Update on Behavioral Prevention of the Spread of Coronavirus

by Tia Will

The following is a summary of recent information on the transmissibility of the coronavirus and my current thoughts on how best to protect ourselves, both on the individual and community level from viral spread.

Primary means of respiratory viral spread:

  1. Sneeze –“The largest droplets rapidly settle within 1 to 2 m away from the person. The smaller and evaporating droplets are trapped in a turbulent puff cloud, remain suspended, and, over the course of seconds to a few minutes, can travel the dimensions of a room and land up to 6 to 8 m away.” – New England Journal of Medicine
  2. Cough – believed to spread droplets up to six meters
  3. Loud talking/ singing – forceful exhalation of air as in shouting, loud speech, singing tends to send smaller aerosolized particles further than 6 ft – exact distance unknown
  4. Surface transfer – demonstrated to be significant in studies assessing transfer of substances meant to mimic droplets on objects such as shared serving instruments at buffets, cutlery, napkins, table cloths, door knobs, light switches with implications for subsequent transfer to one’s face. However, this transfer seems to require a significant amount of virus on the surface and is felt to be very unlikely from home deliveries, food packaging and items purchased from grocery stores.

Other important factors:

  1. Time – brief encounters carry less risk. Encounters such as walking past another person or jogging are not even considered significant encounters by many researchers. Being even socially distanced for extended periods of an hour or more is considered significant.
  2. Ambient conditions – outside with appropriate distancing is safest due to dispersal of particles by air circulation and distance.
  3. Enclosed spaces with poor ventilation such as small bars/restaurants/airplane cabins/cruise ships are likely to represent increased risk.

Means of protection:

  1. Vaccine – not yet available for this coronavirus
  2. Specific medications either preventative or curative– not yet available
  3. Behavioral
  4. Isolation – critical for those who are either culture-positive or who have strong clinical indication of COVID-19. A good idea for those at high risk of a serious course of the disease, early thought to only include seniors and those with significant medical problems or undergoing treatment which could affect the immune system. However, more recent information suggests that as many as 20% of individuals hospitalized have been under 50 and approximately 12 % of those have required ICU care. Also, of concern although still rare is the presence of a Kawasaki-like inflammatory disease which has been found in association with coronavirus positivity in children under the age of 16.
  5. Social distancing – the practice of maintaining a protective distance, usually defined here as 6 feet apart based on early droplet studies.
  6. Hand washing with soap – useful for removal of virus thus preventing transfer from high-touch surfaces to one’s face or other surfaces.
  7. Face coverings

Those who have read my previous articles know that while I initially thought face covering was a good idea, I also believed there was not enough evidence to support mandatory face coverings outside a medical setting. Three circumstances have changed my mind.

  1. The existence of asymptomatic spread. Unlike colds and the seasonal flu, the novel coronavirus is unique in having been demonstrated to have significant asymptomatic spread, meaning that an individual may never show signs of infection and still transfer the virus by any of the above means.
  2. Pre-symptomatic spread. This is the ability of an individual who is destined to develop classic COVID-19 symptoms to transfer the virus prior to exhibiting any symptoms.
  3. The existence of atypical presentations of COVID-19 including abdominal pain, vomiting and diarrhea as presenting symptoms.
  4. Additional studies supporting the efficacy of near universal use of masking in prevention of community spread.

Types of masks:

  1. N95 masks – named due to their ability to block passage of 95% of viral particles in previously known respiratory illnesses. Capable of protecting both the wearer and contacts from droplet and aerosolized particles. Must be fitted and tested to be effective.

In our current setting, appropriate only for first responders and medical personnel.

  1. Surgical masks – Intended to be single use and primarily protect contacts from the wearer although they also serve as a physical barrier of protection for the wearer from bodily fluids of patients. Like N95s, due to current conditions, appropriate for medical personnel.
  2. Cloth face coverings – while not effective in protection of the wearer, have been shown to decrease risk for individuals encountered by the wearer. Most effective when usage is is between 80-100% of the population, and when enacted early in the outbreak. In addition to articles previously linked by Richard McCann and Robert Canning, a recent article sent to me by David Greenwald: Mask Study has led me to agreement with the following recommendations, mostly from the article, in addition to isolation of high risk groups, social distancing, personal hygiene, testing and tracing.

Additional current recommendations:

  1. Mandatory masking in high risk settings such as public transportation, shops, areas where social distancing cannot be maintained.
  2. Mandatory masking for workers in essential services.
  3. National availability of adequate masking for the entire population in times of pandemic
  4. Cloth face coverings should be encouraged for nonmedical personnel until such time as PPE becomes readily available for first responders and medical personnel.
  5. Clear messaging from the government should occur early in an outbreak and convey the reason for face covering as the protection of all members of the community, not just the wearer or those deemed most vulnerable.
  6. These relatively simple measures: isolation when ill, social distancing, alternatives to hand shaking, increased hand washing and facial covering, if considered the new normal, could prevent the spread of the novel coronavirus, & also prevent transmission of viruses responsible for the common cold, seasonal flu & the next, and inevitable, pandemic.

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About The Author

Tia is a graduate of UCDMC and long time resident of Davis who raised her two now adult children here. She is a local obstetrician gynecologist with special interests in preventive medicine and public health and safety. All articles and posts written by Tia are reflective only of her own opinions and are in no way a reflection of the opinions of her partners or her employer.

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  1. Bill Marshall

    Good morning Chicken Little…

    These relatively simple measures: isolation when ill, social distancing, alternatives to hand shaking, increased hand washing and facial covering,if considered the new normal, could prevent the spread of the novel coronavirus, & also prevent transmission of viruses responsible for the common cold, seasonal flu & the next, and inevitable, pandemic.


    So, social distancing (good luck dating, falling in love, greeting close relatives [not living with you] with a hug), alternatives to hand-shaking (I’m good with knuckle bumps, but I have Dupetryns, so that’s easy), and permanent facial covering until one dies (and, perhaps beyond that!) is the “new normal”?

    Not a world I want to live/love in… just me…

    And with all the restrictions outlined, to prevent even colds and flu, how would an individual, or ‘the herd’ ever get resistance/immunity?  Best way to induce a pandemic!

    But I don’t mind if the anti-vaxxers are isolated (might be carriers), maintain social distance (the exaggerated 6-8 meters away should be the minimum), avoid hand shaking (no problem there, would not even want to shake hands with them), and have to be like “bubble-boy”…

    1. Tia Will


      I may be a rarity. I am an individual who is not tightly wedded to the way things have “always been”. Maybe because I have traveled a fair amount, I can see the value of alternatives that might work better and would be willing to adopt them.

      For example, in Japan, it is the custom, not a rarity, for an individual who feels “a little off” to wear a face mask for the protection of others. There is no “fear or panic” involved. It is what they do for the well being of their community. They also do not seem to lack immunity any more than we do. Another example from Japan. A small bow is a frequent greeting instead of a handshake or fist bump. A sign of respect, friendship, and camaraderie all in one.

      In France and Spain ( although the latter was a long time ago) many greetings, especially between women were done with bilateral “air kisses” rather than any actual physical contact.

      My son, who I had not seen in about a month, visited a few days ago. His partner works in an assisted living facility. He is protective of my partner and me.  He did not come into the house. He was masked. We shared a “virtual hug” when he arrived, sat on our patio socially distanced, and when he left shared another virtual hug. I can live without the hug much better than I can with the thought of contracting a circulating killer for folks in my age group. We will all have many choices to make in the next year not only about how much risk we are willing to take personally but also how much risk we are willing to subject others to just to restore “the way things were”.


    2. Alan Miller

      Not a world I want to live/love in… just me…

      W/M, I really don’t understand your attitude at all.  This is a war.  That isn’t an over the top statement.  The virus, or our reaction to it, has stopped the world.  It’s humans vs. virus.  This is no hoax and no conspiracy.  While each country (even each county) is reacting differently, none are ignoring this or not taking it seriously.  Indeed, this is dead serious.

      Not a world you’d like to live/love in?  Since when do humans get to choose when humans are at war?  Did wives and children not want to live/love by the terms of the Germans and Japanese during World War II, having loved ones leave and often die?  Did they get to say, “I don’t want to live/love in such a world” and bow out?   The virus defines this.  Yes, we define our response to it, but pointing at people who are taking this seriously and saying “you are chicken little” is ridiculous.  With chicken little, the sky wasn’t actually falling.

      War is real.  The inability of some people to conceive of an invisible, soul-less enemy that tricks people by spreading asymptotically and with days without symptoms rather blows my mind — but it is making so many feel invincible, or believing it will only spread in ghettos and nursing homes.

      I so want to be rude again, but I’d probably have to apologize again.


      1. Bill Marshall

        Virus and bacteria comes and goes… part of nature… usually starts with animals, or their parasites… fact of life, fact of science…

        The great plagues were caused by bacterium (Y Pestis)… per capita, those were much more devastating… because of lack of knowledge, it was often blamed on a certain ethnic group… ironic, as their sanitary habits were better than the masses…

        It is a ‘war’… and when some innocent folk were being murdered in Europe (gypsies, homosexuals, metally ill, and yes, Jews) and Asia (mainly raped, as in Nanking)… but the US government was slow to react, and join in the war… by years…  yet, even tho’ folk made sacrifices to win the wars, they kept the economy open… which led to winning those wars and stopping the slaughter of the ‘pestilence’…

        If WWII folk were banned in the US from participating in the ‘wars’, by staying in place, no travel, well, you can figure out what that outcome would have been…

        Ironically, the ‘Spanish Flu’ and many of the plagues, came as the aftermath of ‘wars’… second wave, as it were… fear and deprivation were precursors…


        1. Tia Will


          You just made a very good case for not downplaying the problem and acting early. I agree the US should have joined the allies much sooner than we did. I also believe that this administration and its supporters should have, and should now admit the seriousness of the current threat and act more cohesively and consistently to contain and resolve it.

          One other point. You are right. This virus is a part of nature. But the word “natural” does not equal “desirable”.

          Heart attacks, strokes, diabetes, and cancer are all “natural”. We accept that we do not want any of them and devote large amounts of money to detect and defeat them.

          So what, other than politics makes this community health threat any less dangerous or undesirable?

  2. John Hobbs

    Thanks Tia, this morning I had a necessary in-person appointment with my cardiologist. After donning my bandana mask and gloves I left the safety of my car and went into the building. I took the earliest appointment in hope of avoiding as many people as possible in the elevator and waiting room. to that end I was successful, but 45 minutes later as I left the waiting room was packed, nothing close to six-feet between patients and one unmasked 70ish white guy loudly complaining about being asked to wear a mask right in front of the reception desk where I had to pass. Bloviating blatherskites like that may be major spreaders of the virus. I waited until he finally stepped back before going ahead to the exit. I am keeping my face and hands covered anytime I leave my home.

    “Not a world I want to live/love in… just me…”

    Hopefully all of the ignoranti will infect each other and die in sufficient numbers to stop dragging the rest of us down.

    1. Alan Miller

      the waiting room was packed, nothing close to six-feet between patients and one unmasked 70ish white guy loudly complaining about being asked to wear a mask right in front of the reception desk where I had to pass.

      Good God.  We are doomed.

  3. Tia Will

    Thanks for sharing your experience, John. Perhaps because of my profession, or perhaps just because I see the world as a creation in flux where I never make the assumption that the way I am used to doing things is the best way, I am hopeful that one thing we will not resume in “getting back to normal” is to always assume that we have an unalterable right to act in our personal own best interest with little thought of others. That is not a normal I want to return to.

    1. Alan Miller

      That is not a normal I want to return to.

      And yet . . . we haven’t even opened up yet, and this is how waiting rooms are in a medical facility, today, before even the first steps towards a new normal?  How is that even possible?  Isn’t this criminally irresponsible on the part of medical facility staff?  [Never mind the selfish f*ck 70-ish white guy]

      1. Tia Will


        I don’t know about “criminally irresponsible”, but I do see it as very poor planning and completely avoidable. It should be entirely possible to have outdoor waiting or ask people to wait in their cars with a device that signals when their provider has a room available much as many restaurants do… or I should say did when there were eat in restaurants.

  4. Alan Miller


    Thanks for the excellent summary.  I wonder if you could run this, with a small bit of streamline editing, as a ‘special’ to the Enterprise, where more people would read it.  Any transmission thwarted could save a suffering or hundred, a life, or more lives.

    I’m glad you have come around on the issue of masks with more evidence coming forward — I know you were reluctant at first — and I appreciate that you are OK to change your mind.

    One thing I would add to your list (and TE probably already said the same thing, I will read comments in a moment), is that masks with open outflow valves are actually dangerous and should not be used.  They protect the wearer somewhat — but the point of masks for everyone to where them in enclosed spaces — to protect everyone else.  The open outflow valves just dump the wearers vapors into the room.

    As well, it must be clearly emphasized regarding the need for “the efficacy of near universal use of masking”.  That means it only works if d*mn near everyone is wearing them.  This creates the need for “near universal use of” giving a d*mn about your fellow human beings, and having half a brain about you.

    Watching whats happening in Georgia, Texas, Florida, Virginia, Sacramento County, what we have is “near universal use of” one’s tonsils, mucus and pancreas for thinking, instead of our God-given grey matter inside our skulls.

    I generally agree with freedom/independence/self-reliance/low-taxes/law&order/etc., and I may be considered a conservative in this town.  But whiney conservatives are co-opting these values for selfish convenience and fail to see we are at war with a virus and would have found World War II was “inconvenient” because of rationing gas and losing children in battle, so let the Germans take over Europe.  Now these right-wing-value imbeciles fail to recognize an enemy and ‘want to see their friends’ and ‘want to get their nails done’ and think ‘it only happens in the black part of town’.  F*ck all y’all!

    And f*ck Sacramento.

    I’m all for re-opening many businesses, but much as I love my local cafes and hair dressers — I’ll do like I do with the latest operating system on my phone — I’ll let all of you be the guinea pigs and see how it goes for awhile first. I believe in what TW says about close contact and enclosed spaces — and even sanitization, universal masks and a prayer won’t change the actual physics of virus transmission. Salons and indoor restaurants sound like a bad idea to me.

    My hair is getting really long.

  5. Tia Will


    A note re personal maintenance. Some are getting creative. My own hairdresser has opened her back porch as her salon…masked and one customer at a time in an open air space. You know how locked down Robert and I are, and I am considering making an appointment for next week.

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