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What you need to know about COVID-19: August 13, 2020
Indoors in a public space? Wear a mask
Whether or not we think about it all the time, we live our lives through probabilities, not certainties. COVID-19 has sharpened our awareness of risk, but the truth is that we have never been one hundred per cent safe. With summer upon us and social distancing rules relaxed, how do we balance the risk of activity with the need to live our lives?
Susan Kirkland, head of Dalhousie University’s Department of Community Health and Epidemiology, stresses that we can’t forget how hard we’ve worked to lower the number of cases, and how quickly the virus can rebound if vigilance wanes.
“The early lockdown was because what we know about SARS-CoV-2 is that the reproduction rate of infection is quite high. Untethered…one person infects two or three people,” says Kirkland.
“And if one person infects two or three people and then those people infect two or three people, you can see that very quickly we’re going to be in a very serious situation. The lockdown really halted that.”
The lockdown was never about keeping everybody safe forever, she says.
“The reality is that if everybody stays home and nobody leaves home then there’s no opportunity for the disease to spread. The reality of it is that we can’t go on like that indefinitely, but what we did is we blunted the effect of it and were able to flatten the curve,” says Kirkland.
“The ironic thing about public health strategies is that when they work, it looks like we overreacted. It looks like it wasn’t necessary. But you have to think about what the counterfactual is, and what if we hadn’t done that?”
What are the risks, then, as we begin eyeing summer activities?
“It all comes back to all of the basics that we know we should do. Every single time. You have to just look at (summer activities) with that in mind. So, the first line of defense is, wash your hands,” she says.
If soap and water isn’t available, break out the alcohol-based hand sanitizer.
“We just go through the list of all the things that we know that will mitigate risk in any circumstance and then make sure that we do it,” she says.
This might be frustrating for people looking for hard numbers, percentage estimates of risk, as they consider whether to attend a barbecue or swim in a pool. But if this virus has shown us anything, it’s that there is a wide gulf between what we want and what is.
That being said, Kirkland suggests thinking critically and understanding you can mitigate the risk of contracting the virus even if you can’t wholly eliminate it.
“We’re lucky that we’re coming into the summer. Being outdoors is a lot better than being indoors and the risk is a lot less with being outdoors. We just have to practice harm reduction and be smart about the things that we do,” she says. “
Here are some of Kirkland’s thoughts on how to weigh the risks of some popular activities.
A lot of conversation about pools has focused on how well the virus tolerates water. Kirkland advises thinking holistically about what’s involved getting into a pool.
“In a pool, there’s not too much evidence that you're going to transmit the virus in water. But if you think about getting into a pool, you hold onto the railing. And everybody will be holding onto the railing,” she cautions.
“So that railing needs to be cleaned all the time. When you're outside of the pool, you still have to maintain social distancing. Even when you're in the pool, you have to maintain social distancing. It’s just doing what you can in whatever situation you're in to decrease the risk.”
Now that more people can gather together, that family barbecue looks like more of a possibility. Again, less risk does not mean no risk. Social distancing isn’t required in all provinces, but it is still a valuable mitigating factor in group settings.
“If you're having a barbecue, you have the barbecue outside. There doesn’t seem to be too much risk associated with transmitting the virus through food. But, you think about utensils. Maybe you decide, ‘OK, everybody brings their own utensils.’ Or maybe you say ‘We’re going to use plastic utensils and everybody just throws them straight in the garbage.’ You just, again, try and mitigate the risks,” says Kirkland. “All the while doing things like handwashing and practicing social distancing.”
Distance is safety, and the larger the space, the greater the possible distance.
“To me, the thing that carries the least risk, I would say, is hiking outside,” Kirkland says. “Assuming that you're not on a hiking trail that has a lot of people. I really think that doing whatever we can to be outside is probably the best strategy.”
Public outside areas
“We’re really fortunate in Nova Scotia, in that we don’t have a high-density population, so there are areas that we can get out easily to and not feel like it’s really hard to practice social distancing. I can’t imagine what it’s like being in New York City and just having to walk down the street and going in elevators with people,” says Kirkland.
Any sporting activity that involves body contact or proximity, or involves touching a shared object of play, is going to be riskier than a solo sport.
“Things like basketball and soccer and all of those kinds of things, where you are running around. You're yelling, you're sweating. You're in physical contact, and I think those are the more difficult things to really come to grips with. And I'm not sure there is a safe way of doing it,” says Kirkland of team sports.
This is as opposed to a game of catch or tennis, where you remain distant but share an object of play.
“It’s like a light switch. Everybody’s touching the same thing, but as long as you don’t touch your face and as long as you are sanitizing, as you say, before and after, then chances are the risk is relatively low. If you're doing some kind of contact sport, like football, where you're tackling somebody, not so much.”
Festivals and concerts
Summer conjures images of seas of people in front of outdoor stages, but this is a tableau that Kirkland isn’t eager to see in 2020.
“In the summertime, we have almost a festival a week. There’s lots of stuff going on, but it’s really hard in those kinds of circumstances to maintain physical distance. I think about all of the free musical programs and people stand very closely and listen. It seems such a shame to not have those things, but I really think that the biggest risks are when we’re in groups,” she says.
Besides physical proximity, a second risk factor is how loud you have to be just to be heard in a crowd.
“Granted, outside is better than inside, but I don’t think that there’s no risk at all. Even raising your voice and talking loudly is more likely to transmit the virus than speaking in a lower voice.”
“I do think that the air is generally well-filtered in airplanes. But we all know that it’s like being in a cattle car these days, flying in an airplane. You are so close to the next person. And the server is leaning across you to provide you with drinks and food and things like that,” says Kirkland. “Again, I think you just do everything to decrease the risk. You wear a mask, you sanitize your entire seat. You do all those things. Do I think flying’s a high-risk activity? Yeah, I do.”
As with the pool, the risk in flying is less dependent on the environment on the craft itself than it is on the environment getting onto the plane.
“I can’t imagine standing six feet apart in a lineup to get onto the plane and have everybody not run into somebody else. Airports are congregate spaces.”
Brave new world
With fewer new cases across the East Coast, it’s natural to want to believe that the risk is zero. It’s important to remember that the testing numbers are not a perfect match to what’s actually out there.
“I think we’re probably missing a few (cases), but I think that if it was more wide-spread, we’d see it in terms of hospital admissions,” says Kirkland. “I can’t give you the actual risk level, but I think that, particularly now, particularly because essentially we have the first wave under control, there’s not a lot of community infection that we know about right now. But I think we need to still be testing and I do believe that we will have a second wave.”
Summer activities are going to carry an extra layer of risk until a treatment or vaccine is found.
“I think we just have to understand that there are risks, and keep in mind the things that we can do to minimize them. Social distancing is a key one, even if you're outside. If you're social distancing and you're outside, I think that it’s probably OK to not wear a mask. But I really believe that if you're indoors in a public space, you should wear a mask.”
Given that every trip outside carries some risk of infection, Kirkland advises prioritizing the things you really want or need to do outside your home.
“If you decrease the number of interactions that you have, you decrease the risk. It doesn’t mean that you have to have zero interactions. But you just have to understand that the more interactions you have, the greater the risk becomes,” she says.
“I don’t think it comes down to not doing anything. I don’t think you have to stay home. But we do a lot of things that we don’t really need to do. I think we just have to be really mindful.”
And if you’re under the weather, it’s not the time to try to be a hero and fight through it to go to any event.
“I think it’s absolutely critical though that if you're sick, you stay home. If you're sick in any way,” Kirkland says. “We know that there’s a lot of mild infections. We know that there’s a huge range of symptoms. It’s not worth taking the risk.”