An Achievable, Sustainable, New Normal

An Achievable, Sustainable, New Normal:

In efforts to prepare volunteers for outreach work, and to prepare for service development projects, we remain up to date with local bio-psycho-social risk and protective factors as well as local procedures and policies relating to emergency and general medicine, including infectious diseases and tropical diseases, with relevant management or preventative options, such as vaccines, in various countries.

Questions are asked about a ‘new normal’ on a daily basis in many countries. Many are concerned that they will have to wear face masks for the next 1-5 years, when there is no good clinical evidence to support the wearing of face masks for healthy individuals in the community, as the World Health Organisation and the ECDC agree. Many have raised concerns regarding increased risk and harm due to indiscriminate mandatory face mask initiatives. Many are concerned that regular #travel (without face masks or quarantine) will not resume within the next 2 or more years; many elderly patients report “we need our cruises” and “we want to get back to travelling, but not with face masks”.

We have been asked for our thoughts regarding a ‘new normal’.

In our opinion it is important that we focus on longstanding, well-established, evidence-based strategies (only good clinical evidence) to reduce #risk of #infection or #disease (morbidity and mortality) and to protect (evidence-based protective factors – based only on good clinical evidence). This is likely the first step in #creating #positive and #lasting #change for children and adults – high and low risk individuals.

1. TOOLS – Give all individuals #tools to practice good #hygiene – this relates to alcohol gel on tables, wash rooms with running water and soap, and allow #homeless people access to tools too (more than 50% returning #veterans who risked their lives for the nation’s #freedom , needing and wanting access to #water and #soap , in some states and nations – please know that currently more or less 40,056 veterans are homeless on any given night (see link) – many are informed that they are not allowed to use outside showers, even at night or early in the morning when no one is around).

#Food and drinking water, as well as appropriate shelter, might be relevant here too.

Water quality, which affects children, adults and communities, is relevant. Please see previous comments relating to Bangkok, Thailand and the river – this is relevant in many nations. #Sewerage drains leaking eg into beaches or rivers need to be addressed as a matter of urgency in every country – these concerns precipitate and maintain many different infectious diseases. Numerous infectious diseases including coronavirus can be found in urine/faeces.

Let’s start with the basics, with simple measures, let’s get it right, before we make it more complicated and introduce measures not based on good clinical evidence. What affects one of us, affects all of us – this is relevant in most contexts, but especially with infectious diseases and general health, if a global health perspective is employed.

2. BE AT HOME IF YOU ARE SICK – Be at home and stay at home, if you feel sick, have symptoms or have been in recent contact with a confirmed case – and contact health services for advice. Too many individuals attend #work or #flights or #travel when they are not well. Employers should support employees in this systemic approach. We often offer emergency services during flights and most often the person felt unwell whilst still at home. Individuals report on a daily basis that they travel or leave their homes when they know they have a cold or flu, even during this pandemic, eg “I knew I was getting sick, I felt awful, but I took the flight and thought I will get better on the beach” and “I went for a quick breakfast with my wife although I was sick with the flu, but I thought it would make me feel better”. We observe individuals on a near daily basis who have a cold or flu (raised temperature, clearly sweating but experiencing cold, coughing etc), mostly at restaurants or airports.

3. COVER YOUR NOSE AND MOUTH IF YOU COUGH OR SNEEZE – Cover your nose and mouth if you cough or sneeze whether you wear a mask or not, and no spitting. These behaviours reduce risk. Some nations now offer fines for non compliance.

4. SHARING – Do not share food, drinks, cigarettes or #hookah / #shisha or anything relevant in this same context if you are not confident the person is healthy – think mouths, noses, eyes and hands.

5. FOOD – Food hygiene – cover food at buffets, do not touch items unless you are taking those items with you and supervise children at all times.

6. VENTILATION – Ventilation – open windows and doors to facilitate ventilation or improve ventilation in any way appropriate – this is especially relevant for #restaurants or cafes, #schools , #hospital waiting rooms and #GP practices, and any area where large groups of individuals gather eg during #transit or travel.

7. SPACE – Positive Space – create and maintain space inside and outside, in shade, with seating where individuals can rest and relax in an enjoyable quiet atmosphere. Theme parks such as #DisneyWorld can be wonderful places for #children to #enjoy, #develop and #learn, (we have liaised with numerous children in need or at risk who report their lives have changed with messages from Disney, such as “anything is possible” or “let your conscience be your guide”), however, when there are limited seating options, groups gather in small areas to rest in the same shade to keep an eye on the same seats hoping they would be available. This is also relevant for cruise liners – particularly when doing emergency drills, preparing passengers, when passengers stand in close proximity, often in hot weather.

#Airports and #airplanes are relevant here. Boarding and disembarking are often associated with chaos and several lines, up to 5 lines to board one flight, streamlining with planning and preparation is possible. Airplanes where seats are very small, passengers sit close together and passengers recline onto other passengers’ laps with no healthy or positive space is of particular concern, and avoidable. Many airlines now stop individuals from reclining, which offers more personal and positive space. We have observed, firsthand, that these positive changes are possible in airports and flight in Asia – social distancing and ventilation were facilitated, passengers were asked not to wear face masks unless they presented with clinical indications, with good clinical outcomes.

Small changes can have significant effects on health, mental health and social risk.

8. NUMBERS – Limit numbers to avoid #chaos and #crowding. It is the #culture to encourage and be proud of long #lines and #crowds – it provides messages of popularity, demand and ‘not to be missed’, however, these same factors lead to increased risk in terms of health, mental health and safety. We usually aim to avoid these contexts, by choosing quiet times or alternative options. This is especially relevant for contexts such as cruise liners and theme parks. Individuals sometimes report that they wait in 3-4 lines before entering a theme park, and then wait for approximately 5-7 hours in lines for coffee, food, entertainment or rides – this increases risk, not only during a pandemic. Most individuals report that they “cannot wait for #Disney to reopen” or “I can’t wait to get on a cruise again”, reporting benefits relating to mental health and general health, however, small changes can inspire great health benefits.

9. EDUCATION – Education regarding evidence-based protective factors for the immune system, general health, mental health and social risk. More or less 3/10 individuals could provide us with more than 3 evidence-based protective factors for health, mental health or social risk. Evidence-based protective factors significantly improve prognosis, morbidity and mortality, in terms of mental health, general health and social risk. Please see previous comments on evidence-based protective factors, children’s development, normative activities and the immune system. 

Education regarding evidence-based risk reducing initiatives should also be prioritised eg relating to #respiratory diseases and also #mosquito born diseases – many #infections can be avoided with a little #education and planning. We often ask individuals about the country they have travelled to or are travelling to and less than 3/10 of adults were aware of local health risks or relevant vaccines. These topics reduce risk and harm.

10. EVIDENCE – A commitment to follow only good clinical evidence during clinical or medical emergencies, urgent medical matters and routine medical matters – to weigh evidence-based risk and protective factors, and to first do no harm, ensuring that health and mental health related statistics (morbidity and mortality), as well as child protection statistics, improve, not worsen. A commitment to transparency and collaborative work within nations and amongst nations during clinical or medical emergencies – a global health plan for global health emergencies. These are the #strategies #doctors employ every day during #health #crises to ensure #good #clinical #outcomes (or the best chance of good clinical outcomes) – it only makes sense that these strategies be employed on a larger scale, a #global scale, as part of a global health plan, to protect nations.

Medical doctors engaging in clinical work (who work with patients) usually do not use strategies based on inconsistent or weak evidence – they focus on strategies (recommendations or management plans or treatment) based on good clinical evidence only – before they return to the drawing board (if good outcomes are not achieved) and reconsider their risk assessment, clinical impression and management plan, asking themselves if they have missed anything, liaising with colleagues, and then if the answer is ‘no’, they possibly consider more creative options.

We have been asked whether face masks should be part of a new normal. We would strongly advised that face masks not be #normalised in any way. Face masks have a specific clinical indication where they are likely to be of benefit for certain individuals. We have liaised with the relevant Health Commissions and Health Ministries regarding these concerns, including relating to children in the context of child development and schools.

Based on our experience travelling through different countries, meeting with individuals from various cultural backgrounds, ranging from the most vulnerable to the most fortunate, it is our opinion that these 10 items would improve morbidity and mortality statistics for every child and every adult markedly, in the context of the pandemic, future pandemics and general health risks.

Many countries in Asia reported that they were prepared for the pandemic, based on previous experiences, and that they believe it is likely that repeat occurrences will be relevant. Statistics support their approaches. It is unfortunate that many now report pressure from countries with less experience in infectious diseases to comply with initiatives not based on good clinical evidence.

Let’s learn from our neighbours and follow good evidence to reduce risk and to protect.

#NewNormal #education #children #space #medical #doctors #psychiatrists #travel #health #mentalhealth #volunteer #socialrisk #flight #cruiseline #cruise #themepark #entertainment #symptoms #achievable #sustainable