Americans are fed up with staying indoors. Support for social distancing requirements is down in polls, and survey and cell phone data show that people are starting to leave their homes. Most states, ready or not, are about to reopen part of their economy.
In the past two months, the advice of the experts has been absolute: if possible, stay at home and avoid interacting with those with whom you do not live. In the new reality, with a vaccine likely still in months or years, some experts warn that a new approach is needed to keep people safe during the coronavirus pandemic – a risk reduction approach.
It might be better for people to stay at home all the time, but since many can’t or won’t, giving them advice on how to reduce harm for themselves and others is worth it. better than emphasizing the ideal.
Julia Marcus, infectious disease epidemiologist at Harvard, compared choosing to preach abstinence versus advice on safe sex during the worst days of the HIV / AIDS epidemic: completely avoiding sex would keep someone safe from HIV, but since most people will not do it For this, it is better to give them the tools to practice sex in the safest possible way.
“There has been a polarization between two supposed options of staying at home indefinitely … versus returning to business as usual,” Marcus told me. “The idea of harm reduction gives us a way of thinking about risk as a continuum and thinking about the balance between these two options.”
The safest thing you can do in the midst of the Covid-19 epidemic is still the same as a few months ago: Stay home as much as possible to avoid catching or spreading the virus until we get an effective vaccine or treatment or until the pandemic ends. This is especially true for sick people who should do everything they can to avoid exposing others to the coronavirus.
But failures will occur. Some people were never able to stay at home in the first place; as states begin to reopen, many more will have to leave their homes to work. Others will do it simply because they are tired of being trapped at home, even if it is not recommended for their own health or for the public.
So I turned to several experts with a question: what can people do to minimize the damage to themselves and others if they decide to go out?
Some of the tips reflect the message we have heard for months: wash your hands. Don’t touch your face. Wear a mask. Avoid shared spaces and crowded environments, and keep a physical distance – at least 6 feet – from people you don’t live with. If you are 65 or older or have chronic health conditions, you should take all of these tips more seriously.
Other tips were more original. For example, if you want to do something outside your home, it’s best to take advantage of the fresh air and do it outside rather than indoors when possible. If you want to meet certain friends or family, consider a pact with them in which you will both agree to minimize or eliminate contact with someone else, in order to reduce the overall exposure of everyone involved. .
The most important thing: avoid indoor spaces that bring you within 6 feet of people outside your home for long periods of time. “It’s about density. It’s about the length of contact, “explained Cyrus Shahpar, director of Resolve to Save Lives.
Overall, experts were willing to apply harm reduction concepts to social distancing. They recognized that this was not a perfect analogy with HIV or drug use, since a person who has risky sex or uses drugs is seen as doing a lot of harm while people who catch and spread the coronavirus also put others in immediate danger. Yet experts have taken a pragmatic view of harm reduction as a whole.
“This reflects the fact that this virus will be with us until there is a vaccine,” said Amesh Adalja, senior researcher at the Johns Hopkins Center for Health Security. “People will find their own ways of living with it. It will be different for each person, depending on their own risk tolerance. He added, “It is important that people are well informed about the risks and how to minimize them. “
So here is how to get out and stay as safe as possible during this coronavirus pandemic.
1) Stay outside
Experts have always given advice to people who leave their house: if you can do something outside rather than inside, you should do it outside.
Coronavirus appears to spread through airborne droplets and droplets that land on surfaces, which people then pick up with their hands. The outdoors mitigates these spreading vectors in several ways.
First, the outdoors will make it much more difficult for airborne droplets to reach other people. Shahpar said there was an element of common sense in that: “Any smell I get from cooking in a kitchen will last longer than if I had it outside. It’s just his nature. ”
Second, it’s easier to keep distance from others outside than inside.
Third, there is evidence that sunny, hot, humid weather hurts the coronavirus a bit. Initial research to date suggests that heat and UV light appear to kill the virus, while humidity can prevent airborne droplets from blowing from person to person. It is not enough time to stop the coronavirus – as the main epidemics of Covid-19 in sunny and warm Ecuador, Louisiana and Singapore demonstrate – but it at least seems to help.
Research on coronaviruses and the outdoors, although still very early, confirms this, Kelsey Piper explained for Vox:
A study from China (which has not yet been peer reviewed) examined 318 epidemics with three or more people across the country. Only one occurred outside and only two people fell ill: each epidemic with at least three cases occurred inside. Another study (also not peer-reviewed) in Japan found that “the odds of a primary case transmitting COVID-19 in a closed environment were 18.7 times higher than in an outdoor environment”.
So if you have friends, consider going outside (and keep it in a small group). If you want to eat in a restaurant, look for outdoor seating. If you are going to run, go to the park, the beach or the streets instead of the gym. Some experts said policymakers could also take advantage of the outdoors – organize outdoor trials or close certain streets to cars so pedestrians can use them better.
“This is a good year for outdoor dining and shopping and all kinds of outdoor activities,” said Mark McClellan, who previously ran the Centers for Medicare and Medicaid Services and the Food. and Drug Administration of President George W. Bush.
The only exception, of course, is your home. As long as it is only you and the people you live with there, it is safe – probably even the safest place during this pandemic if no one inside is sick.
This is not to say that the outdoors are completely safe. Being around people you don’t live with will always create risk during a pandemic. It’s a matter of weighing the pros and cons: does the relatively low risk of other people outside outweigh the benefit of spending time outside your home? Different people may come up with different answers.
But all other things being equal, the outdoors is the safest place for activities outside your home. For some, it is a reprieve which makes all the other demands of social distance a little more bearable.
In addition, spending time outside can be good for you alone.
2) Follow good hygiene practices
You’ve probably heard it a million times already, but it’s worth repeating: wash your hands frequently and don’t touch your face. If you are going to venture away from home often, this advice is particularly relevant.
“These are harm reduction aspects that have already been incorporated into the messages we have seen,” said Saskia Popescu, infectious disease epidemiologist.
Studies have shown that the virus can survive on different surfaces for hours or days at a time. If you touch these surfaces and then touch your face, you could catch the virus in your eyes, nose, or mouth – and soon, you could be infected.
Currently, there are many guides on how to avoid touching your face and washing your hands. To touch the face, the big thing is awareness. Until you break the habit, you will need to dedicate some free space to your face and avoid touching it. (I touched my face three times just by typing this paragraph, so, yes, it will take some effort.)
For hand washing, do it frequently – before, during and after you go out. Soap and water work very well; wash for 20 seconds, and don’t forget the backs of your hands, fingers, thumbs and wrists. If you don’t have access to soap and water, a hand sanitizer with at least 60% alcohol also works.
Yes, good hygiene can be tedious, and we are all tired of hearing about it over and over again. But it works. If you want to minimize the risk to yourself and others, you must do so.
3) wear a mask
After some mixed messages from federal authorities at the start of the Covid-19 epidemic, there is a broad consensus that people should wear masks when going out – a surgical or medical mask if they have one, a cloth mask if they don’t have one.
The Centers for Disease Control and Prevention recommends masks “in public places where other social distancing measures are difficult to maintain (for example, grocery stores and pharmacies), especially in areas of significant community transmission.” But other experts – and, in some cases, government mandates – go further, saying that you should wear a mask in virtually any place outside your home as long as the Covid epidemic- 19 continues.
The main reason a mask is to stop transmission from the wearer to other people, especially infected but asymptomatic people who, therefore, may not even know they are infected. If you are wearing a mask, you are less likely to spray virus-containing droplets on surfaces or on other people when you breathe, talk, sing, laugh, sigh, sniff, cough, sneeze, and everything else you could do. with your mouth and nose.
A mask also gives you some protection by creating a physical barrier to other people’s droplets in front of your mouth and nose (at least if you’re wearing it properly – make sure it covers both).
Research on masks is not great, but there is suggestive evidence: as long as people wear the masks and use them properly, studies indicate that they have some effect on reducing disease transmission in people. ‘together. Some experts speculate that the masks have played an important role in containing the epidemics of Covid-19 in several Asian countries where their use is widespread, such as South Korea and Japan.
It can still be difficult, depending on where you live, to find medical masks. But there are fabric alternatives that you can make at home. The CDC offers a comprehensive tutorial. And here is that of the American surgeon general:
There are also things you can do to help others wear masks. For example, if you are hosting a big event or even hosting a party – it is not advisable, but it will happen – offer masks to those present.
When you wear a mask, don’t move with it – it would touch your face – and avoid removing it until you get home. Throw away disposable masks once they are used and wash the reusable masks after using them.
Masks are no excuse for mitigating other hygienic practices. In fact, you want to wash your hands before and after you remove a mask – before you avoid putting anything on your face and mask, and after you get rid of everything that was on your mask.
And yes, it is normal to breathe a little more difficult while wearing a mask for a long time. But this discomfort must be weighed against the risk of getting sick or infecting others without a mask.
4) Stay away from congested settings
One of the most common pieces of advice throughout this pandemic has been to keep 6 feet or more away from people you don’t live with, summed up by the catchy slogan “The distance of 6 feet determines our existence.” The closer you are to someone, the more likely they are to spread their coronavirus all over you, and vice versa.
A revealing but preliminary study comes from a South Korean call center: the coronavirus has spread to 43.5 percent of people working in the call center on the 11th floor. Proximity seems to play a big role, as this graph shows, in which the offices marked in blue indicate an infection.
The risk here is near and prolonged contact. A jogger that you run for a few seconds is not the end of the world. But if you are within 6 feet of someone else for longer – especially for hours – it could be dangerous.
“The two variables that worry us are the distance from another person who could be sick and the time spent with them,” said Crystal Watson, a senior researcher at the Johns Hopkins Center for Health Security.
This also applies to the exterior. While the outdoors are generally safer than the indoors, it’s always a good idea to avoid crowded parks or beaches. People who do not live together should not be grouped together in any environment for long.
So if you’re going out to eat, consider skipping the crowded restaurant. If you are going to a park or a beach, look for an area without too many people around. If you are hosting an event, avoid inviting too many people. If you are meeting friends or family, try to stay at least 6 feet away and avoid handshakes, hugs and kisses.
Part of avoiding crowded spaces also makes these places safer for those who need to be there. For example, public transportation can be quite busy, but some people use it to get to work or the grocery store. If you have other transportation and use it instead, you leave more room on the bus or the metro for those who have no choice.
You don’t have to do it all perfectly; in some circumstances, this is unrealistic. But the better you can do it, the lower the risk.
5) Avoid shared surfaces
If the coronavirus spreads when people pick up droplets containing viruses on different surfaces, one way to minimize this risk is to avoid shared surfaces as much as possible.
So even if you go outside, maybe avoid the surfaces touched by different people, like swings, slides or benches – or, at the very least, wipe them down before using them. If you have to use public transportation or get inside a building that isn’t your home, try to minimize the amount of space you touch.
And if you meet people you don’t live with, avoid sharing things – food, drinks, toys, board games, etc.
This does not mean that you have to be paranoid to pick up food or have various things delivered. (As Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, said to me, “I am often asked the question,” Can I get takeout? “I think you can. ”)
But it does mean that a little caution is required, whether to avoid these surfaces or to take steps to clean them before touching them.
6) Space out as much movement as possible outside the house
Whether you leave your house because you have to eat or work, or you go out because you can’t stand the sight of your apartment anymore, one way to minimize the risk is to space out where you go.
With every company outside, you put yourself at risk of contracting Covid-19 in a world still engulfed by a pandemic. The risk calculation is therefore simple: try to limit the frequency with which you do it.
“Going to the store everyday is not a good idea,” said Kates. “You want to minimize the number of times you could expose someone [to coronavirus] or you could be exposed. ”
One way to do this is to make the most of the necessary trips. If you’re going to the store, try to buy as much as you can and wear it all at once, and plan ahead so you don’t forget anything. (Remain reasonable and conscientious towards others; taking a year of toilet paper is not necessary and could force others to make more trips when the store is exhausted and they have to go home empty-handed.)
This also applies to social gatherings. If you’ve seen friends recently, maybe go a few days or weeks before you see them or any other group of friends. Two weeks would be ideal, as they would correspond to the possible incubation period of the coronavirus.
Just like avoiding crowded spaces and keeping a physical distance, it’s not something everyone will be able to do perfectly. Sometimes we all forget things in the store and have to go back there sooner than we’d like. But the more spaced outside the home, the better.
7) Create a “closed circle” with specific friends or family
Especially if you’re single and living alone, these days can be pretty lonely. One solution that some experts have suggested is to create a “closed circle” with a friend or family member, in which two people or a group agree to spend time in person but avoid contact with others.
If you and your inner circle avoid everyone, you will reduce the chances of infecting each other and the rest of the world even if you go out regularly. And if one of you gets sick, the spread should be limited to a small circle.
As Sigal Samuel explained for Vox, this idea is not without risk and some experts oppose it. There is a risk that people will simply not follow the pact, putting the whole circle at risk of infection – perhaps even at higher risk if it creates a false sense of security and people in the circle act recklessly towards each other. But even if everyone follows the pact as best as possible, the concept expands your social network and, therefore, your risk of infection – not only from those in the circle, but from anyone in the circle who has to interact with the grocery store, pharmacy, work or any other setting.
But it’s harm reduction. The closed circle may not eliminate the damage, but it does minimize it.
Consider the alternatives. If people are going to interact with friends and family, but they do it without a closed circle, it is inherently worse than having a pact, even one that is not fully followed.
“Is there a way to make everyone 100% meet these standards?” No, “said Kates. “But it is a harm reduction approach. “
The risk that a closed circle will not work as expected should also be weighed against the significant risk of loneliness. As Samuel noted, “A meta-review of 70 studies found that loneliness increases your risk of premature death by 26%. Some experts say it’s as bad for longevity as smoking. We know it really hurts our white blood cells. We can try to alleviate this loneliness with Skype, Zoom or phone calls – but, for some people, this will not be enough.
“There are people who suffer in isolation,” said Marcus. “In order to keep this going for months, even years, we need to think about how we can connect with others so as to reduce the risk as low as possible, which makes people feel as if they lived their lives. “
It is also possible to mitigate the risk of violations in a closed circle by following the other tips in this list: even when you hang out with your closed circle, go out if possible, wear a mask, observe good hygiene and keep a physical distance each other’s other. A closed circle does not necessarily have to be a license for much riskier behavior; it can just be an extra layer of protection if you want to see other humans in person regularly.
8) If you are part of a particularly at risk group, be extremely careful
Some people are more vulnerable to the coronavirus. Certain chronic diseases, including asthma, diabetes, liver disease and obesity, appear to increase the risk of complications and death from Covid-19. Those who are older, especially those 65 and over, are also at greater risk.
It’s not fair, but it does mean that those who are most at risk should be very careful.
One-way experts have described this concept: if you belong to one of these risk groups, follow the advice in this list, but go to another level. While most people generally wash their hands seven times a day, a member of a risk group should do so 14 times. If others are to stay within 6 feet of people, those in risk groups should try within 10 feet. If the typical person minimizes trips to the store once a week, people in risk groups should try to minimize trips to once every two weeks. Etc.
The safest thing for the elderly and those with chronic illnesses, like everyone else, is to stay at home as much as possible. But like everyone, it won’t be possible for some people all day, or at least something that everyone will be ready to do for weeks or months.
“People will take risks, whether we like it or not,” said Marcus. “The best thing we can do is give them strategies to reduce the harm in these situations. If we don’t, we miss an opportunity. ”
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