The New Normal

by Jennifer Ashton, M. D.

  Don’t wear gloves. I’ve talked about this on air multiple times because it’s a really important concept: Unless you’re trained in sterile technique and concepts of cross-contamination, most people should not wear gloves to protect themselves against COVID-19. If you do, you may be increasing your risk of exposure to the virus.

  Gloves provide people with a false sense of protection. When you wear gloves in a public place, you likely touch more than you would with your bare hands, including doorknobs, store products, your mask, your cellphone, your glasses, your credit cards, your handbag, etcetera. When you touch nonsterile items with sterile gloves, you cross-contaminate everything and spread more germs by touching more things.

  Doctors, on the other hand, only touch a patient and those items we know to be sterile whenever we wear gloves. As soon as we touch something that isn’t sterile, we recognize that our gloves have been contaminated and will need to be replaced immediately to avoid germ transmission and exposure.

  The layperson doesn’t know this. Instead, when you wear gloves in public, you go home, remove them, and (hopefully) wash your hands. But the moment you use your clean hands to take off your mask or pick up your phone, glasses, purse, or anything else contaminated by your gloves, you’re exposing yourself to possible pathogens—and probably more microbes than if you had touched these items with bare hands.

  Another reason not to wear gloves is that there’s no documented cases of COVID-19 being spread through contaminated surfaces—again, it’s a respiratory virus that is spread primarily through respiratory droplets and aerosol particles. If you’re wearing gloves but not a mask—or not a mask that covers your mouth and nose—you’re doing yourself a serious disservice.

  Safety Tips from the OR

  As an OB-GYN, I have spent a lot of time in the operating room, performing surgeries like hysterectomies and C-sections. This means I know how to stay safe in the presence of potentially deadly pathogens. You can increase your awareness, too, by learning about the basic principles of operating room safety.

  First, the steps doctors take to ensure sterility in the OR are primarily done to protect the patient, not the doctors or nurses in the room. The main reason surgeons wear masks, for example, is to prevent our germs from contaminating the patient, not to prevent our exposure to possible pathogens.

  Doctors wear gloves in the OR to protect the patient, not ourselves, but as soon we put them on, we don’t touch anything that’s not sterile other than a patient’s body. If we do touch something, we know our gloves are contaminated and thereby unsafe. This is why surgeons don’t bring gloved hands below their torso—it’s a training technique we learn so that it’s ingrained not to touch anything while wearing gloves. We’re so schooled in this technique that we’ll ask a circulating nurse in the OR to scratch an itch, push up our glasses, or fix our masks for us.

  The same applies to clean hands: Contrary to what you see on Grey’s Anatomy, doctors wash their hands before surgery with their masks covering their nose and mouth, not around their necks. Otherwise, we’d have to touch an unsterile mask after we’ve washed our hands, which would contaminate our hands.

  Finally, surgeons don’t wear every piece of protective gear available to them just because they can. For example, I could wear a sterile hood or white-paper hazmat suit like those now popular with anxious air travelers whenever I operated on a patient, but doing so would be uncomfortable, restrict movement, and possibly increase the risk of cross-contamination.22

  Don’t sanitize your food. The coronavirus is transmitted through respiratory droplets or aerosolized particles, not food or drink. It is highly unlikely and undocumented to date that you can contract the virus because someone touched the sandwich you ate or breathed in the vicinity of your French fries. Despite these facts, some people have mistakenly assumed that if hand sanitizer is good for their hands, it must be good for other organic material like food. Not true: Hand sanitizer can be poisonous and even fatal when ingested, which has sadly already happened to several Americans who’ve died after eating sanitized food.

  Don’t sanitize your groceries. The CDC never recommended at any point in time that the general public sanitize their groceries, and there’s no documented cases of anyone contracting the virus from food containers or packaging. But wiping down your groceries with bleach can harm your health in other ways. Studies show the fumes emitted by bleach can trigger symptoms similar to COVID-19, like shortness of breath and coughing; can acerbate asthma and other lung conditions; and can boost the risk of serious health problems.23 In addition, using bleach on food containers increases the likelihood of contaminating food with the toxic chemical, which can burn skin and is poisonous when ingested.

  Don’t wash and sanitize at the same time. Many viewers have asked me if it’s best to wash your hands and then use hand sanitizer as an extra safety measure. Millions of Americans already do this, but the reality is that you actually may be harming your health by doing so.

  Hot water, soap, and hand sanitizer dry out skin, stripping essential oils and reducing its natural moisture barrier. When you wash and sanitize consecutively, you give your skin a double-drying treatment, leaving your hands more prone to developing microscopic cuts. You won’t be able to see or feel these tiny cuts, but they provide a fantastic portal for infectious microbes, including staph, which can cause you to experience a rash, fever, swelling, and tenderness. You can also contract MRSA, a type of staph infection that can cause serious complications. This is where perspective can help with health anxiety: If you’re washing and sanitizing consecutively to prevent COVID-19 but end up in the hospital with an antibiotic-resistant MRSA infection, you’ve done yourself more harm than good.

  Don’t constantly disinfect your home. According to the CDC, the general public should routinely clean frequently touched surfaces like doorknobs, handles, light switches, and cellphones to help prevent the spread of the coronavirus. But what does routinely entail? I suggest wiping down high-touch surfaces on a daily basis. I don’t suggest, however, wiping down these surfaces multiple times a day or scrubbing and disinfecting your entire home on a daily basis (unless someone in your household is already sick). Doing so is unnecessary and may exacerbate any health anxiety you may have.

  What’s more, most household cleaners are toxic, especially those like bleach that are capable of killing the coronavirus. Continual exposure to chemicals found in household cleaners can irritate lung conditions and may even increase the risk of cancer and birth defects.24 To stay safe, use cleaning products in well-ventilated areas and wear protective clothing and rubber gloves to protect skin from absorption.

  While health anxiety is clearly a serious condition now impacting millions of Americans, no matter how much or little health anxiety you believe you have, worrying too much about your health can make you sick, both physically and mentally. Take the time to identify whether health fears are interfering with your well-being and be proactive about mitigating that anxiety now in our new normal—because the threat of the coronavirus isn’t going away. No one should live in fear, and learning to think like a doctor can not only reduce your anxiety but also help you better understand your body and disease pathology so that the world’s next pandemic isn’t as frightening.

  Chapter 8

  Medical News

  At the beginning of the outbreak, as we learned the virus was sickening hundreds in China, Americans began to buy face masks, sometimes in very large quantities. At the time, the CDC, the U.S. surgeon general, and I, along with most other doctors on TV and at patients’ bedsides, told Americans we didn’t need masks for two reasons: (1) We use masks primarily on sick patients to prevent viral spread to healthy people, so unless you actually have COVID-19, you don’t need a mask, and (2) the United States had a severe mask shortage that was already endangering high-risk healthcare workers. No one wanted to see the public, who was at low risk of catching the virus at the time, gut the nation’s mask supply like we would eventually de
cimate store shelves of bleach and toilet paper.

  Two months later, however, the CDC flipped its script, announcing that everyone should start to wear face coverings immediately when in public. This abrupt U-turn confused millions, outraged some, and left many feeling betrayed, wondering how Dr. Anthony Fauci or I could have misled them. I still get angry comments now and then about it on my social media.

  So what the heck happened? The answer is something that happens all the time in medicine, but usually doesn’t get nearly this much publicity: We learned something new. At the same time, what we already knew didn’t change at all. Let me explain. To doctors, new information is known as progress, good science, and good medicine. But given the high profile of the issue and the controversies that have stemmed from it, this reversal in guidance or insight came to be viewed as suspicious, if not incompetent.

  After the CDC recommended Americans wear face coverings, I went on ABC to explain why. I told viewers the concept behind the fact that masks were for sick people hadn’t changed—that was still a fact. What had changed, however, was that we had learned that up to 45 percent of people infected with COVID-19 show no symptoms, which meant that it was impossible to tell who was sick and who wasn’t. In other words, we had to assume that everyone could be sick. There was also still a shortage of surgical masks, which is why the CDC advised people to wear face coverings and not surgical or N95 masks.

  The CDC, however, didn’t explain that the reversal was based on new information about asymptomatic spread, unfortunately. The same day the CDC announced its new guidelines, President Trump told Americans he would not wear a mask, which raised the volume on the country’s confusion.1 In some ways, I think this personal rejection of CDC recommendations was meant to show that “tough people” don’t need to wear masks and that a mask was for the protection of the person wearing it, when the reality was, at that time, the CDC was recommending masks mainly for the protection of others. What’s more, false claims—like the CDC originally thought cloth face coverings wouldn’t be effective, wearing masks cause oxygen deficiency or can lead to carbon dioxide intoxication, and the agency was really harboring a secret coronavirus cure—circulated like wildfire on the web, further confusing people and complicating the message.

  The moral of the mask mix-up is that it’s critical to know how to interpret medical news and be able to sort fact from the increasing amount of fiction in our new normal. For decades, Americans have struggled to understand health news and interpret medical headlines. This isn’t because they’re not intelligent enough or lack the proper education. Instead, medical news is often emotionally threatening, personally impactful, and ever-evolving. That’s a lot to unpack in a single article or segment, which can be only 400 words or 20 to 120 seconds long. Additionally, not all doctors, no matter how competent they are in the OR or by the bedside, can effectively communicate information.

  In the pandemic era, it’s become even more difficult to understand medical news—and a lot easier to fall for fake headlines and false claims. A joint Franklin Templeton–Gallup research project found that many Americans are misinformed, with a “gross misperception of COVID-19 risk”—results that researchers call “stunning” and “shocking.”2 This profound degree of confusion can be detrimental or even deadly.

  My job as chief medical correspondent of ABC News is to unpack complex, oftentimes emotionally charged medical news for the public. I’ve done this on national network TV for fifteen years, but ever since the COVID-19 outbreak began, I’ve been doing it on a near-daily basis. Because I’ve been doing it for so long, I can tell you with certainty that the ecosystem around medical news has changed drastically in our new normal, as we’ve seen an unprecedented uptick in misinformation in health and science. This infodemic has made it more essential to know how to read behind, above, below, around, and through all medical headlines.

  Similar to what happens in medicine and science, headlines can suggest something that seems directly contradictory to what we used to think. If we assumed we knew it all in medicine and never reexplored, reanalyzed, or reconsidered our original hypothesis, we would never advance our knowledge base. If we didn’t remain open-minded to seeing things differently, learning something new, and changing our recommendations, we would be stuck in the medical and scientific dark ages. The ability to interpret new data or headlines and integrate new information is one characteristic of the scientific mind. Recognizing what is known, as well as what isn’t known, is the mark of intellectual integrity. It isn’t always about having all the answers; sometimes it’s also about asking the right questions. And when you know how to read behind the headlines, you’ll be able to better navigate the pandemic era and decipher any important information about your health in the future.

  When Too Much Information Becomes an Epidemic

  The coronavirus has been malicious in many ways, unseating the world like arguably no other medical, political, or social threat has. But the virus isn’t the only enemy we face in our new normal. The amount of misinformation generated by the pandemic has also been devastating, as false claims, unproven treatments, and conspiracy theories have spread as widely as the virus itself.

  At one point, 80 percent of all Americans were exposed to fake news about the virus, according to the Pew Research Center.3 One team of international researchers discovered more than 2,300 reports of rumors, stigma, and conspiracy theories in twenty-five languages and eighty-seven countries, concluding that false claims led to eight hundred deaths and thousands of hospitalizations in the first three months of the outbreak alone.4

  Today, “we’re not just fighting an epidemic; we’re fighting an infodemic.”5 That’s a quote from the director-general of the WHO, which recently held a first-ever conference in response to the infodemic. The WHO defines an infodemic as “overabundance of information—some accurate and some not—occurring during an epidemic.”6 No matter what you want to call it, this onslaught of misinformation has deeply troubled the WHO, along with doctors all over the world, including me.

  As a physician and the chief medical correspondent of a major national news network, I’ve been on the front lines in the fight against misinformation with patients and viewers for months. I’ve been on air almost every day to tell millions of Americans succinctly, accurately, and honestly what I know and don’t know about the pandemic.

  Never before, however, have I observed so many people asking the same questions, not understanding the news, and feeling confused or even misled by information related to the pandemic. Statistics underscore this observation: While 86 percent of Americans say they follow news about the pandemic “fairly closely,” nearly 40 percent say it’s become increasingly difficult to know what’s true or false about the virus, according to the Pew Research Center.7

  While some might admit they can’t tell fact from fiction when it comes to COVID-19, it hasn’t stopped many from trusting inaccurate and potentially harmful claims. In fact, up to 25 percent of all Americans believe fake news about the virus, according to Scientific American, and up to 60 percent either identify accurate information as false or can’t tell if it’s true.8 Perhaps even more disturbing: One-third of all Americans who’ve heard the conspiracy theory that the pandemic was planned think it’s true, according to the Pew Research Center.9

  The reasons people don’t understand medical information or end up believing misinformation, even material as outrageous as many conspiracy theories for COVID-19, isn’t because they’re not intelligent. Low health literacy has been a problem for decades, straddling education level, socioeconomic class, political party, and ethnicity. As a doctor, I’ve seen plenty of highly intelligent patients who simply can’t analyze, integrate, or even process medical information.

  Many people have a difficult time dealing with medical news because it poses an emotional threat, since the information can affect them both personally and profoundly. In the instance of COVID-19, medical news can literally mean the difference between life and
death. That’s an immense amount of pressure to get the information right. And when we feel under pressure, intimidated, or scared, it’s also often easy to get confused.

  These factors—low health literacy and an emotionally charged medical issue—have caused the American public to limp into the pandemic era at a significant disadvantage. Add to this some characteristics unique to COVID-19 and it’s easy to see why misinformation has come out swinging in our new normal.

  COVID-19 is a new and complicated disease that even doctors have struggled to understand. Even if you strip away COVID-19’s complexity, few Americans comprehend the basic principles of infectious disease. The pandemic has forced the public to learn a new lexicon of epidemiological terms like comorbidities, community transmission, and PPE that were never part of our everyday vocabulary before.

  Good data about the disease has also come out at an unprecedented pace, as what we know about the virus has changed on an almost-daily basis. This has caused a degree of informational whiplash. For example, while many were obsessed with disinfecting surfaces at first, after we learned more about how the virus spreads, the CDC stated that fomite transmission—infection through contaminated surfaces—wasn’t the primary means of viral spread. This development left many feeling confused and wondering why they had spent weeks smoke-bombing their homes and groceries with disinfectant.

  Complex and rapidly evolving data on its own doesn’t instigate an infodemic, however. Supply comes on the heels of demand, and in our new normal, we’ve demanded more medical news than ever before. Whether we want to watch or not, news about the pandemic has become essential: We can’t exactly turn a blind eye as to whether there’s a mask mandate in our area or a new vaccine that can protect us from serious illness. This makes medical news different from other media buckets like economics, politics, and sports, all of which you can tune out if you’re not interested in what the markets are doing, who is lobbying for which legislation, or what team is winning the game.