Care fatigue

Last Wednesday I started to talk about the surge in COVID-19 cases and why contact tracing is so important, not just tracing how infections started and spread but also publicizing the findings, without mentioning names of patients and communities (or, increasingly, offices).

I gave examples of some of the infection clusters, underscoring how we are blindsided by events that we don’t associate with COVID-19 but which can be superspreaders: cockfighting, private parties, even a barkada basketball or volleyball game. I also warned about karaoke, what with people huddled together, singing at the top of their voices and sharing microphones.

Let’s move on now to workplaces. You may have read about clusters of infections among MRT staff, as well as several government and private offices. I suspect that amid all the information and communications campaigns, there are risks that are not even discussed, putting people in harm’s way.

Like karaoke and birthday parties, there are activities that we take for granted because they’re so much a part of culture. Take for example the habit of establishments, especially Japanese restaurants, to shout out greetings and goodbyes to customers. A few seconds wouldn’t be so dangerous, but if there are many customers coming in and out of the restaurant, the shouted greetings can be frequent, and diners, without their masks because they’re eating, might be endangered.

I worry, too, about how we Filipinos like to sing, anywhere, any time, and sometimes almost as if we are competing.

I’ve seen American advisories on reopening offices suggesting getting rid of, or reducing, muzak—background music—because it makes it harder for office staff to hear each other, and makes them end up raising their voices. For the Philippines, I’d add on the problem of muzak making office staff sing along!

Workplaces (including public transport) are riskier than our homes because you bring together people from various places, and of unknown COVID-19 status. But don’t let your guard down with your homes. If you have household staff (including security guards) who live out, they have to be reminded about precautions when they arrive at work, and also before they leave to return home.

You need even stricter precautions for people who come into your homes to do stuff like repairs and construction. I have to move out of UP this week and have prepared shields for the movers, knowing it’s hard to breathe through masks while carrying heavy boxes and furniture.

Don’t forget possible transmission through phones. No, the virus doesn’t travel through the air or phone lines. Rather, you may as well be kissing someone with whom you share a phone. Do not share cell phones. As for landlines, reduce their use for now. Have disinfectant wipes on hand, just in case you have to use them.

You might have read about the World Health Organization being pressured by scientists to declare that airborne transmission is possible for COVID-19. I am worried that this might rekindle fears of the virus being “in the wind (nasa hangin),” which is not what the medical people are referring to. They’re talking more about indoor air, and it still goes back to droplet and aerosols. I will write about this in greater detail next week.

For now I want to emphasize that we shouldn’t be worried about the winds carrying in the virus from the next barangay with a COVID-19 outbreak. This means physical distancing and masks are still the most effective ways of cutting down transmission, but the use of masks can become problematic because of something called care fatigue. After several months of quarantine and nonstop messages in media, we tend to forget to use masks, and to use them properly. Last month, I did an informal study of mask use in a busy street in Quezon City and, while almost everyone had masks on, many had the masks covering only the mouth… or the chin!

I wanted to mention, too, at least two local infection clusters involving health care facilities, where it’s becoming clear that infections did not come from patients but from fellow health workers, possibly while they were socializing during off-duty periods. Of course you have to lower the masks to eat or drink, but if you are not sure if you yourself, or your friends, have been exposed, you must do physical distancing, and put the mask back on to cover your mouth and nose as soon as you’re not eating.

In these times, the advice shouldn’t just be “Don’t let your guard down,” but also “Don’t let your masks down.”

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