Hrev_master [page 48] [Healthcare in Low-resource Settings 2023; 11:11204] Compliant strategies to contain coronaviruses amidst the inconveniency of social distancing Takele Taye Desta, Tewodros Mulugeta Department of Biology, College of Natural and Computational Science, Kotebe University of Education, Addis Ababa, Ethiopia Abstract Social distance is the most promising technique for containing respiratory disor- ders such as coronaviruses. However, social separation is impractical in some situations where physical proximity is unavoidable. This research proposes alternative and com- plementary preventive and suppressive social distancing measures. This study explored the literature, produced critical ideas, and synthesized personal insights to develop realistic respiratory syndrome con- tainment measures. Client-initiated conges- tion is common in enterprises and institu- tions that supply critical goods and services, according to experience. When overcrowd- ing is unavoidable, containment methods such as using face masks, practicing proper cleanliness, improving the health of living and working environments, expanding access to critical supplies and services, and boosting social wellness must be imple- mented. Additionally, using (locally avail- able) antiseptics, avoiding risky behaviors such as aggression, loneliness, smoking, drug abuse, and excessive alcohol con- sumption, eating greens, getting enough rest, receiving psychological treatment, and forming social ties could all help to reduce the negative effects of respiratory syn- dromes. Snipping hot liquids, preferably with honey, providing special attention to the elderly and individuals with comorbid diseases, seeing on-time healthcare workers and following their advise, and decreasing stress-inducing lifestyle factors all help to regulate respiratory syndromes. To control the transmission of contagions that cause respiratory syndromes, cost-effective and simple-to-implement measures should be used. Ignoring impoverished and marginal- ized communities in pandemic cases allows contagions to flourish unchecked, increas- ing the recurrence and circulation of patho- logically important respiratory disorders. Introduction Respiratory syndromes like the Spanish flu and various lineages of coronaviruses that we have encountered recently have cre- ated unprecedented challenges for the glob- al population and unparalleled challenges for the global healthcare system.1 Especially following the devastating impact of the Spanish flu and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), millions of people across the world have lost their lives. As the name implies, conta- gions that cause respiratory syndromes infect the respiratory tracts of patients. People with upper respiratory tract infec- tions can transmit contagions to healthy people that are in close contact through sneezing or coughing infectious droplets and aerosols, especially when their nose and mouth remain uncovered.2,3 Moreover, con- tagions that can infect the respiratory tract can be spread while breathing, talking, and through respiratory secretions like mucus and saliva.4 Although potent vaccination has been made possible against coron- aviruses,5 no effective treatment methods have been invented to treat coronavirus dis- ease 2019 (COVID-19);6 consequently, the virus keeps circulating.7 Still, the most reli- able containment strategy is behavioral change.8 Behavioral change among others, practically refers to social distancing or social isolation. Social distancing is among the widely used mitigating strategies that halt the spread of coronaviruses. According to the U.S. Centers for Disease Control and Prevention,9 close contact is defined as being within an approximately 2-meter dis- tance among individuals for a reasonably long period and/or being exposed to the infectious secretions of coronavirus patients. In some guidelines, physical dis- tancing is, however, dragged down to 1.5 meters.10 However, coronavirus carriers may not be identified, for example, in the case of asymptomatic individuals, which crumbles the containment practices. Close physical contact is inevitable under some circumstances and cultural set- tings, especially in developing countries. For example, when the frontier of physical space is limited, as in the case of companies producing and delivering essential products and services, refugee camps, overcrowded urban settings like shantytowns, congested marketing places, retail outlets, and prisons, social isolation is unbearable. Likewise, in elderly care homes, among homeless indi- viduals, on public transport, at airports, when several individuals are sharing a com- mon living or working room, and in multi- generational homes11-13 most likely, it is dreadful to bear the guidelines of social dis- tancing. Moreover, people with disabilities and mental health problems likely face dif- ficulties practicing social distancing.13 Healthcare workers who spend a significant part of their time with coronavirus patients or carriers would not have a chance to main- tain the recommended physical distance. Children are less susceptible to coron- aviruses compared to adults,14 however, they can serve as carriers of the conta- gion. During the coronavirus pandemic, parents and daycare workers were unable to keep their children at a safe distance. Working from home through virtual platforms, distance learning, and online shopping is less practical in the less devel- oped world where internet service is weak and unreliable,15,16 which then forces most people to communicate in person. Large proportions of the residents of the less developed world use communal bathrooms Healthcare in Low-resource Settings 2023; volume 11:11204 Correspondence: Takele Taye Desta, Department of Biology, College of Natural and Computational Science, Kotebe University of Education, Addis Ababa, Ethiopia. E-mail: takele_taye@yahoo.com Key words: impracticality of social distancing, contagions, alternative and complementary containment, suppressive strategies, over- crowding, essential companies and institutions. Conflict of interest: the authors declare no potential conflict of interest, and all authors confirm accuracy. Ethics approval and consent to participate: not applicable. Patient consent for publication: not applicable. Availability of data and materials: all data generated or analyzed during this study are included in this published article. Received for publication: 24 January 2023. Accepted for publication: 29 June 2023 This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2023 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2023; 11:11204 doi:10.4081/hls.2023.11204 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affili- ated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guar- anteed or endorsed by the publisher. No n- co mm er cia l u se on ly and water taps; both lifestyles make them contact each other frequently. A significant proportion of the inhabitants in less devel- oped nations earn their livings as street ven- dors and rely on a daily wage or work in the informal employment sector,17 all of which make them come into physical contact daily. People most likely do not abstain from sex where physical proximity is indis- pensable, perhaps the sex industry has sub- sisted on prostitution even during the worldwide lockdown. The incidence of sex- ual harassment has escalated across the globe following the coronavirus-induced lockdown.18 It might also be possible that people disproportionately capitalize on sex during the lockdown because the landscape of physical entertainment is virtually limit- ed to the home. Therefore, when social dis- tancing is impractical, alternatives and/or complementary preventive or suppressive strategies should have to be devised. This study reports various strategies that can be adopted to contain respiratory syndromes when social isolation is impossible. Materials and Methods The study used a mixed approach to compile the report. Accordingly, it consult- ed literature, elicited critical thoughts, and synthesized personal insights and experi- ences. A literature search was made using the general search engine of Google and the keywords coronavirus and prevention and suppression methods. Based on this infor- mation, the study proposed prevention and suppression strategies against coronaviruses in such a way that they especially addressed the context of the less developed world. It also highlighted plausible medication options. Results and Discussions The result and discussion section main- ly deals with plausible preventive and sup- pressive strategies against coronaviruses and COVID-19. Prevention and suppression of con- tagions Much has been learned about how to prevent and contain emerging contagions of respiratory syndromes like coronaviruses. Indeed, much has been left to understand about the etiology of highly infectious con- tagions and the driving factors behind their outbreak and fatality. Expansion and refine- ment of prevention, suppression, and treat- ment methods could save lives and resources and enhance and elaborate the efficacy of mitigation strategies. The central dogmas for major areas of intervention to mitigate the adverse impact of respiratory syndromes like coronaviruses are presented in Figure 1 according to their decreasing order of importance but increasing level of complexity. Regardless of this, all three strategies are intended to achieve a similar goal. Although they may not represent an exhaustive list, core prevention, suppres- sion, and treatment methods are summa- rized in Figure 2. The lists show that the types of interventions decrease as we move from prevention to suppression and then treatment. It is worthwhile to opt for long- lasting and affordable interventions like prevention and suppression to enhance the efficacy of containment strategies. However, the three main containment strategies are complementary to each other and interrelated (Figure 3). The adoption of the proposed containment methods, howev- er, needs to be context-dependent. Prevention strategies When social distancing is impractical, wearing face masks and other personal pro- tective equipment, frequent hand washing, disinfecting with antiseptics,10 and practic- ing proper hygiene19 have been recom- mended to reduce the spread of the coron- avirus. However, in less developed coun- tries, and at least in some areas of these nations, it is impractical to abide by the very basic preventive guidelines because the communities have limited access to even basic provisions such as water (especially in the case of dryland regions) and antiseptics.20 Moreover, there is a tradition of communal living and the sharing of lim- ited resources, and overcrowding is fre- quent in service-delivery centers and public spaces. Under these circumstances, there is a sense of urgency to devise alternative and complementary preventive strategies for social distancing. Otherwise, it takes a long time to eradicate respiratory syndromes once they have a foothold in the communi- ty. The following plausible alternative and complementary preventive strategies have been proposed to be implemented in line with the local context. The suggested strate- gies are grouped into clusters based on their practical application. Short Report Figure 1. The linkage among the three core containment strategies of respiratory syn- dromes. Figure 2. Prevention, suppression, and treatment methods of coronaviruses and sibling respiratory syndromes. [Healthcare in Low-resource Settings 2023; 11:11204] [page 49] No n- co mm er cia l u se on ly Personal protective equipment (PPE) and self-hygiene The strategies concerning the personal protective equipment (PPE) and self- hygiene are the following: i) enforcing the consistent use of readily accessible, durable, and reusable protective coverings such as face masks and gloves: ii) the use of natural soapberry plants with antimicro- bial/antiseptic properties like Phytolacca dodecandra and wood ash for cleaning clothes and handwashing; iii) avoiding garbage dumps — an excellent medium for the proliferation of pathogens. Enhancing the condition of residen- tial units and working quarters The strategies concerning living spaces are: i) artificially boosting the temperature of the living and working rooms, for exam- ple, using burning charcoal to create an inauspicious environment for the coron- aviruses, especially during cold seasons. The anecdotal report shows that a family member living in Addis Ababa and infected by coronavirus was fumigated with Kebericho (Echinops kebericho Mesfin) to the point of deadly sweating, which has made the coronavirus scramble. Moreover, in Ethiopia, there is a long-lasting tradition of smoking garbage in open spaces around homesteads on November 21st, i.e., the day dedicated to St. Michael by the Ethiopian Orthodox Church, perhaps to symbolize the taking away of the Spanish flu that had severely affected Ethiopia in November 1918; ii) allowing the free circulation of fresh air; iii) constructing low-cost shelters for the homeless; iv) freeing some of the prisoners who committed pardonable crimes to reduce overcrowding in the pris- ons; v) the use of green classrooms, such as green areas and wide canopy trees, reduces overcrowding in conventional classrooms; vi) the adoption of multiple shifts, perhaps combined with virtual classes, reduces the number of students attending a session. Enriching supply units, market- places, and transportation services As far as infrastructure are concerned, the suggestions are: i) sustained provision of essential services and supplies; ii) restricting nonessential traffic among over- crowded settings and areas that have been infected by the coronaviruses; iii) shifting or splitting bus or taxi stations into wider and less congested, and in multiple places; iv) splitting big open-air markets into mul- tiple locations to provide close access to the point within walking distance and to reduce overcrowding. Moreover, cautions need to be made when disease outbreaks with the potential of being pandemics are expected and to become safe from avoidable infections, as presented in Table 1. Along with hygiene, healthcare man- agement, and public awareness initiatives, efforts need to be made to enhance the well- being of the community. Enhancing well- ness (Table 2) is vital to contain the spread of contagions and suppress their adverse impact. In some instances, contagions could escape prevention efforts. When prevention methods do not contain contagions, they will have the chance to infect the communi- ty. Once infested, if the case is mild to mod- erate, suppression could work; if the case is severe, it likely requires treatment. Suppressive strategies If any kind of strict prevention strategy could have been implemented, they may not have completely avoided coronavirus infec- tion, as the battle is against the invisible and highly infectious orphan virus. Infection by the coronavirus broadly produces asymp- tomatic, mild, moderate, and critically ill cases. In the latter three cases, effective treatment is required in line with their level of fatality. In this report, suggestions are made to treat mild to moderate cases of coronavirus infection: i) sipping hot drinks such as tea and coffee, preferably with honey, could suppress the multiplication of coronaviruses; ii) under normal or mild conditions, adopting the commonly used guidelines or using home-brewed cures and spicy foods that have been at least tradition- ally proven effective to treat the common cold and influenza; iii) feeding leafy green vegetables and citrus fruits may boost the immune response;23 iv) at any cost, avoid- ing dehydration. Moistening the nasal cavi- ty boosts the body’s defense mechanisms; v) regular sex may improve health condi- tions by activating the innate immune sys- tem;24 however, sex (especially unprotect- ed) could expose them to sexually transmit- ted diseases; vi) avoid anxiety and frustra- tion once you contract the coronavirus while taking all possible care; vii) confi- dence can be built using psychological treatments that have been commonly prac- ticed by the communities of the less devel- oped world, such as prayer, and swearing;25 viii) using and working with herbal medicines with robust antiviral activity. For example, Bergner (1996)26 recommended the use of garlic in the form of a nose drop to suppress the common cold. Moreover, Desta et al.27 reviewed an extensive list of studies conducted on edible medicinal plants as potential remedies to treat coron- aviruses; ix) limited and healthier intake of alcoholic drinks may suppress the negative impact of coronaviruses.28 For example, in Ethiopia, a local drink made up of fractional distillation called katikela had high market demand during the coronavirus-induced lockdown period. Trained phenotype Even under worldwide coronavirus pan- demics, immunity has been developed by a significantly large proportion of the world population through natural infection,29 which can be evidenced by the low fatality rate of SARS-CoV-2 cases in Africa surviv- ing with an underdeveloped healthcare sys- tem. This might be intriguing; however, the reality is that Africans have experienced repeated exposure to circulating sibling viruses causing various types of respiratory syndromes; hence, they have developed a robustly trained phenotype with a broad Short Report Figure 3. The cause and effect of repeated exposure to natural infections. [page 50] [Healthcare in Low-resource Settings 2023; 11:11204] No n- co mm er cia l u se on ly spectrum of fighting capacity. Moreover, a large proportion of the African population lives scattered in rural areas, which reduces the spread of contagions. Africans are also known to possess high genetic diversity30 and live in ecologically highly diverse trop- ics. This diversity creates an ideal environ- ment for exposure to various contagions and enables them to develop high genetic polymorphism and diverse environmental conditions that induce expansive immune responses. Repeated exposure to contagions makes the immune system develop robust immunity against various types of infec- tions.31,32 Treatments Most conventional medicines are made from plants. Enhancing the consumption of medicinal herbs, vegetables, fruits, and healthy diets could, to some extent, help treat non-critical cases. If there is no effective treatment for respiratory syndrome, the most plausible alternative is treating comorbidities and tirelessly working through international connections and the prevailing state-of-the- art technology and expertise for the discov- ery of at least partially effective drugs. Conclusions Unless locally tailored alternative and complementary preventive strategies are developed and enforced as quickly as possi- ble when an epidemic emerges, the interna- tional effort that has been made to contain contagions could fall apart. Interventions that have been developed to combat the coronavirus pandemic need to be extensive- ly documented and researched for their effi- cacy. Traditional knowledge and wisdom need to be verified and form part of contain- ment strategies. Overlooking marginalized communities and disadvantaged groups amidst epidemiological crises could enable the contagion to circulate unchecked, which in turn serves as a recipe for the resurgence of the devastating contagion. References 1. Dorn F, Khailaie S, Stoeckli M, et al. The common interests of health protec- tion and the economy: evidence from scenario calculations of COVID-19 containment policies. Eur J Health Econ 2023;24:67-74. 2. Wouk H. Tuberculosis. Marshall Cavendish; 2010. 3. Rai NK, Ashok A, Akondi BR. Consequences of chemical impact of disinfectants: safe preventive measures against COVID-19. Critical Rev Toxicol 2020;50:513-20. 4. Stetzenbach LD. Airborne infectious microorganisms. Encyclopedia of Microbiology, 2009:175. 5. 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Category Measures need to be taken Hygienic measures Avoid sharing personal belongings Cover your mouth and nose while coughing or sneezing Avoid touching the nose, mouth, hair, or eye with grubby hands Safely dispose of and avoid direct contact with discarded materials Wash hands frequently or use a sanitizer Handle and prepare food safely Clean and disinfect commonly used surfaces Cough and sneeze into a tissue or a sleeve Make the equipment and facilities of the healthcare system tidy Safe disposal of body fluids and wastes Cautiously approach pets and other domestic and wild animals Health management Stay home when feeling ill Enhance wellness Consistently and correctly wear a high-quality mask Keep a physical distance and reduce the incidence of close contact Contact tracing21 Health risk assessment Developing healthy eating and drinking habits Immunize on time22 Practice safe sex Publicizing Earnestly follow news developments Mass education and training Devising conspiracies and pseudo-science mitigating strategies Table 2. 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Int J Public Health 2020;65:713-4. 26. Bergner P. The Healing Power of Garlic. Prima Publishing, 1996. 27. Desta TT, Jemal K, Sitotaw R, et al. The antiviral properties of edible medicinal plants: potential remedies against coro- naviruses. Healthcare Low-res Sett 2023;11:11205. 28. Foster RK, Marriott HE. Alcohol con- sumption in the new millennium– weighing up the risks and benefits for our health. Nutr Bull 2006;31:286-331. 29. Ioannidis JP. The end of the COVID-19 pandemic. Eur J Clinical Invest 2022; 52:e13782. 30. Campbell MC, Tishkoff SA. The evolu- tion of human genetic and phenotypic variation in Africa. Current Biol 2010;20:R166-73. 31. Shah VK, Firmal P, Alam A, et al. Overview of immune response during SARS-CoV-2 infection: lessons from the past. Front Immunol 2020;11:1949. 32. Desta TT. Selective vaccination could suffice to develop a robust herd immu- nity against SARS-CoV-2. J Cell Dev Biol 2022;4:43-5. Short Report No n- co mm er cia l u se on ly