I had no immune system for months after my bone marrow transplant. Here’s how I avoided viral illness, and how you can, too. It’s easier than you think.
Everyone is scared of COVID-19 (the disease caused by novel coronavirus). I get it. I’ve been in the hospital a lot in my life, and I definitely don’t want to go back. But a lot of the advice that I’ve seen lately about how to stay safe is pretty ridiculous. I’ll address some specific myths at the end, but first — let me tell you how I know what works and what doesn’t.
I have a genetic defect, one that I was born with. Because of it, my immune cells weren’t good at combating infection or illness. It meant I got sick a lot more often than most people.
I had a bone marrow transplant in 2017. Most people don’t really know what that is. In the simplest possible terms, it means that my doctors gave me a new immune system, by replacing my sick bone marrow with healthy bone marrow from my sister.
The transplant process is basically a blood transfusion, but instead of blood cells, I received new immune cells from the bone marrow, which then took over my body and made it their new home, thus giving me a new immune system that worked normally.
In order for the transplant to work, I had intensive chemotherapy to kill off my original defective immune cells. For a month before and for many months after my transplant (until the new immune cells fully took over), I did not have a functioning immune system. This means I was vulnerable to EVERYTHING.
Many transplant patients get weird infections that most people have never heard of. Many common viruses, that healthy people easily clear without a single symptom, become deadly in a person with no immune system to fight them.
This is the situation I was in after my transplant.
You might think that there were a bunch of crazy rules I had to follow, and maybe that I had to live in a bubble, or travel around in a hamster ball. As fun as the hamster ball might have been, that was not the case.
I followed three basic rules.
1. Constant, thorough hand washing and hand sanitizing.
2. Constant, thorough cleaning and sanitizing of surfaces that I touched.
3. Completely avoiding primary vectors of transmission.
Hand Washing and Sanitizing
At this point, you’re probably sick of hearing people tell you to wash your hands. It sounds so basic. It’s easy to think that it can’t possibly be that effective. I mean, this is a PANDEMIC. If hand washing is so effective, how could it get so bad?
Because people don’t do it. People think hand washing is silly and basic, and they don’t do it often enough or thoroughly enough.
Hand hygiene is probably one of the greatest innovations of 20th century medicine, behind only the discovery of penicillin and widespread vaccination. It prevents countless infections, and its importance cannot be overstated. Your hands are everything.
After my transplant, I washed my hands constantly, and I washed them thoroughly. I washed the palms, the backs, my wrists, each finger individually (concentrating on the finger tips), and then I scrubbed my fingernails in my palms. The whole “wash your hands for 20 seconds” thing made me laugh when I first heard it. If you truly wash your hands thoroughly, with the goal of removing any trace of pathogen you may have touched, it always takes at least 20 seconds, if not more.
I washed my hands like this after every time I used the bathroom, before I ate, after touching anything in a public place, immediately after returning home from being out anywhere, after working out, after driving my car, after working on my computer, after feeding my pets, after cleaning my house.
If I wanted to scratch my nose, or I needed to put in my contact lenses, I washed my hands first, before ever touching my face.
If my hands didn’t physically feel freshly washed, I washed them.
If I couldn’t remember the last time I washed them, I washed them.
If this sounds extreme, consider how much simpler and easier this is than being sick. Washing your hands constantly is just a matter of habit. You have to make yourself do it for a while, and you have to really focus on remembering, but once you do that long enough, you create a habit that will protect you for the rest of your life. In a globalized world ripe for pandemics, this is a necessary 21st century practice.
I have that habit now, because I didn’t have a choice. The hospital is not a fun place to spend a few months. Being sick is not a vacation. I was in constant discomfort and pain. It was difficult to eat. It hurt to move. It was exhausting to simply take a shower. I did not want to prolong my transplant recovery by acquiring an infection that could have been prevented if I had just washed my hands after I touched that door handle (or whatever). You have to have clarity about why it must be done, and then all that remains is doing it, every. single. time.
If you find yourself wondering whether you’re washing your hands enough, then you aren’t. You know when you are. You carry hand lotion around everywhere you go (because your hands look like a crumpled paper bag), and you go through hand soap like (should I say it?) toilet paper.
Every time you wash your hands, imagine trying to poop in a bed pan. Be grateful for the chance to wash your hands.
The best way to give your dry, crumpled-paper-bag hands some relief is to meticulously clean the surfaces that you touch, so that you know you aren’t continuing to spread germs or virions (virus reproductive particles) onto your freshly washed hands.
If you’re isolating at home, clean everything thoroughly once, and then continue to clean each surface that gets touched when someone enters or leaves the house. If you make a habit of washing your hands immediately upon returning home, you won’t have to keep wiping down everything in your house.
This is what I’m doing now, to protect myself from COVID-19. It’s similar to what I did in the months after my transplant.
Upon returning home from any excursion, I wipe down my keys, phone, credit card (if I used it), car door handle, car steering wheel, garage door handles and front door handles. I keep Clorox wipes in my car and right beside the front door to make this easy.
Once I’ve done that, and before I touch anything else in my house, I wash my hands in the kitchen sink. Now everything I’ve touched with my hands is clean, and my hands are clean. I don’t wear outside shoes in the house.
When I go grocery shopping, I take my wipes into the store with me. I wipe down the handle of the shopping cart and the credit card swiper buttons before I touch either one. When I get back to my car, I load my groceries, and then wipe down the car door handles, my credit card, keys, and phone, and finally use hand sanitizer before I touch my steering wheel.
If someone in your house is sick, wipe down everything that people touch, and do it every single day. The sick person should avoid touching things as much as possible to make this easier. When I was recovering from transplant, we wiped every touchable surface in my room and the bathroom, every evening.
I get that this sounds, again, extreme. But consider how uncomplicated it is. Germs and viruses are not mysterious. They are microscopic organisms that hang out on things you touch.
Clean the things you touch. That’s all. Do it consistently. Don’t avoid it or get annoyed about it. Just do it.
Avoiding Contact (vectors of transmission)
The primary vector of transmission of novel coronavirus is people.
People, and the things people touch.
You can’t tell if an elevator button or a bar stool has been contaminated.
So, stay away from everyone, and don’t touch public surfaces. When you have to be around people, do not get close to them. When you have to touch public things, don’t touch your face or body until you wash your hands.
I open doors and push elevator buttons with my elbows. I open the bathroom door with the paper towel I just used to dry my hands after washing them. I do not lean on or touch countertops in public places.
Most of all, now, I do not go out to places that have elevator buttons, or public door handles, or public countertops, unless I absolutely have to.
If you work an essential job that prevents you from isolating at home, focus on the first two rules. Do them perfectly. The only time you should EVER touch your face is AFTER washing your hands, literally before you touch anything else. If you can keep 6 feet of space between you and other people at all times, do it. The virus can linger in the air (although not for very long), so don’t breathe other people’s air.
For the rest of us, the most foolproof protection is to stay home with the people you already live with, and have no contact with anyone else.
Being outdoors in the sunshine is safe and healthy — as long as you’re not near other people. Go for walks, hikes, runs and bike rides. Just don’t get near other people. Cross the road instead of walking past someone on the sidewalk. I know it feels weird. Do it anyway.
It’s a lifestyle change
Believe me, I know. I’ve spent many more months painstakingly following these rules than you have spent even thinking about maybe having to follow them. When I was recovering from transplant, I had to avoid a whole long list of potentially dangerous illness vectors, including fireplaces, potted plants and strawberries (no joke). I know it can be done, and I know that it works.
But there is one major problem that people have, when it comes to following these 3 simple rules:
People resist simplicity and consistency.
Whether out of fear or arrogance, some people insist on complicating things by trying to add rules that may sound logical but ultimately don’t make a significant difference. This creates anxiety over keeping track of all the stuff you think you should be doing, and worse, the inability to focus on the things that really matter.
Take, for example, one suggestion I’ve seen, to shower immediately when you get home from being out.
(If you work directly with sick people, then by all means, take a shower when you get home.)
For the rest of us –
If your body hasn’t touched other people, and you didn’t rub yourself all over the deli counter at the supermarket, how would the virus have come in contact with unexposed parts of your body?
If your answer is, “because I opened the public bathroom door and then touched my face, and then scratched an itch on my neck, and then finger-combed my hair and adjusted my septum piercing” then you need to focus WAY more on the 3 rules we already discussed.
You are not going to be safer with multiple showers a day than you would be by just being vigilant about washing your hands, not touching things, and not being close to other people.
Similarly, coming home and immediately taking off all your clothes at the front door is not necessary (though it may amuse your housemates, which could be good for isolation stress? Idk, you do you.)
If you’re practicing social distancing, hand washing and surface cleaning, your clothes and hair will not be a significant vector of transmission. (Again, healthcare providers are an exception, but this is part of the reason why they wear scrubs.)
Below is a long list of crazy rules I’ve heard people suggest as safety precautions against COVID-19.
As someone who had the mighty responsibility of preventing herself from contracting all manner of illness for a long time, I can tell you that none of these things are useful.
(If someone you know is advocating any of these, please tell them to read this article, or, better yet, get their preventative advice directly from the CDC, and stop giving credence to random lists of things on Facebook that supposedly come from an unnamed “friend of a colleague who works at a hospital.”)
- You cannot kill novel coronavirus by heating up your nasal passages with a hair dryer, sauna, steam from your tea or soup, etc. This is probably the most hilarious suggestion I’ve heard. The flawed reasoning goes like this… “Coronavirus dies at 133 F, and it enters through the nose, so if I heat up my nose to 133 F, that will kill coronavirus.”
There are so many issues with this, but here are two major ones:
Novel coronavirus doesn’t confine itself to your nose, waiting for you to blast yourself in the face with a hair dryer. When your mucus membranes (eyes, mouth, nose) are exposed to it, it enters your cells. It populates your lungs and may live throughout your GI tract. You can’t “catch it” before it reaches your lungs. If you’re positive, you’re positive. Everything after that is your body’s immune and inflammatory response to viral infection — including the pneumonia that causes so many deaths.
Pro-tip: If the inside of your nose reaches 133 F, you is burning 🔥😬
133 degrees Fahrenheit is the temperature of scalding water. The inside of your nose is a watery mucus membrane, so if it ever got that hot, you would need medical attention. But it never gets that hot under normal circumstances, even in the desert, even in a sauna. Why? Because you’re a mammal, and your body regulates its internal temperature independent of the environment it is in.
- Drinking hot liquids does nothing to prevent viral infection (but they do warm you up and make you feel good, so enjoy!)
- “Keeping the mouth moist” and drinking frequently to “wash the virus into your stomach, where the gastric juices will kill it” is completely ridiculous. Novel coronavirus is present in stool samples. It survives in the GI tract. For other reasons why this is silly, read this: No, drinking water doesn’t kill coronavirus — BBC Future
- Gargling with “vinegar, salt, garlic, or lemon” does not kill the millions of microscopic virions that invade the cells of your mucus membranes when you become infected with novel coronavirus. Vinegar, salt, garlic, and lemon have mostly antibacterial properties — they are not sufficiently antiviral to be useful in this case.
- “The virus can live on hair and clothes.” This falls into the realm of technically true, but not meaningfully true (healthcare providers excepted). If someone literally coughs directly onto your hair or clothes, go take a shower and wash your clothes. Otherwise, shower daily, wear clean clothes, and wash your clothes regularly, like a normal human person who is clean. The virus infects when it comes in contact with your eyes, nose or mouth. The likelihood of transferring a critical mass of virions to your face because you went to the grocery store and your sleeve touched the checkout counter is very low (assuming you don’t go home and eat your dirty clothes).
- “Avoiding cold foods” has no effect on viral infection or transmission (but if you feel cold, drink or eat something warm! Duh.)
- The virus doesn’t “live in your throat” for three days before “moving” to your lungs. Again, when you are infected, you are infected. There aren’t levels of infection. There are stages of symptom progression as your body ramps up its immune response to the virus, but you can’t prevent virions from invading your lungs by gargling something when you have a sore throat (especially not with mild antibacterial agents like vinegar/salt/garlic/lemon). Viruses do not work like bacteria.
As a brilliant emergency medicine physician (and collaborator on this article) said,
“You can’t disinfect the entire inside of your body unless you are dead and embalmed.”
In conclusion: Don’t be scared.
When people aren’t over-complicating prevention, they are doubting that something so scary can even be prevented with such simple methods, and so they act as though it’s hopeless, and there’s nothing they can do.
In reality, if you can just commit to these 3 simple (albeit, tedious) recommendations, you will dramatically reduce your risk of infection and transmission.
If you do the three things I’ve outlined here as though your life depends on it, then you don’t need to feel afraid. I know it sounds exhausting, but I promise you that you can do this. You just have to become consciously and constantly aware of your contact with things and people, at all times.
I had WAY less natural immunological protection in my body than most of you have, right now, in your bodies. The hard thing is, you have to do these 3 things we’ve talked about, and do them well, every single time. The easy thing is, it’s just these 3 totally uncomplicated, straightforward things.
Wash your hands, clean the things you touch, avoid people (and the things people touch).
You’re gonna be ok.
I collaborated on this article with Dr. Brandon Faza, M.D., who is a physician of emergency medicine in Tampa, Florida, and a wonderful human being. He made sure all of my myth-debunking facts were indeed facts.
My wonderful bone marrow transplant doctor, Dr. Dennis Hickstein, M.D. (National Cancer Institute/National Institutes of Health), was kind enough to take the time to review this article and provide feedback as well. I will never be able to adequately repay him for saving my life. ❤