Sulfur Mining

In Friday’s blog I talked about the most dangerous jobs in terms of actually dying from accident or injury. These are acute incidents. But exposure over time—what I’m calling chronic hazards—can be just as deadly, often with prolonged pain and suffering. 

In truth, it isn’t always an either/or situation. If they are combined, being President of the United States is the deadliest job in the country. To date, 8 of the 45 presidents have died in office: 4 were assassinated and 4 died of natural causes.

The ill effects of exposure over time is the focus here.

Heavy metals

Not that kind of heavy metal

Heavy metals” and metal compounds are notoriously harmful to people’s health. Some toxic, semi-metallic elements, including arsenic and selenium, are as well. In very small amounts, many of these metals are necessary to live. However, in larger amounts, they become harmful by building up in the body’s systems. People were dying from such exposures long before they knew the causes or had explanations. Of the 35 metals that are of concern because of residential or occupational exposure, 23 are heavy metals. Here’s a partial list.


Common sources of exposure to higher-than-average levels of arsenic include working near or in hazardous waste sites or in areas with high levels naturally occurring arsenic in soil, rocks, and water. Arsenic released by human activities is triple the exposure from natural sources.  Most paints, dyes, soaps, metals, semiconductors, and drugs contain arsenic. Some animal feeding operations, pesticides, and fertilizers also release arsenic to the environment. 

Occupations with high exposure:

  • Alloy manufacturing
  • Carpentry
  • Chicken and swine farming
  • Electronic manufacturing technicians
  • Electronic waste disposal
  • Pesticide, insecticide, and/or herbicide applicators
  • Smelter operator or engineer
  • Glass manufacturing
High arsenic levels in drinking water causes health problems in areas of India, Bangladesh, China, and other countries.

Symptoms of lower arsenic exposure include nausea and vomiting, reduced production of erythrocytes and leucocytes, abnormal heart beat, pricking sensation in hand and feet, damage to blood vessels. Prolonged exposure leads to skin lesions, internal cancers, neurological problems, pulmonary disease, peripheral vascular disease, hypertension, cardiovascular disease, and diabetes mellitus (Type 1 and 2). Many of the effects are irreversible. There is no effective treatment for arsenicosis. Exposure to high levels of arsenic can cause death.


Beryllium Strip Mine

Elemental beryllium has a wide variety of applications. Occupational exposure most often occurs in mining, extraction, and in the processing of alloy metals containing beryllium.  

Industries and occupations include:

  • Aerospace
  • Automotive parts
  • Computers
  • Construction trades
  • Dental supplies and prosthesis manufacturer
  • Electronics
  • Industrial ceramics
  • Laboratory workers
  • Metal recycling
  • Mining of beryl ore
  • Nuclear weapons
  • Precision machine shops
  • Smelting foundry
  • Tool and die manufacture
  • Welding
X-ray of a patient with Berylliosis

Beryllium causes sensitization and lung and skin disease in a significant percentage of exposed workers.


Chocolate sometimes has dangerous amounts of cadmium. I’m going to cry.

Cadmium is an extremely toxic metal commonly found in industrial workplaces, particularly where any ore is being processed or smelted. Several deaths from acute exposure have occurred among welders who have unsuspectingly welded on cadmium-containing alloys or with silver solders. Beware jewelry makers!

Cadmium and its compounds are Group 1 carcinogens as classified by the International Agency for Research on Cancer. It can cause both acute and chronic effects: high toxic to kidneys, bone mineralization, osteoporosis, lung damage. Smokers are more susceptible to cadmium intoxication. The biggest contributor to human cadmium exposure is fossil fuels, 33%.

Hexavalent Chromium

Green snow caused by leakage from a an old slurry tank in Pervouralsk in Siberia.

When chromium is in a valence state (+6 oxidation), it becomes hazardous to health. Calcium chromate, chromium trioxide, lead chromate, strontium chromate, and zinc chromate are known human carcinogens. An increase in the incidence of lung cancer has been observed among workers in industries that produce chromate and manufacture pigments containing chromate.

Such exposure is likely in these jobs and industries:

  • Welding and other types of “hot work” on stainless steel /other metals that contain chromium
  • Use of pigments, spray paints, and coatings
  • Leather tanning
  • Operating chrome plating baths

Besides cancer: when broken skin comes in contact with any form of chromium compound, a deep hole will form; also targets respiratory system, kidneys, liver, and eyes. 


The brain is most sensitive to lead poisoning.  Symptoms may include abdominal pain, constipation, headaches, irritability, memory problems, inability to have children, and tingling in the hands and feet. It causes almost 10% of intellectual disability of otherwise unknown cause and can result in behavioral problems. Some of the effects are permanent.  In severe cases anemia, seizurescoma, or death occur. 

Occupational exposure to lead is one of the most prevalent overexposures. Industries with high potential exposures include:

  • Construction work
  • Most smelter operations
  • Radiator repair shops
  • Firing ranges 

Outside the workplace, the main sources of exposure to lead occur from contaminated air, water, dust, food, industrial emissions, and soil, or consumer products such as paint, gasoline, toys, and cosmetics.  Lead-based makeup was used in Ancient Greece, but became especially popular when Queen Elizabeth I started using it to hide her chickenpox scars. It killed her. Symptoms prior to death include hair loss, skin welts, and inflammation of the eyes.


All except this form

As far as I can find, all forms of mercury are hazardous.  Common occupational sources of mercury exposure include:

  • Mining, production, and transportation of mercury
  • Mining and refining of gold and silver ores 

High mercury exposure results in permanent nervous system and kidney damage. Depending on the specific form of the mercury, symptoms include shyness, tremors, memory problems, irritability, and changes in vision or hearing; lung damage, vomiting, diarrhea, nausea, skin rashes, increased heart rate or blood pressure; depression, memory problems, fatigue, headache, hair loss, etc.

Mercury poisoning—a.k.a. mad hatters disease—wasn’t nearly as fun as the tea parties in Alice in Wonderland.  Mercuric nitrate, used to make felt, is extremely toxic, and breathing the fumes all day, every day resulted in uncontrollable twitches and tremors, as well as emotional changes, mental decline, kidney trouble, and respiratory failure. As early as 1757, a French physician noted that hat makers seldom lived beyond 50 years, and suffered ill health long before that.

Pregnant women are advised to limit their consumption of fish, especially fatty fish because of mercury buildup.

Toxic Exposures That Aren’t Metals At All


The bacterium Bacillus anthracis causes anthrax, usually lethal to humans. Inhalation anthrax is caused by breathing in spores and has an especially high fatality rate. Person to person spread is rare.

Bacillus anthracis is an unfairly pretty bacterium

Anthrax infections occur naturally in wild and unvaccinated domestic animals. It is contracted primarily from livestock—which is another way farming, ranching, and large-animal veterinary practice can be hazardous to your health.


Asbestos Miners

Asbestos is actually a group of naturally occurring minerals that are resistant to heat and corrosion.  Things made of asbestos will not burn—and therein lay its appeal. 

Ancient Greeks and Romans knew about it. By the 1850s, French firefighters wore uniforms of asbestos cloth. In the period of hoop skirts, asbestos fabric seemed the perfect solution to skirts ignited by open flames. 

Men who mined the ore, women and children who prepared and spun the raw fibers into cloth, all developed asbestosis, scarring of the lungs. This led to chronic shortness of breath, increased risk of some cancers, and eventual death.

Asbestos Lady was a Marvel villain who frequently fought the Human Torch

Asbestos is a heat-resistant fibrous silicate mineral. Besides being woven into fabrics, it is used in fire-resistant and insulating materials. Brake linings, pipe insulation, and house shingles were common uses for asbestos.

NBC caught this image of the Dominion building imploding.

Heavy exposures tend to occur in the construction industry and in ship repair, particularly during the removal of asbestos materials due to renovation, repairs, or demolition. The recent implosion of the Dominion building in Richmond is one example. It was in need of renovation and building a new building was less expensive than trying to remove the asbestos.

Lung cancer from asbestos

Asbestos is well recognized as a health hazard and its use is now highly regulated by both OSHA and the EPA. 


Naturally occurring formaldehyde in pears is not enough to make you sick.

Previously mentioned in the context of harmful clothing, formaldehyde is a chemical (composed of carbon, hydrogen, and oxygen) formed when burning methane. It is used to make other chemicals, as a disinfectant, and as a preservative.  In spite of numerous adverse effects, it’s still widely used.

Formaldehyde poisoning is caused by breathing the fumes, either by working directly with it or using equipment cleaned with it. It can also be absorbed through the skin. Short-term effects include eye, nose, and throat irritation, headaches, and/or skin rashes.  Long term, it is well known to be a human carcinogen. Workers exposed to formaldehyde, such as funeral directors and embalmers, are at increased risk of leukemia and brain cancer. 

Inhaling above 50ppm concentration of formaldehyde can cause severe pulmonary reactions within a short period: pneumonia, bronchial irritation, and pulmonary edema. Lower concentrations cause coughing, wheezing, and bronchial asthma, sore throat, and red irritated eyes.

Ionizing Radiation 

Natural sources of ionizing radiation include radon and uranium. Types include alpha- and beta-decay, X-rays, and gamma rays. They can strip atoms of electrons, damaging DNA. At high enough levels, it kills instantly.

Occupational settings with ionizing radiation:

MRI technician
  • Medical and dental offices (X-rays)
  • Hospitals and outpatient treatments centers (radiology, computed tomography, nuclear medicine, radiation oncology, interventional fluoroscopy or radiology, cardiac angiography
  • Veterinary facilities
Sendai Unit 1 was the fits nuclear power plant to restart in Japan after the disaster at Fukushima Daiichi.
  • Nuclear power plants and their support facilities
  • Nuclear weapons production facilities
  • Industrial operations (testing materials or products)
  • Research laboratories
  • Manufacturing settings and construction
  • Air and space travel and transport operations, especially at high altitude
  • Fracking for oil and gas well development


From the play Radium Girls at Skidmore College
From the movie Radium Girls (2018)

All isotopes of radium are highly radioactive.  Radium, in the form of radium chloride, was discovered by Marie and Pierre Curie in 1898. It glowed, and quickly became popular in Europe. Various companies produced radium-based luminescent paint. It was used to make glow-in-the-dark instrument panels and watch dials, among other things. Women and girls (as young as 11) were hired to paint the watch faces, and were encouraged to twirl the brush tip between their lips to get the finest, most precise point—and with each lick of the brush, they swallowed radium.

Some of the girls had a bit of fun with it, painting their nails, teeth, etc. just because who wouldn’t want to glow in the dark? Between the paint ingested and applied and radium dust in the factories, soon the workers glowed as they walked down the street. Radium was in their clothes and under their skin.

Early research using radium to kill cancer cells had been a success, and soon the public thought radium was a cure-all. Doctors started experimenting with it for everything from tuberculosis to lupus, and quacks started touting products for acne, baldness, impotence, and insanity.

LD Gardner began marketing a health water he called Liquid Sunshine. The market was flooded with radium toothpaste, cosmetics, children’s toys, and theatrical costumes. Fortunately for consumers, radium was so expensive that many products didn’t contain real radium.

X-rays of radium poisoning patients

When workers got sick, they got sick slowly. Most of the girls became truly ill in their 20s. Radium is absorbed into the bones just like calcium, and then the rot starts. Some suffered chronic exhaustion first. But for many, it started with teeth falling out one by one. When rotten teeth were removed, their gums wouldn’t heal. Sometimes the jaw disintegrated at the dentist’s touch. Not surprisingly, bad breath was common. Skin became so thin that the slightest touch would cause open wounds. Skin ulcers formed for some. Pregnant women had stillborn babies. Death came slowly and painfully. Bones became honeycombed and crumbled, limbs were amputated, the girls became anemic, bedridden, and unable to eat.

By the late 1930s, enough were dead or dying that they got national attention—but never did they get compensation. One controversy was over whether all of this was caused by radium: how could one element cause such diverse problems?

Because it is so good at killing cells, today the Royal Society of Chemistry says the only appropriate use for radium is targeted cancer treatments.


Viscose is a thick orange-brown solution made by treating cellulose with sodium hydroxide and carbon disulfide. It’s used as the basis for making rayon and transparent cellulose film. 

It was developed in the early 1900s. Fumes emitted during manufacture drove workers insane. They suffered horrific bouts of mania. Historian Alison Matthews David said that one factory put bars on the windows so “workers, demented from carbon disulfide exposure, would not jump out.” Such exposure also leads to Parkinson’s disease.

Many household products contain chemicals which may be harmful to the environment or hazardous to your health if inhaled, ingested, or absorbed through the skin.  They should be used and disposed of according to instructions on the packaging. Common examples include:

  • Drain cleaner
  • Laundry detergent
  • Furniture polish
  • Gasoline
  • Pesticides
  • Ammonia
  • Toilet bowl cleaner
  • Motor oil
  • Rubbing alcohol
  • Bleach

Writers: Consider all the ways occupational exposure to these products could be harmful to janitors, maids, housecleaners, etc. Consider how they might be used to cause intentional harm. And consider how they might bring serious harm to toddlers.


Sometimes the job does not cause death in a direct way but by creating such stress that the employee turns to self-destructive behaviors.


Edouard Manet – Le Suicidé

Nothing says self-destruction like taking one’s own life. From 2000 to 2016, the suicide rate in the U.S. population of working age (16-64) increased by 34%. Suicide rates for employed men are three times higher than for women. FYI: the occupations with the lowest suicide rates are education, training, and library. The Bureau of Labor Statistics uses only 23 classifications of occupations; thus, for example, college teachers and library archivists are lumped together.

Among the BLS categories, the one with the highest suicide rates for men was construction and extraction. This includes everyone from boilermakers to electricians to hazardous materials removal workers. 

For women the category was arts, design, entertainment, sports and media. This category includes everyone from artists to singers to athletes to court reporters. I find these categories too broad to be helpful.  Unfortunately, there doesn’t seem to be a more refined basis for comparison. 

In 2018, according to an article in PhRMA, American health-care workers were committing suicide in unprecedented numbers. Some are expecting a tsunami of suicides caused by the COVID-19 crisis.

Police officers and firefighters are more likely to die by suicide than in the line of duty. Their depression and PTSD rates are five times higher than within the general civilian population.

Alcohol Abuse 

No construction workers were inebriated in the making of this photo. That’s water.

The top three professions with heavy alcohol use are (1) mining, (2) construction, and (3) the accommodation and food services industry. Arts, entertainment, and recreation are 4th.

A 2012 study in JAMA found that 25.6% of female surgeons and 13.9% male surgeons showed symptoms of alcohol addiction. These surgeons were more likely to report feeling burned out or depressed, and/or to have made a major medical error within the previous three months. 

Among lawyers 29% in their first decade of practice report problem drinking behavior; 21% of lawyers in their second decade of practice have alcohol use disorders. Lawyers in law firms abuse alcohol at the highest rate. Overall, 33% drink problematically, 28% suffer from depression, and 19% exhibit symptoms of anxiety.

Drug Use/Abuse

An estimated 10% of health care professionals abuse drugs, about the same as the general population. However, doctors are more likely to abuse/misuse prescription drugs than their patients. They use prescription drugs to manage physical pain, emotional distress, and stressful situations. Psychiatrists and emergency room doctors used drugs most, surgeons and pediatricians the least.

Accommodation and food service workers leads all other industries in past-month illicit drug use and past-year. There is no one drug these workers abuse most, including both depressants and stimulants. 

Miners are more likely to use illicit drugs (5%) than opioids (1%).


The highest prevalence of smoking was among workers in the accommodation and food services industries (28.9%), followed by construction (28.7) and mining (27.8%). The lowest rates were in education services (9.2%).

COVID-19 Adds Hazards

Current circumstances have made already hazardous jobs worse; professions that used to be relatively safe now carry a constant risk of infection. Similar shifted dynamics have occurred with pandemics throughout history, though the specific risks and professions vary.

Workers With Added Risk

Many professions already at risk for acute or chronic health problems are experiencing even more danger. Here are a few of the workers society has finally started to recognize as essential to function in the face of

Healthcare: Nearly every member of the healthcare profession has added stress now, whether from direct contact with infected patients or from increased workload as their colleagues shift to other departments or fall ill themselves. Separation from family and friends to avoid spreading infection adds to the mental strain as well as removing one of the major sources of relief. Add in longer hours and the very real threat of becoming infected, and it’s no wonder mental health experts are predicting a sharp increase in suicides and PTSD among healthcare workers. These extra health hazards are affecting everyone from home health aids to hospital janitorial staff.

First Responders: Paramedics and Emergency Medical Technicians face all the risks associated with healthcare work, but they also have to work in extremely high-stress situations. Firefighters, police officers, medical pilots, National Guard, dispatchers, emergency chaplains, etc. now face the additional risk of infection in every interaction they have with the public. Budget cuts in many areas have caused layoffs, adding extra stress and longer hours for other employees. Firefighters, who often double as medics, generally spend 24-48 hour shifts in close quarters when not responding to calls.

Food Production: Employees at every stage of the chain producing food for tables are facing added risks of infection and added workload. The people who harvest crops (already backbreaking work in its own right) often face the additional health threats of close living conditions, lack of access to regular medical care, and frequent moving among regions.

Employees at meat processing plants face similar external health risks, with the additional infection burdens of longer shifts in close-packed factories, and a lack of sufficient personal protective equipment. Some of these people have been ordered to continue working in the face of Health Department concerns and their own fears for their health.

Cargo Transportation: Relatively empty roads reduced the risk of vehicle collisions temporarily, but drivers faced added risks from longer hours, longer routes, and additional delivery pressure. For every driver who becomes sick or stops driving to take care of family members, other drivers take on additional work to cover routes. In addition, drivers now face a risk of infection at every pick-up, delivery, and rest stop.

Workers With New Risk

Many careers formerly considered relatively safe now come with risks entirely the result of the pandemic. Massive layoffs have put extreme performance pressure on remaining workers as well as adding the constant risk of economic uncertainty. Those deemed “essential” to the continued functioning of society as we know it often face threats of retaliation if they don’t remain at work. And still, these careers tend to be among the lowest-paying jobs in the US economy. They often lack proper safety equipment, paid sick leave, adequate health care, childcare options, and numerous other ways to mitigate risk and stress for themselves and their families.

Bottom Line: Many people/characters have little or no idea of the hazards their jobs hold for their health, both short and long term. Tension, illness, and death possibilities are nearly limitless! Consider an entire family’s suffering.


Stress and alcohol go together like peanut butter and jelly—a burger and fries, mac and cheese, bread and butter, mashed potatoes and gravy, milk and cookies, or any other iconic duo you can think of. Yes, they can be separated but—oh, so often—you don’t have one without the other.

I started thinking about this when the Richmond Times-Dispatch ran a front page story (above the fold!) about liquor sales in Virginia. You will recall that ABC Stores have remained open as “essential” services. And according to numbers from the Virginia Alcoholic Beverage Control Authority, sales now hover around $22 million a week. 

In March, as the social distancing began, the ABC stores had more than $30 million per week.  Sales in April 2020 were up about 15% over a year ago. The article goes on to identify the top selling brands for the state and for the Richmond Planning District (City of Richmond, Henrico, Goochland, Hanover, Chesterfield, and Powhatan counties). I was less interested in the rankings than in the sheer volume!

Alcohol consumption is up all over the country. To look at one other location, in Tulsa, OK, one liquor store reported that looking at sales March 15 to April 15, liquor sales were up 56% and beer 48%. Compared to a similar date in April of 2019, one-day sales in April 2020 were up by 100%. 

According to one store owner, buying habits are changing in that people are buying more at a time, shopping more during the day and less in the evenings and on weekends.

In order to facilitate buying alcohol, providers are offering digital ordering and delivery, curbside pick-up, hosting, hosting virtual tastings and/or cocktail hours. And some are branching out by stocking hand sanitizers and face masks. Virtual cocktail parties among friends and families are now common.

If your aim is absolutely perfect, your cocktail parties with neighbors don’t have to be virtual!

Estimates of the increase in U.S. alcohol consumption from now to the same time last year vary from 25% (WHO) to 55% (Healthcare Home [//]).

The uptick in alcohol consumption is not solely a U.S. phenomenon. The World Health Organization has issued statements urging countries world-wide to try to curb drinking during the current pandemic. They cite several health reasons to try to control excessive alcohol consumption. No matter how bad a situation is, excess drinking can always make it worse!

Magic Snowman Tea is guaranteed to be 100% alcohol free.
There are other substances one can turn to in times of stress. This is one of my favorites.

Also according to WHO, alcohol-related deaths number 3 million every year—before the pandemic.  And the WHO now has the added difficulty of trying to quash the misinformation that has circulated to the effect that drinking can make someone immune to the COVID-19 virus and/or cure one if infected. The presumed medicinal value of alcohol has a long history (see below), perhaps with roots in the dulling of physical pain.

Jackie Chan is a master of Drunken Fist Kung Fu ( 醉拳 )

The link between stress and alcohol consumption is so well established that it’s actually called “self-medication.” In fact, such self-medication can be pretty effective, at least initially, in relieving anxiety and depression. Alcohol is a “downer” (i.e., a system depressant) so if people are wound up, rapid heart beat, etc., alcohol can definitely make those symptoms of stress go down. But as mentioned above, alcohol also depresses inhibitions, increases risk-taking, decreases logical decision making, increases violence, and — after all that — is still likely to interfere with restful sleep.

Being home all day with bored and curious toddlers is a very stressful circumstance.

COVID-19 presents a set of circumstances that are problematic with regard to alcohol consumption.

  • High levels of anxiety associated with the unknown
  • Isolation from one’s usual support system
  • Loneliness
  • Economic distress/job loss
  • Food insecurity
  • Fear of infection/death
  • Mourning the loss of a loved one
  • Stress at having to work from home
  • Stress of having to work in an “essential” job interacting with the public

COVID-19 is dominating today’s headlines, but it is far from unique. Research indicates that alcohol use and abuse increase during and after “violent conflicts”—e.g., wars, periods of martial law, government coups. Other psychotropic substances are also used to deal with psychic strains and trauma, but alcohol is generally the most likely to be readily available, legal, and (at least within limits) socially acceptable.

Totally non-addictive!

During the 1918 Influenza Pandemic, bootleg whiskey was viewed as a respectable medicine. At the time, more than half the states in the U.S. had passed Prohibition laws and thus were “dry.” But for medicinal purposes, some officials decided to tap the vast stores of liquor that had been confiscated initially to aid the military, although the Army mostly remained silent about using it. In Richmond, Virginia—reportedly—two railroad cars of confiscated whiskey arrived for the benefit of Camp Lee. Over time, confiscated whiskey was distributed to civilian hospitals, too.

Medical isopropyl alcohol is now available at vending machines in Moscow.

The United States Pharmacopeia dropped whiskey, brandy, and wine from its listing of therapeutics in 1916. In 1917, the American Medical Association resolved that “the use of alcohol as a therapeutic agent should be discouraged.” Even so, more than half of physicians believed it was “a necessary therapeutic agent.” It continued to be available by prescription in dry states. To this day, strong alcohol is prescribed for medicinal purposes in some areas, even by doctors!

Besides the demand for alcohol, the Spanish Flu pandemic shared other characteristics with COVID-19:

  • Wearing masks
  • Social isolation
  • Use of disinfectants
  • Limiting group gatherings, including churches
  • Hospitals and funeral homes were overwhelmed
  • During Spanish Flu the treatment of choice was aspirin, up to 30 grams daily which is a toxic dose; currently, think ingesting bleach or disinfectants.
Bootlegger tunnels in Miami during Prohibition

Bottom line for writers: people use alcohol to self-medicate for stress. The current stressor is COVID-19 BUT consider all the other stressors out there, which might occur alone or in combination with COVID-19: death of a loved one, job loss, divorce, physical illness, mental illness, physical disability, too little money, going hungry, being homeless… Do you have a character who does—who could—self-medicate with alcohol?


Let me be clear, right up front: I hate that we—all around the world—have to endure this pandemic.  But as with everything big and small, it’s fuel for writers.  Nothing ups the stakes like a global pandemic.

There is a long history of authors writing about society-wide epidemics, both real and fictional. One of the earliest examples is the plague in the Epic of Gilgamesh. A Journal of the Plague Year, by Daniel Defoe, is a first-hand account of the Bubonic Plague that devastated London in 1665. More examples of literary illnesses are below some important information from the Center for Disease Control and the World Health Organization.

Although you’ve no doubt heard much of what follows, I will nonetheless provide the cautions from the CDC website. According to the CDC, the virus is thought to spread mainly from person-to-person, and everyone should TAKE STEPS TO PROTECT HIM/HERSELF.

Clean Your Hands Often

  • Wash your hands often with soap and water for at least 20 seconds (twice through the Happy Birthday song) especially after you have been in a public place, or after blowing your nose, coughing, or sneezing. (Remember thumbs, backs of hands, and between fingers.)
  • If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry. 
    • Writers note: at this time, there is a run on hand sanitizer. Suppose your character looks online for a DIY recipe (2/3 cup 99% rubbing alcohol [isopropyl alcohol] or ethanol; 1/3 cup aloe vera gel; 8-10 drops essential oil, optional) and has a panic attack trying to find the ingredients.
    • Writers note: some people are allergic to hand sanitizer and can only use the soap and water method. What would they do if hand washing facilities were not available?
  • Avoid touching your eyes, nose, and mouth with unwashed hands. 
    • Writers note: on average, people touch their faces 20 times an hour (women typically touch their faces more than men; people with glasses touch their faces more). Consider a non-obsessive/compulsive person trying to follow even these three guidelines. Would thinking about it make them touch their face even more? Or consider a character who chooses not to do these things, or not to do them conscientiously.
Mustache stickers not included
  • If you are NOT sick, you do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers. 
    • The two most common types of facemask are those shaped like a rectangular piece of folded paper and those shaped like a cup. The cup-shaped masks are more effective, and they should be reserved for people in the most risk of infection.
    • Writers note: what if someone who needs facemasks can’t get them?
Italians keeping the mandated 1 meter distance

Avoid Close Contact

  • Avoid close contact with people who are sick. 
    • Writers note: what if the sick person is a spouse or child? Is the child old enough to understand why there are no hugs? Does your character avoid or not? And how does the sick person feel about that?
  • Put distance between yourself and other people if COVID-19 is spreading in your community. This is especially important for people who are at higher risk of getting very sick. The recommended distance is at least 6 feet. 
    • Writers note: what if your character is a health-care provider, first responder, police officer, bus driver, or … ? 
    • Also note: people at higher risk are those with pre-existing conditions (like heart disease, etc.) and anyone 60 or over. What if your character is high risk? 
    • Plot point: what if an otherwise healthy characters becomes an unwitting carrier for the virus, spreading it to someone who would otherwise have been safe?

Take Steps to Protect Others

Stay Home If You’re Sick

  • Stay home if you are sick, except to get medical care. Learn what to do if you are sick.
  • Call ahead: If you have a medical appointment, call the healthcare provider and tell them that you have or may have COVID-19. This will help the healthcare provider’s office take steps to keep other people from getting infected or exposed.
  • Isolate yourself: people who are mildly ill with COVID-19 are able to isolate at home during their illness. You should restrict activities outside your home.
  • Stay at home until instructed to leave: Patients with confirmed COVID-19 should remain under home isolation precautions until the risk of secondary transmission to others is thought to be low.
  • Talk to your healthcare provider:  The decision to discontinue home isolation precautions should be made on a case-by-case basis, in consultation with healthcare providers and state and local health departments.
  • Avoid public areas:  Do not go to work, school, or public areas.
  • Avoid public transportation:  Avoid using public transportation, ride-sharing, or taxis. 
    • Writers note: tension points for employed people (and/or partners and children) are obvious. And what about childcare? And school children who rely on breakfast/lunch programs?
  • But for writers, staying home could be handy writing time!

Stay Away From Others 

Onions are a flu vaccine?
  • Lock yourself in: as much as possible, you should stay in a specific room and away from other people in your home. Also, you should use a separate bathroom, if available.
  • Limit contact with pets & animals: You should restrict contact with pets and other animals while you are sick with COVID-19, just like you would around other people. Although there have not been reports of pets or other animals becoming sick with COVID-19, it is still recommended that people sick with COVID-19 limit contact with animals until more information is known about the virus.
  • When possible, have another member of your household care for your animals while you are sick. If you are sick with COVID-19, avoid contact with your pet, including petting, snuggling, being kissed or licked, and sharing food. If you must care for your pet or be around animals while you are sick, wash your hands before and after you interact with pets and wear a facemask. 
    • Writers note: how will your character get food, medicine, toilet paper, … ?

Cover Coughs and Sneezes

  • Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow.
  • Throw used tissues in the trash.
  • Immediately wash your hands with soap and water for at least 20 seconds.
    • If soap and water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol. 
  • Writers note: consider a character who is bullied or shunned because of seasonal allergies.
  • Writer’s note: in many countries, blowing one’s nose in public is considered as rude as farting loudly in church. How does a character in such a country stem the drip safely?
  • If you are sick:  You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) and before you enter a healthcare provider’s office.
    • If you are not able to wear a facemask (for example, because it causes trouble breathing), then you should do your best to cover your coughs and sneezes, and people who are caring for you should wear a facemask if they enter your room.  Learn what to do if you are sick. 
    • Writers note: not just any facemask. It must be one that hugs the bridge of the nose and the area around the mouth. So what if a sick person uses the wrong type of facemask?
  • Monitor your symptoms
  • Seek medical attention: seek prompt medical attention if your illness is worsening (e.g., difficulty breathing).
  • Alert health department: ask your healthcare provider to call the local or state health department. Persons who are placed under active monitoring or facilitated self-monitoring should follow instructions provided by their local health department or occupational health professionals, as appropriate.
Pro athletes have said that playing in empty stadiums is eerie and not much fun.

Clean and Disinfect

  • Clean AND disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks. 
    • Writers note: would your character do this or not? Or interfere with someone else doing it?
  • If surfaces are dirty, clean them:  Use detergent or soap and water prior to disinfection.
Cleaning and disinfecting products are already becoming hard to find

Pandemics Past and Present (Fiction and Non-Fiction)

As promised, here are some of the other authors who have written about illness sweeping through society and the ripples that spread out.

  • World War Z by Max Brooks
    • Unlike most zombie narratives, this book follows the entire course of a zombie plague, from Patient Zero to the eventual reconstruction of society. The “historical narratives” are provided by characters from every background and every part of the world. For an extra amazing experience, check out the audio-book, with actors from many countries providing a range of voices and accents.
  • Year of Wonders by Geraldine Brooks
    • Set during the Bubonic Plague in 1666, this is a historical fiction account of a rural English village that quarantined itself to prevent the spread of plague to surrounding areas. The characters and most of the their interactions are fictional, but the story of the quarantined village is true.
  • The Old Drift by Namwali Serpell
    • Following the history of Zambia from the end of the colonial era, the author covers in haunting detail the toll that HIV/AIDS has had on the country. She writes from unfortunately first-hand experience of losing an entire generation of Zambians.
  • A Journal of the Plague Year by Daniel Defoe
    • Defoe published this account of London in 1665-1666 as a warning to later readers. He included lists of how many people died in each parish, how entire households were forcibly quarantined, the morning dead carts being pulled through the streets (and what was likely to happen if you fell asleep on the sidewalk!), and lots of individual stories of the people around him in London.
  • The Two Princesses of Bamarre by Gail Carson Levine
    • Young adult fantasy novels and horrific plagues are not common bedfellows (bookfellows?), but Levine has included a twist on the typical hero’s journey, a fabulous protagonist, and interesting side-quests. Still, behind all the heroism and romance is the inescapable dread and death that affects every member of society.
  • Survivors by Terry Nation
    • This was a television series in the 1970s, made into a novel by Terry Grant, and then made into another television series based on the novel in the 2000s. Except for the very beginning, Survivors deals with the aftermath of a pandemic that wiped out most of the world population; characters have to adapt to a society with no law or order.
  • Pale Horse, Pale Rider by Katherine Anne Porter
    • This short novel is set around the Spanish flu pandemic in 1918 and focuses on a young woman falling in love with a soldier, as both influenza and World War I threaten to destroy their entire world.
Patients coming off a recently docked cruise ship and going directly into quarantine

Bottom line for writers: any calamity can be good for writers—both fiction and non-fiction writers. Consider the daily news: quarantined cruise ships, all passengers aboard; quarantines for nursing homes and senior living facilities; schools and colleges closing. And the spin-off of people preparing to be quarantined, causing panic buying of hand sanitizer, disinfectants, toilet paper, frozen foods, disposable diapers, etc., etc., etc.

This is a prescription I can definitely follow!