What is a quarantine bubble and how do I design one for my family?

WHAT IS A QUARANTINE BUBBLE AND HOW DO I DESIGN ONE FOR MY FAMILY?

After months of social distancing and with holidays approaching, many people are turning to quarantine bubbles, to try to balance the risks of the pandemic with the social and emotional needs of life. When done carefully, research shows that quarantine bubbles can effectively limit the risk while allowing much needed social interactions with family and friends.

Make no mistake, however, staying indoors, avoiding all contact with friends or family, and having food and groceries delivered would be the best way to limit your infectious risk, particularly if you are in a very high risk group. But overall health also includes mental as well as physical being.

However, the negative mental health impacts of the pandemic are becoming more evident. A recent survey found 13.6% of US adults endorsed symptoms of serious psychological distress, up from 3.9% in 2018. One quarter of young people 18-29 years old reported serious psychological distress, the highest levels of all age groups. Quarantine bubbles, therefore, are not just a convenient concept to allow us more social interaction. Isolation poses serious health risks — both physical and emotional — that “bubbles” can help alleviate while improving social well being and quality of life.

If you do decide to gather, do all you can to make sure it’s safe, and follow basic guidelines. Dr. Bonnie Maldonado, Professor of Pediatrics (Infectious Diseases) at Stanford Children’s Health has some advice, “This is a time when we all want to see our family and friends, and we can still do that, but I think we just have to be very cautious about how and when and how many.” She recommends only meeting in a “small group” where you know what other interactions people have had, and advises hand-washing and masking as much as possible. Outdoor gatherings are usually safer, but if you must meet indoors, make sure to open windows or doors for increased airflow and better ventilation.

HOW TO BUILD A QUARANTINE BUBBLE

First, everyone must agree to follow the rules and be honest and open about their actions.  Individual behavior can put the whole team at risk, and the foundation of a quarantine bubble is trust. Bubbles, which should be no more than 8 – 12 people, should discuss in advance what to do if someone breaks the rules or is exposed to an infected person. If someone starts to show symptoms, everyone should agree to self-isolate for 14 days.

Second, everyone must decide how much risk is acceptable and establish rules that reflect this decision. This is not a time for shyness or ambiguity, no assumptions should be made, no hesitations left unaddressed. Some teams feel okay to have friends visit, but only outside with everyone wearing masks. Other bubbles with higher risk members might not agree to that.

Finally, everybody has to actually follow the rules, comply with physical distancing outside of the quarantine bubble, and be forthcoming if they think they may have been exposed. The rules can change over time as we learn more about this virus, so communication should be ongoing and dynamic, so that everyone can completely understand and agree to any new rules.

THE RISKS OF JOINING A QUARANTINE BUBBLE

Any increase in social contact comes with more risk. Understand two important considerations in deciding how much risk you are willing to accept in joining a bubble:  

First is asymptomatic spread. Current data suggest that at any given time, up to 45% of infected people are asymptomatic or pre-symptomatic and able to transmit the virus to others. The best way to know is to get tested, and some teams might want to require testing before joining.

Second is that the consequences of getting sick are not the same for everyone. For people in higher risk groups, the risk must be seriously considered in relation to how strictly observant a quarantine bubble is, how many members it has, or whether to join at all. The consequences of a high risk person getting sick is much more serious.

One of the most unsettling aspects of this pandemic is uncertainty about this virus and what lies in the months ahead. But many things are known. If individuals are informed and sincere in their efforts and follow the regular guidance of social distancing, mask wearing, and enthusiastic hand-washing, quarantine bubbles can offer a robust and structured middle ground approach to manage risk while experiencing the joy and benefits of friends and family. 

Sky Pittson, MD, October 12, 2020