Why washing your hands is important

Wash your hands: What you can do to stop the spread of the Corona virus 

The pandemic Corona virus Covid-19 is spreading over the world rapidly. Countries have closed their borders. Large areas are under lock-down and the Intensive Care Units in hospitals are flooded with people severely affected by the virus. Authorities are frantically trying to prevent the pandemic to peak too fast, because otherwise we won’t have enough people, facilities and materials to deal with the patients.

Preventive measures

Something as threatening as a pandemic kicks our survival mechanisms into full gear. We see the usual responses to danger: Some flat-out deny the threat or play it down while other succumb to panic and turn into hoarders. Everyone is looking for answers on what the virus is, what the symptoms are and how you can prevent contamination. We follow the news and hope for words of wisdom and relief from our leaders and experts. It becomes painfully evident that one small and vulnerable individual is no match against the force of nature.
But being vulnerable doesn’t mean that we can’t do anything and we just have to let it wash over us. We won’t have to wait for smart and powerful people to solve the crisis, because we can take at least one of the preventive measures: wash our hands.

A hand has four sides, wash them all

Here in the Netherlands our National Institute for Public Health and the Environment (RIVM) informs our nation on how to take preventive measures to protect yourself. Apart for refraining from shaking hands, keeping your distance and staying indoors when you have flu-like symptoms, they advise us to wash our hands. The institute even issued an informative movie clip on how to wash your hands properly. “First wet your hands, then use liquid soap to clean every part of hands including fingertips, between fingers and underneath jewellery. Then dry with a clean towel of paper towel”. It sounds almost absurd that a national institute has to explain the population in a movie how to wash their hands. Someone even said “Mind you, a hand has four sides! Wash them all!”
Although this advice come across as condescending and silly, washing your hands could actually save lives. You might think this sounds overly dramatized, but it is actually more shocking that someone was once called insane because he proposed just the same thing. 

Ignaz Semmelweis and puerperal fever

Before Louis Pasteur discovered his germ theory of disease in the 1860’s, someone else discovered the phenomenon of contamination although he didn’t quite understand how it exactly worked. That person in question was Ignaz Semmelweis, who worked as an assistant professor in the maternity clinic at the General Hospital in Vienna.
At the time the hospital had two maternity clinics. In the first clinic the women were treated by students training to be a physician, and the second one was used to train midwives. One day Semmelweis realised that it was odd that more women died of puerperal fever in the first clinic than in the second. Curiously he started to analyse the differences between the two clinics, and conducted all kinds of experiments to find the answer. For instance, he noticed that in the second clinic the midwives delivered babies with women lying on their sides, while in the first clinic women gave birth lying on their backs. He ordered that all women in both clinics should give birth lying on their backs. But it didn’t make any difference. He later observed that in the first clinic a priest would walk past the bed of the deceased woman, while slowly ringing a bell. He thought that the sound of the bell might be traumatizing for the other women, and immediately banned the priest from the clinics. This also didn’t help. 

The start of the antiseptic era

But when a colleague who was working as a pathologist had died of the same illness that killed the expecting mothers, he had an epiphany. The illness had to be somehow related to the corpses. With this new insight Semmelweis observed the two clinics again. He soon realized that the students would learn anatomy by dissecting corpses, and continued to deliver babies on the same day. The midwives in training however, didn’t dissect bodies. He surmised that something like ‘cadaverous particles’ were transferred to the pregnant women via the students’ hands. As a preventive measure he ordered that everyone should wash their hands with a chloride solution before surgery. The choice for a chloride solution was spot on, although not a very scientific one. Semmelweis just reasoned that the solution would do the job, because it worked best in removing the foul putrid smell of decomposing matter. To the astonishment of all his preventive measure worked. Within weeks the death rate fell in both clinics, but the most dramatic change was in the first clinic were the physicians worked. In that clinic the death rate dropped from 12.24% to 2.38%. Seeing that his theory worked, Semmelweis ordered that the equipment used in surgery also had to be washed with the chloride solution before use. Unknowingly Semmelweis had started the antiseptic era.

Gentleman’s hands are not unclean

But not everyone was happy with Semmelweis’ conclusions. The physicians and their students were not amused that they now had a bad reputation and were considered sloppy. Some physicians were offended at the suggestion that they should wash their hands, because as a gentleman their hands couldn’t possibly be unclean. According to others it was morally inacceptable to “contravene the operations of those natural and physiological forces that the Divinity has ordained us to enjoy or to suffer”. And when he finally wrote a book about his theory called ‘The Etiology, Concept and Prophylaxis of Childbed Fever’, a colleague in Prague referred to his work as “the Koran of puerperal theology.”
It didn’t end well for Semmelweis. His term at the General Hospital in Vienna ended, and wasn’t prolonged. Disappointed he left because he was “unable to endure further frustrations in dealing with the Viennese medical establishment”.
Semmelweis became bitter and resentful because no-one would accept his theory. In the end he was admitted in an insane asylum, where he was put into a straightjacket, beaten and locked in a dark cell. He died within 2 weeks. 

The Semmelweis effect

Semmelweis’s theory conflicted with the opinions of the established scientific and medical community. The same happened when Louis Pasteur introduced his germ theory of disease. The difference with Pasteur and Semmelweis is that Pasteur was already an expert in the field of chemistry, and held the recognition and respect of his peers. And even with that advantage Pasteur was also ridiculed. You can imagine that a mere physicist specialised in midwifery wasn’t making much of an impression. Furthermore, Semmelweis could not offer an acceptable scientific evidence for his theory, whereas Pasteur was able to prove his theory with a test and a scientific explanation.
There is actually a term for the way the scientific community rejected Semmelweis’ theory. When someone rejects new evidence or new knowledge because it contradicts established norms, beliefs, or paradigms, it is called a ‘Semmelweis reflex’ or the “Semmelweis effect”.

Washing your hands is a epidemiological strategy

When we think about innovation, we mostly think about machines and technological advances. There still is a tendency to dismiss less prestigious and ambitious scientific research and seemingly insignificant innovations. But the fact that such a small and insignificant intervention like washing your hands could have such a huge impact stresses the importance of an open mindset when it comes to innovation. But the main takeout from this story is that a simple bit of advice from a mere physician of low stature transformed the way we deal with diseases. These days Semmelweis is referred to with great reverence whenever the topic of antiseptics is taught and the importance of washing your hands is stressed. And as repeated constantly these days washing your hands is one of the epidemiologicalstrategies to prevent the spread of the virus. 

How can you fight the pandemic?

In times of crisis we look towards smart and powerful people to come up with a plan to save us all. But the story of Ignaz Semmelweis shows us that the solution might come from a mere assistant professor working at a maternity ward. 
Everyone is able to contribute in one way or another. Of course, firstly by following the advice of Ignaz Semmelweis. But we can do more than that. We can follow Semmelweis’ example and help to find a solution.
The same virus is the reason most of us are currently advised to stay at home, under lock-down or quarantined, which means we have lots of extra time on our hands. Let’s use this time to think. Start up those cogwheels and put your knowledge and creativity to work to find a way to fight the pandemic and the disastrous effects it has on our health and society. Health- and other organisations have made all their data accessible precisely for this specific purpose, for instance the COVID-19 Open Research Dataset (CORD-19)EU  COVID-19, or Coronavirus Datasets. That means you even won’t have to do all the research yourself, like Semmelweis did. And you don’t have to do it alone. Various individuals are joining forces and initiatives are popping up, and you can even get your idea funded here at this Swedish initiative.

 So, the next time you hear that washing your hands will prevent the spread of the Corona virus Covid-19, remember Ignaz Semmelweis and that you too can help to save lives.

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