Dining Out, Public Beaches and Hugs? Here’s Expert COVID-19 Guidance
As our communities gradually re-open we find ourselves asking the question “What is safe?” To address some of these concerns and answer your questions about socializing and leaving your home, we spoke with UVM Health Network infectious disease expert Tim Lahey, MD.
Is it safe to eat inside at a restaurant, even with social distancing?
Crowded restaurants where diners sit in close proximity for prolonged periods have been shown to be really effective at transmitting SARS-CoV-2, the virus that causes the COVID-19 respiratory illness.
Yet we don't want the restaurant industry to collapse. People need jobs and we all love a break from cooking.
The happy medium will involve making restaurant dining different for the near future. Takeout and delivery will both become a bigger part of the restaurant business. Eventually, when local outbreaks have quieted down, we'll figure out how to return to modified restaurant dining. Examples include spacing tables out widely enough, installing physical barriers between tables, and making sure kitchen staff aren't as crowded together as usual.
Now that retail stores are open, how can I safely go shopping inside?
Retail stores will implement ways of spacing customers out, including having limits on total customers. Since most visits to a retail store are brief, the risk of transmission is not huge. Preventive measures should allow shopping to happen soon, as long as the epidemic is locally contained.
Should I use public restrooms?
Avoid crowded restrooms. If you do use a public restroom, wash your hands after using the facilities.
Is it safe to go inside the home of a friend, just to quickly use the bathroom or to drop something off?
So far, I have kept visits with friends to the great outdoors. If the epidemic remains locally contained, we can relax those restrictions and consider short visits to friends and families.
With restrictions lifting, is it safe to visit indoors with older family members or friends yet? What if I'm healthy and have been isolating at home?
When making this decision, it's important to consider your safety and the safety of the person you want to visit. While visiting a healthy friend briefly has low but not zero risk, visiting someone who has underlying health conditions for a long visit could be high risk for them. One of the last physical distancing rules to relax will be long visits to medically at-risk friends and family who haven't already had COVID-19. It's important to have a conversation with our friends and family about what the risks are and to negotiate boundaries that everyone is comfortable with. Better safe than sorry.
How do I tell my friends or family that I'm not comfortable with relaxing certain protections, like face masks or small group socializing?
We can all lead by example. I wear a mask and I practice social distancing, and I expect the same thing of my friends. When possible, I will encourage a friend who isn't following the rules to do so.
That said, I don't think it's helpful to engage in direct confrontation about these things. Some people who aren't wearing a mask have a good reason. Others may want to express their personal freedoms at the risk of others. Either way, lecturing them is likely to achieve little.
Importantly, if the vast majority of people do their part, the virus will be transmitted less than it would be even if there are a few holdouts.
Is it true that the virus doesn't spread as easily or as much as initially thought on surfaces? If so, do I have to continue disinfecting surfaces in my house? What about the surfaces outside my house? Door handles? Shopping cart handles?
What we do know about transmission of SARS-CoV-2 is that it occurs mostly between people who spend prolonged periods of time in close proximity, such as nursing home residents, the incarcerated, and people who work or live in crowded buildings.
In those settings we believe transmission occurs via some combination of inhaling aerosols and touching your face after coming into contact with contaminated surfaces. Nobody has proven what percentage of transmission results from which source in part because it's really hard to tell in retrospect how transmission occurred.
All of the above has led the CDC to soften its messaging about how much the virus is transmitted off of surfaces – but there is still much to learn.
What we know now is that the most effective ways to prevent transmission are to avoid crowding and breathing in the air of someone who could be infected. Handwashing is safe, easy to do and likely does offer some level of protection.
Is it safe to drive an older family member or friend to a necessary medical appointment? If necessary, how do I make this transportation safer for them?
I have been deeply concerned to hear that some people have avoided medical care and other necessary errands because they fear contracting COVID-19.
This feels upside-down. If you need care for a known medical condition, it's much riskier not to get treatment and thus get sicker than it is to stay home in the theoretical hope of avoiding COVID-19.
Once you get to the clinic or hospital, you've come to the safest place outside your home. Everyone there is wearing masks and there are measures in place to keep patients and health care workers safe.
There are some reasonable measures to take when traveling to that appointment. If two people who don't live in the same household have to drive together, they should wear masks for the duration of the drive. They can keep the drive as short as feasible and if the weather allows you to open the windows to allow for good ventilation, I would. And the medically frail person should continue their usual attention to handwashing after coming into contact with public objects.
Is it safe to go back to church and other places of worship?
One of the sad realities of the COVID-19 pandemic is that there has been aggressive transmission of SARS-CoV-2 during church services. It makes sense: the virus loves to spread in closely spaced crowds that spend more than a few minutes together. As a result, churches and other places of worship will need to find ways to make worship safe. They can hold outdoor services that are better ventilated when possible, and wherever services occur perhaps they can schedule additional times of worship so that fewer people attend each service. In each service, the religious leader can encourage worshippers to sit at least 6 feet apart and wear masks. These changes to longheld worship practices can be really discombobulating – I sympathize with the challenge they could present! I also feel confident that religious communities can be incredibly supportive of their members, so I have no doubt they will be creative and thoughtful in the way they keep their communities safe.
Can I hug someone if I have a mask on?
We suspect masks reduce the risk of transmission of SARS-CoV-2 but they aren't perfect. Since close contact with other people transmits SARS-CoV-2, hugging them may defeat the purpose of wearing a mask. Use common sense. If a wave or namaste will do, let that be a small act of protection of your neighbors from this deadly outbreak. If both people absolutely have to hug, then you can take that risk but it is a risk that could affect more than just you so take it thoughtfully.
How can I safely get a haircut when the salons finally reopen?
Like restaurants, salons bring multiple people from different households into close physical contact with each other. As a result, they will need to undergo more changes to be safe. Measures can include ensuring good salon ventilation, signs that encourage customers with symptoms to stay home, spacing out customers at least 6 feet apart and perhaps having physical barriers between haircutting stations, having the hair stylist attend to careful hand hygiene and having both the customer and hair stylist wear a mask during the cut. The CDC has now released guidance to local businesses on how to reopen safely, so you should see more information about the specifics coming out soon.
Public beaches and other swimming areas are reopening -- what is safe to do there?
Outdoor spaces are much less likely to result in transmission of SARS-CoV-2 than poorly ventilated and crowded indoor spaces. Plus, it's good for the soul to get some sun on your face and breathe in fresh air. To ensure the great outdoors is safe, avoid crowds, stay at least 6 feet from strangers, and wash your hands after touching public surfaces.
If people have their own N95 mask, should they wear it?
Some N95 masks have a one-way valve. They protect the wearer from incoming viral particles, and the valve makes it easier to exhale. Unfortunately, the valve also allows the wearer to exhale the virus, thus potentially defeating one major purpose of wearing a mask in public. Also, N95 masks are still in short supply even for clinicians who need them for high risk work. That means it makes sense for the general public to wear a double-layer cloth mask or a surgical mask.
Is a vaccine close to being available to the public?
There are around a hundred vaccine candidates being studied right now all around the world. This spring we will hear that many of them will elicit immune responses and as a result will progress to bigger trials. That's progress, but I wouldn't get too excited too soon. We need to give the scientists time to get the science right, which will take months and months. The earliest I can imagine scientists will be able to show that a vaccine is safe and protect people from COVID-19 is fall 2021 – and even that would require incredible luck. Speaking of predicting the future, you should be skeptical of anyone who thinks they can, including me. We are all learning as we go, so certainty is probably the only wrong way to feel.