Vox: How to go out and not spread coronavirus this summer

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Source:  Vox

By Katherine Harmon Courage 

As the coronavirus pandemic drags on, many of us are feeling desperate to see friends and family in person, keep kids busy, and get the heck out of town. And with the July Fourth weekend before us, it’s extremely tempting to shed our crusty quarantine skins of spring and seize a glorious, social summer.

But should we?

It can be difficult to know since the situation across the US varies so much, as this map of county-level risk based on the number of new daily cases, from Harvard’s Global Health Institute and Edmond J. Safra Center for Ethics, shows:

 Harvard Public Health Institute

Meanwhile, guidance on the safest way to enjoy socializing, playgrounds, and vacations is inconsistent. States, towns, and cities are not uniformly enforcing — or even encouraging — safest practices as they lift (or in some cases, reinstate) coronavirus restrictions.

But one pattern is clear: As some places have relaxed social distancing measures before getting the virus under control, their case numbers have surged. Which suggests that there are probably many things, like packing together in indoor bars, that we shouldn’t be doing — even if they are technically permitted.

“The Covid-19 situation in the US has changed over the past couple of weeks to the extent that no one should be out without a mask, and everyone should be trying to distance as much as feasible, even if retail [and other businesses] are opening up,” Krysia Lindan, a clinical epidemiologist at the University of California San Francisco, wrote in an email to Vox.

Public health experts are particularly worried about the upcoming holiday because they say Memorial Day weekend festivities helped seed the current outbreaks in places like Arizona and Texas. “I’m very concerned, especially given this coming weekend, that the same types of spikes and surges could be seen not just in the places that are currently experiencing surges but in places that have already experienced surges, and in ones that haven’t yet,” Josh Barocas, an assistant professor of medicine at Boston University and an infectious diseases physician at Boston Medical Center, said in a recent Infectious Diseases Society of America briefing.

Getting out and about is risky in large part because “people can transmit the virus before they start feeling symptoms,” says Eleanor Murray, an epidemiologist at the Boston University School of Public Health. By some estimates, about one in five people who get the virus never develop symptoms. And for those who do end up getting sick, many have the highest level of virus in their bodies before they start feeling ill. So, Murray says, “we can’t just rely on how we’re feeling today.” Or, for that matter, how the people around us are feeling.

If you’re in one of the higher-risk orange or red counties in the Harvard map above, sheltering in place is probably the safest move. If you’re in a yellow or green county, you may be ready to venture out, and might be asking: What’s the safest way to have an outdoor get-together with some friends? Is it okay to travel this summer? I lost a tooth filling in April — is it safe to go to the dentist?

I checked in with experts about the best and worst ways to do seven common things this summer, and here’s what they told me. (Risk is ranked only for each category, so a “moderate risk” option for one category might not carry the same level of risk as a “moderate risk” option for a different category.)

Get out of town

The first thing to know is that traveling from a high-risk area to (or through) a low-risk one increases the chances that you will spread the virus to places where more people might be out and about. “I don’t want to encourage anyone to think that gallivanting around during the summer is a good idea,” Lindan says.

Safest: Camp

Be sure to camp — and hike — at least 6 feet from others. Make plans and reservations ahead of time, and bring disinfecting supplies.

To get there, “drive with people in your household and who you know who are either uninfected or have been unexposed and/or safely practicing social distancing for two weeks,” Lindan says. Keep in mind that using public bathrooms, especially those that might not be cleaned super-regularly or those that are very busy, ups the risk for transmitting the virus. “Wash your hands after using the toilet, and always use a mask,” Lindan notes.

Next safest: Get a vacation rental

“Find out how long since the rental was last occupied and what type of clearing has been done between guests,” Lindan says. If other people were staying there more recently than 72 hours before your arrival, make sure surfaces have been wiped down. (The common booking site VRBO has detailed cleaning guidelines for property owners, and Airbnb has a cleaning commitment hosts can make — or opt for a 72-hour buffer window between guests.) Also, drive there, using the above precautions.

Moderate risk: Hotels

“Find out what precautions the hotel is taking,” Lindan says. Hotels should be using enhanced cleaning protocols; staff should be wearing masks and being tested regularly, and if anyone has tested positive there, staff who were in close contact should follow local health department instructions. And add one more item to your packing list: “Bring your own disinfectant and use it,” Lindan says.

Riskier: Traveling by plane

The level of risk likely depends on several things, Lindan says: how crowded the plane is, how long the flight is, where you are traveling from and to, and how busy the airports are. Before you fly, “ask the airline how far apart the passengers will be seated,” she notes (ideally it would be at least 6 feet), as well as what type of cleaning they are doing between flights (an industry group has released aircraft cleaning guidelines, but it is up to individual carriers to implement them and determine if every step is completed for each new group of passengers or just during longer stops). Also, she says to aim for a window seat with no one next to you or behind you. Although that might not be possible on all flights now, as some major airlines have announced that they will once again start booking entirely full flights.

Takeaways

Before you leave your area, look to see how much the virus is spreading there, where you are hoping to go, and any places you will pass through along the way. Murray advises that no one should be traveling to or from the hardest-hit areas of Arizona right now, for example (and probably Texas, Florida, and many other Sunbelt states). Traveling from a low-risk area to (or through) a high-risk one means you will be more likely to pick up the virus, so not only will you be more likely to get sick, but you might also bring it back to your community when you return home.

See older folks, like parents and grandparents, or other high-risk people

Safest: Virtual visit

“Call, email, or communicate through one of the services that allow you to see and hear each other virtually,” Nancy Nielsen, a dean for health policy at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo and former president of the American Medical Association, wrote in an email. If you are wanting to connect with someone who is in an assisted living facility, inpatient facility, or hospital, many of those places can help you get set up with a virtual chat — in part because it also helps them keep risks lower.

Next safest: Outdoors

Especially if you are visiting someone who lives in an assisted living facility, try to arrange a way to visit outdoors away from others who might be high-risk, such as people 65 and older. But if you must visit near the facility, “You would for sure always want to be wearing a mask and keeping 6 feet of distance as possible,” Murray says.

Moderate risk: In-home visit

This option depends a lot on how well everyone involved has been keeping up best practices of distancing (and how widely the virus is spreading in the area). “This is the question you need to ask yourself,” Lindan says: “If you are not being safe by not wearing a mask and avoiding crowds, do you want to infect and potentially kill your grandmother? If you haven’t been very careful in the previous two weeks, then don’t put your elderly relatives at risk — do a Zoom call.”

Riskier: Traveling to stay

This one depends on the above factors but also on where people are coming from and going to, as well as how likely you (or they) are to have been exposed to the virus, Murray says. For example, if you are an essential worker or health care professional, she advises a 14-day quarantine (staying at home and avoiding contact with others) first. Or if traveling there involves contact with lots of other people, she suggests planning on a 14-day self-isolation period (no contact with others) nearby before going to their home. Lindan agrees: “If you are visiting them for a long period, be sure to have self-isolated for two weeks beforehand or be very careful about your social distancing.”

Riskiest: Indoors at a care facility

“The highest risk would be actually visiting a retirement home where there are a lot of elderly people in an enclosed space,” Murray says.

Takeaways

Be especially cautious if you are seeing older people or others with higher risk for severe Covid-19 complications. And you can do other things to stay connected with these folks that doesn’t involve being in the same room, says Nielsen. “Shop for them, depositing groceries outside their front door.” Or say hi through a closed window.

And definitely skip large groups. “This is not a good time for family gatherings,” says Nielsen. And it’s something we will need to accept for many months to come. “Those may not be very safe until a safe and effective vaccine is available,” Nielsen says. We only have to look to the May surprise birthday party with 25 guests (hosted by a presymptomatic carrier) that ended up spreading Covid-19 to 18 people — including two people in their 80s and one person with cancer — and sent many to the hospital, to see how easily the virus can spread at a gathering, putting older relatives (and others) at risk.

Get routine medical care

Safest: Routine medical visits

“If you need a physical exam or Pap smear, get one,” Lindan says. Make sure that the office or facility you visit is cleaning all surfaces, has providers using N95 masks, and screening patients for Covid-19 (and keeping those who might be positive away from other patients), she notes.

Safer: Dental procedures

“Dentists have been using masks and eye shields for a long time, so going to a dentist is probably fine,” Lindan says. Especially for the patient. (“The risk is more to the dentist or dental hygienist than to you, because of aerosols and droplets that are inevitable during procedures,” Nielsen says.)

Moderate risk: Eye appointments

“It depends on what the ophthalmologist is doing,” Lindan says. If they are taking the best safety precautions, including disinfecting everything (surfaces, instruments, etc.), and wearing gloves and an N95 mask, that makes it safer. (The American Optometric Association has put out guidelines for best practices for the field.) But “given there is a lot of potential eye contact with the instruments, hands, etc., and that Covid-19 can be transmitted to the [mucous membrane of the eye], this might be higher risk,” Lindan says. “Of course, if you have an urgent eye problem, you [will] have to be evaluated.”

Takeaways

“Go now for those medical and dental services you’ve been putting off,” Nielsen says. “Medical and dental offices are acutely aware of risk,” she says. Everyone should be wearing a mask at all times — except for the time you might need to take one off to have your nose or mouth examined. These visits should be safe and can be essential for maintaining other important areas of health. For her part, Nielsen says, “Go for the elective surgery, Pap smears, physicals, eye exams you’ve postponed.” (There is a chance, though, that as Covid-19 case numbers spike in some areas, elective procedures will be put on hold to maintain hospital capacity.)

See friends

Safest: Virtual hangouts

You might have video chat fatigue by now, but it is still the absolute safest answer for socializing with those outside of your household, Nielsen says.

Next safest: Outside gathering

“Getting together in person is more soul-satisfying, of course,” Nielsen says. And you don’t need expansive empty parks for this. You can sit on a friend’s porch or patio so long as you can safely stay at least 6 feet apart. If there is food or drink, people should bring their own. And definitely avoid anything shared or in a buffet style. Also: “No hugs or handshakes!” Nielsen says.

If you’re considering ducking inside a friend’s home to use the bathroom, the riskiness of that depends on how closely those in the home — and you — have been following physical distancing. If you decide all have been adhering well, it should be okay — just wear a mask, wash your hands well, and thoroughly disinfect surfaces before you leave the room.

Should you wear masks when you see friends outdoors? Lindan says that “if you’re outside with a friend who has been cautious and probably not exposed, you probably don’t have to wear a mask” if you keep up physical distancing. But that is something to be mindful of because staying physically far enough apart from someone you know well is difficult — even if you’re both trying your best. “It’s difficult to maintain these social distances,” Lindan says. “It’s not how we live as humans.”

But distance and fresh air don’t necessarily prevent the spread of the virus. “Spewing respiratory droplets over a longer distance can occur if someone has a vigorous cough,” Lindan says, or if people are talking loudly or singing — even outdoors.

Moderate risk: Inside a home

The level of risk here is strongly tied to how careful you and your friend (and whoever else you and they live with or see regularly) are being. If everyone has been extremely careful, you might be able to “wear a mask until all are safely distanced, then don them again if you’ll pass people closely,” Nielsen says. (Lindan goes so far as to suggest that “if they are not maintaining social distancing or wearing a mask when outside, then maybe they are not your friends.”) But still no hugs, handshakes, or shared foods.

Riskier: Meal at a restaurant

“Sit outside if possible,” Nielsen says. The restaurant should have tables spaced at least 6 feet apart. The staff should be masked, “as should all guests until beginning to eat or drink,” she says.

Riskiest: Crowded bar or event

As far as bars are concerned, Lindan says, “don’t go into them … unless you can drink outside at a distance from others.” Even if you enter with a mask on, you and others will take masks off to drink. “Plus, getting intoxicated is likely to result in less ability to continue to be safe,” she says. “It is likely that upticks in cases in some places are the result of parties and bars.”

Add to this that “it’s more than the lack of social distancing,” Nielsen says. “It’s that speaking loudly, shouting, cheering, etc., have much more potential for droplet spread” that could spread the virus.

Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases echoed these sentiments at his June 30 Senate hearing: “Bars: really not good,” he said. “Congregation at a bar, inside, is bad news. We really have got to stop that.”

Takeaways

The bottom line is that “Nothing has changed about precautions to prevent yourself and others from becoming infected,” Lindan says. “Wear a mask at all times that you are out, except when you are eating or drinking, which ideally would occur at least 6 feet away from others in your ‘safe’ group. Clean/disinfect your hands. Being outside for activities, for seeing friends, and for eating is better than inside.”

Keep children busy

Safest: Home — or outdoors with household members

Everyone might be stir-crazy by now and very tired of one another. But keeping children with members of the household is the safest for not just preventing them from getting sick (which does happen) but also to reduce the chances of their spreading the virus to others (data on this is still evolving).

Safer: Playgrounds

A quiet playground, especially one that has just been cleaned, could potentially be okay (especially if transmission in your area is low). Adults and children over 2 should wear masks and maintain physical distancing, and everyone should disinfect hands frequently. “You can try to clean off playground equipment before your child uses it, but it’s probably easier to periodically clean your child’s hands while they are at the playground,” Lindan says.

Moderate risk: Play dates

To keep play dates safest, limit the number of kids and families involved — ideally to just one other family that you trust to be keeping up good distancing practices. Perhaps most important is to “be aware of what the parents are doing,” Lindan says. “Parents pose the most risk. So avoid kibitzing in close proximity with parents whose social distancing practices you are unaware of and who aren’t wearing masks.” Also, ask other parents to wear masks when they are around your children.

Riskier: Camps

Lindan recommends trying to avoid sleepaway camps for now because it is hard to be sure counselors and other staff have all been distancing and wearing masks outside of their time with the children. “Camp experiences that are based outdoors and with smaller groups of children are better compared to an [indoor] computer camp, for example,” she says.

Takeaways

Any activity with children is particularly tricky because, especially with very young children, they are unlikely to be able to follow all of the health recommendations (staying away from other people, not touching common surfaces, wearing a mask correctly, etc.).

A lot remains to be learned about the rate at which children transmit the virus to one another and to adults. And although children do not seem to experience more typical severe Covid-19 infections as frequently as adults do, they can still get very sick and die as a result of the virus.

 

Get a personal treatment

Safest: DIY

Want a haircut? Manicure? Back massage? “The safest thing to do would be to do it at home or have a roommate or housemate do it for you,” Murray says.

Next safest: Quick haircut

Murray suggests this could be fairly safe “if you’re getting a 15-minute haircut, especially if you’re all wearing masks and you’re 6 feet away from other clients,” she says.

Moderate risk: Manicure or pedicure

These should be done with a plexiglass shield between the client and aesthetician, Murray notes. Also: Everyone should be wearing masks, and clients should be spaced far apart. If you’re deciding between the two nail services, “a pedicure may be somewhat safer than a manicure, since you’re not so close to one another, and you are unlikely to touch your face with your feet,” Lindan says. But it’s not entirely about the extremity you choose. “Think about how long you are going to be there and in close proximity to other clients and staff,” she says.

 Eva Marie Uzcategui Trinkl/Anadolu Agency via Getty Images

Riskier: Lengthier hair treatments

Dyeing, relaxing, and other longer-duration hair treatments up the risk simply because you’re spending longer indoors in a salon. “You might not be in such close contact with [a stylist], but you are going to be in their studio for a long time,” Murray says.

Murray also adds to this category of risk: massages and body waxing, like leg waxes (“if you yell when they pull the wax off, it’s more risky for the person doing the procedure,” she says. “And it can take a long time.”) Nielsen also suggests tattoos are in this level of risk “due to proximity and prolonged encounter time, even when masks are worn by all.”

Riskiest: Eyebrow and face waxing

“I would discourage people from getting their face waxed at all,” Murray says. Really any face-based treatment falls in this category, including other eyebrow services, facials, or a shave.

Regardless of the treatment, says Lindan, “make sure that all instruments have been sterilized between clients (which should be done regardless), that you and the staff are wearing masks properly and washing hands.”

Get around without a car

Safest: Walking or cycling

The fresh air and not being in sustained proximity to others helps to minimize risk — especially if most everyone is wearing masks when passing close to others.

Next safest: Private ride-hail or taxi

“The idea would be that it’s just you and the driver, and you could wipe down surfaces that you would touch and wash your hands afterward — and both be wearing masks,” Murray says. You can also keep the windows open to increase air circulation.

Moderate risk: Quiet bus or metro

“They may be reasonably safe,” Murray says. “If you’re the only person in the subway car, you’re probably fine.” But follow the same good hygiene practices that you probably should use in public transportation anyway: Don’t touch anything you don’t absolutely have to, clean off your hands as soon as you can — and don’t touch your face before you can do so. And when there are a handful of other people, “sit far apart from other passengers,” Lindan adds.

Riskiest: Crowded bus or metro

“If it starts to look like commuting hours used to, where people are squishing in, you definitely don’t want to get in,” Murray says.

Make the summer safer for everyone

Most of these activity evaluations depend on whom you are seeing and where you are. “It’s hard to make gradations of risk,” Lindan says. “It depends on what your friends have been doing, and it depends on the transmission in the community.”

Before we see anyone these days, it should be part of the new routine to let them know if we are feeling well and if we have traveled in the past two weeks anywhere where Covid-19 cases are prevalent, Nielsen says.

It is easy to find out what case levels are like in your area by going to your local health department’s website, the Centers for Disease Control and Prevention’s Covid-19 Data Tracker, or checking the rate of positive tests available from Johns Hopkins. “Become informed!” Lindan says. “It’s not difficult.”

German Lopez/Vox

The lesson is that life is very different this summer. And even though some activities are allowed — and even if we see friends and family members engaging in them — that doesn’t mean we should take part. In fact, says Murray, “The types of things people should be doing are the same things they should have been doing since February or March.” These include keeping distance from others, wearing a mask, washing hands frequently with soap and water, and avoiding touching shared surfaces.

This isn’t just to help you avoid getting the virus, which, as Murray notes, “sounds very bad even for mild cases.” It is to help stop the spread of the virus to others and ultimately slow the runaway pandemic.

Or, as Lindan puts it: “You cannot drive 100 miles per hour on the highway. Even if you want to risk killing yourself, it’s not acceptable to kill others. The same is true for Covid-19.”

So for everyone’s sake, try to summer safely.

Katherine Harmon Courage is a freelance science journalist and the author of Cultured and Octopus! Find her on Twitter at @KHCourage.