ASK A PANDEMIC EXPERT: Virtual Q&A with Whitney Adams

Our network is fortunate to be working with an expert on pandemic preparedness and response, who has agreed to help answer network members’ questions as they begin planning for COVID-19.

Here is a little about Whitney’s background:

Whitney Adams, MPH, has worked in global public health and development for 17 years. She led CARE’s pandemic preparedness programs for four years, including during the swine flu pandemic in 2009. Although Whitney is not serving in an official capacity for the COVID-19 response, Whitney was an implementer and advisor to WHO, CDC and USAID for pandemic preparedness programs.

Do you have any questions about precautions you should be taking for COVID-19? Feel free to ask them here.

Whitney will be available to communicate with network members. We will “moderate” by grouping similar questions together, so Whitney can answer as many as possible.

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We are an organization of people living with HIV and from last year our government has put everyone living with HIV on TB Prevention treatment for six months. HIV treatment is for life. What precaution measures shall we be observing in this crisis period? John Masuwa.

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WHO has not issued special guidance for people living with HIV, but they have provided short Q&A [here].(Q&A on COVID-19, HIV and antiretrovirals )

1. In addition to basic hand hygiene, any vulnerable populations should consider how they can best self-quarantine and reduce contacts as much as possible.

COVID-19 is mostly spread through close contact with an infected individual. You can cut your risk of infection by:

  • Reducing your contacts to as few people as possible. Stay home if possible. That won’t be an option for everyone. Don’t stress about the contacts that you can’t cut, but think about what you can reduce!
  • Stay 6 feet (2 meters) away from other people. The virus spreads best through droplets (infected people coughing, sneezing, speaking) in close range.
  • If you must leave the house, try to reduce or eliminate any time in enclosed spaces. Outside and air circulation is best! Choose to walk or bike instead of taking public transportation, for example. Shop at an open-air market when it’s less busy instead of entering a small kiosk or busy supermarket.

2. Work with local medical professionals to determine what treatment can be done at home.

Because you need to reduce your contacts, all treatment and care that can be done at home instead of in a clinical setting, should be done at home. Healthcare facilities can be the biggest spreaders of COVID-19. Work with local healthcare professionals to create new ways of accessing TB & HIV treatment if at all possible. Can medicines be delivered to people’s homes? Can patients connect with their healthcare provider by phone or WhatsApp instead of seeing them in person? Help create local solutions to reduce the need for people to be treated at a healthcare facility, where risk of infection with COVID-19 will likely be high.

WHO also recommends: “People living with HIV who are taking antiretroviral drugs should ensure that they have at least 30 days and up to 6-month supply of medicines and ensure that their vaccinations are up to date (influenza and pneumococcal vaccines). Adequate supplies of medicines to treat co-infections and comorbidities and addiction should also be ensured.”

Above all, do maintain treatment for HIV and TB, even if that means having to go to a health facility! Remember that most people, even vulnerable populations, will recover from COVID-19 infection

3. Help people in the network access basic hygiene materials (soap and water, or hand sanitizer)

If people living with HIV do not have access to basic hygiene, can the network help with that?

Here’s instructions of how to build a Tippy Tap, if running water is not available: https://twitter.com/i/status/1243534860867813379

Here are instructions of how to make hand sanitizer, if it’s possible for you network to make it and distribute it (Note, hand sanitizer is not better than soap and water. It’s simply an option if soap and water are harder to use or come by): There are many ways to make hand sanitizer. To be effective, choose a formula that’s at least 60% alcohol and only follow instructions from trusted sources. You can find WHO’s guidelines for preparing hand sanitizer here. This is a very thorough guide on the different substances and formulas that can be used. If that’s overwhelming, you can follow the guidance in this article. The simplest recipe is 3 parts isopropyl alcohol to 1 part aloe vera gel.

4. Make a plan in case someone in the household becomes ill with suspected COVID-19.

It’s possible that someone in the household will become ill with COVID-19. People living with HIV should make a plan ahead of time. Is it possible for the ill person to self-isolate elsewhere? It is possible for the person living with HIV to safely self-quarantine elsewhere. If not, review guidance from WHO on treating people with mild or moderate COVID-19 at home. It’s possible to prevent the spread of infection, even in a home! Be ready to follow as much of the guidance as possible:

5. Consider using a homemade mask

WHO is still recommending that healthy people not wear homemade masks. However, many experts are rapidly revising their opinions on this topic. In general, wearing masks is better at preventing you from spreading the infection than getting the infection. Many experts still believe they are better than no protection at all. If people choose to wear a cotton, homemade mask, ensure that they understand 1) Masks don’t make you invulnerable! You still need to reduce contacts and wash hands carefully 2) Masks need to be washed after every use. Otherwise, they can trap viruses and bacteria, making the situation worse. 3) Be conscious that masks can make us more likely to touch your face, which increases your risk.

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Thank you, @WhitneyAdams! @johnmasuwa, does that help you?

Do others have anything to add, or additional questions to pose? We are looking forward to hearing from you.

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@johnmasuwa Also, please find the Infographic for UNAIDS. Might be helpful to distribute or translate in local local languages.: https://www.unaids.org/sites/default/files/hiv-and-covid19_infographic_A3_en.pdf

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Hi @WhitneyAdams! Thanks so much for answering questions in this Q&A.

Many of our partners and network members live and work in very densely populated areas - including large informal settlements, refugee camps, and other high-density urban neighborhoods.

In these places, people may live with up to 5 to 10 others in a single room, with rooms close together and hundreds sharing the same toilet facilities. Water and soap are sometimes scarce, though in many places there are efforts now being made to prioritize access and encourage frequent hand washing as a preventative measure. But social distancing in general - and self-isolation should someone exhibit Coronavirus-like symptoms - seem particularly difficult to implement. Many people have expressed feeling “stuck” because they are unsure how to apply Coronavirus-related guidance to these contexts.

What best practices exist, and what advice do you have, for network members living and working in these areas to protect themselves, their families, and their communities?

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As your question implies, we don’t have great options. London School of Hygiene & Tropical Medicine is promoting a strategy of “shielding” vulnerable populations. Their recommendations are based on the understanding that a) lock downs or significant social distancing is not feasible and b) scale up healthcare capacity to meet the need is not feasible (gap is too astronomical) c) the majority of deaths and severe illness will be in vulnerable populations. So then, how can think about protecting vulnerable populations instead of focusing on everyone?

The idea of shield vulnerable populations would include 3 options:

  1. Helping families/households create a room to separate and house vulnerable individual
  2. Having several households shift their space – i.e. 2 vulnerable members take one household and the other household members share the second household.
  3. Small group homes for vulnerable populations supported by government and communities. Presenters stressed this not like a nursing home. There would be no or very limited visitors vs. homes where you have high traffic coming in

Essentially, it’s a difficult and risky strategy.

A few thoughts from me:

  • It’s by far the least resource intensive and most feasible strategy. Govt. could mobilize to provide the resources to make it happen. Communities can raise the necessary resources to do this on their own, even.
  • It could be done with local flexibility to find the best solutions.
  • Even without strong testing resources, this could be done. For example, if you were to do a group home, you could arrange for a total individual quarantine of 14 days before they entered the small group (should prevent asymptomatic individuals from coming in). You could also have care workers voluntarily quarantine with them (this is currently being done by nuns and nursing home staff in Italy). You can identify people who you’re 99% sure had COVID-19 (either by tests or symptoms) and have them be the caregivers and bringers of food, etc.
  • This strategy will get progressively easier as you have more people who are at least temporarily immune
  • If the strategy is not implemented very carefully, results could be tragic. It’s kind of in the high risk/high reward category
  • Even if we cannot quickly mobilize to get this done in the first wave, it’s still a viable strategy for second wave.
  • This would be hard. It would be really until we have a vaccine, which could be two years for these populations. However, helping them ride out the first few waves in whatever capacity can increase our knowledge of how to safely treat and capacity to do so.

You can find the guidance here.

My recommendation is to share this with local health authorities and community leaders. Perhaps find ways to host virtual forums for deciding whether this could be a feasible strategy for implementation. Keep in mind, if it’s done incorrectly, it could lead to tragic results. However, I strongly believe we should give communities and leaders the best information we can and help them make their own informed choices.

If you are on twitter, you can also follow @LSHTM_Crises for updates to this guidance.

I would also say to share basic info on masks, tippy taps, and recipes for locally made hand sanitizer (in the answer above). These may be doable strategies, even in resource-constrained settings.

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