While state and local governments have outlined multi-phase plans to reopen their economies from pandemic closures, many of us are without a roadmap for how to assess lingering risks as we begin to engage in aspects of public life after months of isolation.
There is no such thing as returning to some past version of “normal,” especially amid protests over racial inequality and police brutality, which have brought communities together to seek connection and comfort as well as demand change. Anytime you relax social distancing, whether for protest or pre-pandemic routines, there could be serious health risks — even as there are compelling, positive health reasons to find ways to gather safely. Social distancing, combined with the economic stressors of the pandemic, can exacerbate or trigger feelings of boredom, fear and confusion for many, and risk compounding depression or anxiety for those already dealing with mental health issues. And for many black Americans, who were already grappling with the disproportionate impact COVID-19 has on their communities when George Floyd was killed by police late last month, being able to gather is critical, and protesting in particular “can be incredibly uplifting and restorative and psychologically and emotionally healing,” said Dr. Lynn Bufka, a psychologist with the American Psychological Association.
At the same time, she said, we are still living in a public health crisis. This means “any time you are interacting with other people, there is some degree of risk involved,” said Dr. Leana Wen, an emergency physician and public health professor at George Washington University.
The World Health Organization has warned that nations that reopen too quickly could experience a second peak of infections. A greenlight to open the economy may mislead people into thinking that we have more control over the virus than we really do right now, warn experts like Dr. Abraar Karan, a physician at Harvard Medical School, who is treating COVID-19 patients and doing research and public health policy work on the disease. “It’s the virus that dictates the economy, not the other way around,” Karan said.
Still, public health experts say there are ways to get out of the house while limiting your chance of contracting and spreading the virus.
“The key is not to get to zero risk because that means that we’re never going outside and never working and never seeing anyone,” Wen said. “The key is to try to reduce that risk as much as possible.”
Consider these three factors
No matter what activity you’re hoping to resume, your risk will depend on a number of different factors.
Dr. Caitlin Rivers, an epidemiologist at Johns Hopkins University, said she advises people to consider three different factors when evaluating risk regarding COVID-19.
Plot your coronavirus risk
- Indoors versus outdoors
- Enclosed space versus open space
- Wearing a mask
- Proximity to those around you
- Risk level of those around you
First, contact intensity: Think about how close you will be to other individuals, and for how long.
“The highest risk situation is indoors, in a crowded space for a prolonged period of time and, in particular, if you’re going to be doing something like being close and speaking loudly,” Wen said. Early outbreaks in settings such as a church choir practice showcased the heightened COVID-19 transmission risk when it comes to indoor activities such as singing or holding conversations close to one another.
The CDC has said that if an individual has had exposure to the virus for just 15 minutes, they are at a higher risk of contracting the virus.
Second, number of contacts: In general, the smaller the gathering or limited number of people you see, the better. A number of states have advised residents to keep gatherings to ten or so people at a time.
After Missouri allowed hair salons to reopen, two stylists in Springfield potentially exposed some 140 people to novel coronavirus. And around a dozen people who attended church services on Mother’s Day in California — violating a state order — recently tested positive for the virus.
And third, mitigation: Think about how you can reduce risk while doing this activity. Mitigation can involve anything from moving it outside, to spacing chairs 6 feet apart at a gathering.
As businesses like restaurants and hair salons start to reopen, the question of mitigation will fall mostly to store owners. But as a patron, you can still prepare ahead and think about the choices you can make. If you want to go to the hair salon, make sure that your stylist is wearing a mask, and that you’re not in close contact with other customers. If you’re eager to go out to eat, make sure that you’re able to sit outside at a safe distance from other customers.
Recognize that the situation of the outbreak is constantly changing, and as things start to reopen, case numbers could rise, too.
“Just because things are opening doesn’t mean the risk is gone,” said Wen. “I would think quite the opposite — because things are reopening, we know there’s going to be an increased rate of transmission, because what was keeping the virus at bay was our keeping apart…That’s why we should be even more careful and limit our social interactions.”
For most activities, being outdoors is safer than being indoors
As the weather gets nicer, public health experts say there is no problem with getting outdoors — in fact, it is likely a safer option than staying in.
“Go exercise outdoors, go for hikes and runs,” said Dr. Megan Ranney, a practicing emergency physician and researcher at Brown University, adding that you should bring a mask in case you encounter others on a crowded trail. “Think about being near someone who has a really strong perfume on or near someone who is smoking a cigarette…You’re not going to smell it very strongly, if at all, if you’re outdoors on a hiking trail. So it’s a pretty safe thing.”
If hosting an outdoor gathering, consider how many people will attend, whether they’ll be able to wear masks and sit more than six people apart from one another.
“The best thing to do is to have a get-together outdoors where there is plenty of room and people all know to keep their distance,” said Wen, who recommended spacing out chairs at the recommended distance and keeping families in designated areas if possible.
“When people are being social, they have a tendency to get closer to each other,” said Jaydee Hanson, the policy director at the Center for Food Safety, who cautioned against sharing food at barbecues or cookouts. “If you’re used to having a potluck barbecue, everyone should just bring their own dish and just eat that one.”
Just because a pool is clean doesn’t mean it’s safe
As public pools and beaches start to reopen, temptation to cool off in the water will rise. The CDC has issued guidelines for public pools and water playgrounds to prevent the spread of COVID-19, advising them, for example, to encourage the use of cloth face coverings as well as change deck layouts to ensure that individuals can stay 6 feet apart.
“The water itself…is likely to be very low in terms of the risk it presents of disease transmission or transmission of this virus more specifically,” said Ernest Blatchley, an environmental engineering professor at Purdue University who studied how chlorine and UV radiation affect water treatment. Blatchley noted that in a properly maintained pool, the risk of exposure to the novel coronavirus from the water itself is minimal. He emphasized, though, that this “doesn’t alter the need for social distancing” in order to prevent the spread of COVID-19.
The level of risk all depends, then, on how you’re using the pool. Blatchley noted that many behaviors that people have grown used to at pools and beaches over the years — sharing towels and food, sitting close to one another — are not well suited to the current health crisis. Recognize that your typical behavior will need to change in order to mitigate risk should you choose to swim this summer.
If you do want to go swimming, being outside at a pool or beach will be lower risk, said Blatchley, because sunlight is a fairly effective disinfectant, and is likely to be effective against COVID-19. If you are in a pool, chlorine will likely help to inactivate it, too, although there is no conclusive data on this yet.
In planning get-togethers, consider your risk to others
More than three months into the coronavirus lockdown, many are eager to expand their social circles, meeting up with friends or extended family.
In considering whether to see people beyond your immediate circles, take the same precautions as you would with anything else, and be sure to consider the risk you might pose to others you come in contact with, particularly those who are elderly or immunocompromised.
“If you are a family and you want to spend time with grandparents, make sure you are committed to reducing risk with your grandparents,” said Rebecca Katz, the director of the Center for Global Health Science and Security at Georgetown University.
“It really becomes thinking about the risk factors of a grandparent getting really sick, or another family member…and how comfortable you are with thinking about, what if you gave it to them? Because we do know that many people can be infectious without having symptoms,” added Megan Ranney.
When it comes to playdates with young children, try to limit this circle as much as possible, and consider the risk of each individual child. Both Katz and Wen said they would not be comfortable taking the risk to expand their children’s social circles for playdates right now.
But Rivers suggested choosing a few friends or families and consistently limiting playdates with those within this small circle. Ranney advised to take the same basic precautions you would with kids as in any social setting, having them wear masks and play outside, as well as avoid activities like basketball, where the same hands will be touching the same item.