Health Advice

Can We Hug Yet?

At the start of the pandemic, hugs wouldn’t have ranked high on most people’s list of major deprivations. But after months of social distancing, a lot of grandparents, siblings, and loved ones are surely desperate to give one another a good squeeze.

There’s evidence that this urge to hug has deep biological roots. The skin is the human body’s largest sensory organ, as well as the first to develop in utero; we all feel life before we can see, smell, hear, or taste it. Research on newborn-parent interactions has found that a mother’s nurturing touch — holding, cuddling, massaging — plays an important role in infant development and behavior, and the benefits of physical affection seem to persist throughout life. Studies on both kids and adults have found that holding hands, hugging, and other forms of affectionate touching can ease stress and induce measurable reductions in heart rate and blood pressure.

All this helps explain why eschewing hugs may come with real health consequences — especially for those who are isolated from others. But to curb the spread of Covid-19, the CDC and other public health authorities recommend social-distancing measures that discourage hugging.

While some experts agree with these guidelines, others say hugging — especially if people take a few simple precautions — may be a relatively low-risk, high-reward activity.

“If you’re going to hug, just agree not to talk while you’re doing it. And your faces should be lateral — so cheek to cheek.”

What makes a hug “safe?”

Many of the current Covid-19 guidelines are based on science’s understanding of other viruses. When it comes to the novel coronavirus, specifically, the research is inchoate and evolving day to day. This makes it hard for experts to nail down the true risks associated with different behaviors, and not all agree on hugging’s position in the risk hierarchy.

“I never stopped hugging,” says Shanina Knighton, PhD, a researcher, nurse, and infection prevention expert at Case Western Reserve University in Cleveland, Ohio. Knighton says that there is no conclusive data showing that hugging can transmit Covid-19, and that her understanding of how viruses spread suggests that hugging is a low-risk activity — especially if neither person is showing symptoms.

“You do have to be purposeful about how you do it,” she says. For example, talking or exhaling directly into someone’s face during a hug is a bad idea, especially if someone is symptomatic and neither person is wearing a mask. “If you’re going to hug, just agree not to talk while you’re doing it,” she advises. “And your faces should be lateral — so cheek to cheek.”

This advice is in line with the opinions of some other experts. On June 4, the New York Times ran a piece in which an airborne pathogens expert at Virginia Tech used non-coronavirus infection data to model the risk of virus exposure during a hug. That model found that, as long as neither person is talking or coughing during a hug, the risk of transmission is low. The piece also said that keeping embraces short and free of tears is a good idea.

But not everyone agrees. “I think hugging is a substantial risk,” says John Swartzberg, MD, an infectious diseases expert and emeritus clinical professor at the University of California, Berkeley School of Public Health. Swartzberg says that the Virginia Tech scientist’s conclusions in the Times piece are “perfectly reasonable” based on the available data. The problem is that the available data is woefully incomplete. “For example, we don’t know what the infectious dose is — whether it’s one viral particle or 1 million,” he says. “No one really thinks it’s one particle, but anyone who tells you they know what the right number is, is guessing.”

Talking or exhaling directly into someone’s face during a hug is a bad idea, especially if someone is symptomatic and neither person is wearing a mask.

Some research efforts have found that speaking or even breathing can expel virus-containing droplets into the air. “If you’re hugging someone or are in very close proximity, you could inhale those particles,” Swartzberg says. “We know the larger particles we expel tend to drop within six feet, so that’s why we have the six-foot social-distancing rule.”

While he believes that hugging is hazardous, Swartzberg says that everyone “needs to do their own calculus” when it comes to the risks they’re willing to take. “If you’re talking about two young people hugging, the risk of them getting very sick and dying is small, and for children the risk may be approaching zero,” he says. “But if someone is in their seventies or older, the risk could be exceedingly high.”

Knighton, meanwhile, says that huggers likely don’t have much to worry about as long as they’re taking the precautions she described above and are also washing their hands before an embrace. Especially if two people are outdoors where, by some estimates, the risk of virus transmission is many times lower than indoors, she says that any risks associated with hugging are outweighed by the benefits.

“Hugs are essential,” she adds. “They’re an emotional connection we all need.”

To fight COVID-19, get a flu shot

To minimise second wave until there is a vaccine, we must boost rate of flu vaccination

With many nations seeing increasing coronavirus infections, it’s clear that COVID-19 is not leaving us anytime soon. That’s a problem now, and it stands to become an even bigger one this fall, when a return to school and other indoor activities and the onset of flu season threaten to intensify outbreaks.

One essential strategy to minimise COVID-19’s potential second wave and keep the economy going as much as possible until there is a COVID-19 vaccine is to boost the rate of flu vaccination.

This can help build the infrastructure and experience that will be needed to inoculate millions of people against the coronavirus, once those vaccines become available.

Children and older adults are more likely than young adults to be vaccinated. Fortunately for public health, all the hand-washing, mask-wearing and social distancing that people are practicing to prevent covid-19 will help reduce flu infections, too. Boosting the flu vaccination rate would improve the picture much more

Seasonal flu, after all, is one infectious disease that doctors are able to minimise through vaccination. Note that in a typical season, hundreds of thousands of people are hospitalised with the flu, and 12,000 to 61,000 die in the US alone.

Minimising the toll

It’s always important to minimise this toll — but this fall, more than ever. The nightmare scenario would be an exceptionally severe flu season arriving along with covid-19.

Normally, the US fails to meet public health goals for flu vaccination. During the 2018-19 season, only 45.3% of adults got a flu shot. That is above average but below the 70% target set by the Department of Health and Human Services for 2020.

The CDC’s immunisation advisory committee recommends universal flu vaccination to cut individual and population risk, and sees 70% in the general population as an “ambitious but achievable” goal.

Children and older adults are more likely than young adults to be vaccinated. Fortunately for public health, all the hand-washing, mask-wearing and social distancing that people are practicing to prevent covid-19 will help reduce flu infections, too. Boosting the flu vaccination rate would improve the picture much more.

As always, some people will worry that there are risks in getting the flu vaccine. Or they will say it doesn’t work, so why bother?

It’s true that the vaccine is never perfectly protective — and its efficacy varies year to year — but it consistently reduces the severity of flu infections, and thus hospitalisation.

No influenza

And side effects beyond a fleeting headache or soreness around the injection site are extremely rare. An enduring misconception is that the flu vaccine causes influenza. It doesn’t.

Efforts to communicate the value of vaccination — especially for health care workers — should be made broadly, starting now. This year, the case for vaccination is stronger than ever.

Vaccines are especially important in risky environments such as classrooms. School districts should require children to be vaccinated against seasonal flu this year, just as they are required to be vaccinated against measles.

Employers, too, should institute vaccine mandates especially for those working in dense, high-contact environments. Yes, some people would object, but a certain amount of controversy may be the price of protection.

People also need to be assured that they can be inoculated in places where they are safe from contracting COVID-19.

State and local governments should open dedicated vaccination sites, perhaps coexisting with covid-19 testing tents and drive-through centers, and advertise their existence via TV, radio, the internet, direct mail and telephone.

This would help accommodate people who have no primary care doctor or easy access to vaccination at a workplace or college campus. This infrastructure could be repurposed for the rapid distribution of COVID-19 vaccines when they exist.

Who will pay for all these shots? US federal law requires health insurers to pick up the cost of annual flu vaccination, as Medicare does. But Medicaid vaccine coverage varies by state. And as unemployment has shot up during the pandemic, millions have lost employer-based health insurance.

This year especially, it’s important for states and the federal government to work together to make shots free or at least very inexpensive for the uninsured.

The government should also contract with vaccine manufacturers for additional supplies to meet extraordinarily high demand.

There are many ways to prepare for an autumn surge in COVID-19 — from strengthening public health efforts to track outbreaks to stocking up on personal protective equipment for health care workers.

No strategy should be overlooked, especially not a tried-and-true approach to minimising seasonal flu.

Max Nisen is a columnist covering biotech, pharma and health care

Bloomberg

COVID-19: Longer time in bed during lockdowns has worsened sleep quality

The sleep experts have a tip for those whose sleep has deteriorated

London: People are sleeping for longer hours during lockdowns and work from home scenario as they do not need to travel to workplaces but the quality of sleep has become worse in many, reveals new research.

If the differences in sleep timing and duration between work days and days off become too large, this can lead to “social jetlag”.

A latest survey by the University of Basel in Switzerland found respondents admitting sleeping up to 50 minutes longer than before the lockdown. One factor contributing to this could be that people no longer had to commute to work in the morning.

Flexible working hours, no commuting and potentially more time to sleep led to a reduction in “social jetlag”, according to psychologist Dr Christine Blume from the University of Basel.

However, the reduction of “social jetlag” was not paralleled by an improvement in perceived sleep quality.

To the contrary, those surveyed reported that their sleep quality actually deteriorated a little during the lockdown.

This is not very surprising, explained Blume, “as this unprecedented situation also was highly burdening in many ways. Financial and health concerns or stress related to child care are just a few relevant aspects”.

More than 85 per cent of the respondents were working from home at that time. Overall, the participants slept rather well and 75 per cent of them were women.

The survey found that a relaxation of social rhythms – for example, through more flexible working hours – led to a reduction in “social jetlag”.

“This suggests that the sleep-wake patterns of those surveyed were guided by internal biological signals rather than social rhythms,” Blume added.

Many sleep disorders are caused by our modern lifestyle, which is characterised by pressure to constantly perform and be active.

Rhythms of work and leisure activities thus set a cycle that is often at a mismatch with the body’s internal biological clock.

If the differences in sleep timing and duration between work days and days off become too large, this can lead to “social jetlag”.

The sleep experts have a tip for those whose sleep has deteriorated.

“Our findings suggest that physical activity outdoors could counteract deterioration in sleep quality,” they suggested.

CoCare App Can Save Pakistan From COVID-19

Cheetay, in partnership with the Punjab IT Board (PITB) and Conrad Labs, has launched CoCare, a public-private partnership mandated to combat COVID-19 in Pakistan.

CoCare, a multi-functional COVID-19 contact tracing app, will visualize data on the spread of the pandemic in Pakistan, share educational resources on Coronavirus symptoms and preventative guidelines, have an integrated self-diagnostic tool, and will enable access to essential stay-at-home services like testing, medicine delivery, and telehealth.

The app will have both an English and Urdu version and will be free.

CoCare securely and anonymously logs physical proximity between Mobile Phones using Bluetooth technology to trace possible exposure to the virus. Once people anonymously self-report if they have tested positive for the virus, individuals who have been in contact with them are alerted to the potential exposure and advised to look out for symptoms or get tested.

The CoCare app will also allow individuals to actively keep records of contacts or location visits through QR codes; functionality that will be essential for employers and businesses to safely reopen the economy.

“By now we have all come to the realization that we are neither immune nor safe from the Coronavirus. However, given our country’s limited resources, we can’t afford long and chaotic economic lockdowns,” said Majid Khan, CEO of Cheetay.

Contact tracing, rapid and accurate testing, social distancing along with smart mitigation and suppression techniques are the best tools we have to combat the pandemic. CoCare is designed to address this challenge in an organized, creative, and intelligent way of using technology.

As offices around the country are trying to reopen, companies have been concerned about how to effectively limit their employees’ exposure to the virus. “PITB will be recommending that all government institutions and offices adopt the CoCare protocols. We are proud to be spearheading the CoCare public-private initiative. The technology we are creating will be invaluable in ensuring that we can safely reopen our economy,” said PITB Chairman Azfar Manzoor.

Capt (R) Muhammad Mahmood, Commissioner Rawalpindi, the first Government official to recognize the need for such an initiative and endorse CoCare said,

We are now in the thick of the fight, and we’re losing. We need to find intelligent and practical solutions like CoCare to safely navigate through to a new normal. CoCare is by no means a stand-alone panacea but it is a huge step in the right direction.

The Country Director of 47 Ventures, Khurram Zafar who is a strong advocate of public-private initiatives said,

If there ever was a time to step up, to collaborate, to contribute, and put our collective national interest above our own, it is NOW! I am glad Cheetay is leading from the front and reaching out to others who can contribute. That is how we fight this fight and how we win! I am glad to be a small part of this very vital effort.

Abbas Yousafzai, co-founder of Conrad Labs, who helped design the app commented,

CoCare has been developed to a global standard. It is a testament to Pakistan’s rapidly growing tech capabilities that the app was created in record time by some of our best local engineering talents. This is something we can all be proud of. We are using advanced algorithms and best-in-class technology to implement a contact tracing protocol that is very sensitive to privacy protections and maintains the highest levels of anonymity and security.

A number of organizations have provided support for CoCare, including PITB, Conrad Labs, 47 Ventures, Oladoc, Eocean, Sehat Kahani, Eikon 7, ProPakistani, NIC Lahore (Faisal Sherjan), Chughtai Lab, Shaukat Khanum, Healthwire, Rizq, Robinhood Army.

Download the app here.

Information about the app is available at www.cocareapp.com.