Unwavering public health recommendations to stay home and avoid close contact with others to the greatest extent possible have caused Americans (and people the world over, of course) to lose precious opportunities to connect with friends, family, support networks, and loved ones. Indeed, of all of the myriad ways that COVID-19 has altered our lives, social distancing— an affront to the human instincts to touch, gather, and interact — is among the most excruciating to bear. It is no wonder that, after several months of staying at home, people are searching for loopholes that will allow them to reunite with loved ones and return to some degree of normalcy. This begs the question: how do we responsibly and wisely weigh the expected mental health benefits of reduced isolation with the risk of catching or spreading a deadly infectious disease?
For the record, my heartfelt recommendation, in alignment with the CDC and virtually all public health agencies and officials, is that older adults stay home to the greatest extent possible, leaving only for necessary errands and medical care and avoiding non-essential travel and socialization. COVID-19 is a horrible disease: those with mild illness can experience symptoms as uncomfortable as a particularly rough flu; moderate illness involves pain and shortness of breath and typically requires hospitalization for oxygenation support; severe COVID-19 disease requires intensive care, and often mechanical ventilation, with dire ramifications ranging from lasting physical impairments and psychological trauma to death; and those who are fortunate enough to experience asymptomatic or very mildly symptomatic cases can readily and unwittingly transmit the disease to others who may not fare so well. If you are wondering if there is any safe way to visit family or friends while COVID-19 continues to spread rampantly across the globe, the regrettable answer, for all intents and purposes is, “no, there is not.”
That being said, I know that many Deerfield residents are willing to accept some degree of risk in order to experience social connection, especially the pleasure of visiting with a loved one. Instead of ignoring this fact, I’m excited to educate residents on the harm reduction approach to social distancing. While entirely safe activities, outings, or visits are virtually impossible these days, understanding differential risk and the transmission patterns of COVID-19 can empower you to make safer choices. Below are questions that you should ask yourself when you’re thinking of venturing out or socializing as well as clarification and rationale explaining why these considerations are so crucial:
Do you consistently practice everyday preventive actions?
In the last 14 days, how diligent have you been in monitoring yourself for symptoms, avoiding touching your face with unwashed hands, cleaning your hands frequently, social distancing, disinfecting surfaces, wearing cloth face coverings in public, and staying at home if you are sick or under quarantine advisory? Any of us, at any given moment, may unknowingly be a contagious carrier of COVID-19. In order to be conscientious citizens, when considering the risk inherent to activities outside of the home, we have a moral obligation to acknowledge the risk that we may pose to others as well as to assess the risk that we may personally incur.
How many people do you expect to interact with?
The more people you encounter, the likelier that at least one of those people are infected with the virus, thereby increasing your risk for exposure to COVID-19. Large gatherings, like weddings, funerals, and graduations, are particularly risky.
How much do you trust the people that you expect to interact with?
Do you trust that the person/people you will interact with has/have consistently adhered to COVID-19 prevention measures?
If the person/people you plan to interact with are trusted friends or family, have you talked with them about their relative risk?
If you’ll be spending time with people you know, it is important to have open conversations about COVID-19 prevention in advance of your meeting. Do they acknowledge that they consistently wear a mask in public and practice appropriate social distancing? Have they experienced any recent worrisome or risky encounters, such as attendance at large gatherings? Do they or anyone that they’ve been in close contact with have any symptoms? Are they an essential employee with potential occupation exposure risk? Are they at high risk for severe COVID-19 syndromes should they contract the virus?
Will you be able to maintain a distance of at least 6 feet between yourself and others?
The closer you are to a person who may be infected with COVID-19, the greater your risk for contracting the virus. Exercise vigilance in maintaining a minimum of 6 feet of distance between yourself and others. When spacing chairs for a gathering, use a tape measure! It’s surprising how inaccurate humans are when estimating measurements.
Will masks be worn by everyone involved?
Each day, evidence mounts to support the efficacy of cloth face masks in preventing the transmission of COVID-19. Cloth face masks offer some degree of protection to the wearer, but are at their best when acting as a barrier to prevent a COVID-19-positve person’s respiratory droplets from infecting others.
Will you be able to minimize the amount of time you spend with others?
The longer the amount of time you spend with a person who may be infected with COVID-19, the greater your risk of contracting the virus.
Will you be indoors or outdoors?
Outdoor spaces are often larger than indoor spaces, making it easier for people to stay six feet apart, or more. Furthermore, outdoor spaces involve sunlight, humidity, and wind, all of which work to disperse and disrupt the virus, thereby reducing relative exposure risk.
Can you avoid sharing objects (tools, equipment, or utensils, for example) with other people and touching surfaces that others are likely to have touched?
Choose places where there is limited sharing of items and where any items that are shared are thoroughly cleaned and disinfected between uses. If you anticipate that sharing objects (or touching high-touch surfaces like elevator buttons, door handles, stairway railings, etc) will be unavoidable, make a plan in advance to keep your hands clean. Use a tissue or towel to touch potentially contaminated surfaces. Ensure that a sink with soap and water will be present, bring hand sanitizer with you.
Can you avoid public transportation?
Public transportation generally involves large numbers of people and reduced opportunities for appropriate social distancing and should be avoided when possible.
Can you drive separately?
Whenever possible, drive yourself in your personal vehicle. If you must share a vehicle with a person who does not live in your household, ensure that everyone in the vehicle wears a mask/face covering, create as much space between passengers as possible, and roll down the windows to increase ventilation.
Can you ensure that the person/people with whom you plan to interact are negative for COVID-19?
You can never be certain that an individual does not have COVID-19. People who are infected with COVID-19 are contagious before showing symptoms, and many never feel sick at all. COVID-19 tests can have up to a 30% false negativity rate. And if a negative test result is accurate (which is always uncertain), it is only a snapshot of a person’s status at the moment in time that the specimen was collected. Lastly, plenty of people (trust me, it’s extremely common) contract COVID-19 despite being extremely cautious, are shocked to learn of their test results, and have absolutely no idea where or when they became infected.
What is the degree of COVID-19 spread in your community (or the community you’ll be visiting)?
COVID-19 is not spreading identically in all parts of the U.S. In order to make an informed decision about risk, you need to understand the specific situation in your area or the area you plan to visit. An individual’s degree of risk for COVID-19 exposure increases as incidence and the rate of community spread rise. Be aware that reopening plans consider priorities aside from the public health and that reopening does not equate safety. To learn about current trending in Buncombe County or North Carolina, visit the COVID-19 dashboards at: www.buncombecounty.org and www.ncdhhs.gov
What is required by current local and/or state order?
As we’ve experienced, government may impose restrictions on citizens’ movement and/or activities in order to mitigate the spread of an infectious disease. The degree of restriction may wax and wane throughout the course of a pandemic, and government orders are subject to frequent change, potentially with little notice. To keep abreast of current local and/or state orders, visit these websites: www.buncombecounty.org and www.ncdhhs.gov
What is your personal risk for severe COVID-19 illness?
If you are an older adult, you are not any more likely than a younger person to contract COVID-19. However, you are at a significantly higher risk for suffering a severe syndrome of COVID-19 (requiring intensive care and possibly leading to death) if you do contract the disease. If you happen to have certain underlying medical conditions, your risk is further compounded.
Consider the person you live with. What is that person’s risk for severe COVID-19 illness?
COVID-19 spreads readily within households because of unmitigated close contact and because the disease is readily transmitted in the absence of overt symptoms.
Clearly, there is a lot to consider and the challenge of risk assessment is compounded by the novelty of this virus and the ever-evolving scientific and medical understanding of its features and transmissibility.
In the context of rather dramatically increased incidence of COVID-19 in the state of North Carolina, it is incumbent upon us all to exercise great caution. Venture out if you so choose, but only with your guard firmly up and with careful plans in place to ensure your ability to avoid crowds, maintain a minimum of 6 feet between yourself and others, wear a mask properly, keep your hands clean and, ideally, remain outdoors.
Taryn Tindall, RN, on behalf of the Deerfield Leadership Team