Dr. Keith Roach

DEAR DR. ROACH: There is much information about the spread of COVID germs from coughing, sneezing, speaking, etc. However, I have not seen anything about two other ways that could also spread the germs. Could you please address these in your column?

1. Spitting: My husband (and many others) spits on the ground frequently, especially during exercise.

2. Disposal of tissues: After my husband blows his nose, he will drop them on the floor and build a pile to take to the trash when he gets up. He also will drop them on the floor of the car below his seat until he gets back home.

I have asked him to refrain from both of these practices, but he continues. I also think these two unsanitary practices spread other germs as well. Please clarify. — Anon.

ANSWER: That’s not merely unpleasant, it is a possible way of transmitting viruses. It also fails any basic level of acceptable behavior.

Viruses can live for long periods of time in wet conditions, such as a wet tissue. Once completely dry, viruses become noninfectious within hours (or possibly a few days), but cleaning with soap and water or cleaning fluids is effective at disinfecting surfaces.

If my opinion is helpful, I will certainly say that hygiene and politeness require that he dispose of any used tissues in the trash can immediately, and that spitting is both rude and potentially dangerous during the pandemic.

DEAR DR. ROACH: I’m 71 years old. Five years ago, I had a partial knee replacement. One year ago, I was developing pain in that knee. An X-ray proved all is well in the knee, and my doctor assumed that I had arthritis showing up under the kneecap causing this pain.

He gave me a cortisone shot with the warning if I became infected the procedure would be to remove the implant, clear the infection and then perform a total knee replacement.

Five months later I asked for another shot because the pain came back. He gave me the shot with the same advisory and mentioned that the only way out is to perform a total knee replacement.

I’d like to ask your opinion. Is the risk huge by taking this shot of cortisone? In this age of COVID and the pressure on hospitals, I feel it’s just best to keep taking the shot every five to six months if I need it. — J.J.

ANSWER: Steroids are potent anti-inflammatories and are useful for many conditions, but they also suppress the immune system and increase risk of infection. In people who have not had surgery, careful injection technique reduces the risk of infection to very small. However, the risk is much greater in a person with hardware in the knee.

Recent advances in COVID-19 vaccines have given me hope that the end of the pandemic may be within the current calendar year, so deferring elective surgery is a reasonable choice.

A partial knee replacement, by the way, resurfaces only one of the three compartments of the knee. It normally has a quicker recovery time than total knee replacement, but, as you have seen, some people may need a total knee replacement after the partial. You can read more about total versus partial knee replacement here: https://orthoinfo.aaos.org/en/treatment/unicompartmental-knee-replacement.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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