By Sara L. Merwin, MPH with Amanda Merwin Lewis, MPH
It is sometimes difficult to determine how we can best keep ourselves safe during the Covid-19 pandemic. Our decisions will be impacted by multiple factors: governmental mandates in our jurisdiction, our specific age and medical conditions, our abilities to adhere to guidelines and our innate sense of risk aversion.
To make matters more difficult, as time goes on, we are forced to constantly re-evaluate what is prudent, what is safe and what is important to us.
Like everyone else, I have evolved my thinking over the past few weeks in accordance with local restrictions but also with growing concern about the explosion of cases. I have made adjustments and become much more cautious over time. This is because I am both concerned about the safety of my family and because I feel a moral and civic responsibility as a public health professional to limit the spread of disease.
Further, as I write this, many friends and colleagues are risking their lives taking care of patients with Covid-19.
Over the last several weeks, friends and family have posed questions about what to do and what not to do in the face of the risk of contagion and transmission. This has been a moving target. Here in New York there is no longer an interior debate about whether it’s wise to go to the gym; our governor has prudently taken away that option. Some people have been slow to incorporate changes; this is understandable. Most of us have had to evolve our attitude and approach as we took stock of the enormous changes in our life brought on by the pandemic.
From the first days of the coronavirus’ entry into the US and on a continuing basis, I have been following the reports from the WHO, CDC and the many qualified experts in science and medicine who have modeled Covid-19 growth and instructed us on how to prevent its spread. I have noticed that the top experts state with reserve and humility that not enough is yet known about so many aspects of this coronavirus and how it behaves. Yes, it is true that younger people are less likely to become very ill than frail, older adults with underlying conditions, but it has now become clear that some young people without risk factors are becoming very ill and not surviving. Nonetheless, we must all take into account a multiplicity of factors about ourselves, our contacts and the penetration of the virus into our local area.
I offer below a practical, highly subjective guide to assessing risks of what to do versus what not to do. The following scenarios rely on equal parts science and common sense. Remember that the arrow goes both ways: the risk to you and the risk of spreading to others. In general I have responded in the direction of risk to you. But to flatten the curve it is essential that we do not spread Covid-19 to others.
Here are the questions posed to me and my responses: Notice there are qualifications and caveats for all. This series assumes that you are not currently symptomatic, tested positive or had direct exposure. (If that is the case, avoid all contact with other people, including those in your household.)
Q:Is it safe to be outdoors?
A: A qualified answer: depends on where you live. In dense urban areas it is not possible to remain 6 feet apart, so in those locations, the answer would be no. In addition, people passing through hallways and elevators of apartment buildings, in order to exit, are in contact with other people and surfaces, increasing opportunities for exposure.
In the suburbs and country areas, assuming there is a direct exit to outdoors, it is safe and advisable to get some fresh air so long as there is a 6 foot distance from people not in your immediate household.
- My risk assessment – low with caveats (if you can be outdoors and remain at least 6 feet apart from others)
Q: Is it safe to go to parks with friends?
A: Two weeks ago I was asked if it was ok to meet a small group of friends in a park. At that time, I responded that it seemed fine if everyone was careful (this was at the beginning of the stringent social distancing message). Within a day, Orange County California banned all gathering in parks. Apparently, there was concern that not all people would adhere to advice to keep distance.
- My risk assessment – low provided that true social distancing is observed
Q: Is it safe to eat in restaurants? (posed two weeks ago, California)
A: For many of us, this is no longer a choice. In many areas of the country restaurants have been ordered not to serve dine-in customers. However, at the time I was asked this question, my response was still a solid no to eating in a restaurant. There are too many unknowns: many different people with unknown exposure status: servers, other customers, cooks. And possibility that decontamination of surfaces is lapsed or absent.
- My risk assessment – moderate – cannot control variables
Q: Is it safe to order food in?
A: Yes and no. We now know that the coronavirus does not live long on cardboard (such as a pizza box) but longer on plastic. However it only takes one sneeze or cough from a delivery person to contaminate the container. We are advised to transfer cooked food from a take out container to one’s own dishes and then carefully wash hands after discarding take out container.
- My risk assessment – low with appropriate precautions
Q: Is it ok to have friends over?
A: Better not to. If you can qualify how much contact the guest has with others (takes public transportation, works in health care vs almost total isolation), you can make an informed decision. In any event, be very particular about whom you invite into your home. Decide if this person is so important to you that you risk getting ill.
- My risk assessment – low to moderate if only one or two people who you trust to have been careful
Q; Is it necessary to decontaminate food, mail and packages coming into the house?
A: If you or a person in your household is deemed high risk, then it’s not a bad idea. It is difficult to do it correctly and is quite labor-intensive . In general, the experts believe that for the average person it is not necessary to decontaminate. On the other hand, we are now hearing that Amazon packing plants are not protecting their workers with appropriate gear, the U.S. postal service is not providing hand sanitizer and we have heard reports of sick Fedex workers staying on the job. Here are instructions from a professor who studies viruses, in the event you want to embark on a decon mission: https://www.colorado.edu/mcdb/coronavirus-information/professor-sara-sawyers-decon-station-instructions
- My risk assessment – quite low but exercise discretion
Q: May we have contractors, cleaning persons, household help in the house?
A: Definitely not. Postpone all non-essential human traffic in the house. There is a discussion of cleaning help in the New York Times: https://www.nytimes.com/2020/03/26/us/coronavirus-house-cleaner.html
The only exception would be home health aides for older adults or vulnerable people.
- My risk assessment – moderate
Q: Is it ok to fly somewhere for non-essential purpose?
A: Hard no
- My risk assessment – extremely hazardous
Q; Is it ok for older adults to go to the supermarket during senior shopping hours?
A: Not really. This is an environment in which we cannot control many factors. Remember that exposure is on a continuum and the mechanism of spread is principally from person to person. Therefore the more we minimize exposure, the safer we will be. Every time we step into a store we are taking the chance that someone will cough or sneeze near us, or will stand too close on line or we will inadvertently touch our faces after coming in contact with a contaminated surface. Conversely if you are sick but not showing symptoms you may spread the virus to someone else — someone who may not survive a Covid-19 episode. It is far more prudent to get groceries delivered if that is possible in your area.
- My risk assessment – moderate
Q: Is it safe to bring goods into an assisted living or senior housing facility if hallway doors are closed?
A: Probably not for the residents: we cough, we sneeze, we touch. In addition, the conditions in congregate living arrangements facilitate spread so the person entering the building is at risk. Sadly, this is such a dilemma for people taking care of older relatives. They must be cared for and helped but we may be introducing peril when we enter the premises where they live.
- My risk assessment – moderate
I hope the above has been helpful to you in arbitrating decisions about safe practices during the Covid-19 pandemic. Again I must close with the wise words of Dr. Anthony Fauci: “If it looks like you’re overreacting, you are probably doing the right thing.”