How to Navigate Your Community Reopening? Remember the Four C’s

By | June 9, 2020
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When the country was largely under lockdown, at least the rules were mostly clear. Essential workers ventured out; everyone else sheltered in. Bars and restaurants were closed except for dining out; hair salons and spas were shuttered. Outings were limited to the supermarket or the drugstore.

Now states are lifting restrictions, but detailed guidance about navigating the minutiae of everyday life is still hard to come by — and anyway, there’s never going to be a ready solution to every problematic circumstance you may encounter.

“Ramping down was easy by comparison, even though it felt hard at the time — we basically flipped a switch,” said Dr. Preeti Malani, an infectious disease expert who is chief health officer for the University of Michigan.

“Reopening is much more complicated. There is no template, no playbook. We can’t just say, ‘Follow these 10 rules, and you’re good.’”

Even in the absence of detailed directives, however, there’s scientific consensus about a general approach that can reduce the spread of the virus as the world around you reopens. As you tiptoe toward normalization — whatever that is, given these times — try to follow three precautions: avoid contact, confinement and crowds. And make realistic choices.

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Credit…Jim Watson/Agence France-Presse — Getty Images

You need to continue with social distancing precautions. That means wearing masks, washing hands well and often, and keeping a distance of at least six feet from one another. No hugs, at least not in the usual way. No handshakes.

Try to make sure that public spaces you frequent are maintaining mitigation measures: spreading out tables at a restaurant, limiting or spacing out patrons in shops and parks, and conducting frequent cleaning and disinfection.

The virus is spread most efficiently from person to person, but the Centers for Disease Control and Prevention nonetheless recommends frequent cleaning of high-touch objects and surfaces like tables, doorknobs, light switches, countertops, handles, phones, keyboards, toilets and faucets, touch screens, A.T.M.’s and gas pump handles.

Any 15-minute face-to-face conversation between people who are within six feet of each other constitutes close contact, said Dr. Muge Cevik, an expert on infectious diseases and virology at the University of Saint Andrews School of Medicine in Scotland.

The longer the conversation and the closer the physical proximity between the participants, the greater the risk of the virus spreading if one person is infected.

That explains why transmission is rampant within households, and why family gatherings where people embrace and spend a couple of hours together over a meal have led to outbreaks.

In one case investigated by federal health officials, an individual with mild respiratory symptoms attended a funeral in Chicago in February, setting off a chain of transmission that led to more than a dozen people getting sick and three deaths.

The individual was a family friend who embraced the mourners at the service, spent a few hours sharing a takeout dinner and a potluck meal, and went to a family birthday party.

As various relatives fell ill, household members who took care of them were also infected; birthday party guests w
ho had contracted the virus went to church, infecting congregants sitting in the next row.

Altogether, 15 people were infected. The C.D.C. has recommended limiting funerals to immediate family or holding virtual memorial services, depending on local transmission of the coronavirus.

Indoor activities in confined enclosed spaces, even large ones, are more conducive to spreading the virus than events held outside, especially if the air inside the building is being recirculated or the windows don’t open.

Many infections have been traced to public transportation vehicles like buses and vans. Some experts have raised questions about the safety of enclosed public spaces, like office buildings, indoor restaurants and nightclubs.

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“When there’s stagnant air, the droplets could persist longer than you would expect, and there will be a lot of contamination on surfaces,” Dr. Cevik said.

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A flow of fresh air dilutes the virus, she added: “When you’re next to a good air flow source or by a window, your upper respiratory tract won’t be exposed to that much virus anymore.”

Dr. Cevik referred to a study that traced a Covid-19 outbreak in China to a service at a Buddhist temple in Ningbo, in Zhejiang Province, in January.

Some 300 people were at the service, which lasted two and a half hours and included lunch. It was held outdoors, and most of the worshipers were not infected. And of the 30 people who were infected, most had traveled on the bus to the temple and back with the first person who became ill, about an hour’s drive each way.

On that bus, no one sitting by an open window got sick, with the sole exception of an individual who sat directly next to the infected woman.

In recent guidance to businesses that are reopening, the C.D.C. told employers they must make sure ventilation systems are working properly and take steps to maximize the circulation of outdoor air by opening windows and doors and using fans.

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Credit…Jim Wilson/The New York Times

Large groups are risky, no matter where they are gathered. Even outdoors, crowds mean more people, more contacts — and more potential sources of infection. And ultimately, preventing infection is a numbers game, where less is more.

“It’s a really different way of thinking that most people in the world aren’t used to,” said Dr. Barbara Taylor, an infectious disease specialist at the University of Texas Health Science Center at San Antonio. “It’s all math.”

The Coronavirus Outbreak

  • Frequently Asked Questions and Advice

    Updated June 5, 2020

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • Will protests set off a second viral wave of coronavirus?

      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

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Many bars in Texas are outside, she noted, and are therefore relatively low risk. But the number of patrons in a space still matters.

“You can create a scenario where you have everybody six feet apart, but if that scenario involves 500 people, that is inherently more risky than if that same scenario involves 30 people,” Dr. Taylor said. “There’s more potential for one of those 500 people to have Covid-19 and be spreading it,” she said.

Another concern about drinking holes: As people become inebriated, they let their guard down and lose their inhibitions.

The C.D.C. ranks dining options from lowest to highest risk situations. The lowest risk is a drive-through, delivery, takeout or curbside pick up of food. Restaurants with the highest risk have indoor and outdoor seating with no additional spacing between tables.

Every individual ultimately must make a personal decision about the level of risk he or she is comfortable with, weighing their own age and health status, life circumstances and general level of risk aversion or tolerance.

People at high risk for developing severe disease if they become infected with the coronavirus will want to take the greatest of precautions. That group includes those 65 and over; residents of nursing homes and long-term care facilities; and people with compromised immune systems, chronic lung or kidney disease or heart conditions or who are severely obese.

But young, healthy adults and children should also consider the protection of people around them, including family members, colleagues or friends who are vulnerable because of chronic disease or other life circumstances, Dr. Taylor said.

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Her tolerance for risk is very low, she said. Though Dr. Taylor has no health problems, she is a physician who treats vulnerable and immunocompromised patients, and also sees her parents regularly.

“We are our brothers’ keepers,” she said. “Although I’m not in a risk group, I’m regularly in contact with people who are, so it comes down to not just thinking about ourselves, but our whole communities, and how we all have to protect one another.”

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