A nurse helps explain some of the more baffling COVID-19 restrictions affecting everyday life

Since the beginning of the pandemic, guidelines and restrictions and mandates have come at us in a dizzying fashion. Each state has done things differently, and in most states each county has its own approach as well. And while some of the mitigation measures make perfect sense, others seem questionable or downright silly.

Some criticisms are certainly legitimate. Allowing certain indoor gatherings while closing down outdoor park spaces, for example, is an approach that has been panned by prominent experts in epidemiology who rightly point out that outdoor spaces are safer. But that doesn't mean that all measures that seem odd to us aren't based in solid reasoning.

A nurse on Facebook offered a response to a post that's been going around asking why certain measures have been put into place when the people who are charged with carrying them out don't know how to explain them. Marking her answers to the points with two asterisks, the nurse explained why what might seem illogical from a lay perspective actually has solid grounding in virology expertise.


"This has been making its rounds, so we decided to provide some answers:

Me AT GROCERY STORE:

Why is there plastic on the payment keypad?

Cashier: to protect people from Covid.

Me : but isn't everyone touching the plastic keypad the same way they would the regular keypad?🤦♀️🤷♀️

Cashier: no words. Confused look. 👀

**cashiers generally do not study virology, epidemiology or public health. This is the wrong person to ask.

Answer: less porous plastic coverings over key pads offer a surface that is more easily sanitized without risking damage to the mechanisms of the machine by harsh liquid chemicals. The plastic coverings are supposed to be wiped at close intervals of time to reduce the fomite transmission of virus.

Me : Why Dont you pack the grocery bags anymore?

Cashier : Because of covid 19 to reduce the spread of catching or spreading the virus.

Me : But a shelf packer took it out of a box and put on the shelf, a few customers might of picked it up and put back deciding they Dont want it, I put it in my cart then on the conveyer belt, YOU pick it up to scan it.. But putting it in a bag after you scan is risky??

Cashier : no words, confused look 👀

**cashiers generally do not study virology, epidemiology or public health. This is the wrong person to ask.

Answer: having no grocery bagger, an infection reduction strategy employed by many places does eliminate 1 person's set of hands on the groceries, which is somewhat helpful, however the real reason to eliminate the bagger position is to reduce the risk to the cashier and the bagger. While customers move through the store quickly, reducing their exposure time, a checker and a bagger standing at close proximity for hours (even masked), increases employee exposure risk. This risk can translate to employee outbreaks, reducing the workforce for the company. Spreading employees out, or reducing the numbers of clustered employees prevents the spread of infection within a store's workforce.

Me AT DRIVE-THRU

Server: (holds a tray out the window with a bag of food for logical friend to grab)

Me: why is my bag of food on a tray?

Server: so I don't touch your food because of Covid.

Me: didn't the cook touch my food? Didn't the person wrapping my food touch it and then touch it again when placing it in my bag? Didn't you touch the bag and put it on the tray? Didn't you touch the tray? 🤦♀️🤷♀️

Server: no words. Confused look. 👀

**drive-thru servers generally do not study virology, epidemiology or public health. This is the wrong person to ask.

Answer: the food is touched by the cook, and then by the person who wraps and bags the food. The wrapper/bagger then places the food onto the servers tray, and the drive-through server only touches his/her tray instead of the bag, eliminating one set of hands on the bag for the customer, but more importantly eliminating the need for the server to touch anything other than their own tray for the day. This protects the amount of hand to hand contact the server has with others throughout the day as well as the recipient of the food.

Me in SOCIETY

Society ; If you cough or sneeze do it in your elbow or sleeve,

Also society : Dont shake hands or hug anyone or you will spread the virus..

To greet people do an elbow tap instead.

Me : Elbow tap 🤷♀️? Isn't that where you tell people to sneeze or cough? into their elbow? Now you want people to tap each other with that elbow 🤦♀️

wouldn't it be safer to sneeze into elbow and shake hands like we did before Covid 🤷♀️

**Answer: these 2 infection control measures are really supposed to be taken in separate. Hands are the primary germ spreaders, almost everyone understands that. When we cough or sneeze into our hands, and then touch other surfaces, we are likely to spread these germs and possibly make others ill. If you do have to cough or sneeze, using the inside aspect of your elbow, a surface that you are not likely to utilize in other activities is less likely to spread germs. However, if you are frequently coughing or sneezing into your elbow, you should not be in public greeting anyone at all, whether it's with a handshake or an elbow bump. You should be at home, away from others.

Me AT RESTAURANT:

Hostess: ok, I can seat you at this table right here (4 feet away), but I will need you to wear a mask to the table.

Me: what happens when I get to the table?

Hostess: you can take off the mask.

Me: then it is safe over there?

Hostess: yes.

Me: are those fans blowing above the table? Is that the air-conditioning I feel? Is the air circulating in here?🤦♀️🤷♀️ Hostess: no words. Confused look.👀

**hostesses generally do not study virology, epidemiology or public health. This is the wrong person to ask.

Answer: wearing your mask while walking with the hostess to your table protects you, the hostess, and others who you may breathe, sneeze or cough on en route to your table. Once at your table you should be seated six feet or more away from other guests who are not part of your party. Your party should only consist of members of your own household who you routinely gather with unmasked. Air conditioning, ventilation and fans help disperse and recycle air that may contain virus evenly throughout the space, to be eventually filtered. While stagnant air sits for long periods of time with high concentrations of virus, well-circulated air allows diffusion of the virus into concentrations less likely to cause infection in individuals nearby. Since a certain concentration of virus uptake is needed to make someone ill, this is an effective mitigation strategy that is proven by studies showing less viral transmission among people in well-ventilated spaces.

SOCIETY : You are not allowed to stand and drink at the pub you have to sit down.

**Answer: same as the restaurant scenario. Standing around a bar in close proximity to people that are not from your household leads to the spread of the virus into other households who then spread it to each other. Preventing the mingling of households is the object here. ETA: having patrons sit, also protects the bartender & other staff from being surrounded by a wall of unmasked customers.

But at the shopping centre you are not allowed to sit down, all the chairs are roped off.

**Answer: shopping for essentials should be limited to getting what you need in the quickest period of time reasonable. Eliminating the option to linger in public by eliminating seating areas reduces the amount of people in a single area at a time which reduces transmission.

Who thinks this stuff up?

**Answer: Virologists who study the makeup and behavior of viruses, epidemiologists who study the infectious behavior of pathogens, and public health officials who study public behavior and modification strategies as they pertain to health and safety.

Life is hard for logical people right now. We are being raised without the ability to process and execute logic 💯

**Life is hard for everyone right now, but a lot of us are making it harder by assuming that "logic" is the same as expertise. 💯"

While it's not a bad idea to ask questions about what we're being asked to do, it's a good idea to actually ask people who have the ability to answer those questions from a place of knowledge and experience. Simply saying "it doesn't make sense" doesn't mean that it doesn't, and we'd all be better served if we posed our questions to those qualified to answer them.

For John Shults and Joy Morrow-Nulton, the COVID-19 pandemic brought more than just health threats and lockdown woes. For the two 95-year-olds, it also held something remarkable—another chance at romance.

Both Shults and Morrow-Nulton had been married twice and widowed twice, but they were determined to find love again. They met in May of 2019, brought together by Morrow-Nulton's 69-year-old son, John Morrow.

"She was cute, I'll tell you that," Shultz told the New York Times of their first meeting. "And she was smart and she had a delightful sense of humor. And she smiled at me."

Shultz asked her to lunch a few more times before it became crystal clear to Morrow-Nulton that he was on a mission to date her.

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For John Shults and Joy Morrow-Nulton, the COVID-19 pandemic brought more than just health threats and lockdown woes. For the two 95-year-olds, it also held something remarkable—another chance at romance.

Both Shults and Morrow-Nulton had been married twice and widowed twice, but they were determined to find love again. They met in May of 2019, brought together by Morrow-Nulton's 69-year-old son, John Morrow.

"She was cute, I'll tell you that," Shultz told the New York Times of their first meeting. "And she was smart and she had a delightful sense of humor. And she smiled at me."

Shultz asked her to lunch a few more times before it became crystal clear to Morrow-Nulton that he was on a mission to date her.

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True

Each year, an estimated 1.8 million people in the United States are affected by cancer — most commonly cancers of the breast, lung, prostate, and blood cancers such as leukemia. While not everyone overcomes the disease, thanks to science, more people are surviving — and for longer — than ever before in history.

We asked three people whose lives have been impacted by cancer to share their stories – how their lives were changed by the disease, and how they're using that experience to change the future of cancer treatments with the hope that ultimately, in the fight against cancer, science will win. Here's what they had to say.

Celine Ryan, 55, engineer database programmer and mother of five from Detroit, MI

Photo courtesy of Celine Ryan

In September 2013, Celine Ryan woke up from a colonoscopy to some traumatic news. Her gastroenterologist showed her a picture of the cancerous mass they found during the procedure.

Ryan and her husband, Patrick, had scheduled a colonoscopy after discovering some unusual bleeding, so the suspicion she could have cancer was already there. Neither of them, however, were quite prepared for the results to be positive -- or for the treatment to begin so soon. Just two days after learning the news, Ryan had surgery to remove the tumor, part of her bladder, and 17 cancerous lymph nodes. Chemotherapy and radiation soon followed.

Ryan's treatment was rigorous – but in December 2014, she got the devastating news that the cancer, once confined to her colon, had spread to her lungs. Her prognosis, they said, was likely terminal.

But rather than give up hope, Ryan sought support from online research, fellow cancer patients and survivors, and her medical team. When she brought up immunotherapy to her oncologist, he quickly agreed it was the best course of action. Ryan's cancer, like a majority of colon and pancreatic cancers, had been caused by a defect on the gene KRAS, which can result in a very aggressive cancer that is virtually "undruggable." According to the medical literature, the relatively smooth protein structure of the KRAS gene meant that designing inhibitors to bind to surface grooves and treat the cancer has been historically difficult. Through her support systems, Ryan discovered an experimental immunotherapy trial at the National Institutes of Health (NIH) in Bethesda, MD., and called them immediately to see if she was eligible. After months of trying to determine whether she was a suitable candidate for the experimental treatment, Ryan was finally accepted.

The treatment, known as tumor-infiltrating lymphocyte therapy, or TIL, is a testament to how far modern science has evolved. With this therapy, doctors remove a tumor and harvest special immune cells that are found naturally in the tumor. Doctors then grow the cells in a lab over the next several weeks with a protein that promotes rapid TIL growth – and once the cells number into the billions, they are infused back into the patient's body to fight the cancer. On April 1, 2015, Ryan had her tumor removed at the NIH. Two months later, she went inpatient for four weeks to have the team "wash out" her immune system with chemotherapy and infuse the cells – all 148 billion of them – back into her body.

Six weeks after the infusion, Ryan and Patrick went back for a follow-up appointment – and the news they got was stunning: Not only had no new tumors developed, but the six existing tumors in her lungs had shrunk significantly. Less than a year after her cell infusion, in April 2016, the doctors told Ryan news that would have been impossible just a decade earlier: Thanks to the cell infusion, Ryan was now considered NED – no evaluable disease. Her body was cancer-free.

Ryan is still NED today and continuing annual follow-up appointments at the NIH, experiencing things she never dreamed she'd be able to live to see, such as her children's high school and college graduations. She's also donating her blood and cells to the NIH to help them research other potential cancer treatments. "It was an honor to do so," Ryan said of her experience. "I'm just thrilled, and I hope my experience can help a lot more people."

Patrice Lee, PhD, VP of Pharmacology, Toxicology and Exploratory Development at Pfizer

Photo courtesy of Patrice Lee

Patrice Lee got into scientific research in an unconventional way – through the late ocean explorer Jacques Cousteau.

Lee never met Cousteau but her dreams of working with him one day led her to pursue a career in science. Initially, Lee completed an undergraduate degree in marine biology; eventually, her interests changed and she decided to get a dual doctoral degree in physiology and toxicology at Duke University. She now works at Pfizer's R&D site in Boulder, CO (formerly Array BioPharma), leading a group of scientists who determine the safety and efficacy of new oncology drugs.

"Scientists focused on drug discovery and development in the pharmaceutical industry are deeply committed to inventing new therapies to meet unmet needs," Lee says, describing her field of work. "We're driven to achieve new medicines and vaccines as quickly as possible without sacrificing safety."

Among the drugs Lee has helped develop during her career, including cancer therapies, she says around a dozen are currently in development, while nine have received FDA approval — an incredible accomplishment as many scientists spend their careers without seeing their drug make it to market. Lee's team is particularly interested in therapies for brain metastases — something that Lee says is a largely unmet need in cancer research, and something her team is working on from a variety of angles. "Now that we've had rapid success with mRNA vaccine technology, we hope to explore what the future holds when applying this technology to cancers," Lee says.

But while evaluating potential cancer therapies is a professional passion of Lee's, it's also a mission that's deeply personal. "I'm also a breast cancer survivor," she says. "So I've been on the other side of things and have participated in a clinical trial."

However, seeing how melanoma therapies that she helped develop have affected other real-life cancer patients, she says, has been a highlight of her career. "We had one therapy that was approved for patients with BRAF-mutant metastatic melanoma," Lee recalls. "Our team in Boulder was graced by a visit from a patient that had benefited from these drugs that we developed. It was a very special moment for the entire team."

None of these therapies would be available, Lee says without rigorous science behind it: "Facts come from good science. Facts will drive the development of new drugs, and that's what will help patients."

Chiuying "Cynthia" Kuk (they/them) MS, 34, third-year medical student at Michigan State University College of Human Medicine

Photo courtesy of Cynthia Kuk

Cynthia Kuk was just 10 years old when they had a conversation that would change their life forever.

"My mother, who worked as a translator for the government at the time, had been diagnosed with breast cancer, and after her chemotherapy treatments she would get really sick," Kuk, who uses they/them pronouns, recalls. "When I asked my dad why mom was puking so much, he said it was because of the medicine she was taking that would help her get better."

Kuk's response was immediate: "That's so stupid! Why would a medicine make you feel worse instead of better? When I'm older, I want to create medicine that won't make people sick like that."

Nine years later, Kuk traveled from their native Hong Kong to the United States to do exactly that. Kuk enrolled in a small, liberal arts college for their Bachelor's degree, and then four years later started a PhD program in cancer research. Although Kuk's mother was in remission from her cancer at the time, Kuk's goal was the same as it had been as a 10-year-old watching her suffer through chemotherapy: to design a better cancer treatment, and change the landscape of cancer research forever.

Since then, Kuk's mission has changed slightly.

"My mom's cancer relapsed in 2008, and she ended up passing away about five years after that," Kuk says. "After my mom died, I started having this sense of urgency. Cancer research is such that you work for twenty years, and at the end of it you might have a fancy medication that could help people, but I wanted to help people now." With their mother still at the forefront of their mind, Kuk decided to quit their PhD program and enter medical school.

Now, Kuk plans to pursue a career in emergency medicine – not only because they are drawn to the excitement of the emergency room, but because the ER is a place where the most marginalized people tend to seek care.

"I have a special interest in the LGBTQ+ population, as I identify as queer and nonbinary," says Kuk. "A lot of people in this community and other marginalized communities access care through the ER and also tend to avoid medical care since there is a history of mistreatment and judgement from healthcare workers. How you carry yourself as a doctor, your compassion, that can make a huge difference in someone's care."

In addition to making a difference in the lives of LGBTQ+ patients, Kuk wants to make a difference in the lives of patients with cancer as well, like their mother had.

"We've diagnosed patients in the Emergency Department with cancer before," Kuk says. "I can't make cancer good news but how you deliver bad news and the compassion you show could make a world of difference to that patient and their family."

During their training, Kuk advocates for patients by delivering compassionate and inclusive care, whether they happen to have cancer or not. In addition to emphasizing their patient's pronouns and chosen names, they ask for inclusive social and sexual histories as well as using gender neutral language. In doing this, they hope to make medicine as a whole more accessible for people who have been historically pushed aside.

"I'm just one person, and I can't force everyone to respect you, if you're marginalized," Kuk says. "But I do want to push for a culture where people appreciate others who are different from them."