I have heard from SolveEczema.org users, including doctors, who used the SolveEczema strategies just so they could wash their hands a lot and not dry or damage their skin.
Based on my research and observations, and my experience trying to help people on the eczema side, I see so many misconceptions about what causes dry skin, that after writing the first post, I pretty much gave up on trying to make a separate set of instructions for ameliorating skin dryness. The best I can do is recommend: Read and understand the SolveEczema.org website! (It’s not what you think when you first look at it.) The principles work for dryness whether you have eczema or not.
You may have to dig a little bit, and keep an open mind. SolveEczema was never built to be the most efficient way to best explain the new concepts of how to problem-solve eczema this way, because, again, people’s preconceived notions get in the way. The site was built for people with infants, and to best help the most number of people—given the most common preconceived hurdles—to see this very different way of looking at skin health and persist in getting the benefits in their unique circumstances.
I think medical research, and basic biological principles, are at least pretty clear that the modern eczema epidemic is above all an environmental problem, with a genetic susceptibility. But there seems to be an underlying assumption that the environmental influence happens early and that children and adults with eczema have a fundamental immunological or skin defect that stems from an early environmental circumstance that can no longer be reversed. This assumption is wrong, and I believe I can demonstrate that it’s wrong.
When I went to solve my child’s eczema, I could see that the one indisputable aspect of the problem, according to research, was that it is primarily environmental, something about the modern environment, but I didn’t see anything that I recognized as environmental problem solving anywhere. So that’s what I did. This is why the SolveEczema site is basically an environmental problem-solving guide. Sometimes I despair of ever helping most people understand so they don’t keep suffering from what I believe is the completely solvable problems of eczema and atopic asthma, and even the majority of dry skin.
In solving eczema, it became really clear that everyone is affected by these same environmental influences even if they don’t have eczema—and I don’t just mean people, I also mean animals (indoors and outdoors), but that’s a topic for another day—and that the impacts are both short-term and long-term. Both short- and long-term impacts on membranes are reversible with the right environmental changes. The best results come from understanding and ameliorating both the short-term and long-term consequences of those environmental influences, but people can do a lot to solve dry skin just by understanding and ameliorating the short-term impacts.
Now that everyone is washing their hands frequently because of the coronavirus pandemic—since washing is superior to hand sanitizer when it comes to preventing the spread of infection—I’d like to try sharing this very different way of looking at skin dryness again. Because when people understand it, they can wash their hands really well, getting them very clean and even scrubbing, without drying out their skin and without needing moisturizers.
This kind of advantage is critical for medical professionals because damaged skin can harbor microorganisms and make doctors susceptible to infections themselves through broken, bleeding skin. Let’s face it, damaged skin just plain makes people not want to wash their hands frequently, too. Hand sanitizers, while important for when hand washing is not possible, don’t work as well as washing, and the alcohol (and other chemicals) in them can be absorbed. Sanitizers don’t work at all against some viruses like norovirus. Sanitizers have nevertheless become ubiquitous even where hand washing is available because handwashing is harder, and let’s face it, often times painful, because of the drying. It doesn’t have to be.
It’s so ingrained that washing well damages skin, there’s even a pandemic commercial that shows a medical professional scrubbing and proudly holding up red raw hands, as if it is an inevitable sacrifice. In my experience, for the majority of people who understand this different perspective, this familiar outcome of handwashing is not necessary, there is a better way.
If you’re willing to follow along and understand this very different perspective, at the end of this article, I will share a simple experiment you can do to demonstrate these principles at home.
With that goal in mind, the first and most important point I need to make is this:
Point #1: Washing hands to get them really clean, washing hands often and really thoroughly, is NOT what is drying your skin.
Let me say that again another way: the reason your hands get dry, cracked, and raw when you wash them a lot, is not, as is commonly believed, because you are stripping oils from your skin when you wash.
Yes, there is something about the washing process that is making your skin dry and raw, but what you and pretty much everyone else have assumed and concluded about why is wrong. Understanding this can change everything.
The second critical point I need to make, and which I have made for over a decade on this blog, and tried to make more memorable by giving it a dopey name (my apologies), is Lumsdaine’s Law:
Point #2: Lumsdaine’s Law: For most people, under most conditions, eczema and dry skin are more the result of what is left on the skin than what is stripped from the skin by washing.
Your skin is not getting dry from washing away oils. Your skin is getting dry because the residue of whatever you washed with—and there will be a residue, no matter what the product maker promised about rinsing—has unnaturally increased the permeability of your skin so that it loses more moisture than the natural dynamic repair processes of the skin can replace on an ongoing basis.
This is especially true for modern synthetic detergents like sodium lauryl sulfate, even the organic ones. (The important characteristic being the molecular properties of the products, notably, how hydrophilic—attracted to water, and thus, how good at increasing membrane permeability—they are, not the starting ingredients.) This characteristic of modern synthetic detergents has been amplified beyond anything possible in traditional soaps, and more so over time (in step with the allergy epidemic since WWII, I would note.)
Even a layer of water on the skin, all by itself, increases the permeability of skin. Not as dramatically as detergents do, and especially detergents with a layer of water, but you can see this if you wash your hands in the winter and don’t dry them properly, they chap. Your hands feel “moist” just after applying the water, but over time, they lose excess water because that extra layer of externally applied water increases the permeability of the skin. (Though few people would know the effect of water alone anymore since the vast majority of people have residues of detergents on their hands even if they rinse just with water. But the effect is the same.)
The molecular properties of surfactants that make them good at destroying surface tension/mixing with water and therefore good at cleaning also happen to make the residues left on skin good at unnaturally increasing the permeability of skin. Modern synthetic detergents (as defined on SolveEczema.org) are inevitably far more hydrophilic than soaps (also as defined on SolveEczema.org) and thus increase the permeability of skin far more. This is an underlying principle of SolveEczema. Even tiny residues of modern detergents left on the skin (yes, even “organic” ones) can unnaturally increase the permeability of skin on an ongoing basis.
Translation: Rinsing with hard water left more detergent residues on people’s skin. The detergent residues remaining on the skin increased the loss of water from the skin and were associated with irritation, especially in people who are genetically prone to having eczema and allergies.
Bingo.
This still doesn’t address the, in my experience, wrong idea that skin dryness is the result of oils being stripped from the skin from washing, but it’s a start. (I will write more about this later, but based on my research, it seems that this idea, that washing away oils causes skin dryness, is more the consequence of innovations in 20th century advertising than scientific evidence.)
Point #3 Using creamy moisturizers and “moisturizing” washing products backfires. Skin seems moisturized right after using them, but over time, they cause the skin to lose water.
This is also described in SolveEczema.org. I’ve heard this phenomenon described as the skin becoming “addicted” to the moisturizer and not producing enough oils because of the externally applied moisturizing, and that if people just stop moisturizing, after a painful period of adjustment, skin will be less dry. Again, this is a wrong interpretation that sadly causes unnecessary suffering and poor results.
What’s really happening, as I describe in SolveEczema.org, is that the creamy moisturizers are creating a condition much like water on the skin, in which it is temporarily externally hydrated in a way that causes increased permeability and excess water loss over time, and thus, dry skin.
A test Here’s that test I promised to prove all this to yourself, if you are able to handle very dry skin for a couple of days. (Note: if you have hard water, the results could be affected by the water hardness, per the paper I cited above. Given the need to wash hands because of Covid-19, I wouldn’t do this full test if you have to be out in the world and need handwashing for serious infection control. “Moisturizing” soaps don’t tend to clean very well, for one.) It’s a 3- to 6-day test, so set aside a time when you don’t expect to go out much.
First step: Get a “moisturizing” bar soap. Also get a very neutral bar soap (like from my list of favorites, such as Sappo Hill unscented, which you can get by the bar at Whole Foods) that doesn’t feel especially oily or moisturizing and does a good job cleaning. Stick with “soap” as defined on SolveEczema.org, at least for the neutral soap. Do not use a product with detergent ingredients for the neutral bar soap. If you use a product with detergent ingredients (detergents as defined on SolveEczema.org) for moisturizing soap, then it may take more time to restore your skin to “normal,” possibly a lot more time. For the sake of keeping as many things controlled as possible, if you want to try a detergent in the first phase, maybe do a second trial after trying it first with only soaps (again, as defined on SolveEczema.org).
Glycerine “soaps” are perfect for the “moisturizing” one, although you can use any soap that feels really oily when you touch it, with added moisturizing ingredients. Such soaps won’t feel like they clean very well, but seem to leave “moisturizing” residues when you wash. (If you use them, you will see why I no longer recommend glycerine soaps at all, even though they are not detergents as defined on my site. They’re not really drying enough to cause eczema, in my experience, but … you’ll see.)
Second step: Once you have the two products, for the next 3 days, ONLY wash with the “moisturizing” product every time you wash your hands (showering counts, but use the soap in the shower then). Rinse well. Remember, don’t use a different product because you’ll wash off the residues of the test product. If you aren’t a SolveEczema site user, please recognize that your skin is regularly touching and absorbing detergents in your environment. Dry your hands for all of these tests with a paper towel (not a washed towel) to minimize that influence after you wash hands. Important: Don’t use a separate moisturizer for the duration of the test.
Comment: Immediately after using a glycerine bar or very moisturizing product, the skin seems very soft and hydrated. But then over time, over a period of hours in the short-term, and days in the long-term, it gets really dried out. You’ll probably see the effect within a day, but if you want to have no doubts, go 3 days. (Unless you get fed up from the dry skin earlier, in which case, move forward.)
Third step: After 3 days, wash your hands one more time with the “moisturizing”/glycerine soap, and wait for the moisturized-feeling phase to wear off—probably a couple of hours but may be shorter—so that your skin feels really dry.
Fourth step: Get out the neutral soap, like the Sappo Hill unscented (the best is an aged bar), and wash your hands really well. Get them super sudsed up, between your fingers, the back of your hands. Rinse them really well. Then dry them with a paper towel.
Wait the same amount of time that it took your skin to feel super dry after washing with the glycerine soap. (Try not to do things that would get more detergents on your skin, such as handling dust or clothing.) How do your hands feel? Your skin should be considerably less dry, more supple. If the cause of the dryness had been stripping oils from your skin, your skin would have been only more dry.
Keep washing with only this new neutral soap for 3 days. Notice the difference.
The Sappo Hill (or whichever product you chose) isn’t especially moisturizing or oily. It washes away oil and dirt better than products that are.
Having substances on the skin that increase the permeability so much that the skin’s natural dynamic repair processes can’t restore water fast enough is what is causing dry skin. You can wash those substances away; when you do that, your skin can replace water and become less dry fairly rapidly. It’s not days like the people who subscribe to the oil-moisturizer-addiction perspective think, it’s more like tens of minutes or hours, and the results are far better. If you don’t follow the SolveEczema site strategies, you are likely to be introducing hydrophilic substances that can cause drying to your skin in ways you don’t appreciate, which have long-term effects, but you should still be able to see the results of this test.
If you still want to moisturize your skin after this process, and you may, wash with the neutral soap, dry with a paper towel, and use a thin later of Aquaphor (which you can even wipe off with a paper towel—again, not a washed towel—almost entirely so it isn’t greasy, seriously that will work just as well or better than lots of product). If you keep using the neutral soap (and you don’t have exposure to other surfactants like the detergents that comprise virtually all commercial shampoos including the organic ones), you probably won’t need to use the barrier again. Note: this same principle is at play with all of the surfactants you come into contact with: the laundry detergent, the detergents in personal care products, the dishes and household surfaces, the dust in your home (which is made up so much by lint, skin cells, and hair). It has been my experience and that of others using the SolveEczema site that changing to less-permeability-inducing household products can improve skin dramatically in the longer term, too.
Point #4 Read my previous post about aging soap. Aged true soap may be less alkaline, I’ll have to do some testing on that. Regardless, a true soap that is neutral (non-oily) yet drying when you use it, will typically no longer be drying after it’s aged. If it has tons of moisturizing ingredients, though, so that the bar feels oily when you touch it and/or your skin feels like it has a coating of something moisturizing after you use it, aging the soap will never make it better.
Point #5 Water hardness has such a dramatic impact on the performance of soaps and detergents—how well they suds, remove dirt, and rinse off—in my observation, water softness/hardness is typically a more important factor in cleaning performance than exactly what brand of soap/detergent one chooses. It is also a factor in dryness.
Over and over again I find with my site users that people with hard water have the most difficult time getting the detergents washed out of their clothing. Research has shown that there is more eczema in hard water areas than those with soft water. Soap doesn’t work well in hard water, and it forms insoluble residues. Detergents do, too, just not to the same degree. Those residues are why soft white fabrics get grey and coarse after repeated washing. When washed in real soap and soft water, soft light-colored fabrics stay light-colored and soft over time.
People tend to use a LOT of detergent when they have hard water, too, because hard water doesn’t allow sudsing or rinse as well and thus leaves a lot of residue (see the paper above). This is not an intuitive fact, because soaps and detergents develop lather and suds so much more easily with soft water, it can seem harder to rinse off. The reality is that with soft water, you can get things clean with far less product, and you can SEE the suds. That squeaky feeling people get when rinsing with hard water is actually residue, not actual clean.
This is not common knowledge, in fact there is a lot of misinformation on the internet about whether hard or soft water rinse better. Remember, the 2018 paper above showed that more detergents are left on the skin from HARD water rinsing. But because people see the suds disappear faster with hard water, they assume hard water rinses better. Even the Unites States Geological Survey gets that wrong: They wrote: “Hard water is actually much better at binding with the molecules in soap, allowing us to use less water to wash soap away, and making our skin feel “squeaky clean”.” That is exactly WRONG!!!
Remember what the research study above proved? “Sites washed with hard water had significantly increased sodium lauryl sulfate deposits.” And “Softening the water to remove calcium and magnesium ions significantly reduced the level of SLS deposition.”
Hard water doesn’t rinse away detergents well. Soft water rinses much better, and you can use less soap or detergent to begin with in soft water. Those residues increase membrane permeability, which increases water loss from your skin.
The USGS example is one of many you can find, which are likely the result of rationalizing from a simple observation, rather than using direct scientific testing. The same is true of old beliefs about dry skin and washing away oils, which as near as I can tell, came about because of advertising innovations mid-20th century.
At a time when washing hands well is so important to reducing spread of disease, it’s probably also important to know the difference between hard and soft water, and how each affects the performance of soaps and detergents, in particular, rinsing microbes away.
The best results come from following the SolveEczema site strategies fully. When fully and properly implemented, Solveeczema.org strategies typically result in a long-term improvement to skin which is most obvious in the first two months after full implementation. (Note: As I say frequently on my site for good reason, do not implement without first understanding it fully and keeping your doctor in the loop, it is a very different perspective and things can go wrong.)
When I was younger, if I traveled, I inevitably got cracked, dry, bleeding hands. Using those thick workmen hand creams only helped some, and they were a messy hassle. I thought for sure it was the dry air on airplanes. After implementing the site, I just take my own true soap (as defined on SolveEczema.org) with me in a pocket foaming dispenser to wash my hands with when I travel, and I don’t ever have dry skin anymore. I usually take Aquaphor with me but almost never have to use it. My soap is neutral, not moisturizing, and cleans really well—which is why it isn’t drying even when I have to wash frequently. Washing away the many harsh detergent residues I come into contact with when traveling also helps—so washing becomes an important way to prevent dry skin!
I would really love to impart this benefit to every doctor and nurse in the country who is suffering from handwashing, not just since the Covid-19 crisis, so that they can wash their hands as often as they need to, get them very clean, yet not suffer the kind of dry skin they may be suffering now.
The Aliso Canyon gas leak in Southern California was big news a few years ago. As a result, a dozen and a half elementary schools in the area were provided high quality air filtration in every classroom. Measurements were made to assess levels of outdoor pollutants entering the classrooms, and children’s math and reading test scores were also analyzed and put through various comparisons.
Very little outdoor pollution made it into the classrooms, as it turns out, but the filters cleaned up typical indoor pollution. As air quality improved in the schools that received the filters, so did the students’ test scores. A lot. Test scores improved so much, the benefit was “equal to the learning benefits from reducing class sizes or providing intensive tutoring.” While the researchers noted a drop in illnesses and absenteeism among occupants of these classrooms, the improvements could not be attributed to those benefits alone.
Test scores improved so much, the benefit was “equal to the learning benefits from reducing class sizes or providing intensive tutoring.”
While the article and the original paper both bear reading, the benefits of better air quality in schools is not news. Prior research already linked air quality in schools with student test scores and achievement, and poor air quality with student and teacher illnesses and absenteeism (which are further connected to a litany of other ills).
Healthy schools = healthy kids
The EPA even developed a whole body of helpful, evidence-based resources for schools to use, their Tools for Schools, upon which many other well-researched indoor air quality management plans have been based. Indoor air quality management plans are just well-researched strategies that help make schools healthier and keep them that way. If you want to really delve into the issue, the EPA has an indoor air quality master class webinar series which is free and definitely worth the time: IAQ Master Class Professional Training Webinar Series
Although this research shows just how dramatically better indoor air quality can improve student performance and reduce illnesses and absenteeism in the classroom, an even greater takeaway should be that:
a) evidence already exists that schools can get such dramatic benefits from adopting indoor air quality management plans, without filtration, and often at very little cost, and
b) using filtration in addition to adopting indoor air quality management plans could be powerful tools to both reducing illnesses spread in schools and improving student achievement.
The well-researched tools to accomplish this have been available to schools, for free, for many years, yet less than half of schools have an indoor air quality management plan, despite the EPA reporting that half of schools have problems related to air quality, and despite the aging school infrastructure—the majority of schools in this country built over 50 years ago.
Although such problems can affect children in poorer districts disproportionately by compounding other factors, rich districts are not immune. Recent research in California schools found inadequate ventilation and poor air circulation (with the attendant harm to learning and student health) in the vast majority of classrooms, around 85% of classrooms they looked at, a finding that confirms previous research. They found new school sites were just as prone to having poor ventilation as older ones.
It has always been something of an ongoing tragedy that this major body of environmental health research hasn’t been recognized and adopted uniformly across the nation, because very small investments can reap such major rewards for our nation’s children.
This may be in part because adopting such plans can seem complicated and is completely voluntary, and next to no legal obligations exist in virtually any states to ensure good air quality in schools or to allow parents recourse to fix things when their children’s schools have air quality problems. I’ve had discussions with school administrators who told me frankly that they follow many regulations and they believed if adopting such plans were important, there would be a law they had to follow. I’ve had discussions with experienced environmental scientists who told me frankly (going back many years, irrespective of partisan turnover in Washington) that they are under considerable political pressure and the best way to get schools the benefits of this research is for the EPA to share what they can and make it voluntary.
And thus the fundamental problem here, a gap in understanding between environmental health scientists and school health stakeholders, including teachers, parents, students, and the doctors who care for them all, leads to an unnecessary and easily-removed health burden on our nation’s children and teachers.
How this school filter research could help students return to schools and colleges
Looking ahead to the fall of 2020, with so many uncertainties and the likelihood of both the flu and Covid-19 surging at the same time, schools and colleges are trying to cope with the staggering adjustments that will have to be made in order to safely return students to campuses.
Unfortunately, the impact on colleges is especially severe with the economic strain of many students, especially international students, staying home, deferring, or simply not going to college at all next fall. Any livelihoods that depend on gatherings, such as live music and restaurants, travel and tourism, all stand to be hit even worse if there is another surge of infections in the fall, thus compounding the problem for colleges with the greater demand for financial aid as a large percentage of families lose jobs and income. Certainly, a coronavirus vaccine will help, but there is almost no scenario under which there will be a proven effective vaccine in place before fall, and if one is rushed and doesn’t work, or worse, has unexpected, serious consequences, it could undermine faith in other vaccines.
Attention to research like this should be part of the planning picture, because improving indoor air quality doesn’t just demonstrably improve student performance, per considerable research, it also reduces the number of infections the occupants of buildings get and pass around.
Improve indoor air quality, and you reduce the rate of infections and absenteeism, not just in those with asthma, but in everyone. Fewer children and teachers get asthma, and those who have asthma get fewer attacks. This is well-established by decades of environmental science, including specifically in schools.
Adopting an effective framework for indoor air quality management can improve air quality by more than just the simple filtration reported in this paper, and adding filters can mean even greater benefits. Especially since few people seem to be minding proper two-step disinfection, and are using detergent wipes like they’re going out of style. Such products leave residues that build up as dust and cause asthma.
According to the CDC’s Healthy Cleaning and Asthma-Safer Schools: “AVOID DISINFECTANT WIPES Disinfectant wipes are used regularly, but they usually contain asthmagens. “ (Substances that are known to cause asthma.) It is possible to achieve the same or better cleaning and disinfection results without causing asthma at the same time.
We all know that asthma is a risk factor when it comes to Covid-19, and people can also develop inflammation in the lungs that makes them susceptible from these same environmental influences short of having diagnosable asthma. The CDC cleaning recommendations, the two-step process I blogged about earlier, can be done—in fact, are better done—without increasing asthmagenic chemicals in the environment which can increase susceptibility to infection.
Another serious problem that schools face this fall, is that environmental scientists have also long known that when a closed up space, like a school, has been shuttered and unoccupied for a period of time, when it is reopened, the new occupants stir up all kinds of stuff that worsens air quality and causes spikes in infectious diseases and other known consequences of poor air quality. If this is not understood and addressed before schools, workplaces, colleges, and other communal spaces reopen globally in the fall, the predictable, attendant spikes in upper respiratory symptoms AND infections could cause a preventable wave of more deaths and lengthier shutdowns.
When a school has been closed up for a period of time, when it is reopened, the new occupants stir up stuff that worsens air quality and causes spikes in upper respiratory infections and other known consequences of poor air quality.
Seriously adopting indoor air quality management plans in all schools now, even without filtration, could help reduce this phenomenon, which could cause panic in the fall as schools and colleges around the world reopen for the majority of students after being closed up for so long. Filtration could reduce problems further, and it could be an important tool for allowing more normal life again as one of many tools.
From what I learned about the topic, filtration is actually a poor second cousin to implementing an indoor air quality management plan. It’s better to avoid building up unhealthy chemicals and particles in the first place than to try to filter them out, but in practice, I have observed that the easy, cheap indoor air quality management steps seem to be the hardest for people to believe work.
The EPA has done previous research with filters in classrooms, when a known environmental problem could not otherwise be remediated (mold), with good results, but they did not use commercial filters which tend to be too small and too loud. They used cabinet-sized filters that resulted in more robust filtration without adding noise to the class room environment. (Don’t quote me on this, but I vaguely remember the company involved in that work was also involved in providing the plug-in filters for this research.)
One of the reasons I brought up the question in my last post—why are people still getting sick?—and wondered if it’s possible to keep detailed data on new infections, is the possibility that a more refined understanding of exactly how people get sick in groups (or not), and how they don’t, in as much detail as possible, could help mitigate the extreme response, even mitigate the indiscriminate use of disinfectants.
Such an understanding would especially help schools and colleges understand the parameters for safe return of students. In the meantime, measures to improve indoor air quality need to become a priority, as they can be adopted while students are home, and are already proven to significantly improve student performance and reduce the spread of infectious illnesses in schools.
–AJ
*I should note that while mechanical filtration can filter out viruses, it’s not necessary to do that in order to get the benefits above, such as reducing illnesses going around in schools. Simply removing the harmful chemicals (like those that come from mold growing in the environment) and particles that cause damaging health effects like airway inflammation, including “remodeling” of the upper respiratory system from chronic inflammation, is enough to improve student performance and reduce the incidences of colds and flus going around at school. Further research would be necessary to know the best kind of filtration to get the absolute best reduction of novel coronavirus spread.
After weeks of sheltering in place, as the nation reopens, I would like to know what has been done in the interim to sharpen the understanding of hygiene to contain the virus and allow normal life without fear of making things worse again? Hygiene is not cleaning or killing every germ, it’s what you do to prevent the spread of infection.
The sheltering in place was clearly necessary and saved many lived. But after all these weeks, I am left to wonder why there aren’t more nuanced hygiene instructions? This is not intended as criticism—scientists and doctors working on this problem have been working hard, heroically, really.
But I don’t want to lose sight of the problem solving opportunity here. As public health efforts increase testing, they should also consider taking methodical data on when and how everyone got infected, or likely was infected, down to the nitty gritty details and the spectrum of possibilities, the way the health inspector investigates after food poisoning complaints at restaurants.
Knowing more about exactly why people do get sick from interactions and the kinds of interactions they don’t get sick from—and teasing apart why some people get sick from seemingly similar interactions and others don’t—will make all the difference in whether students can go to school or college in the fall, safely, or people can travel again, or restaurants get customers next month instead of next year. If I were Disneyland or Johns Hopkins University, I would be throwing money at knowing that information.
After all these weeks of lockdown, people are still getting sick. Is it because 6 feet apart isn’t enough? Is it that people aren’t maintaining known recommendations? Are some of those recommendations unnecessary for a lot of circumstances and people? What if we could be resuming, like, 80% of the things we used to do because we understand in better detail how and why people are still getting sick and how to avoid it?
Who is systematically trying to understand human interactions in more detail right now so we understand why infection continues to spread, or when it doesn’t? Contact tracing is necessary, but it’s not the same thing.
The lockdown is like a national allergy elimination diet — you can eliminate everything you eat to stop reacting, but you can’t live like that forever. But you go through the sacrifice because it allows you to track down what causes a reaction so that you can eat almost everything else again and remain healthy.
If you go through the trouble of eliminating everything just to stop reacting, then reintroduce foods simply because you want to get your digestion going again but without truly trying to track down what causes problems at every step, then you lose most of the value of the original sacrifice.
Continuing the lockdown without using it to get a more nuanced understanding of hygiene is like reducing your diet to just toast forever. Reopening the country without understanding the nature of interactions that are still spreading disease and why, is like going to all that trouble to stop eating everything to stop the allergy, only to just start up eating everything willy nilly and losing the advantage of the temporary sacrifice.
Many people and parts of the country are probably safe to resume life. But we don’t know the nuances of the conditions under which those behaviors go from safe to dangerous and vice versa. Just expanding testing isn’t going to tell us that. We need a systematic attempt to understand how this virus is transmitted and how to prevent it, and our current situation where almost everyone is still sheltering in place but the disease continues to be transmitted is the ideal time to do that.
Having that knowledge could allow us to better move forward confidently and safely, and resume more normal life. We need this prevalence testing and contact tracing, but I hope researchers will also start taking detailed data that allows a more nuanced look at when and how infection is being spread, and when and how it is not being spread. Is it really necessary to shut down the beaches, for example? Knowing more detail about the conditions of how the infection is spreading in the world now, and not spread, hand-in-hand with testing, could help make such decisions with confidence.
Some years ago, I posted a page on my blog with homegrown steps for preventing colds and flus by heading them off before they get going. I am reposting them below, updated, for family and my doctor.
In the close to 20 years that I have employed these strategies, I have never had the incipient symptoms of an upper respiratory infections—like sore throat, congestion, cough from post-nasal drip—turn into anything. I’ve experienced the beginnings of runny noses or bad sore throats plenty of times—and I don’t mean minor ones, I mean the kind of sore throats that are so inflamed and painful, it’s hard to talk or swallow your own spit, including fever—and other symptoms that at one time would have always turned into a major illness.*
These strategies have reliably helped me (and my family members and friends who have used them) to cut those symptoms short and get better quickly without ever developing a systemic illness.
As with SolveEczema.org (environmental strategies for eczema and astham), the strategies involve taking simple measures that anyone can do, generally regarded as safe, and that are based on a combination of my own research and methodical, empirical observation. And just as with SolveEczema strategies, it can be easy to make wrong assumptions and miss getting the results unless one reads and understands that these strategies are something new and different despite familiar elements.
And just as with SolveEczema.org, I tend to keep things low-key until there is research to back it up—even more than SolveEczema, these flu-prevention strategies could be easily validated with appropriate clinical trials. Which are difficult to get done as an outsider. (As SolveEczema.org users know, I am not a medical professional.)
But as the Covid-19 pandemic has progressed, I feel I should speak up. Testing the above strategies would be easy and fairly low risk, with the potential benefit of reducing the number of people who get sick with Covid-19 after exposure, allowing for a faster recovery, faster resolution of the epidemiological “curve” and faster and more confident transition to normal life. Especially for healthcare workers and people in essential jobs like first responders, grocery and delivery employees, construction and transportation workers, having a way to regularly mitigate the likelihood of infection even after exposure or development of new symptoms would be very powerful. If these steps prove broadly effective, it could significantly reduce the risk of illness because of exposures in their work. The strategies could conceivably reduce transmissibility and thus cut short the epidemic.
There would be relatively few downsides to a clinical trial. The strategies could be employed by half of those with a known exposure but who have not gotten sick and comparisons made with the other half for how many came down with the full-blown disease. Another group could be health care workers or public health professionals who get constant exposure, with half getting the strategies (modified specifically for their circumstances), half not.
The best trial would be to test the strategies with people who get incipient symptoms like GI problems, sore throat, or congestion, because these strategies work best in my experience when used at the beginnings of an illness or right after a known exposure, rather than as regular well-care prophylaxis, but from what I understand, the typical symptoms of an incipient flu are not necessarily present very often at the start Covid-19.
The other kind of trial that might be helpful is to give the strategies to a portion of those who develop incipient flu symptoms and give only partial strategies that are already in common use to others, and see if it changes the number of people who get sick with flus. Even if the strategies don’t work with Covid-19 as well, if they are generally as effective as I have observed with flu, they could reduce the number of people who need medical services for flu, and thus help free up the healthcare system at this time of crisis. (And would also help reduce the number of flu deaths every year!)
These are not just typical strategies such as to reduce the pain of a sore throat by gargling with salt water, they are a combined set of strategies to eliminate the sore throat altogether within a short period of time and keep something worse from developing. I speculate from what I have observed that the strategies may allow the immune system to catch up, essentially.
I have updated the strategies and posted them below for convenience. My next post will include selected updated research support for this from medical literature, and why I believe these strategies could help with Covid-19 control WITH APPROPRIATE CLINICAL TRIALS FOR VALIDATION. Please note again that if you have symptoms, CONTACT YOUR DOCTOR. If you want to try these strategies, run them by your doctor and understand when you should call. Do not use something anyone provides you from the Internet, even me, in lieu of professional medical attention.
Wishing everyone Good Health as we all do our parts to end this pandemic as soon as possible.
Best, AJ
*Only one time, I had something that seemed to go straight into my lungs without any sore throat or other symptoms first, but even then, the strategies allowed my to keep the coughing from starting up so I could sleep.
Better than chicken soup* – Our family’s best home remedy for heading off colds, sore throats, and cough from post-nasal drip
This is what we do during cold and flu season — it really seems preventive and to head off sore throats, colds and coughs. I couldn’t say if it beats my Grandma’s onion poultices because — sorry Grandma! — making onion poultices is not my idea of a soothing solution when I am sick! These steps seem to work fast — without onions — and help head off the congestion that tickles the back of the throat and becomes a cough, especially at night.
As you might expect if you follow SolveEczema.org, I developed this because of research I read over the years, and copious experimentation and observation. Since following these steps, I’ve never had a sore throat turn into anything, and the few times I’ve had problems that seemed to bypass the sore throat stage, it was still helpful at heading off the coughing and letting me sleep at night — without a lot of medication.
DISCLAIMER: As always, I feel like I need to make a disclaimer, because even if this is effective for you — especially if it is effective for you — DO NOT do this instead of consulting your doctor. Only do with your doctor’s blessing, and after making sure nothing more serious needs to be addressed! That H1N1 flu, for example, moves FAST into the lungs and gets scary serious even faster — this is NOT a substitute for getting urgent care for something like that, and is NOT a home remedy once something has moved into the lungs, among other problems. See your doctor immediately if there is any question of there being pneumonia or infection in the lungs. (My readers know how cautious I am about medical treatment — even I recommend everyone getting flu shots.)
So, with that in mind ….
Not all of these steps are always necessary — the essential ones are starred *** — but the order of all the steps is important, regardless. With very young children, check with doctor before doing any of these steps:
Whenever a sore throat, congestion, or cough starts (a cough that isn’t yet in the lungs but comes from higher up):
1. Brush teeth — use a new brush or disinfect toothbrush first with peroxide if possible, use toothpaste from a new tube, don’t contact the bristles to the tube.
Brushing can be skipped in a pinch, but it’s a good idea to start by brushing. The microorganisms don’t just inhabit the back of the throat, and brushing reduces the bacterial soup swimming around the mouth.
2. Drink a large glass of warm water — it’s so important for the immune system and also because you don’t want to drink right after the next steps. Many people come from cultural traditions that view warm water (room temperature or slightly warmer rather than cold water) as important for health — there is research support for this notion now, and from my own empirical observation, I am in agreement with this view.
Simply Saline Allergy and Sinus ****
***3. Rinse sinuses with Simply Saline sterile nasal spray from each side per instructions (regular or Allergy and Sinus formula, they are both non-detergent and JUST saline) and blow nose.
Simply Saline is my favorite product for this purpose, it works well and the mist delivers the product into the sinuses in a very gentle way, especially for children, though you may still have to talk them through it. You can also use other products, or a Neti Pot but not if you are EVER tempted to use it without sterile water!!! (I can’t stress that enough, never put unsterilized tap water in your sinuses!!!!!)
Step #3 is important EVEN IF YOU ONLY HAVE A SORE THROAT AND DON’T YET HAVE CONGESTION.
For very bad congestion, after rinsing well with regular Simply Saline, rinse again with the Allergy and Sinus Simply Saline. That works the vast majority of the time, but if things come back and repeating the steps using those isn’t enough, you can rinse with Simply Saline then follow with Nutribiotic Nasal Spray, per instructions, probably one or two sprays per nostril. (I am concerned about how well the valve works so I always spray it into a clean tissue once or twice after every use, keep the nozzle wiped clean, and throw it away when I no longer need it for that illness.)
***4. Gargle several times with a glass of warm salt water (just use ordinary table salt, maybe a spoon in a glass, it doesn’t have to be ocean-salty). Swish some of the salt water around in your mouth, between the teeth, and spit out. (If you have high blood pressure and need to watch salt intake, discuss with doctor beforehand.)
Step #4 is important EVEN IF YOU DON’T HAVE A SORE THROAT BUT ONLY HAVE CONGESTION AND/OR COUGHING FROM POST-NASAL DRIP.
***5. Dissolve a dose of probiotic in a small amount of warm water, like only just a teaspoon or two of water, then swallow so it coats the back of the throat and tongue.
My favorite probiotics for this (including for myself) are Jarrow Baby’s Jarro-dophilus. (The link is for information only, this product has to be refrigerated and is available in most health food stores, although it can be ordered here with a cold pack if necessary.) It comes in powder form and can be measured out by the teaspoon or fractions of. It tends to clump, so make sure it is well dissolved. Primadophilus Intensive is also good. It comes in a powder, in separate packets. (I can no longer find this product in stores, perhaps they don’t make it.)
I find in a pinch, just taking the concentrated probiotic can help combat a sore throat. LINK
If you don’t have those brands, you can use what you have, split open a capsule and dissolve it in the glass. Be sure it’s a refrigerated acidophilus with live bacteria. Dead shelf-stable ones are better than nothing, but you may not get the same results. Use a probiotic with as many strains as possible. If you only have one, that’s better than nothing, but 6-12 strains is best in my experience. (There is at least evidence that 2 strains is better than one when it comes to cold and flue prevention.)
You may have to try more than one probiotic product to hit the right one to beat back whatever is causing the problem sometimes — it’s always more effective to do this at the very start of the sore throat than after it gets entrenched. How do you know if it’s a good probiotic? It should begin working right away. If it makes no discernible difference, you need a different probiotic. The difference is usually pretty obvious.
Repeat whenever the pain returns. But try to do after eating rather than before.
This seems to work really well to ward off sore throats and congestion when they happen and keep them from turning into something else, and also, it has been very useful to stop the coughing at night when lying down, whether there is a sore throat or not. Even if you don’t seem to be congested, the stuff that comes down postnasal can be very irritating and be the reason for the cough. This really seems effective at getting all that stuff out of the way, if you do it right before going to bed, so you can sleep and the immune system can do its job better.
If you want to be really hard core — it does seem to help — eat healthy and don’t eat sugary and starchy foods while sick, the bad microbes seem to love those foods as much as we do. If taking an antibiotic, take probiotics during treatment (not just after) per medical advice — take oral enteric coated probiotics in addition to the dissolved per #5 above.
Lastly, if you spend time at school or the doctor’s office during cold and flu season, when you get home, wash hands (of course) and change into clean clothes (bag the dirty ones and put them by the laundry, don’t leave them in your room even in the hamper). I don’t know if the question of how much doctors’ coats and ties are spreading disease has been settled LINK , but taking this step has definitely worked for me from personal experience.
So the steps are again:
1. Brush teeth with a clean brush and paste. 2. Drink a large glass of warm water. 3. Rinse sinuses with sterile saline nasal rinse (whether you are congested or not), immediately followed by: 4. Gargle with warm salt water (whether you have a sore throat or not). 5. Dissolve a dose of probiotic in a small amount of water, just a teaspoon or two, and drink. 6. Repeat the whole process as soon as symptoms return. Use Allergy & Sinus Simply Saline in all subsequent repeats if the regular wasn’t enough to make things go away completely the first time.
Remember to rinse and sterilize the sink when you are done, as necessary.
Do not get “lazy” and let things go just because the steps make things feel instantly better when you do them. They work best if you go do them right when the symptoms start and repeat them right away if symptoms come back. Doing this, I have been able to reliably get rid of even aggressive sore throats and congestion and keep them from turning into a something worse for around 20 years now. If symptoms get entrenched, it’s not too late—following the steps seems to help reduce the severity and duration of any illness that gets a foothold.
Be Well! I hope this helps!
AJ
*My opinion! Believe it or not, I think chicken soup can actually claim published support for its healing properties!
**As everyone who reads my site knows, I am a mom, not a doctor. I have given this advice to my own doctor!
****I have mostly suspended affiliate marketing, because it’s a lot of work, and people get the wrong impression. I do earn a very small percentage if people buy using the links, but with personal care products, it earns very little, it’s just a convenience. Sadly, my favorite site for personal care products was bought up and closed down. As of this writing, Simply Saline products are available at Costco, Amazon, and many drugstores.
If you have used SolveEczema.org’s environmental strategies to address eczema, you may be wondering: is there a difference between soaps and detergents—in the way SolveEczema.org defines them—for washing hands and surfaces to protect against the new coronavirus SARS-Cov-2 that causes Covid-19?
According to a publication of the US Environmental Protection Agency, cleaning and disinfecting together in one step is less effective: “Dirt and organic material make some disinfectants less effective, so cleaning is necessary before disinfecting in most cases.”
The EPA publication and CDC guide repeatedly recommend a two-step process for cleaning and disinfecting.
–The CDC guide says “[Disinfection] does not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, [disinfection] can further lower the risk of spreading infection.” –“If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.” —The EPA publication says “Sanitizing does not necessarily clean dirty surfaces or remove germs. Most sanitizers, as well as disinfectants, require a clean surface in order to be effective at killing germs. “ And, –“Incorrectly using a disinfectant may kill the weaker germs, but the more resistant germs survive. Incorrect use includes “disinfecting a dirty surface” …[and] “using a combination disinfectant/cleaner without first removing visible dirt from the surface.”
Many disinfection products contain both surfactants (invariably, detergents) and disinfectants because companies believe the public will not follow a two-step process because it’s too much trouble. In ordinary times, they are probably right. Today, the public is going to great lengths to follow CDC recommendations. Plus, many articles suggest that washing hands properly with soap may be more effective than using sanitizer against the new coronavirus.
As for disinfecting surfaces, again, the CDC recommends cleaning first, then disinfection (if necessary).
Note the first product on the disinfectant list is a Cleanwell product, which disinfects with thymol. Disinfection products containing hydrogen peroxide or ethanol or citric acid or iodine or bleach are also recommended, it is not necessary to choose a detergent-containing product.
If you want pure bleach without detergents, I recommend “Germicidal” Clorox because the Clorox quality is very consistent, and if you are trying to avoid surfactants, look for the “Germicidal” line only, as of the last time I looked, it was the only one of their consumer bleach products that did not also contain detergents. Note that they do not make it for or recommend it for the laundry— I do a short wash first with soap and only then using the bleach when disinfection is necessary, but you need to know that the company only recommends products that contain detergents for laundry at this point. With bleach being necessary for medical environments, it may not be possible to buy a bleach product at all right now anyway. If your child cannot tolerate the detergents, I just wanted to point out that the CDC says you can use other disinfectant products.
Next question: does it matter whether the cleaning is done by what SolveEczema defines as natural soap or detergents?
Short answer: No. According to everything I have read, all “soaps” should be effective. SolveEczema.org users should be able to use true soap and non-detergent disinfectants and comply with CDC recommendations for cleaning during this pandemic, without compromising their environmental strategies for eczema. Many soap producers are small businesses and have soap available for purchase.
Big caveat: remember that soap (and detergents) don’t lather well in hard water. So it’s tempting to use a great deal too much product yet think it rinses away quickly, when that’s not actually what’s happening. With hard water, surfactants aren’t rinsing away quickly, the hard water is just destroying the suds. Keep washing and rinsing for the recommended time.