Coronavirus: the behaviors to have to avoid it

In the carnage of the First World War, an influenza epidemic caught on in the frontline trenches and subsequently spread all over the world, infecting a quarter of the world's total population and eventually killing more people from the same war.

Before it ended, between 50 million and 100 million people died from what became known as "the Spanish flu". The mortality rate currently accepted for Spanish flu is between one and three percent and its total mortality numbers are partly shocking due to its widespread reach, proliferating in all countries around the world.

A familiar name
The Spanish flu pandemic was triggered by a virus which is now a household name: H1N1. The H1N1 resurfaced in 2009, spreading back to the ends of the planet, but with only a small part of the death toll from its first appearance.

Although not an identical virus, it could theoretically have been equally deadly, in part because of its potential to kill people of a younger age and not otherwise considered vulnerable to flu-related mortality. The absolute mortality rate of the 1 H1N2009 pandemic was 0,001-0,007 percent. The total death toll in this case was hundreds of thousands worldwide, with a disproportionate number believed to have been affected in Southeast Asia and Africa.

Why the big differences in mortality? These two versions of H1N1 did not have the same origin and there is also an evolutionary push to make subsequent versions of the same virus less lethal. So the two versions of H1N1 would have been different in these respects.

But above all, the world was also different. The conditions under which Spanish influence conquered the world were disgusting. The First World War had raged for several years and the first lines where the disease emerged were places where young soldiers lived among corpses, mice and contaminated water and had little opportunity for personal hygiene.

In 2009, even the poorest nations in the world had better living conditions than those experienced by the average soldier in the trenches of the First World War. Despite this, nations that have had the least ability to provide clean environments for their populations have been the most affected by H1N1 infections, with a high number of infections and many deaths.

The spread of COVID-19 in China - and the recent cases that appear closer to home - have worried people about another scenario of Spanish influence. This may not be another Spanish influence, but we have an important opportunity to control the proliferation of the virus within our own populations.

Behavior and immunity to the herd
Herd immunity is a concept that comes from the field of zoology. It refers to the ability of a population of animals to resist infections by a pathogen - such as a virus - because a sufficiently large number of individuals within the population have humoral immunity at the individual level. Humoral immunity is the ability of the immune system to form antibodies against a specific infectious agent.

With herd immunity, transmissibility in a population is drastically reduced through immunological mechanisms. This is the theory behind vaccines, which increase specific immunity within (ideally) a very large percentage of the population, so that a communicable disease never becomes a foothold.

Note the term "immunological mechanism" and consider whether the same principle could apply behaviorally.

As the body's humoral immune responses deflect the infection, so do the pathway blocking behaviors in the body for an infectious agent. With a very large percentage of the population constantly implementing behavior that reduces transmissibility, epidemics can be prevented or largely limited, without the reactionary measure of quarantine.

Just as humoral immunity does not transmit perfect protection to the individual, the same applies to behavioral immunity; it is simply important that a very high percentage of the population is performing precautionary behavior consistently. Protection is at the level of the herd, rather than at the level of the individual.

Are we talking about the wrong things?
In the context of this concept of "herd behavioral immunity", current discussions of COVID-19 in conventional and social media can be focused on the wrong things. Instead of talking about counterfactual scenarios that induce fear (what ifs), we must focus on crowdsourcing strategies that limit the ability of the infection to take hold in our population.

A vaccine would be nice and will eventually come. But in the meantime, epidemics like COVID-19 can be prevented by increasing the prevalence of precautionary behaviors in the general population that prevent their spread.

These measures include some family maxims, none of which are implemented consistently enough and some unfamiliar, which must be taken individually en masse. And so on.

The familiar ones:

wash your hands frequently and properly;
cover your mouth (with your arm) when you cough or sneeze;
avoid close contact with those who are already infected.
Before erasing the obvious above, we should ask ourselves: do we do these with absolute consistency? Can we do better? Also consider the following less obvious but equally important behaviors:

1. Disinfect the screen of your mobile device twice a day: it is a portable Petri dish, which accumulates bacteria and, yes, viruses. Antibacterial wipes are needed here, as they generally also kill viruses. Clean the device at least twice a day, once for lunch and once at dinner time (or connected to another daily routine). A recently published study estimates that viruses such as COVID-19 may persist for up to nine days on smooth glass and plastic surfaces, such as a cell phone screen.

2. Avoid touching your face. Mouth, nose, eyes and ears are all pathways in your body for viruses and your fingers are constantly in contact with surfaces that may contain viruses. This simple measure is very difficult to maintain consistently, but it is essential for infection control.

3. Use masks only if you are sick and give social compliments to people who are responsible enough to use them when they are sick.

4. Self-quarantine if you are sick and have a fever.

5. Engage your social network to brainstorm on other simple behavioral changes.

Preventing spread
Strengthening herd immunity through behavior is critical to preventing the spread of COVID-19. We need to talk more about it and do it more. In the sea of ​​uncertainties that cause fear, this is something we control individually and en masse.

We do better on implementing the above precautionary behaviors with high consistency and in the long term.

And here's a side benefit: we will prevent the spread of many other infectious diseases, including seasonal flu, which kills more people in an average month than COVID-19 last month.