In recent weeks, many local governments have relaxed restrictions related to the coronavirus (COVID-19) pandemic, rolling back stay-at-home orders and allowing businesses and restaurants to slowly reopen.
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While many are still following CDC guidelines like social distancing and wearing masks in public to fight the spread of the virus, recent headlines have put a spotlight on packed patios and crowded bars and restaurants where those precautions aren’t being heeded as closely.
It’s an understandably difficult balance to achieve: the need to remain vigilant about the virus while seeking out a feeling of normalcy. But “normalcy” is relative in the middle of a pandemic and while there is more flexibility about what we can do and where we can go, that doesn’t mean we can disregard the risks associated with COVID-19.
In fact, the death toll from COVID-19 recently surpassed 100,000 in the United States and several states have experienced a spike in new cases in recent weeks as re-openings commenced.
“It’s a really tough spot,” says pulmonary and critical care physician Joseph Khabbaza, MD.
“Even though active cases may be trending down or at a plateau, reopening is probably going to lead to at least a slight rise in cases,” he says. “But there are also significant consequences to keeping the economy shut down which include non-COVID-19-related health consequences: losing your job, your health insurance, and your ability to feed your family.”
Dr. Khabbaza shared his insight as to how we can navigate this measured reopening by remaining cautious and adapting to a new coronavirus reality.
Yes, coronavirus is still being spread
While healthcare providers and researchers are constantly learning new things about the coronavirus, one thing that has stayed consistent is how it spreads and how we can protect ourselves from spreading it to others.
“If you put three simple measures in place, you’re going to make it hard for that virus to get transmitted while you’re out,” Dr. Khabbaza points out. “Wearing a mask when you’re around other people minimizes the amount of droplets you deposit in your immediate environment if you sneeze, cough, or simply speaking.”
It’s mostly through close, sustained contacts, even just 10 to 15 minutes, that you’re most at risk, he says. “If you’re keeping your distance, you’re less likely to acquire an infection from being near somebody who is infected. And if you frequently wash your hands and you’re aware of not touching your face, it’s going to be very hard to get infected.”
But dropping your guard can still lead to infection and, worse, spreading the infection to friends and family you come in contact with.
Everyone can still be exposed
As cities and states have rolled back restrictions, many people rushed to gather in large groups and celebrate despite these ongoing concerns. But the danger remains and it’s not just about exposing yourself to the virus; there’s also the risk of taking it with you to your loved ones.
“We’ve seen a lot of cringe-worthy photos lately of crowded pools and other gatherings,” Dr. Khabbaza says, “and there’s definitely a risk there. A person could be doing everything perfectly, protecting themselves against the virus but then a part of their small social circle or family member goes into a higher risk setting like that and brings the virus home, increasing a risk of pre-symptomatically spreading it without being aware.”
That’s why it’s so important to still maintain limited close contact with a small social circle, he says, so you always know where everybody has been. “If somebody has been in a higher risk setting in your social circle, it’s probably best to take a week or two break from being close with them just to make sure no symptoms develop in that time,” he says.
Airborne droplets are the main spreader
Even though the expelled respiratory droplets that can spread the coronavirus are usually heavy enough to fall to the ground after travelling several feet, it’s still possible for the virus to be spread via an airborne route.
As an example, Dr. Khabbaza points to a well-known case from Washington state where, during a choir practice, just 1 symptomatic person was able to infect 52 out of 60 other people.
“Just the act of singing produces a lot of smaller droplets and those can float about in the air for a bit,” he explains. “If you’re singing around someone long enough who’s making these smaller droplets, it’s possible to have enough viral particles transmitted to your upper respiratory tract to cause infection.”
He likens this to being in close contact with someone in a crowded restaurant or bar, too. “There are settings when you’re up close to people and if someone is speaking loudly, that creates the potential that you’re going to be breathing those droplets in the air or them directly reaching your eyes. It’s a closer, sustained contact with somebody who’s constantly generating particles that allows the opportunity for direct transmission.”
Getting ready for a “second wave”
While new cases in the United States have plateaued and even climbed slightly in recent weeks, Dr. Khabbaza is optimistic that a bigger second wave, whether fueled by more re-openings or a seasonal wave, will be mitigated somewhat by the precautions that have been taken already and remain in place.
He admits there are too many variables to be able to accurately predict what might happen in the coming months. “I’m optimistic but it’s very hard to predict. In models, trying to predict how human behavior or large numbers of people can affect things tends to not be very accurate. There are just too many variables.”
Still, as businesses — particularly restaurants — reopen, they’re implementing new rules about the number of people allowed in at one time, cleaning and disinfecting their premises and addressing physical distance concerns. And while the risk remains, even this new way of doing business could mitigate new cases — at least as long as most people continue to follow the social distancing guidelines.
“The new normal is very far from the old one,” Dr. Khabbaza says. “Things are so different than they were before the first outbreak and the changes that a majority of places put in place could help blunt the number of cases.”
“When the virus first really hit, no one was thinking about sanitizing their hands, how many times they touched their face, about being in crowded spaces or the importance of wearing a mask,” he adds. “But if we keep these habits up, hopefully any second wave will be of a lower magnitude.”
Reason for hope
While there certainly have been instances in which people haven’t practiced what we’d consider ideal social distancing, Dr. Khabbaza is optimistic about the way most of the country has adopted the preferred guidelines.
“When you go to the grocery store, most people are wearing masks and carts are being sanitized regularly,” he says. “I think it’s a minority of people that feel it’s nothing to worry about or nothing more than the cold or flu. That does have the potential to infect others who are doing their part, but most people do seem to be taking this seriously.”