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Avoid Coughing to Save Lives (COVID-19)

March 15, 2020

We are inundated with messages to wash hands as if it were the most important measure we can take — yet little is said about the risks of coughing.

The Centers for Disease Control (CDC) makes clear that the novel corona virus (causing COVID-19) is transmitted “mainly from person-to-person…through respiratory droplets when somebody coughs or sneezes.” (Source: https://www.cdc.gov/coronavirus/2019-ncov/prepare/transmission.html)

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In addition a recently submitted paper (March 8, 2020) from Wuhan University and other scientists in China found the COVID-19 virus in the air in hospitals. (Source: https://www.biorxiv.org/content/10.1101/2020.03.08.982637v1). We already known flu virus is found in the air.

Hand-to-face contact may or may not cause infection. CDC further states “It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

Source: https://www.cdc.gov/coronavir…/2019-ncov/…/transmission.html

Yet the world is being told to wash our hands and rarely told the importance of covering our coughs and of avoiding areas where people are or have been coughing.

The primary receptors are in the deep lung (ACE2) and our fingers don’t go there — how does the virus get there? Small particles get there all the time, however — whenever we breathe. Many particles are emitted when people cough, including tiny particles.

Moreover, it is coughing and sneezing that most likely deposits the particles we are trying to wash off. Don’t give up on washing hands – it’s important for many reasons – but it’s long past time to emphasize people COVER THEIR COUGH so those particles don’t get all over and onto our hands and into our bodies in the first place.

SELF-QUARANTINE if you are coughing and AVOID people who are coughing. Unfortunately, covering a cough is at best partially effective.

Yes we should already be isolating – but many are partially isolating at most — or people are isolating in groups, some of whom may be infected or are not entirely isolating and may become infected – and we don’t know yet how infectious people with few or no symptoms can be.

I have a family of friends (including two small children) who have been washing their hands so much that their hands are cracking and bleeding. For all we know this could be another source of infection by the virus, theoretically it could be even more dangerous than touching the face – we don’t know yet. Blood-based path of infection could help explain why some people get diarrhea along with COVID-19 (two major areas for the receptor cells are in the deep lung and the intestines, so the bowels could get sick as well from the same virus — for example if the virus enters the cuts in the hands, spreads through the blood, and then somehow enters the receptor cells).

My hunch at this point given everything is that small particles are a significant source of COVID-19 infection, possibly the major source. Small particles by their nature typically stay airborne for long periods of time. In this case presumably the small particles would be emitted primarily by coughing, and also by sneezing.

Please alert anyone suggesting that hand washing is the answer, especially organizations doing outreach, to start emphasizing the key source of the particles. Teach people to avoid exposing themselves and others to coughing as if lives depend on it – they do.


Meggs holds a Master’s in Public Health (Environmental Health Sciences Division) from the University of California at Berkeley.

One Comment leave one →
  1. March 25, 2020 12:55 am

    Since this campaign began, more sources are beginning to emphasize awareness and care to minimize the primary source of transmission (coughing and sneezing) although fear of surfaces continues to dominate. The CDC still says it is possible for touching surfaces to cause infection but unknown. The USA President’s “15 Days” document does not emphasize the importance of COMPLETELY covering ANY cough or sneeze although there is a last-mention of coughing “into” a tissue or “inside” an elbow, ineffective advice and dangerously neglectful. This issue should be front and center. There may well be an analysis in the future as to how much more quickly the virus spread and how many people have died because of failure to alert the public about this issue.

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