Anders Nienstaedt
Since the outbreak of COVID-19, our cultural perception of hand washing has shifted in just a few days. What was once, for many, an insignificant afterthought is now filled with uneasy weight.
Dr. Ajay Sethi and Dr. Nasia Safdar can testify to the importance of hand-washing.
Bottom line: “Hand hygiene is critical for limiting the transmission of disease,” says Sethi, director of the UW-Madison Master of Public Health program and associate professor of population health sciences.
Even so, “Behavior decays over time if you don’t pay attention to it, and hand hygiene is one of those things that’s first to go if you’re not relentless about pushing it,” adds Safdar, professor of infectious disease at the School of Medicine and Public Health at UW-Madison and medical director of infection control at the UW Hospital and Clinics.
Sethi and Safdar are epidemiologists, scientists who study the spread of diseases. Where researchers in other branches of the sciences may spend years studying phenomena with no direct application in mind, epidemiology is fundamentally concerned with results.
Throughout his career, Sethi has studied the interaction between human behavior and a variety of infectious diseases, a broad range that includes everything from the HIV pandemic to fungi in hospitals and antibiotic-resistant bacteria on dairy farms. He doesn’t study COVID-19, and he’s wary of over-extending his expertise. But his work has examined how hygiene behaviors, including hand-washing, affect the spread of disease everywhere from hospitals in Uganda to dairy farms in southern Wisconsin.
“People don’t often think about hospitals and farms as being similar, but they’re both part of the landscape of public health,” he says.
Safdar’s research has focused on limiting infections in hospitals — a leading cause of mortality in health care settings. She studies how hygiene can affect infections in hospitals. The goal is for patients, who are likely in an immunocompromised state, not to catch anything else while they’re in the hospital. Safdar says she will be paying attention to how patients with other conditions could be affected by the changes hospitals will be making to deal with COVID-19.
Together, Sethi and Safdar have examined structural issues related to hand hygiene and infection prevention, finding that factors like sink placement can make a big difference in rates of hand- washing.
Safdar says that good workplaces make hygiene “standardized, convenient, and available.” She makes a comparison to light switches, which we intuitively reach for at a specific height, even if we’re in a new room.
“We strongly believe in nudge theory,” she says. “If you make the right thing to do the easy thing to do, then it is likely that people will do it.”
In the 1850s, an English physician named John Snow became one of the pioneers of epidemiology after stopping a London cholera outbreak by shutting down a contaminated public water pump.
Around the same time, Hungarian physician Ignaz Semmelweis and English nurse Florence Nightingale each saved scores of patients by instituting hand-washing protocols at their respective hospitals. The developments were especially notable given that they happened at a time when miasma (“bad air”) theory was still the mainstream scientific explanation for disease.
It might not get the recognition that history has given to penicillin, but hand-washing was nothing short of a revelation for the field of health care.
As Sethi watches news about COVID-19, he’s concerned by evidence that suggests that the spread of the virus could be driven by people who don’t have severe symptoms. The possibility of spreading the virus before symptoms appear makes containing COVID-19 a particularly difficult challenge. “For now, it appears that inevitably we will have widespread transmission in the United States,” says Sethi.
That’s not to say that we can’t do something about it. Sethi and Safdar both stress the importance of mindful engagement with simple practices.
Regularly and thoroughly wash your hands with soap and water (yes, for at least 20 seconds, and don’t forget to scrub between your fingers). Use hand sanitizer if you can’t get to a sink (if you can get it). Keep an eye on CDC guidelines and updates related congregating in large groups. And avoid touching your face.
“It starts with us becoming more self-aware and then making a personal commitment to improve,” says Sethi.
If you need a reason to be hopeful, it might help to consider the history of epidemiology. The field is responsive, constantly expanding, and in search of solutions — complex and simple alike. Scientists have been studying the outbreak since its first murmurs in Wuhan, China, in December. Over the course of just weeks, they have sequenced its genome.
The rapid progression of scientific knowledge about COVID-19 is remarkable in the context of the history of epidemiology, a science whose first practitioners saved lives without much more than a simple hypothesis: unclean hands and surfaces might spread disease.
“If I were going to go back in time with a time machine, I’d visit them,” says Sethi, speaking of Snow, Semmelweis, Nightingale, and the other pioneers of the field. “I would love to just have coffee with everybody and ask them what they’re thinking about.”
Editor's note: Developments relating to COVID-19 are evolving quickly. Please note that any information in this article is subject to change.
