened immune systems — whether it’s from chronic diseases or chemotherapy or recent organ transplants — who already live by rules of infection control.
The United States has a broad range of people who are immunosuppressed and who long ago adopted the lifestyle changes health and government officials now tout as a way to try to avoid contagion:
- Wash your hands — often.
- Don’t touch your face.
- Avoid handshakes.
- Keep a distance from people who cough and sneeze.
Amelse doesn’t follow the advice perfectly. Of course, she says, she touches her face at times.
“You do these things unknowingly, so forcing yourself to break these habits can be challenging,” she says.
But the incentive to keep getting better is especially strong for her: “If you get a cold and you give me that same cold, you might get it for a week. I’ll get it for a month.”
Even with her dedication, COVID-19 is proving a daunting prospect. And she has a stake in Americans adopting these habits because, while the disease is relatively minor for many people who get it, it can be life-threatening for people with preexisting health conditions.
Amelse works at a health literacy startup in Minneapolis that helps people with complex diseases learn about their illnesses. She knows a lot about health and how to prevent infection. Still, the threat of COVID-19 is unnerving for her and her doctors.
With a virus so new, guidance on what people at heightened risk should do to steer clear of COVID-19 is limited. But the federal Centers for Disease Control and Prevention has said the virus seems to hit hardest in people 60 and older with underlying health worries. There’s also concern for younger people with limited immune systems or complex diseases.
Health officials are asking those at risk to:
- Stockpile two-week supplies of essential groceries and medicines in case they might need to shelter at home.
- Avoid crowds and heavily trafficked areas.
- Defer nonessential travel.
- And track what’s going on in their community so they know how strictly they’ll need to follow this advice.
Infection control always follows a similar set of principles, says Dr. Jay Fishman, director of the Transplant Infectious Disease and Compromised Host Program at Massachusetts General Hospital, who’s a professor at Harvard Medical School. The most important things for people to do now are the things he always recommends to his organ transplant and cancer patients. Again, think hand-washing and avoiding spaces where sick people congregate.
Some people are born with stronger immune systems, and immune deficits exist on a spectrum, Fishman says. How strict people need to be to prevent illness can vary depending on how susceptible they are.
Recommendations also need to take into account what people can and will do, he says. Kids are among the greatest germ vectors of all time, but Fishman doesn’t ask his patients with grandchildren to stay away from their young family members.
“We did the transplant so you can see your grandchildren,” he might tell them.
Similarly, avoiding crowds and staying away from sick people is easy for some but all but impossible if, say, you work in food service. So you need to try to find ways to avoid the risks and reduce them where possible.
There isn’t great research on how well transplant patients and others manage to prevent infection.
Fishman says many of his patients don’t get sick any more frequently than the general population despite their vulnerabilities. But when they do, the illnesses tend to last longer, be more severe and put them at higher risk for additional infections. He counsels them to be vigilant but also to live their lives and not be ruled by fear.
Gauging risks can be tough. Amelse was relieved when a major health conference she was scheduled to attend in Florida was canceled. She wasn’t sure it was safe to travel, but it also was unclear how to categorize an important work trip: Was this essential?
While much has been made of hoarding sprees for face masks, which aren’t recommended for most people, the empty hand sanitizer shelves she has seen are equally frustrating for Amelse. Every 48 hours, she has to mix and administer drugs she places in an IV that goes into her heart. Everything must be sanitized, and she typically gets monthly shipments of antibacterial wipes and sanitizer. If suppliers run out, she’s worried she’ll have to go to a hospital to have the drugs administered — exactly where her doctors don’t want her to be.
Officials are desperately working on a vaccine for the coronavirus for use in as little as 12 to 18 months. But many vaccines are made from live viruses and can’t be given to some immunosuppressed people.
Given the risk COVID-19 poses for people with compromised immune systems, the government needs to stress how important it is for everyone to follow good hygiene protocols, Fishman says: “The worst thing we can do is downplay it.”
For those just getting up to speed on preventing infections, Amelse says this: “Viruses don’t pick and choose. They will latch on anywhere.”
So even if it’s not a serious illness for you, “There are people in your life that you can infect. You have the obligation and the responsibility to take care of your loved ones.”