by Mitchell Kriegman
Information for Action
She wrote a manifesto, which became flattenthecurb.com. It was originally a Google Doc. Her document was uploaded so fast that it broke the Google drive features. She had no idea who was sharing it. It was just staggering. Then someone reached out to her and said they had reserved the domain flattenthecurve.com and wanted to put her Google Doc up on the website. Now the content has been translated into multiple languages and has more than 130 volunteers working on it. It’s routinely monitored and reviewed by a host of doctors and experts. The site is not political and has become the go-to site for the most up-to-date science-based advice about current best practices. It’s reliable and constantly updated as new discoveries develop.
Remarkably all this content was initially compiled here in Santa Barbara by Julie McMurry. She has a master’s degree in public health from the University of London School of Hygiene and Tropical Medicine, as well as a background in infectious diseases and vaccine development. She is currently an assistant professor, senior researcher, at Oregon State University in the College of Public Health. Communication rooted in science is her specialty. On March 13, which seems like ages ago, she posted a new Google Doc with a few other locals Stay Safe Santa Barbara with a plan for Santa Barbara.
The Montecito Journal talked to her via Zoom in her recently renovated home office with her son, whom she affectionately refers to as Captain America, hovering occasionally and politely in the background.
How We Got Here
- As a health professional you’ve made it a mission to address the flood of disinformation people are hearing about the coronavirus.
- I think it’s important that local people are getting sane and prioritized advice. There’s just a swirl of disinformation and in addition to disinformation, there’s the additional layer of well-meaning people who want to help and heard something. It’s making the lives of the real first responders that much more chaotic and difficult.
Is there an essential message you want to convey?
One of the prevailing messages is “Information for Action.” Information for action is very different than information for its own sake. In public health, a lot of outcomes depend on behavior change. Behavior change is one of the hardest things to do. We know how difficult it is to lose weight, to regularly exercise, to get enough sleep, even though these are all things that are in our best interests. “Information for Action” is the first step toward behavioral change. It can motivate people and empower them to make decisions that are in their own personal interest, and also in everyone’s collective interest. Infectious diseases are one of those situations in which there is a straight line from how you behave to what happens to everyone around you.
At the Journal we’ve written about Social Solidarity where, for example, we keep our sick kid home from school, so they get well and don’t infect others. We look after an older person and knock on their door to see how they’re doing. So, it isn’t really that foreign, it seems daunting now because it’s big and seemingly arbitrary. What misconceptions have you heard that we can correct?
The biggest misconception that people have right now is that if they’re not 65-plus, they’re not at any risk. That is patently false. In fact, under 50 constitutes a very substantial number of the hospitalizations. People who are young and healthy are finding themselves in the ICU. They don’t realize how easily they can get the virus and spread it as well.
How do you explain this to younger people and everyone else?
There’s a little local story for you that might help. During the Thomas Fire we lived in San Roque. I was looking at the map and I was looking at the winds and I was looking at our resources and telling my husband we should be ready to leave. He looked at the map and said, “It’s so far away.” And I said there is nothing between the fire and us except fuel. He hadn’t thought about it that way. And that’s exactly the way I saw it. In terms of this pandemic, people are fuel for the spread of the virus. Everyone needs to understand that. That avenue is there and there’s nothing really to stop it from reaching us unless we change our habits. It’s really a waste of time to talk about why it shouldn’t be this way to begin with because it is a problem that is urgent.
Why aren’t there safeguards? Why is it spreading so quickly in our country?
Successful policies in other countries have been difficult to apply here. There are five things in our social policy landscape that make pandemic control especially difficult. First, not having universal paid sick leave. Even the patients with paid sick leave are covered on the order of days and not weeks to recover. Second, zero guaranteed family leave to care for sick family members. Third, zero guaranteed financial and operational support for people who should self-quarantine. So, people ignore the quarantine because they need to make money to eat and may have the milder forms of the illness or worse. Fourth, many people are uninsured and given this cryptic transmission and no available vaccine with very few drugs to curb the severity of the illness, there’s no financial incentive for insurance companies to actually guarantee access to help. Not that they don’t care about people, but from an actuarial perspective it would be cheaper if everyone just died and died fast. Fifth and finally, insurance is tied to employment. So, when people get sick, especially when people get very sick, they are vulnerable to bankruptcy. That’s especially problematic in the economy at large when you have great numbers of people suddenly filing for bankruptcy all at the same time.
So those factors add to the vulnerability of the population?
Yes. You know, there was nothing anyone could have done to keep this pandemic from arriving on these shores. The nature of this virus is the perfect killing machine. It’s just deadly enough to do a lot of damage, maxes out healthcare, but spreads asymptomatically. Somewhere between 50% and as much as 86% of cases are asymptomatic and they are contagious during that phase.
Every day there’s something that makes your head spin. Today it’s that if you’re asymptomatic, your breath still sheds virus which is one of the reasons for six feet distancing. Is that the case?
Yes, it’s possible based on what we know. But it’s really important that the public understand the priorities. I keep coming back to two things: principles and priorities. We have to assume that everyone is infected. We have to assume that every surface is contaminated but because we do not have endless amounts of time and attention there are certain risk factors that are important to pay attention to and evidence based best practices. We don’t want people doing crazy stuff that will either be a waste of their time or just isn’t proven.
How to Take Care of Yourself
So, what do you consider highest priority best practices?
I’ve outlined the basic hierarchy of what’s important to do and then what’s nice to do on flattenthecurve.com. Number one is stay home and wash your hands. Number two is don’t touch your face. Number three is disinfect, especially high touch surfaces, things like doorknobs, light switches, toilet handles, faucet handles. Number four is stay healthy and out of harm’s way. That’s a big one actually because the fewer people we have trying free-fall bungee jumping for the first time, the more capacity our health system has to treat people. Number five is protect yourself when you’re out of the house. So that means not touching things that you don’t actually mean to touch like handrails and in grocery stores commit to buying don’t randomly smear your fingers all over all things and look at the calorie count, just buy it and get out.
What about delivered packages or your groceries when you bring them home?
If you’re at risk and you want to be super safe, isolate packages three to nine days before unpacking. Put on your winter gloves, take that package, put it in a secure location, date the package and let it sit. This is a virus that has only been 136 days on this planet. This particular variant of the virus is completely brand new. That’s one reason it’s a problem. There’s a lot we don’t know right now. We know that it can survive up to three days under ideal conditions on hard surfaces and evidence from other coronaviruses suggest that what’s called fomite transmission is possible. [NOTE: “fomite transmission” refers to the transmission of infectious diseases by objects] What that means is that it can survive prolonged periods on hair, skin cells and soft fibers. The longer you leave your packages, the safer they are.
How can you be sure you’ve cleaned everything?
You’ve got to protect yourself without spending eight hours a day in a lot of anxiety. Decontaminating things is really hard, and hard to do well if you’re not someone who’s been through that training. So, keep it simple. Even something like getting your gloves off without, touching the outside of the glove requires training and practice. So, if you’re not comfortable doing that, if you’re not practiced, put on a pair of winter gloves that are easier to get on and off without touching the outside and just pop those in the washing machine after use. A normal wash and dry cycle will perfectly kill the virus.
We’ve seen videos of how to unpack your groceries that have shown that the issue is the wrapping. Not the food.
Exactly it is the wrapping and not the food, but people who aren’t accustomed to doing it well, can put themselves at unnecessary risk. If you buy six boxes of pasta, are you going to need all six boxes within three days? I have a grocery guide on the website that I put together. One hint is that when you are at the checkout, separate the things you know can sit from those that cannot and be lazy about it. Stuff the rest in a corner and deal with it when you absolutely must.
Can’t we use disinfectants and sterilizers on the package and somehow dump the internals of the package without touching the outside?
I would just caution you that you should use that as a plan B, rather than a plan A.
What about something simple like apples. Can you clean them with vinegar and water and a little bit of lemon?
Yes. However, vinegar won’t cut it. It doesn’t have a high enough, acidity or alcohol content in order to break the lipid layer, the fat that protects the virus. But it’s pretty simple. You just scrub them, wash them with a little vegetable brush and soap and water just as you would your hands. It’s way too complicated for something like fresh berries, lettuce, herbs, if they’ve been handpicked recently. Right now, frozen berries are fine because those were picked in time before the pandemic got going.
What about riding your bike to the ocean for exercise or taking a walk? What about exercising outdoors at a safe distance?
I absolutely encourage people to be outdoors as much as they can. That’s not to say they should be packed on beaches. But staying in nature is going to help keep us sane. Most people in Santa Barbara have very small houses. They can’t stay holed up in their houses and tiny little backyards or patios for weeks. It’s not sustainable. So yes, absolutely get out into nature. If you are not actually touching, is it zero risk? No, there is no such thing as zero risk. However, the risk that people go crazy, is higher if they are in their house for an extended period of time. This is not going to be over in a week and it’s not going to be over in two weeks. We have to really pace ourselves in order to do this well.
What are the biggest misconceptions that are out there right now?
That’s a good question. So, number one as I said in the beginning, is thinking I’m too young and healthy, I’m not at risk. Number two, it’s like the flu, it’s vastly more deadly. Number three would be, that this is overblown, there are no infections near me. The “Don’t Test, Don’t Tell” policy has given the public a false sense of security in the face of an already raging epidemic. Number four is the economy is more important. If a tsunami was coming towards your town, would you complain about the economic cost of evacuating? This outbreak is an invisible tsunami.
What About the Emotional Toll?
Some people are simply paralyzed and terrified by so much happening so quickly, they don’t know how to emotionally deal with it.
For many people this is the first time that they’ve come to grips with their own mortality. People have different timelines for that. People should use this opportunity as an invitation to look at what’s really important to them. It’s important that people take personal responsibility for themselves and for their community to do everything. Don’t be a vector.
Do you have any thoughts on the way the federal government has handled the crisis so far?
We have fewer than 1% of the masks that we would need to do this. Everybody’s going to need these things. This should be nonpartisan. We have to think about the greater good. People should be helped on the basis of need, not the basis of greed. If we don’t use this opportunity to find higher ground with people across the aisle, we will lose this game for us and for our children.