COVID-19 PREVENTION SERIES: First of 5

INFECTION PREVENTION AND CONTROL FOR THE FILIPINO HOME: TOP 10 IPC TIPS for the Home

Regina P. Berba MD, FPCP, FPSMID

Now more than ever, all of us really need to strengthen our collective response and preparedness
against the looming threat of the COVID-19. We must continue to strive to prevent at all cost the
invasion of COVID into our communities and homes. Here is a discussion of 10 practical tips to guide
us in preparing our homes against the COVID-19 using the basic strategies in Infection Prevention and
Control (IPC).

How do we manage this new crisis of the COVID-19 amidst our community? While this problem has
been haunting us for since December 31, 2019, it felt far away- in China, Singapore, Korea and Italy. But
now it feels and is actually so close- with the number of confirmed cases rising from 3 to 5, then 6, 10,
20, then 33 and now 49 - all in the last 6 days.

As overwhelming as it sounds, control of your immediate environment is feasible and could protect your
family. I recommend that parents and heads of families take special note of the following
recommendations:

1) Teach your family and household members about COVID-19. You can use these bullet points:

KEY MESSAGES YOU SHOULD IMPART TO YOUR FAMILY: The COVID-19 is a new infection. It is
spreading fast. It is a droplet infection. We can reduce our risk of infection if we follow some basic
recommendations.

• COVID-19 is a new viral infection which affect mainly the respiratory system. This means that
the person with the infection (you can give him a name: e.g. PERSON COV1) will have cough or
sore throat and usually there will be fever.
• The infection is passed on from PERSON COV1 to the next unsuspecting person by respiratory
droplets1. Droplets are very tiny sprays of saliva admixed with the virus. The droplets are
expelled from the mouth of the PERSON COV1 to the environment when he coughs, sneezes,
laughs, maybe even as he normally talks. The more vigorous the coughing, the more likely that
the infected droplets will travel further than the usual 3 feet distance. In general the virus is
shed in significant amounts only when PERSON COV1 begins to have cough or fever or other
signs of illness.2
• When we are close enough to PERSON COV1 that there is higher likelihood that we may breathe
these droplets and they lodge into our own respiratory tracts that we become infected as well.
The magic number is 3 feet. Staying 3 feet away from people who are ill and coughing, may save
you from a COVID and other infections.
• Small as they are, the COVID infectious droplets are still heavy enough, that they do not remain
suspended in the air for long periods of time. Because of the effect of gravity, they will fall onto
surfaces after about a distance of 3 feet away from the source. If PERSON COV1 coughed near
furniture like tables and desks then the droplets will fall onto them. Vertical surfaces like walls
and doors are less likely to have droplets unless the source coughed onto them very closely like
onto the elevator control panel during an elevator ride.
 • Why do these droplets pose danger to us? Experiments with previous SARS CoV showed us that
the SARS virus can stay viable in the environment over smooth solid surfaces for over 5 days at
temperatures 22-250C and relative humidity of 40-50%3. This means if the surface is not cleaned
and a new person (PERSON 2) touches the table, do not wash his hands, touches his nose and
rubs his eyes, these droplets may move from the hands to the nose and eyes, then the virus has
the opportunity to land onto the person’s respiratory tract. In a few days, that next person may
have cough or fever or both (becomes PERSON COV2).
• The incubation period or how long does it take from exposure to illness? The estimate is
anywhere between 2 days to 14 days4.
• PERSON can now easily infect other unsuspecting persons. And the cycle continues.

2) Teach the value of keeping hands clean using hand washing with soap and water or use of alcohol
or alcohol-based handrubs. Be clear on when to absolutely wash their hands or use alcohol.

KEY MESSAGES FOR HAND HYGIENE: It is very very very important to learn and follow how to keep our
hands clean. Washing hands or using alcohol several times during the day and night.

In addition to the respiratory droplets with viruses, our hands pick up a lot of other germs and dirt and
stuff. We really should wash our hands often- with or without the COVID-19 problem.

Teach and demonstrate to everyone specially the younger ones and helpers how to keep their hands
clean. When we teach medical students, we ask them to show the steps back to us. So do the same for
your children: go to the bathroom and wash hands together.

• Wet your hands with clean water. Apply soap.

• Build a soap lather within your hands by rubbing the palms first together, then the palm of the
right hand over the back of the left hand and vice versa, then between your fingers, around each
thumb, under your nails and finally scrub the fingertips.
• Scrub your hands with soap for at least 20 seconds.
• Rinse your hands well under clean water.
• Dry your hands using a clean towel or air dry them

It is best to clean hands under running water, Turn the faucet off during the 20-second period of
soaping. Then turn the faucet on again when rinsing.

If there is no running water, make sure the storage container as well as the dipper (our usual “tabo”) of
water is clean.

There is no best soap to use. Any soap such as our usual bath soap or laundry soap or dishwashing soap
will do. It is both the mechanical action of scrubbing the hands as well as the chemical effect of
detergent which cleans the hands.

If there is no soap, water alone will also clean the hands but not as efficiently.

When there is no soap and water, use alcohol instead. Same steps.

Some people’s hands get rapidly dry with alcohol so use instead alcohol-based handrub.
Remind them when it is necessary to clean their hands. Always clean hands/make it a habit/ make it
automatic:

• Before eating, feeding others

• Before preparing food, drinks, milk, “baon” or packed meals
• Before caring for sick family members
• Before any clean personal habits like inserting or removing contact lenses, and touching face
and putting makeup
• After blowing your nose, coughing or sneezing, using and disposing tissue paper
• After using the toilet, changing a diaper or cleaning up a child who has used the toilet
• After touching the high-touch environments: like the handles at the LRT or the jeepneys, money,
elevator buttons, escalator handrails and so on.
• After handling obviously dirty items like garbage, animal waste, household dirt

3) Explain RESPIRATORY ETIQUETTE, how and why we should do this. Demonstrate how to do this to
your kids.

KEY MESSAGES FOR RESPIRATORY ETIQUETTE:

• Cover your cough with your elbow, or with tissue paper and discard tissue; or wear surgical
mask. Hand hygiene is a must after use of tissue.
• The hands cupping and covering the mouth during cough IS NOT ACCEPTABLE anymore. Hands
efficiently transmit the germs.
• Spitting is not also acceptable anymore under any circumstance. The spit will transmit the
germs for a prolonged period of time.
• Parents and other adults should provide example to their children by following what they
preach.

Compared to traditional personal hygiene teachings, respiratory etiquette is a relatively newer concept
introduced a few years ago. It wasn’t like this when we, parents of today, were growing up. However,
the principles are the same and stems from the release of infectious droplets from the SICK PERSON
when he coughs or sneezes. We need to get control of the infectious droplets spreading into the
environment. If we can catch these droplets and contain them into disposable tissue paper and throw
the tissue paper into trash cans, then there would be less infectious droplets to infect the community.

If there is no tissue paper at hand, use the one’s own elbow. DO NOT USE YOUR HANDS TO CATCH YOUR
SNEEZE OR COUGH- because that’s the best way to spread the germs. It’s okay to cough into your
elbow, as nobody else touches your elbow. You can clean and wash your elbow as you take a bath.

If by accident you cough into your hands, go quickly to wash your hands or use alcohol.

The use of cloth handkerchiefs for cough is discouraged. After using them for sneezing, you will put
these back into your pocket or handbag and that will contaminate all you the contents of your
bag/pocket.

Make sure used tissue is thrown into trash bins and not left just anywhere.

Finally on respiratory etiquette, DO NOT EVER SPIT. Many people find this disgusting. Regardless of
whether there are or there aren’t people who see you spit, it is unhygienic and unacceptable. If you
need to cough out phlegm, catch this with tissue paper and throw to a trash bin. If you are near a
comfort room, you can spit into the sink but make sure the run water to flush down the spit.

4) Empower the people in your household to do all of the above even if you are not there to remind
them.

KEY MESSAGE ON EMPOWERMENT: We sometimes keep on talking about strategies but do not realize
some people may not have the capacity to implement because they are not equipped with the
essential materials. So for your family members, parents please provide these to your children.

• Provide each member to have small bottle of alcohol, tissue paper and at least 1 surgical mask in
their school or office bags. Have a stash of extra supplies in your own bag or in the car just in
case they forgot.

Alcohol may not have been in your budget before; but it will be good to include it now. The benefits of
alcohol and clean hands far outweigh the cost. Small bottle of alcohol 50ml ranges from P36 to P80.
Each pump of alcohol is close to 2ml dispensed. If we use alcohol 25x per day, that’s about 50ml per day.
Buy the 500 ml bottles (usually P70 to 150) to regularly refill the small bottles.
Buy 60 to 80% alcohol; ethyl or isopropyl both acceptable.
The scent doesn’t affect efficacy but may affect how often your kids would want to use the alcohol. If
they complain of their skin drying up or getting cracks, opt for the alcohol-based handrub which are
made with gels which provide emollients and keep the skin from drying up.

Tissue paper may not also be in your budget but good to have.
Surgical mask may be more challenging to purchase at this time. Hand out the precious masks in clean
brown sandwich bags or unused white clean long letter envelope to keep the mask clean.

5) SOCIAL DISTANCING as a key strategy to both contain and mitigate the outbreak.

KEY MESSAGE: Social distancing has several levels. At this phase of the outbreak response, rapid
isolation of persons who are ill should be planned at your home. What if someone in your household
starts getting cough and colds? If they are mildly ill, persons can stay home until he recovers. If they
are moderately ill and require hospitalization, they should be brought to the hospital and be admitted
for closer monitoring and medical care. Social distancing strategies have begun such as cancellation of
big meetings and events, and just yesterday March 10 with temporary suspension of school. We are all
advised to avoid public places where large groups of people converge. The older persons and those
with chronic illnesses should opt to stay home and avoid unnecessary trips outside the home.

Social distancing will be more fully discussed in a future article. Social distancing measures are taken to
restrict when and where people can gather to stop or slow the spread of infectious diseases like our
current COVID-19 epidemic. This week many events, meetings, conventions have already been cancelled
to limit the coming together of large groups of people. We are advised to stay away from public places.
Should our numbers of confirmed cases continue to rise and clusters of transmission become apparent,
then we will be elevated to Alert Code Red Sublevel 2 and further social distancing will be put in place
such as works and more school restrictions.
Please keep our “Lolo’s at Lola’s” safe at home. Special populations must pay more attention to the
need for social distancing. The largest series of published data4 from COVID-stricken China have shown
that complications occur much more commonly in elderly individuals. These groups are asked to socially
distance themselves and stay at home to reduce their risk of getting infected. Frail grandparents and
other older people who have conditions such as diabetes, chronic lung diseases and other ongoing
treatments should opt to stay home more. Control their movement: let us say going to Mass is
something very important to them, then plan this so that they are able to go a well-ventilated church
during periods of less crowding like early morning mass schedules.

6) Keep your house clean and well ventilated. Disinfect with commercial home disinfectants. You can
use chlorine bleach products and other EPA approved disinfectants.

KEY MESSAGE: You can reduce the risk for COVID by keeping your home clean.

At home, keep things clean. Horizontal surfaces which are frequently used should be regularly kept
clean and dry. Look over the entire house from doorway to each room and identify frequently touched
items and surfaces: doorknobs, light switches, toilet seats and handles, refrigerator door handles. Have a
schedule to clean them with disinfectant. Follow manufacturer’s instructions about how to use
disinfectants. There will be ready to use products and brands which can be diluted. These are wise
investments as a bottle of P35-50 can be good for disinfecting the home for a duration of one week.

At a regular home with all members otherwise in healthy states, it may not be necessary to have a lot of
alcohol all around as there is usually a faucet and sink close by with soap for handwashing. Make a
regular inspection of soaps supply so they are constantly available.

A separate article will be written about care of the home when there is a COVID case in the household.

7) Travel to other countries with community transmission with caution.

KEY MESSAGE: You can reduce your risk for COVID during travel by know ahead of time the COVID-19
rates in the country and city you plan to visit and planning precautionary measures accordingly.

Know what areas in the countries you are visiting are affected. Such information is dynamic and may
significantly change over a matter of days. Keep updated and opt to cancel if the risks become high. The
best reference for countries with ongoing local transmission is the WHO website situational report
which is updated almost daily. (https://www.who.int/docs/default-source/coronaviruse/situation-
reports/20200308-sitrep-48-covid-19.pdf?sfvrsn=16f7ccef_4)5

8) Plan out visits to the hospital or clinic. Stay away from hospitals if you are well.

KEY MESSAGES: Regularly assess health status of members of your family. If you are all well stay away
from the health facilities. If someone is ill, seek medical consultation.

If you are well, stay away from the hospitals. If you feel otherwise okay, the last place you want to go to
are health facilities which may have the infectious patients carrying the COVID-19. Stay away from them.
Delay elective clinic consultations and surgeries in a future time: like dermatologic removal of some
minor lesion in your left foot. Now is not the time to line up with all other sick persons in a hospital
elevator or clinic queues. If you have friends and relatives admitted in the hospital, check on them by
phone and excuse yourself from visiting, unless absolutely necessary.

When to worry that it may be COVID-19:

However, if you have a link to any of the confirmed cases then you have no choice but to seek
consultation early. At this time, we can still identify two risk factors for coming down with the COVID-19:
1) travel history in the last 14 days to countries with local transmission; and

2) contact with a confirmed case for COVID-19. A contact is a person who:

• Provided direct care without proper personal protective equipment (PPE)2 for COVID-19
patients; or
• Stayed in the same close environment of a COVID-19 patient (including workplace, classroom,
household, gatherings); or
• Traveled together in close proximity (1 meter or 3 ft) with a COVID-19 patient in any kind of
conveyance within a 14‐day period after the onset of symptoms in the case under consideration.

If you are any one of the above and you are well, stay in quarantine. While in quarantine

✓ Check out the contact numbers of the surveillance officers (DOH Regional Epidemiology
Surveillance Unit or RESU) in your area of residence
✓ Take note of the nearest hospital you can go to.
✓ Buy a thermometer. No need for the thermal scanner we see in malls. A regular thermometer
from the drugstore will do.
✓ Check yourself daily during the 14-day period: Answer truthfully. Fever is a temperature of
37.8C or higher.
Do I have fever? [ ] YES [ ] NO
Do I have cough or colds? [ ] YES [ ] NO
Do I have diarrhea? [ ] YES [ ] NO

When you develop fever and/or cough or other respiratory symptoms within the 14 day observation
period, give the RESU and the hospital ER a call to inform them of your plan to proceed to the ER and
your exposure or contact history; follow instructions to proceed to the hospital for COVID testing.

BUT NOT ALL COUGH AND COLDS IS COVID-19. Again review your risk for getting the COVID.

9) Others concerns:

• Flu shots. There is enormous data advising all of us to have our annual flu shot (influenza
vaccine). Call your family physician or office clinic or barangay health center to give you a
reminder call when the stocks of the new influenza vaccine for 2020 arrives. Schedule all
members of your family to receive. Again the INFLUENZA VACCINE is an good health
investment. If you have to prioritize members in the family because of limited resources, put in
the top of list our more elderly relatives and those with chronic illnesses.
• Money, bills and coins are always dirty. But it is impossible to clean money and maybe a futile
attempt. So just clean your hands after handling money.
 • I work at BGC or at Greenhills where the cases have been identified. Should I stop working and
just stay at home? In the bigger picture, the transmission is still limited and the patients
identifiable. The exposures could still be traced. Remember the transmission is by droplets and
requires close enough contact of 3 feet for the infectiousness to be successful. We need to
continue working and await advise regarding work from home. Observe basic precautions.
• Disinfecting gadgets like cellular phones. This is a good move and recommended since we use it
constantly day and night. Disinfection again should follow manufacturers’ guide. Definitely do
not use usual home disinfectants or pure alcohol. Current recommendations include using
diluted alcohol 60% water and 40% alcohol with a clean cloth or using microfiber material to rub
off dirt from the phones.
• Follow quarantine rules. Quarantine is advised for persons who may have travel history or
become close contacts of confirmed cases. Some people think this is a vacation from work or a
time for bonding with family. But the whole principle behind quarantine is really distancing
oneself from others, even during the time that the person is not sick at all, so that in the event
that the COVID virus was able to successfully invade the person during the incubation period,
there is less risk for virus to have spread. If the DOH or the Bureau of Quarantine identifies you
to require quarantine, please follow. When a person is placed in quarantine, they must become
truly and physically separated from others. Quarantine implies that the person is not sick at the
moment but because there is a possibility they were exposed to a highly infectious disease, it is
best to keep them away from other people. The Civil Service Commission6 has issued guidance
on this including harsh punishment if the restrictions are not followed by people who should be
on quarantine.
• About surgical masks. Let us continue to use masks prudently as supplies are really low and
difficult. If you feel you are in a setting that poses high risk of getting the infection like a really
crowded bus with several people coughing, or an elevator ride in a busy hospital, or waiting for
your turn to see a doctor in a full clinic, then please go ahead and wear a surgical mask. Wear
the surgical mask properly so that you benefit from the protection offered by the mask. The
colored fluid resistant side should be the one facing the outside, while the plain white side is the
one touching your mouth and covering your nose. In otherwise low risk setting like in your
home and you are otherwise well with no cough or colds, then there is no need.
• If school is suspended, keep your children at home. Do not allow them to go to the mall.

10) Stay informed.

KEY MESSAGE: Follow websites of WHO5, PSMID7, CDC8, the DOH9 and UPManila10 for COVID updates.
If you have time, enroll into self-learning online short courses. Share videos and other links to your
children and family members for greater understanding. For more local guidelines on COVID response
please see the PSMID website.

References:
1) WHO/2019-nCoV/IPC/v2020.2. Infection prevention and control during health care when novel coronavirus (nCoV) infection
is suspected. Interim guidance. 25 January 2020. Available from https://www.who.int/publications-detail/infection-prevention-
and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125.
2) Chen J. Pathogenicity and transmissibility of 2019-nCoV- A quick overview and comparison with other emerging viruses.
Microbes and Infection. Published Online February 4, 2020 https://doi.org/10.1016/j.micinf.2020.01.004 Available from
https://www.sciencedirect.com/science/article/pii/S1286457920300265
3) Chan KH, Peiris JS, Lam SY, PoonLL, Uen KY, Seto WH. The Effects of Temperature and Relative Humidity on the Viability of
the SARS Coronavirus. Adv Virol 2011; 2011:734690.
4) The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an
Outbreak of 2019 NovelCoronavirus Diseases (COVID-19) — China, 2020. Chinese Center for Disease Control Weekly Vol. 2
(8):113-122.
5) World Health Organization website https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200308-
sitrep-48-covid-19.pdf?sfvrsn=16f7ccef_4

6) Civil Service Commission. CSC Memorandum Circular No. 5 series of 2020. February 20, 2020 http://www.csc.gov.ph/new-
updates/1909-csc-issues-guidelines-on-covid-19-absences.html
7) Philippine Society for Microbiology and Infectious Diseases website. https://www.psmid.org/
8) US Centers for Disease Control website. https://www.cdc.gov/coronavirus/2019-ncov/index.html
9) Department of Health website. https://www.doh.gov.ph/
10) UP Manila website. https://www.upm.edu.ph/

Dr. Regina Berba is an Infectious Disease and an Infection Control specialist. She is Associate Professor at
UP College of Medicine and a Board Member of the Philippine Society for Microbiology and Infectious
Diseases(PSMID). She co-chairs the UPManila Committee on Public Education. For comments and
queries: email to rpberba@gmail.com