Execution phase

While this approach primarily focuses on the unique advantage of High-Efficiency PPE, there are a number of other measures that need to be employed in lowering exposure to SARS-CoV-2, getting cases to #Go2Zero, and keeping it at #CovidZero.

The following temporary measures need to be agreed upon and maintained to stop the spread and coming outbreaks. Akin to the traffic regulations, they need to be respected as a temporary norm and social etiquette:

Community care

We highlight community care only because of its importance: achieving zero community transmission is a process, aided and advanced through volunteerism and empathy. Understanding the responsibility you hold as a community member in achieving zero COVID will open doors for you to practice empathy with your neighbors. Being mindful of our shared fate should, and helping one another as a result, is key in cohesive, meaningful action.

Proper selection, usage, and decontamination of PPE

High-efficiency PPE will protect you from contracting the virus, even in the riskiest of circumstances. You can use PPEHotline.com to be informed about the best practices when selecting, using, and decontaminating your high-efficiency masks. Proper fit, seal, and a high filtration efficiency are all ways to mitigate the risk of infection. This virus is primarily airborne; cutting off the primary routes of transmission both assures your health but the well-being of your community as well.

Hand hygiene

While transmission of SARS-CoV-2 is primarily aerosolized and airborne, there is the potential for the original strain to infect through surface (fomite) transmission. Moreover, we don’t know the nature of future variants, thus, it is best to act precautionarily. Lastly, when abiding by best masking practices, there are several steps which require you to clean your hands before proceeding. Ideally, hand washing involves cleaning your hands with warm water and soap, scrubbing for a minimum of 20 seconds.

Proper ventilation

Indoor settings pose an incredibly high-risk of infection. Imagine being with others, confined in a closed space but having one person COVID-19 positive; a poor ventilation system could induce an increase in infectivity across the room, let alone be doing nothing. Increasing the volume of air in a room (by opening doors and windows) reduces the probability one inhales the same viral-particles being exhaled by another. It is important to note that for HVAC systems to be adequately relied upon, they need to be regularly cleaned, maintained, equipped with proper filters, but also installed in a way where the dynamic phenomenon of individuals potentially exhaling viral-particles is not being propagated to other areas in the room without being filtered; this last feature is complex and a rarity to find proven.

CO2 monitoring

The use of indoor CO2 detectors is a great preventative measure for ensuring healthy indoor ventilation. Decreasing your risk of infection is not the only benefit from monitoring indoor CO2 levels; proper indoor ventilation is important for your respiratory health, which influences much of your body processes, including cognitive function. This strategy can be adopted in an array of settings including offices, schools, stores and other businesses. CO2 measure mustn’t be up to 700 ppm.

Living in strict bubbles

A strategy that can help guide what you and your immediate social circle can do is to adopt the bubble strategy. Identify a group of people to form a bubble with; each member within the group assures the rest that they will not interact riskily with individuals outside the bubble. It will be more often than not that the bubble you form will be with your housemates and family. Once formed, you can mitigate the collective risk by assigning one person tasks that involve necessities, such as grocery shopping. In doing so, the group’s exposure is minimized while one person prioritizes in collecting all the external needs. Bubbles can also be prioritized around other facets of one’s lifestyle. Parents with younger children can define a bubble with a set of parents; child play is important for development and prioritizing this would require strict adherence to the bubble’s rules. It is important to repeat that bubbles are mutually exclusive; no one person can be in two bubbles.

Safe Workplaces for essential and otherwise open businesses

To maximize the safety of essential businesses, one can begin by ensuring they are wearing high-efficiency PPE when in these places. For the safety of the essential workers, these masks must be made mandatory; organizations should be looking to give employees added breaks and resources to cope with the uncomfort of having to wear a high-efficiency mask. The risk for these places is especially high as transmission of SARS-CoV-2 has occurred mainly indoors. Enclosed rooms with poor HVAC systems (and HVAC systems not optimized for limiting pathogen spread, which most are not) don’t mitigate the risk of infection (in some cases, it even propagates it). Essential businesses, given the resources, should opt to rapid-test any individual seeking entry to their store.

Travel restrictions at country and community level

Travel should be restricted from regions that are experiencing high incidence rates of SARS-Cov-2 transmission. This should remain true at all scales, especially the local level; restrictions on travel should be implemented to deal with outbreaks amongst the set of communities. Necessary inter-community and international travel, to maintain supply chains for example, should be done under surveillance, ideally by routinely testing the individuals involved; for example, drivers should not leave their vehicles unless they comply with high efficiency PPE. While these are not under the direct responsibility of the community program managers, the restrictions of travel should be advocated for and pushed by local representatives.

Individual Testing, mass testing, including sewage testing

Testing individuals en masse is one means to collect data on the dynamics of community transmission; using PCR tests after CT screening has been proven to be optimal. Many communities, particularly those in South Korea, have gone through weeks of intensive testing; the data collectors were taking a rough snapshot of community transmission, to which the data was used to restrict further transmission. Antigen tests can be used as infectivity tests, offering a measure to when an individual is most infectious.The RT-LAMP testing strategy is a relatively low-cost means to offer thousands of rapid tests (roughly 35 minutes per test) daily to community members. Moreover, using wastewater testing is another tool to identify early community transmission as well as the specific strain being spread. To ensure resources are not being misspent, taking consultation from a public health professional on pushing for a comprehensive testing strategy is the safest path to take.

Isolation facilities for infected family members

Using community assets, such as public commons (schools, religious facilities, courthouses), as isolation facilities is a powerful tool in achieving zero transmission. These facilities should be staffed with human resources (nurses, public health professionals, volunteers) to optimize the stay of those in isolation. This would relieve much of the stress hospitals and other health facilities are currently facing, both directly and in the long-run (by reducing community transmission). Transmission within households accounts for a significant majority of the cases. Testing is only effective as a means of reducing community transmission if people are executing on self-isolations.

Quarantines

Enforcing mandatory quarantines for incoming travel, for a minimum of 14 days, ensures that the overwhelming majority of incoming travelers are being reintroduced to the public non-infectious. There are cases where the 14-day limit was not enough, and given the rise of novel variants, we expect this number to change.

Social distancing Indoors: 2m/6ft is not enough

Physical “social” distancing is maintaining a safe distance from other people as a precaution to infection. The nuance to uncover here is what constitutes a “safe distance”. To physically distance well, one should take into account the direction of wind, the number of people, and (but not limited to) the number of people who are sharing your relative environment. It is important to note that the current 2 meter, 6 feet metric is too low of a minimum distance for it to be recognized as a universal standard across all communities. It is important to understand that transmission, and later infection, of SARS-CoV-2, is more a question of risk than it is of some standard rules. The evidence that SARS-CoV-2 is airborne and, under the right circumstances, has the potential to linger in the air for hours. Physical distancing is simply a measure to lower one’s risk of infection

Go outdoors

People should be spending time outdoors as much as they can, especially in nature. Increasing your exposure to the sun is healthy during extended periods of lockdown and quarantines. Prioritize meeting family members and friends, for the risks are far less, given it is a limited group of people and physical distancing guidelines are adhered.