If you can’t stay locked down forever, what should you do? Again, I want to specify that in this essay I am saying *What I will do and what I think is wise. You will obviously, have to make your own choices and take your own actions. The basic question to ask yourself is this – how much am I willing to accept some chance of getting the virus, and for what return? If the stakes are “I get paid and get to keep my home and the groceries coming in” that is worth some risk to me. If the stakes are “I get to hug my Mom” that might be worth some risk – but if the risk to her is higher, maybe not. If the stakes are ‘I get to buy some nice shoes I could order online or drink beer in a bar instead of my house” it is not worth much.”
Two things inform this post. The first is the exposure + time equation. The second is the HUGELY important fact that 20% of cases produce 80% of the spread. That is, first of all, you have to come into contact with enough virus to infect you – either a lot of virus, all at once (ie, you walk through an unmasked person’s cough cloud) or you are exposed for a long time (ie, in a contained space with someone for a long time.) BUT, while most people expose few people and only those they are close to, about 1 in 5 people are incredibly contagious, and can spread it without knowing it to dozens or hundreds of people.
There is absolutely no way for you to know if you or someone in the room with you is a super spreader, but in those cases, with heavy viral shed, you are at much greater risk than average. Since only 1 in 5 people with Coronavirus is a superspreader and most people don’t have the virus, you are playing odds. If you live in an area with low transmission, wear a mask, are careful with hand washing and come into contact with only a few people, you are most likely to get lucky, since most people won’t have Coronavirus and if they do, most of them won’t be superspreaders. But every person you add contact with, ups the chances that you will come into contact with someone shedding huge amounts of virus. And the higher the rate of transmission in your area, also the higher risk. But even in areas with low spread, for example in the county in Oregon that now has the state’s largest outbreak, associated with a Pentecostal church, being exposed to lots of other people for long amounts of time indoors is a bad idea.
What that means is that you can reduce your risk in general by doing all the common sense things – washing, wearing a mask, not touching your face, reduced number of people, better ventilation, filters, etc… but if you are unlucky enough to share sustained space with a superspreader, you are at increased risk of getting sick. And since no one is perfect in their mask-wearing, not touching, hand washing, those things are much riskier. So to the extent, everyone is able to, common sense involves not staying close to the same people who you are not bubbled within a contained space for very long, even with masks, handwashing, etc… And most of all, avoiding large gatherings.
We know from the case of the two hairdressers with coronavirus in Missouri, that masks can reduce risk of infection, but I suspect it is also the case that neither was shedding that much virus. There is every reason to believe that even with masks if they were superspreaders, the story would be different. For example, in Korean Nightclubs, masks are fairly ubiquitous – and yet Seoul had a superspreader outbreak while people were wearing masks. The good thing is that when you have only two people each with a 1 in 5 shot of something, odds aren’t that bad that you will get lucky. The more people you are dealing with, however, the higher the odds of a superspreader being in the crowd.
That’s why there’s so much variability in infectiousness – one church has been having services for weeks with no signs of infection, another has one service and 30 people get sick. One school system reopens and goes months without an infection, another opens and promptly closes with a huge spike. This is one of the things that makes this disease so hard for people to understand, along with the 2-3 week lag in case spikes. It also means it is really hard to gauge the single most important factor in your risk – am I in the room sharing air with someone really, really contagious? We just don’t know. It is too easy to congratulate ourselves for having done everything right when the thing we don’t control just happened to go our way.
Some people have no choice but to face up to risk due to work or other needed exposures, but the rest of us have a moral obligation to avoid risks that might increase a burden on others – particularly already overburdened health care workers and others we might accidentally infect and kill. My household’s rules are based on reducing exposure and avoiding possible situations in which harm might occur.
Rule #1 – No sustained indoor air contact with anyone, especially air-conditioned air. If I must enter an air-conditioned establishment, it is briefly and efficiently, as for grocery shopping or other retail purchasing. No retail therapy, no trying clothes on in stores, nothing that extends a shopping trip. In and out, one person, as fast as possible, and only for things that one actually needs. I will not shop AT ALL anywhere the proprietor and staff aren’t masked. I do not expect employees to risk fights with non-masked people, but I do expect them to post a mask requirement, and if they can’t enforce it, do something like limiting entry. This is a tough rule for small retail businesses that may have small premises, rely heavily on browsing, etc… I’ll be honest, I suspect a lot of stores aren’t going to make it. I think a lot of it is because people aren’t going to be buying things they don’t need, but it stinks especially for the women’s clothing market. But I still won’t do it.
Rule #2 – Absolutely no eating indoors in a restaurant. Period. You have to take your mask off. You are touching your face with a fork or spoon. At least staff can keep their masks on, but you can’t. Also, restrooms are bad and eating and drinking makes you need them. Take-out only at my house, but if you must eat at a restaurant, eat outside, and only at one that really has thought about distancing. This is terrible for restaurants. I suspect something like half of the ones I love will be out of business by next year. But I think we’ll find that indoor dining is just too risky – a few outbreaks like those now in FL, and I think few people will want to anyway.
Rule #3 – No public restrooms. Period. It sucks, and it is incredibly limiting but unavoidable. There is a fecal component to this disease. Toilets shoot a cloud of droplets into the air and then you breathe them in, which is merely gross most of the time, but dangerous here. Porta-potties are actually probably safer, particularly if you carry hand sanitizer.
For me, that means outings are limited to about 2 1/2 hours or the limits of many people’s bladders. It stinks. I don’t enjoy it. But it is safer. If you are traveling, you need to think about this one.
Rule #4 – No freshwater ponds or lakes due to concerns about fecal contamination, no pools unless incredibly uncrowded and I have faith that increased chlorine levels are being provided as recommended. No water near people, because having your eyes closed, and playing in water makes people struggle with social distancing. Especially kids. I do miss the ocean. I grew up a block from the sea, and could often have beaches to myself in the early morning. I’m going to be sprinkler limited this year.
Rule #5 – No long stretches of time indoors with other people if avoidable – schools, churches, synagogues, colleges and workplaces are all going to be risky, in part because even with the best of intentions, people adjust their masks or take them off momentarily, rub their eyes or forget about distancing. If you have to go back to work, or school or church, be rigorous about your own mask-wearing and move around as much as possible. The last thing you want to do is sit still breathing in the same air all the time. Also, avoid indoor crowds where people are screaming, singing, or laughing
This is the hardest one. Our children desperately want to go to school, and zoom does not cut it. Laughing and singing are two of my favorite things. It SUCKS. I do not blame people who want madly to return to these sustaining things. It is, however, a really bad idea. And one you might not immediately recognize as such. It is easy to congratulate yourself that you’ve done it right when a few weeks or months go by and nothing happens – but it may simply be that the wrong person at the wrong stage of the virus wasn’t in the room. It is easy to become overconfident.
It is a human norm to believe that if you dodge a bullet six times, you are invulnerable, rather than lucky. The fact is, the superspreader reality means that you are just fortunate.
On the other hand, socially distant OUTSIDE activities are ok. It is certainly possible to transmit coronavirus outside – there are multiple examples of this, particularly that famous pool party and at Chinese outdoor markets. But it is harder, and sunshine and fresh air are a good thing.
It would be possible to have many of these activities safely outside with some care, and honestly, that’s what I think communities and families should do. The truth is you never really know what’s safe, but outside is the best possible option. And for those of us in the Northern parts of the US, the window for that is going to close appallingly soon. So I’d encourage people to make such arrangements BEFORE the window closes. Socially distant, outside, shared family and community events seem worth considering IF you can follow the rules.
I would love to see schools open for the month of September with a fully outdoor curriculum and adequate staffing to really ensure safety. That would give kids a foundation for the probably inevitable stretch of home-based or distance learning. I find it unlikely that it will happen, particularly in large regionalized districts that depend heavily on busing, but it would be a good idea.
So those are my rules. How about yours?