How should I think about my risk as the US reopens?  How can I limit my risk as we begin to reopen? – The Village Doctor

How should I think about my risk as the US reopens?  How can I limit my risk as we begin to reopen?

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With many states in the US “reopening” to some extent, how should each of us think about our risk and minimize it as much as is reasonable?

Any increase in social interaction increases risk of contracting COVID-19 to some extent. There will be some things we must all do to protect the most vulnerable in our communities (e.g. wearing masks in public, indoor spaces or when coming within 6 feet of others). Your personal risk tolerance for increasing social interaction with those outside your home may be closer to ‘zero’ if you are high risk for severe infection or live with someone who is (i.e. immunocompromised people or those who have significant chronic health issues).  With these considerations as our foundation, we might begin to analyze and limit the risks we each take personally in venturing more outside of our homes by using two frameworks – the first in relation to our own activities and the second in relation to the activities of others. 

In terms of our own activities, think about the level of proximity, the kind of activity, and the amount of time.  For example, the highest risk scenario is if you are in close proximity, indoors, for a long period of time with someone who is infected.  This is why most COVID cases are contracted from someone at home.  Short-term interactions outdoors are safest (e.g. passing a stranger on a trail).  Longer interactions, indoors, are higher risk (e.g. visiting your hair stylist).  If both people coming together are wearing masks, this greatly decreases risk.

Certain activities expel more droplets, such as singing.  In one case, 52 people in a choir became infected from one infected person.  Other activities, such as some family get-togethers, involve a lot of people hugging one another, also leading to higher rates of infection.  Conversely, there have been no documented cases of someone acquiring COVID-19 from passing a stranger while walking outdoors.

To minimize risk in our own activities:

– Wear a mask whenever you are indoors in public spaces or within six feet of others

– Avoid crowded spaces (bars, sporting events, movie theatres)

– Host get-togethers in a park or your backyard 

– Sit at least six feet away from others who aren’t part of your household.  

– Use your own utensils and bring your own food and drinks.  

– Skip the hugs, kisses and handshakes.  

– Choose take-out instead of eating out.  If eating out, choose outdoor tables at least six feet apart.  

– At work, consider rotating staff in staggered shifts or every other week, spacing work stations and conference room seating by at least six feet.  

– Skip a crowded elevator and wait for the next. Try to stand on opposite sides from other riders and face away from them.

– Minimize cumulative risk: Your risk increases with every additional person you come in close contact with.  If you have to return to work, you can decrease your risk by minimizing social gatherings outside of work.  If you choose to eat at a restaurant, perhaps you can avoid that trip to the hair salon.  

In terms of considering the activities of others, before coming together, consider how friends and family are thinking about their own risk and activities.  Also, consider risk in relation to the current state of local infection rates.

When considering decreased social distance with others, begin with other families who are carefully socially distancing.  You can think of this as ‘pooled risk.’  It’s a bit like how you might consider safe sex practices – those in monogamous relationships are lowest risk and those with mulitple high-risk partners are highest risk.  If you’re planning to come together with others, it is safest to do so with those who have been socially distancing as carefully as you have, particularly during the 2 weeks before the get-together.  If planning to travel with another family, for example, it might be helpful to discuss how socially distanced each family plans to be for the two weeks prior to the trip.  If you are a grandparent who misses your grandchildren, if both families have been sheltering at home carefully for two weeks it should be very low risk for both families to join together.  However, if someone goes back to work or continues to visit the grocery store frequently, this can increase the risk for both families.

When local rates of infection decrease, the individual risks we take out in the community are also lower.  For example, beginning to think about hosting a socially-distanced gathering in your backyard probably makes more sense soon in the bay area but likely would not feel as safe in an area with higher rates of infection such as New York City.

We encourage you to explore the concepts of proximity, activity and time when considering your activities as the US begins to reopen.  Don’t be afraid to bring up these topics with others as you consider decreasing social distance with them.  Taking precautions such as wearing a mask in public and holding smaller events outdoors, socially distanced, without food sharing will help protect everyone, including our most vulnerable, who face the most risk from potential infection and, as a result, the most challenge from the impact of continued stricter social distancing.  We can greatly ease the burden on these community members if we carefully consider the risks we take to minimize local community transmission rates.