By Dr. Gil M. Vicente
We are going through perplexing times because of Covid-19. We are confused with the continually changing directions from health authorities.
At present as you see on TV or in print media, it has been recommended that if you sneeze or cough, use your upper sleeve or elbow.
However, in doing this, we have to consider the following:
The droplets produced should be totally contained.
No amount of droplets should escape the exact spot where the sneezing or coughing was done or else droplets can be caught by somebody near you.
No tinge of wetness, secretions or phlegm or even food particles should be visible in the sleeve after the cough or the sneeze as it will be unsightly.
The fastest way to contain the cough or the sneeze must be employed. Most of the time, you are caught unaware.
The idea of coughing or sneezing onto the sleeve will not satisfy the above mentioned criteria. It is, therefore, not recommended.
What do you think is the best way?
Imagine you are in meeting with your friends, or on a date with your sweetheart or wife. The maneuver, which will satisfy the three criteria is by sneezing or coughing inside your shirt or dress.
Bow down and pull forward and bring your dress or shirt towards your nose and mouth before sneezing or coughing.
The trajectory is toward your chest area. This is what I call the BOPISS maneuver.
BOw down
Pull
Shirt forward and upward and
Sneeze
Let us review our criteria.
First criteria, it should contain all or almost all of the droplets.
With this BOPISS maneuver, almost all of the droplets are trapped. Most droplets will be directed to the chest and if it rebounds, it is caught by the shirt or the dress.
If you have a regular dress or t-shirt which is not too thin, it will be enough to contain most, if not all of the droplets.
It is best to have an undershirt to catch the droplet. But with or without the undershirt, that maneuver will still be a better option to effectively catch the droplets.
The wearing of a tie by men will be a limitation for this maneuver. Because ties are generally not washed after each use, they can be considered fomite-carrying bacteria, virus or germs. The recommended new normal, therefore, is not to wear ties anymore!
A scarf may be helpful too. If loosely worn and wound twice around your neck, it may be really a good trap for the sudden sneeze, but if you sneeze and it gets soiled or wet, it is advised not to wear it anymore for the rest of the day.
Store it immediately in a laundry bag or soak it in a basin of sudsy water upon arriving home.
It is best to bring an extra scarf.
You should have some kind of practice and proper positioning (loosely and doubly worn) to perfect it.
Since thin scarves can allow the passing through of droplets, choose a thicker scarf.
One disadvantage of wearing a scarf is that your hand may catch the droplets, requiring you to wash your hands at once.
Besides, most of the male population may not like the idea of having a scarf around the neck.
Wearing a mask will, of course help, but once it gets soiled after the cough and the sneeze, it should be changed and disposed off right away.
If you wear the ordinary mask and not the N95, the droplets still go out to the sides, up and down as well. So it cannot contain all the droplets from the sneeze.
Most of the time, you also remove the mask when you feel like relaxing from the feeling of suffocation, when your ears are aching or when your head feels compressed, such that sneezing during those moments may catch you unaware.
Definitely, using your sleeves or your elbow will not suffice to contain the droplets that may escape upward, downward and even at the sides.
Second criteria, it should not leave any tinge of wetness, phlegm, secretions or even food particles visible anywhere after the cough or the sneeze.
Using the BOPISS maneuver, all of these unsightly matter are all confined within your chest area and hidden and covered by the t-shirt or dress.
If it is too much for you to tolerate its presence, then you can calmly and slowly go the comfort room and clean the part well with wet or dry tissue or clean the chest area with soap and water. You may spray alcohol, as well. Bringing an extra dress or shirt is a good idea.
The scarf will be able to catch the particles and secretions. Again, practice should make it perfect and also, do not forget the proper tying around the neck—doubly wrapped and loose.
The mask generally catches everything sneezed out of the nose but it needs immediate replacement once soiled.
The sleeve/elbow maneuver will leave the cloth wet, stained and soiled. That will be an unfavorable sight.
Third criteria, take the fastest way to contain the cough or the sneeze.
Discussion on the third criteria to follow.
Dr. Gil M. Vicente, MD., Ear, Nose and Throat, Head and Neck Specialist, St. Luke’s Medical Center.
Belongs to a group of unique group of specialists whom we can consider as chosen few.
Vicente is currently the chief of the Rhinology Section of the St. Luke’s Medical Center. He is also currently the president of the Philippine Society of Oncologists.
He is also a Diplomate of the Philippine board of ORL-Head and Neck Surgery; fellow, Philippine Society of Oncology; fellow, International College of Surgeons; president, International Symposium on Rhinosinusitis and Nasal Polyposis (2017); president, Philippine Society of Otolarynology Head and Neck Surgery (2008); president, International Society on Infection and Allergy of the Nose (1999); president, Asian Research Symposium in Rhinology (2005).
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