How to Wash Your Hands

Instructions for properly washing your hands.

Spring beauty abounds. Birds swirl around bird feeders and sing from the trees. I’ve had ample weeding time in the garden lately. I’ve stopped most errands. No more driving kids to school. I’m heeding the message to stay home to help protect our community from the explosive spread of COVID-19, a disease caused by a coronavirus. As I weed, I think about what more we can do. I’m an infectious disease epidemiologist so there’s a lot to think about, as a professional and as an individual.

Because the virus is new to humans and all are susceptible, it has had free reign to sweep through communities. Before other countries were able to jump to attention, the nimble infection seeded itself across the globe after buffeting China in early 2020. I read about successes and failures to stem the exponential growth of COVID-19. I hoped that before infection rates surged past the containment phase that we would have widespread testing to help us erect a protective public health fence around infected people, that treatments would be identified, that healthcare workers would have access to protective equipment, and that hospitals would be ready to cope with an influx of people sick with COVID-19. But we are not ready. 

So we are left with nonpharmaceutical interventions, when we humans much prefer a “magic bullet” to avoid catastrophe. But, catastrophe is at our doorstep. In 16 days N.C. cases climbed from 1 to over 410 on Monday. Last week Orange County’s first cases appeared. On a community level, Governor Cooper and public health leadership ordered reductions in congregating — closing schools, businesses, events, and religious gatherings. We need to go further. On Monday the N.C. Healthcare Association, representing all 130 N.C. hospitals, requested the Governor order citizens to shelter in place. Three communities have already done so. Even so, these interventions take a week or two to work because infections simmer unobserved before they show up as cases. Interventions also come at a great economic and social cost, but they work. They rob the virus of close contact between humans, required for it to survive. To establish infection, the COVID-19 virus has to touch mucus membranes in our eyes, noses, or mouths, or to ride on a tiny droplet to lodge deep into our lungs. 

Luckily, individuals can help thwart the virus too. We can eliminate unnecessary errands and appointments, keep a safe distance from others (six feet), cancel gathering with others, and protect others through self-quarantine if one develops symptoms of COVID-19 (fever, dry cough, and shortness of breath). I was sad to tell my youngest son he couldn’t have his birthday party. My high school senior won’t have prom or graduation. 

But they understand. They know that we can’t let the virus get to their 90-year-old grandmother in an elder care home, or a friend’s relative battling cancer, or another friend with cystic fibrosis, or a neighbor with diabetes.

We can also take advantage of the virus’ vulnerabilities. A fragile protein coating protects its genetic material. Plain old soap tears that coating apart and water washes it away. Alcohol (at least 70 percent) and simple chlorine bleach solution (4 teaspoons bleach to 4 cups water) sprayed on surfaces, or EPA-approved wipes and cleaners can easily kill it. These are all readily available.

I taught my family how to wash their hands using the highly effective World Health Organization method. We practiced until we got the steps down. I hung a reminder poster (https://www.who.int/gpsc/5may/How_To_HandWash_Poster.pdf) over each sink. Please do the same in your house, your neighbors,’ and friends.’ Wash hands every time you enter the house, before preparing or eating meals, after using the toilet, after catching a sneeze or a cough in a tissue, before and after touching your face. 

The Japanese reported virus survival on cruise ship room surfaces 17 days after infected people disembarked. We can make our environment safer by implementing sanitizing routines. We keep sanitizing wipes in the car. Once home, before we exit the car, we sanitize — steering wheel, instrument panel buttons, shifter, brake, car door handles, key fob, and door handle at the house. Once inside, we discard the wipe, sanitize our cell phones with alcohol, and wash our hands. We sanitize high contact areas with bleach solution, including door handles, light switches, counters and tabletops, sinks, toilets, and railings. Spray and let it sit for 5 minutes. For electronics — keyboards, tablets, and such — we use alcohol. You can do this, too. 

Washing hands and sanitizing surfaces can protect us from viruses as we learn new habits. Researchers found that people touch their faces more than 20 times an hour on average. About 44 percent of the time, these touches involve contact with the eyes, nose, or mouth. It will be difficult to completely avoid touching our faces.

Let’s not lose sight of the good news. First, most people will not require hospitalization if infected with the new coronavirus. And afterwards, it is likely that their new immunity will help buffer the rest of the population from infection. Second, we can take individual steps that protect the vulnerable people in our community from high rates of hospitalization and highly fatal acute respiratory distress syndrome. We do this by stopping viral spread through low-tech ways — keeping our distance from others and repeatedly killing the virus by washing hands, and by sanitizing our environment. 

Luckily, the American people are generous and kind, and helping folks in need is something we do well, especially in times of adversity. Although we are outnumbered by trillions of copies of the virus, we can outsmart them through our collective action. This is the time for us to join with the front lines of healthcare workers in making sacrifices for the greater good. I have faith in the people of N.C. to prevail over this microbe.

Stay home, wash hands, kill virus on surfaces. It’s time to do our part. Help make a difference now. 

Dr. Rachel A. Royce has more than 30 years of experience designing, directing, and managing research in epidemiology and public health practice. Her work has primarily focused on tuberculosis (TB), HIV/AIDS, sexually transmitted diseases (STDs), health disparities, and preterm delivery as well as the design of tools for evaluation of public health programs. Dr. Royce currently is a private consultant. She worked at RTI for 17 years. Dr. Royce has written numerous highly cited publications in peer-reviewed journals, including the New England Journal of Medicine, Journal of the American Medical Association, American Journal of Public Health, and The Lancet. She has directed and collaborated on grants, cooperative agreements, and contracts from a variety of funders, including private foundations, local governments, NIH, CDC, and the Fulbright Commission.