So, What Can We Do Now?
Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here.
Staying at home for months is an onerous thing to ask of people, but what it means is easy enough to understand: Unless necessary to keep your job or keep yourself alive, you just don’t leave. When American mayors and governors began asking people to shelter in place to combat the coronavirus pandemic, the United States, a country generally stewing in deep political acrimony, was unusually united in doing what was asked.
Stay-at-home orders were implemented for many reasons: to stop the virus from silently spreading between people, to prevent the collapse of hospital systems, to allow public-health officials to build up testing capacity, to hire contact tracers to snuff out hot spots before they became full-fledged outbreaks. But at the most basic level, shutdowns bought some time for scientists faced with a novel pathogen to figure out what the hell was going on in the first place. How does the virus spread? What determines how sick someone gets?
Full answers to those questions are still being determined, but preliminary research on outbreaks across the globe has provided some important clues about which behaviors and activities matter most for coronavirus transmission. Taken together, they create a rough sketch of risk and reward that can help people shake off mounting quarantine fatigue. These little bits of scientific relief have arrived just in time: Summer is here, and more states are starting to reopen, forcing people to figure out their own methods of risk assessment in their daily lives.
Public-health experts now have to determine how to deliver the message of moderation in real time, and hope that phrases like spectrum of risk or contact budget will resonate. No matter what term ends up lodged in people’s brains alongside social distancing and flatten the curve, the reality is the same: Thinking about safety as binary isn’t going to cut it anymore. The key to responsibly reopening your life is understanding what makes you and those around you more or less safe at any given moment.
All of the experts I spoke with emphasized that, overall, continuing to stay home as much as possible is still the safest thing anyone can do. “The appropriate precautions haven’t changed, in my view, until we have more data,” Stephen Morse, an epidemiologist at Columbia University’s Mailman School of Public Health, wrote in an email. But they all also acknowledged that many people have grown predictably weary of isolation, and that reopened businesses, like the now-infamous poolside bar at Lake of the Ozarks, will be attractive diversions for some this summer. Extreme isolation isn’t sustainable, and it has to be replaced with something.
“Some people are in a near-panic still, whereas others are completely blasé about it, and we need to find sort of a middle ground,” Tara Kirk Sell, a professor and risk-communication researcher at the Johns Hopkins Center for Health Security, told me. “That’s a complicated dance, but it’s also going to be what everyone needs to do going forward.” First and foremost, she told me, people should be taking basic precautions to protect those around them: wearing masks in public, respecting other people’s space, and understanding that the people you encounter might be in far more danger from catching the disease than you or your immediate family.
Once those precautions are in place, you can start to evaluate different types of errands or leisure. Of the handful of things to consider when deciding how safe a situation might be, Kirk Sell said ventilation is the first one to think about. “If I’m outdoors, my level of concern really goes way down,” Kirk Sell told me. “It’s not the beach that’s a problem; it’s if people then decide to pack bars and restaurants when coming off the beach.” Stick to the surf and sand; skip the boardwalk.
Similar outdoor activities—hiking, camping, jogging, reading a book on a blanket in the park—are all relatively innocuous for most people. Inside, walls and HVAC systems contain and recirculate air that may be full of contagious microbes. Outside, droplets disperse quickly in the open air, so you’re far less likely to unwittingly stick your face in a cloud of viral droplets and keep it there long enough to let a bunch of them inside your body.
Globally, documented cases of outdoor transmission are exceedingly rare so far; the one most frequently cited involved two friends who had a lengthy, close interaction. In countries that have done widespread contact tracing, outbreaks have been squelched without information on the strangers that pass on the sidewalk or sneeze on one another at the park, which suggests those interactions probably aren’t major drivers of coronavirus contagion. Meanwhile, documentation of indoor transmission is widespread: at choir practices, exercise classes, religious services, birthday parties, and funerals, and in nursing homes, conventions, offices, restaurants, nightclubs, meatpacking plants, and prisons.
Those indoor activities and spaces have been the sites of what researchers call “super-spreading events,” in which a single infected person—who might be asymptomatic or very mildly sick—can pass on the coronavirus to a large group of unsuspecting people, who then go out into the world with their new dangerous germs. In addition to taking place somewhere with a lack of ventilation, super-spreading events often have three more characteristics that Kirk Sell said each make any activity or interaction more risky: large groups of people, close proximity, and interactions that last for an extended period of time. Taken together, these conditions create what’s currently believed to be a worst-case scenario for coronavirus transmission. A growing body of evidence suggests that super-spreader events are responsible for a disproportionately large number of infections. If you live in a state that now allows people to go out to bars, return to work in open-plan offices, or attend religious services, even in reduced numbers, the best and simplest thing you can do is to protect your health is to avoid those situations like, well, the plague.
The confluence of these conditions matters because catching the coronavirus requires more than simply encountering a single viral particle. The number of viral particles present when someone is exposed to the coronavirus seems to matter a great deal in not only whether a person becomes sick with COVID-19, but in how sick they become. Changing any of the characteristics that makes these interactions so dangerous—improving ventilation, decreasing the number of people present, shortening interactions, or giving people more space to spread out—helps reduce risk. Changing more than one is even better.
Doing yoga with a friend in the park isn’t totally risk-free, but it’s much less risky than taking an hour-long spin class in a closed studio with a bunch of strangers. The same goes for having a beer with a couple of friends in your backyard rather than going to a bar on a Saturday night. A short outdoor wedding ceremony with a handful of healthy, well-distanced guests? Not recommended, but not nearly as big of a problem as an indoor wedding and reception with a couple hundred people. All of these things are more dangerous than just staying at home and minding your business, but they’re not all the same. Understanding how they compare can help people focus on controlling the risk factors that matter most and provide a bit of relief from the exhaustion of endless pandemic perfection.
How much risk you assume should also depend on how extensive the coronavirus outbreak is in your town, who you are, and whom you might encounter when you go out. “If you are someone who falls into a high-risk group based on age or comorbidities, I would be more cautious in decision making,” Rachael Piltch-Loeb, a research scientist at New York University’s College of Global Public Health, told me. “Similarly, are you someone who lives with or provides for those that may be at higher risk? If so, I would also be more cautious.”
Even with these basic guidelines in place, Kirk Sell told me that some situations are difficult to assess. In particular, “the verdict is still out on what’s happening for transmission in schools,” she said. Should many schools reopen in the fall, some parents could nevertheless resist sending their kids in over fears they could bring home the coronavirus. Although the disease is far less deadly for children, some kids have died in the U.S. and hundreds more have come down with a mysterious inflammatory condition believed to be a complication of COVID-19. In general, it’s still not clear whether children are less likely to catch the coronavirus than adults, less likely to exhibit symptoms, or both. Visits to grandma aren’t safe just yet.
Ideally, all of this advice would come early and often from public-health authorities at the Centers for Disease Control and Prevention or the National Institutes of Health. It would be reiterated regularly in press briefings and interviews by health-department officials at the state and local levels. Politicians would abdicate their starring roles in the spotlight and become members of the supporting cast. Almost none of this has gone according to plan.
Instead, many Americans have begun to calcify at the extremes, believing that staying home 24 hours a day for months on end is the only morally defensible thing to do, or that refusing to wear a mask in a grocery store is an essential expression of personal freedom. For those people, a new recommendation for moderate precautions based on new data might look like an intolerable win for their opponents. To avoid that, leaders need to “set the expectation that things will change, we’re going to learn more, and that guidelines are going to change,” Tom Hipper, a risk-communications professor at the Drexel University School of Public Health, told me. “A level of honesty and openness about the unknowns of where we are now is really important.” Changing rules don’t necessarily mean that the government or scientists were lying to you before. Far more likely is that the rules have shifted to reflect what’s been learned about a rapidly evolving crisis.
It might seem counterintuitive that moderation can make people safer in a situation that, by its very nature, requires an extreme response. But when faced with a long-haul crisis like a pandemic, figuring out exactly what works to keep people healthy shouldn’t be thought of as moderation—it’s progress. A person only has so much energy and focus to put into pandemic fastidiousness, and better guidelines on how they should use it make safety more efficient and people’s mid-crisis lives more livable. “People are going to start making steps toward doing some more things,” Kirk Sell told me. “We can’t forever be in our houses.”