Mike Blake / Reuters / The Atlantic

On the latest episode of the Social Distance podcast, James Hamblin and Katherine Wells answer listener questions about the virus, hygiene practices around the world, and well-being in quarantine.

Listen to the episode here:

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What follows is an edited and condensed transcript of their conversation.

Katherine Wells: This is from Michelle, who asks if a pulse oximeter would be a good tool to use to determine how sick someone with COVID-19 symptoms is. Remind me what a pulse oximeter is?

James Hamblin: It’s that thing that they clip on your finger in a doctor’s office or emergency room that shoots a beam through your fingertip to measure your blood oxygen levels. We really want these early markers so that people aren’t just coming into the emergency room when they’re already extremely ill. People have proposed that maybe a pulse oximeter would be a way to see if you’re about to get very sick. Some people are more excited about it than others. There’s reason to think that in some cases it might show up like, Oh, hey, my oxygen is dropping, but I feel fine, so it’s a good thing I was checking my pulse ox. More often, though, you would be feeling miserable before that occurred. Normally almost all of us are 99 or 100, and if you start to see it drop down to 97 or 96, that might be a sign that something’s bad. But if you had a respiratory infection and a tiny bit of fluid in your lungs, you could be perfectly healthy, not require hospitalization, and see a little dip like that. So it’s unclear exactly what people would do with that and if it would really help.

This is the thing I was trying to find with my story about the immune system and trying to monitor people for the crash so we could give people an indicator to say, “Before you actually collapse on your table or feel like you’re gonna die, you should watch this number, and if it starts to drop, come into the hospital because we’re going to get you on oxygen right now and maybe start you on steroids, maybe start you on an immune-modulating drug, because we see the crash coming.” It would give people a little heads-up, and it would make the process a little less terrifying. But for most people, you’re not going to know what to do exactly with that number, and by the time it starts to fall significantly, you already feel bad enough that you would have sought care.

Wells: So for the average person, it’s not really a legible tool.

Hamblin: Probably not. It can be really helpful for people who do this monitoring a lot and will have a good sense of what is significant for them. Maybe down the line we’ll have some clear guidelines where if you’re normally at 99 or 100 and you’re a generally healthy person, and you see yourself drop to 97, get to a hospital. But we don’t have that yet.

Wells: Our next question is from Joshua. He says he’s seen pictures from around the world of biohazard-clad workers spraying down public spaces with disinfectant. Is that effective? Why aren’t we doing that here?

Hamblin: The speculation is that some of this was hygiene theater to make people feel more safe by showing them this big, strong government response. The only theoretical way that it could possibly matter is if people are walking around seeding the sidewalks with coughs and sneezes, and you walk on it and get a little bit on your shoe, and then walk into your house and then touch your floor. I could see spraying down any [high-contact] surfaces, like walking into the subway and spraying that down every hour. I’m hoping everybody is doing their best to take off shoes every time they come into their home and not touching the bottoms of them and also washing their hands right when they get in. So no, I’m not worried that we should be doing more spraying down. There’s a million things we should be doing before that.

Wells: Our next question is, what are the effects from a psychological, neurological, and functional point of view of the sustained lack of hugs, handshakes, and basic human contact on the human brain?

Hamblin: When you press on the skin, it sends signals to your spinal cord that go up to your brain, and that changes your brain’s output. If you felt a burning sensation on your skin or if you felt a tiger claw on your skin, you would release fight-or-flight hormones. If you feel something gentle and pleasurable, like someone patting you on the back, you might feel relieved. You might feel endorphins.

If you’ve been touched on the shoulder by a human hand, it’s different than if you leaned your shoulder against the wall. Knowing that it’s a human creates this cascade of emotional signals that aren’t re-created, even if it was the exact same pressure in the exact same duration. Depending how sustained that is, and if you have a sort of typical reaction to touch, you’re going to be suddenly without those hormones.  

Wells: Do we know anything about the long-term effects of sensory deprivation?

Hamblin: I wouldn’t expect it would change your relationship to touch long term, but this is just another of the many generally nice and stress-relieving and humanizing inputs that we are missing, which in aggregate is not good for us. They’re not good for that ethereal thing we call health. You might sleep a little less well because you feel a little more stressed and you feel a little more alone and you have a little less dopamine.

Wells: Our last question is from Tony, who notes that we’re all talking about needing more ventilators, but it sounds like the majority of patients that need them are dying. Why aren’t ventilators working as we thought they might?

Hamblin: There’s a lot about the disease that’s surprising us. We’re seeing some early evidence that people who would normally need ventilators are able to get by without. That has partly to do with the weird blood oxygen levels that we’re seeing in this disease that don’t follow what we would normally see. Normally, we’d want to put someone on a ventilator, because you’d be assuming they were in respiratory distress.

It also has to do with how long this disease lasts. People are on ventilators for a very long time, and over time that has negative consequences to the lungs.

Wells: So ventilators are actually doing harm to people?

Hamblin: They’ve saved a lot of lives, but ventilators always have a negative effect, too. It’s not a perfect intervention. You have to be sedated. It is forcibly blowing air into your lungs, and over time that force can cause damage. You have to be weaned off of it slowly, because you can’t go from getting tons of oxygen forced into your lungs to shutting it off, so you’re gonna be out for a while. Then, there’s a rehabilitative process you have to go through. Ventilators have saved many lives in this crisis, but they initially seemed to save so many lives that there was this bias to put everyone on ventilators when they were crashing. Now they’re thinking that if there’s any way to avoid it, they will.

Wells: It seems like that is a potentially positive development, that not as many people actually are needing ventilators as we thought would.

Hamblin: Yeah, it’s also good because it aligns with what was a short link in our supply chain. We still need a ton of ventilators, and we will still run out if we get hit really hard and let up on social distancing. This is not to say it’s not an issue, but when someone has to go on a ventilator, they’re extremely, critically ill, so outcomes are never good. It’s a last-ditch effort to have something else breathe for you. But there’s some hope that some people can avoid them, and that is good news.

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