key: cord-0709216-9vfpadzw
authors: Sherman, Fredrick T.
title: Exhaling, Head Turning and Moving Away: Non‐Pharmacological Maneuvers to Possibly Decrease Risk of Contracting COVID‐19
date: 2020-08-08
journal: J Am Geriatr Soc
DOI: 10.1111/jgs.16798
sha: 5d8a8e4f9832cb10fb03fc8bc8eb60cc08df1224
doc_id: 709216
cord_uid: 9vfpadzw

nan

The current non-pharmacological measures recommended by the Centers for Disease Control and Prevention (CDC) to prevent both the spread of the SARS-CoV-2 virus and contracting COVID-19 are: 1) washing hands often; 2) avoiding close contact both inside and outside the home, especially for people who are higher risk including older adults and people with underlying medical conditions; 3) cover mouth and nose with a mask when around others; 4) cover coughs and sneezes; 5) clean and disinfect frequently touched surfaces; and 6) monitor health daily (1).

While these recommendations need to be adhered to while a vaccine and other pharmacological interventions are developed and tested, what other nonpharmacologic maneuvers can a person do who is in close proximity to someone who coughs/sneezes or is speaking loudly to prevent contracting the SAR-CoV-2 virus and possibly COVID-19?

At about the same time as the CDC issued their respiratory hygiene and cough etiquette recommendations for decreasing the transmission of influenza in 2008 , I thought that rapidly performing three respiratory and physical maneuvers could decrease the chances of inhaling viral respiratory droplets and aerosols from a person who sneezed, coughed or spoke loudly in close proximity (2) . With the COVID-19 pandemic, I revisited these three maneuvers as follows: 1) Immediately exhale against pursed lips regardless of where one is in the respiratory cycle thus minimizing or preventing altogether the inhalation of droplets and aerosols that can carry SAR-CoV-2 virus. Exhaling against pursed lips increases the time it takes to fully exhale, allowing more time to physically This article is protected by copyright. All rights reserved.

Accepted Article increase the distance between you and the source of the cough/sneeze and the droplets and aerosol plume; and 2) While continuing to exhale, rotate your face away from the cough/sneeze and flex your neck, thus presenting the back of ones head rather than ones nose, mouth and eyes to the droplets and aerosol plume and immediately visualizing the sidewalk or floor towards which you will be moving; and

3) While continuing to exhale with head turned and neck flexed, walk or move away if in a wheelchair, for example, from the person who has coughed/sneezed or is speaking loudly. If you can't walk or move away because of space constraints, at least you have looked away.

Training oneself to safely do these three maneuvers in rapid sequence and under various conditions e.g. indoors and outdoors, requires intact auditory and visual senses e.g. hearing and/or seeing the person who coughed/sneezed, and synchronization of respiratory, neck , leg and arm movements if in a wheelchair. It takes practice to not reflexively inhale initially, negating the efficacy of exhaling by allowing droplets and aerosol to be inhaled. I taught myself to do all three maneuvers quickly and safely, using them over the past decade and employing them during the COVID-19 pandemic.

Whether these three maneuvers decrease the risk of acquiring SARS-CoV-2 indoors or outdoors remains to be proven as do many other mechanisms of the SARS-CoV-2 virus (3). Laboratory experiments to determine optically (4) and by viral testing whether there is any benefit from exhaling with and without head turning, neck flexing and moving or walking away would initially involve both a hollow manikin head padded on the inside to approximate the internal shape and volume of the nasal and buccal cavities in an adult (5) which expels the equivalent of a sneeze or cough with and without various types of masks and a similar mobile manikin head with and without a mask that could expel various tidal volumes at different rates, rotate horizontally and flex, and move away at different speeds.

Variables that need to be studied in older adults during these combined maneuvers include tidal volume, velocity of exhaled air, gait speed, use of assistive devices, limitation of head rotation and neck flexion and fall risk. I believe these three maneuvers are worthy of study, initially using manikins and subsequently humans, to determine if they decrease or prevent the inhalation of SAR-CoV-2 virus via droplets and aerosols and ultimately the acquisition of COVID-19 by older adults and people with underlying medical conditions.

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Conflict of Interest: The author declares he has no conflict of interest.Author Contributions: F.T.S is the sole author Sponsor's Role: None; There are no sponsors This article is protected by copyright. All rights reserved.Accepted Article