Understand how we got here — and how to move forward.


May 29, 2020

Weekly line: As America moves toward a 'new normal,' how do you assess your Covid-19 risks?

Daily Briefing

    America's new coronavirus epidemic is still growing. This week, the number of reported U.S. cases of Covid-19, the disease caused by the virus, surpassed 1.7 million, and the country's number of reported deaths linked to the virus topped 101,000.

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    But although the country's numbers of Covid-19 cases and related deaths continue to increase, in some areas of the United States, those numbers are growing at a slower rate. And while health experts say we're not likely to see transmission of the new coronavirus significantly decline or cease anytime soon, many states are forging ahead with plans to reopen nonessential businesses, ease social distancing measures, and get back to "normal."

    As a result, many Americans are unsure of how they're supposed to move forward. On one hand, some experts say Americans should continue practicing social distancing until a vaccine against the new coronavirus or an effective treatment for Covid-19 is available.

    On the other hand, states are lifting stay-at-home orders, restaurants and other entertainment venues are reopening, and many Americans are getting called back to work—leading people to question whether it's okay to once again see family and friends, travel, and partake in other activities that were deemed too dangerous over the past few months.

    Many of the Daily Briefing's readers work as frontline clinical providers or in other health care settings that inherently raise their risk of exposure to the new coronavirus. If that describes you, then clearly you face a dramatically different risk calculus than most Americans, and should of course follow the recommendations of public health authorities and your own organization for managing that risk.

    But what about those of us who work outside of patient care settings, or are still working from home, and are largely isolated from contact with Covid-19 patients? How can we determine what counts as an "acceptable" level of risk for ourselves and those around us as our states and cities reopen?

    A new focus on harm reduction

    The Atlantic's Amanda Mull writes that one thing stay-at-home orders achieved was buying "some time for scientists faced with a novel pathogen" to learn about the new coronavirus, such as how the virus spreads. And while there's still a lot scientists don't know about the new coronavirus, research to date offers a better picture of which behaviors and activities pose the greatest transmission risk, according to Mull.

    For instance, various studies from around the globe suggest that the main way people contract the new coronavirus is from respiratory droplets that are launched into the air when people breathe, talk, or sneeze—and the risk of transmission is particularly great indoors.

    "When you look at public transport, workspaces, restaurants—places where we're just trying to fit many people in a small confined space—respiratory viruses like those spaces," Muge Cevik, a physician and expert in virology at the University of St. Andrews, told Vox's Brian Resnick. That is why many public health officials are encouraging people to wear face masks and maintain at least six feet of distance from one another.

    But even with that knowledge, inconsistent guidelines can make it difficult for people to discern how to best protect themselves against the new coronavirus. That's where the risk vs. reward system can come in handy, Julia Marcus, an infectious disease epidemiologist at Harvard University, told Vox's German Lopez.

    "There's been a polarization between two purported options of staying home indefinitely … versus going back to business as usual," she said. But "[t]he idea of harm reduction gives us a way of thinking about risk as a continuum and thinking about the middle ground between those two options," Marcus explained.

    Below, I break down some key factors experts say people should consider when evaluating risks and deciding whether to partake in certain activities.

    4 considerations when evaluating risk amid Covid-19

    1. Consider the level of risk certain activities—and locations—may pose

    Tara Kirk Sell, a professor and risk-communication researcher at the Johns Hopkins Center for Health Security, told Mull that ventilation should be among the first things people consider when evaluating an activity. "If I'm outdoors, my level of concern really goes way down," Kirk Sell said.

    Mull notes that, so far, there are very few documented cases of the new coronavirus being transmitted outdoors. She explains that, "[o]utside, droplets disperse quickly in the open air, so you're far less likely to unwittingly stick your face in a cloud of viral droplets and keep it there long enough to let a bunch of them inside your body."

    In comparison, Mull notes there there's been "widespread" documentation of the new coronavirus being transmitted in close quarters, including reports of transmission at birthday parties, choir practices, conventions, exercise classes, religious services, restaurants, nightclubs, and more. She explains that, when indoors, "walls and HVAC systems contain and recirculate air that may be full of contagious microbes," and the virus could be transmitted from individuals who are infected but aren't showing any symptoms of Covid-19 or have only mild symptoms of the disease.

    In addition, Kirk Sell told Mull that people should avoid so-called "super-spreading events," such as activities with large groups of people, activities where people are in close proximity to one another, and activities where people interact with one another for extended periods of time—even if those activities occur outside. Mull writes, "If you live in a state that now allows people to go out to bars, return to work in open-plan offices, or attend religious services, even in reduced numbers, the best and simplest thing you can do … to protect your health is to avoid those situations."

    Overall, Mark McClellan, who formerly lead both CMS and FDA, told Lopez, "It's a good year for outdoor dining and outdoor shopping and outdoor all kinds of activities."

    2. Consider the risk of transmission—even in a 'closed circle' of friends and family

    As people consider seeing family members or friends who don't live with them, it's important to keep in mind whether those individuals may have had extensive contact with others. One option that could minimize the risk of transmission is creating a "closed circle" of friends and extended family, according to Lopez. "If you want to meet with certain friends or family," he writes, "consider a pact with them in which you'll both agree to minimize or eliminate contact with anyone else, to reduce overall exposure for everyone involved." 

    However, Vox's Sigal Samuel explains that creating a "closed circle" of friends and extended family doesn't completely reduce your risk of transmitting the new coronavirus to one another, especially if some members of the circle don't stick to the agreement of eliminating or limiting their contact with people outside of the circle. As such, Samuel notes, some health experts oppose the idea.

    3. Consider the caseload in your local area

    People also should consider the severity of Covid-19 outbreaks in their areas, Chunhuei Chi, director of the Center for Global Health at Oregon State University, told the Los Angeles Times' Deborah Netburn. 

    Chi explained that the risk of seeing others or venturing out into the community depends on how likely it is that you, a family member, or a friend in your closed circle could be exposed to someone who is infected with the new coronavirus.

    4. Consider your personal risk factors

    People also must consider their own personal risk factors, such as whether they have any underlying health problems that increase their risk of developing a severe case of Covid-19 and whether they live with any such individuals. Rachael Piltch-Loeb, a research scientist at New York University's College of Global Public Health, told Mull, "If you are someone who falls into a high-risk group based on age or comorbidities, I would be more cautious in decision making. Similarly, are you someone who lives with or provides for those that may be at higher risk? If so, I would also be more cautious." 

    3 keys for going out in public amid Covid-19

    Regardless of which activities you take part in, many public health experts agree there are two key things everyone should do when venturing out in public. 

    1. Take safety precautions—even if they're not mandatory

    First, Kirk Sell told Mull it's key that people recognize the continued need to take certain basic precautions to protect themselves and those around them. Those measures include frequent hand washing, wearing masks while in public, and keeping physical distance from others—even if these measures are optional at the places you're visiting. 

    2. Re-evaluate risks as situations, data change

    It's also important to re-evaluate risks as outbreaks in your area peak and wane, and as new data about the new coronavirus becomes available. 

    There's still a lot we don't know about the new coronavirus, and recommendations on how to protect ourselves from the pathogen will change as researchers learn more about how the virus transmits and how Covid-19 develops. Likewise, those recommendations also could change based on the status of potential treatments for Covid-19 and vaccines against the new coronavirus.

    As Tom Hipper, a risk-communications professor at the Drexel University School of Public Health, told Mull, "[W]e're going to learn more, and … guidelines are going to change."

    3. Keep in mind: Low risk doesn't mean no risk

    Lastly, it's important to remember that, based on what we know about the new coronavirus now, determining that an activity poses a low risk of contracting the virus doesn't mean it carries no risk at all. 

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