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By Allison Aubrey, Laura Wamsley and Carmel Wroth | NPR
It has been around two months of quarantine for many of us. The urge to get out and enjoy the summer is real. But what's safe? We asked a panel of infectious disease and public health experts to rate the risk of summer activities, from backyard gatherings to a day at the pool to sharing a vacation house with another household.
One big warning: Your personal risk depends on your age and health, the prevalence of the virus in your area and the precautions you take during any of these activities. Also, many areas continue to restrict the activities described here, so check your local laws.
And there's no such thing as a zero-risk outing right now. As states begin allowing businesses and public areas to reopen, decisions about what's safe will be up to individuals. It can help to think through the risks the way experts do.
"We can think of transmission risk with a simple phrase: time, space, people, place," explains Dr. William Miller, an epidemiologist at Ohio State University.
Here's his rule of thumb: The more timeyou spend and the closer in spaceyou are to any infected people, the higher your risk. Interacting with more peopleraises your risk, and indoor placesare riskier than outdoors.
Dr. Emily Landon, a hospital epidemiologist and infectious diseases specialist at University of Chicago Medicine, has her own shorthand: "Always choose outdoors over indoor, always choose masking over not masking and always choose more space for fewer people over a smaller space."
Our experts shared their thoughts via phone and email interviews.
Jump to: BACKYARD GATHERING | INDOOR DINING | RELIGIOUS SERVICE | BEACH/POOL | OUTDOOR WEDDING/CELEBRATION | PUBLIC RESTROOM | FRIEND'S RESTROOM | SHARED VACATION HOUSE | HOTEL | HAIRCUT | MALL | NIGHTCLUB | CAMPING | OUTDOOR EXCERCISE
1. A BYOB BACKYARD GATHERING WITH ONE OTHER HOUSEHOLD
Risk: Low to medium
Meeting in a spacious outdoor area with only a small group isn't too risky. But our experts say that safety here depends on whom you invite and what their behaviors have been. "If you have a gathering with one other household that [has] followed social distancing, this would be a low-risk activity," says Dr. Judith Guzman-Cottrill, a pediatric infectious disease expert at Oregon Health & Science University.
What alters risk?To lower risk, avoid sharing food, drinks or utensils — make it a BYO-everything party. Dr. Andrew Janowski, a pediatric infectious diseases expert at Washington University in St. Louis, notes that the food itself isn't the risk, but touching shared dishes or utensils could be.
Watch out for drinking, says Dr. Abraar Karan, a physician and public health researcher at Harvard Medical School, as it can make people sloppy about social distancing. It also increases the odds that people will want to use your bathroom. "Once you move into the house with others, the risk profile goes up," he says.
Some experts suggest wearing a face covering, but Landon points out that you can't realistically stay masked while eating and drinking. She suggests an alternative to a meal would be a backyard lawn tournament: That way, "the kids can play together but still with their masks on." It could be fun for the grown-ups too.
2. EATING INDOORS AT A RESTAURANT
Risk: Medium to high
Indoor dining "is still amongst the riskier things you can do," Landon warns. The trouble is, says Miller, "people tend to linger in restaurants. So even if spacing is OK, the duration of exposure is longer." Also, he says, talking"appears to lead to some release of the virus."
Karan notes that one outbreak in Guangzhou, China, took place in a restaurant with no windows and poor ventilation, and the air conditioning appears to have blown droplets between tables.
What alters risk?Janowski says the risk level depends on how well the restaurant has adapted for the pandemic. Eateries should reduce and space out seating, require servers to wear masks and offer easy access to hand-washing stations.
They should also provide single-use options for condiments so you don't have to touch shared ones, says Janowski. And they should close all self-serve areas such as soda fountains or buffet tables.
If you do go to a restaurant, look for outdoor seating. Landon says she would go with only members of her household, because "I don't want to have to take my mask off in the close proximity of a bunch of other people."
3. ATTENDING A RELIGIOUS SERVICE INDOORS
Risk: High
Worship services involve people from different households coming together indoors for an extended time. "All of the ingredients are there for the potential for a lot of people becoming infected in the short amount of time," says Kimberly Powers, an epidemiologist at the University of North Carolina at Chapel Hill. She points to outbreaks linked to churches: In one, 35 out of 92 people who attended a service at a rural Arkansas church developed COVID-19.
Singing — whether from the pews or the choir — is high risk, several experts noted, citing a study of a choir practice in Washington state where over half of attendees became infected.
What alters risk:If people are appropriately socially distanced, wear masks and avoid singing, it may reduce the risk, Karan says. Also, avoid any shared worship items such as hymnals, Janowski adds.
Risk goes down if places of worship adapt, Guzman-Cottrill says. "My parish began having in-person services last week," she says. The church had advance sign-ups to limit attendance to 25 people. Attendees were required to be healthy, wear face coverings and sit at least six feet apart.
4. SPENDING THE DAY AT A POPULAR BEACH OR POOL
Risk: Low
As long as you can stay socially distanced, this could be a pretty safe activity, our experts say.
The water itself is not a risk. "The sheer volume of water will dilute out the virus, making the water a highly unlikely source of infection," says Janowski.
What alters risk? The key question is, how close are you to others? "Can you ensure that you can stay six feet [or more] from anyone outside of your designated family?" asks Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University Medical Center.
Watch out for crowds at entry points and bathrooms. Maintain social distance both on land and in the water.
Landon says her biggest worry about pools and beaches is kids. At pools, "they make friends with everyone," she says. "If you want to be able to see grandma for Sunday lunch, because that's what's really important to your family, then you don't want your kids running around with other people's kids."
She says a beach is better than a pool in terms of space. Go early in the morning or late afternoon, when crowds are smaller, and look for beaches that mark off spots for people to set up their areas.
5. AN OUTDOOR CELEBRATION SUCH AS A WEDDING WITH MORE THAN 10 GUESTS
Risk: Medium to high
Family-oriented celebrations are usually a summer tradition, but they come with a lot of risk right now. Many weddings have been postponed, with good reason.
"Outdoors reduces the risk, but as people are celebrating and drinking, it seems like they may not social distance as readily," says Karan, the Harvard physician. "These types of events end up being large crowds where people are having extended face-to-face conversations."
The larger the guest list, the greater the potential that one of them is infected, says Powers, the UNC epidemiologist.
What alters risk? The danger varies greatly depending on the size of the gathering and how closely people gather.
If you are considering hosting a celebration, make it a small one with mostly local guests. "Bringing people from other communities" is high risk, says Landon of the University of Chicago. "If people have to travel by car, by plane, from other places, you're really asking for it."
And really think twice about inviting your relatives, particularly older family members or those with underlying conditions. People may feel pressure to attend, even though it's hazardous to their health — and even more so if you emphasize that you're going to try to make it safe, says Landon. One of the largest clusters of deaths from the virus in Chicago occurredafter a funeral in which one of the attendees spread it to many of his family members.
6. USING A PUBLIC RESTROOM
Risk: Low to medium
Restrooms have been designed to prevent disease transmission, says Landon: "There are all sorts of things that you can catch from other people's poop, and you almost never do, because they're set up with all hard surfaces that can be cleaned."
The risk depends on the number of local COVID-19 cases and how clean the bathroom is, says Janowski of Washington University, noting that a bathroom involves multiple high-touch surfaces.
There isn't yet sufficient data to know if there's risk from toilet flushes aerosolizing the virus. Landon says that other viruses, such as norovirus, can be aerosolized by flushing, but norovirus doesn't often spread that way as long as bathrooms are cleaned. The CDC saysit's "unclear whether the virus found in feces may be capable of causing COVID-19."
What alters risk: Miller says the main risk comes from restrooms that are small, busy and poorly ventilated — like "those restrooms in a gas station off the highway where the restroom is outside."
Choose a bathroom that looks clean and is well stocked with supplies such as paper towels, soap and toilet paper. Avoid bunching up in a line to use the toilet or staying there long, if you're within six feet of others. Wash your hands after you go, and use sanitizer if you need to touch any surfaces after that.
ANOTHER VIEW ON RESTROOMS:
7. LETTING A FRIEND USE YOUR BATHROOM
Risk: Low
Landon doesn't think it's a big risk: "What happens in the bathroom is going to be sucked out of the bathroom ventilation, and you can clean all the hard surfaces really easily."
Miller agrees: "You can run the fan, leave the door open after [so air flows] and clean the bathroom later. And if you use the bathroom after they do, just wash your hands."
What alters risk? It's possible that your friend is infected but asymptomatic, says Janowski. "It would be reasonable to decontaminate the bathroom after a friend uses it, including cleaning the high-touch surfaces of the door, toilet and sink."
8. GOING TO A VACATION HOUSE WITH ANOTHER FAMILY
Risk: Low
Experts said that if both families have been quarantining and limiting their exposure to others, this is pretty safe. "If one family is very active or parents have higher-exposure jobs, then the risk increases," Miller says.
Landon thinks this arrangement could be a good idea, especially if the house is "in the woods where you're not going to have a lot of contact with other people," she says.
What alters risk?Landon suggests talking with the other family beforehand to make sure you share the same expectations for the precautions everyone will take in the two weeks before arrival and while you're there. Ensure that no one has signs of illness — if they do, they need to stay home. Miller recommends cleaning the major surfaces in the house on arrival. "And the more that people can reduce exposure in the days leading up to the trip, the better," he adds.
9. STAYING AT A HOTEL
Risk: Low to medium
The consensus is that staying at a hotel is relatively low risk, especially once you're in your room. It's best to limit your time in common areas such as the lobby, gym, restaurant and elevator, where the risk of exposure is higher.
What alters risk?Bring disinfecting wipes to wipe down the TV remote control and other common surfaces. You might also want to remove the bedspread since it may not be cleaned after every guest, suggests Miller. Ask about the hotel's cleaning policies, as many have new COVID-19 protocols. "Beware of the elevators! Use the knuckle of your little or ring finger to press the buttons," says Miller.
Other suggestions: Order room service rather than eating at the restaurant, avoid the exercise room and wear a face covering in public spaces.
10. GETTING A HAIRCUT
Risk: Medium to high
A haircut involves "close contact and breathing that is extended for several minutes," Karan notes. "This is the primary mode of transmission that we know happens. And cloth masks certainly are not perfect for this."
Janowski says this is one of the highest-risk scenarios on this list, because there's no way to keep six feet from someone cutting your hair. "All it takes is [having] one asymptomatic but infected worker, and suddenly many customers are at high risk of infection," he says.
What alters risk? Landon believes the risk is not terribly high if both you and your haircutter wear masks and if COVID-19 is not very prevalent in your area. Look for a salon or barbershop that has (and enforces) policies to protect its employees, such as wearing protective gear and sanitizing hands, she says: "By protecting their employees, they're protecting you too."
And make sure that your barber or stylist is all business, says Karan: "Stopping to chat at close distance like this is something we all love doing with our barbers normally. This is not the time for it."
MORE ON HAIRCUTS:
11. GOING SHOPPING AT A MALL
Risk: Varies
How risky this is depends on what kind of mall it is, how crowded it is and how much time you spend there, our panel agreed. "Crowds with high density lead to substantial increase in risk," says Miller. "The major mitigating factor is that people don't mingle in a single place for long."
What alters risk?Outdoor malls are preferable to indoor ones. And empty malls are better than crowded ones. Avoid the food court and go with purpose, not leisure, says Landon: "As much as you may like retail therapy, you should browse online before you go. Know what you're going to pick up or try on. Wear your mask. Go in, look at it. Make your decision and get out."
Be alert while you're there to avoid close contact. "Maintain your space," says Miller. "Try to go at off-peak hours." Bring hand sanitizer, says Guzman-Cottrill, and use it frequently, especially if you touch any shared surfaces such as handrails or elevator buttons.
12. GOING TO A NIGHTCLUB
Risk: High
There is consensus among the experts that going to a nightclub is a very high-risk activity. Crowds, ultra-close contact, singing, sweating and inhibition-loosening alcohol are a potent cocktail of risk factors. When drinking, people become less compliant with rules, Miller says, and they may breathe heavier from the dancing — "which means more virus is being shed," he says. If there's an infected person in the mix, the virus can spread easily.
"This is a very high-risk situation for an outbreak, as we saw in South Korea just recently," says Karan, referring to an outbreak tied to several nightclubs and bars. "Don't go to bars or clubs right now."
What alters risk?Nothing makes this a good idea right now. If you want to dance, have a dance party at home with the people in your intimate circle. If it's a small outdoor gathering, dancing under the stars — six feet apart — would be much less risky too.
13. GOING CAMPING
Risk: Low
"As far as summer activities go, this is least risky from a virus perspective," says Katz of Georgetown University. You're outdoors and isolated. Miller agrees — but he says that if you're going with a group, be sure you can trust your fellow campers. Have they been social distancing and following the guidelines? If not, they could be asymptomatic spreaders of the virus.
What alters risk?Of course, risks can creep in, depending on the particulars. "Are you camping in an isolated outdoor location with your family?" Katz asks. This is the lower-risk scenario. It's more dangerous if you're at a crowded campground with a shared restroom and communal picnic areas, she says. "Sleeping in tents together with others [not from your household] can certainly be a setup for transmission," adds Karan.
Bottom line: The activity itself is low risk, but the people whom you'll be in close contact with during the trip could increase the hazard.
14. EXERCISING OUTDOORS
Risk: Low
Unless you're playing group sports, exercising outdoors is a good way to burn off steam while staying socially distant. Our experts agree that sports such as golf and tennis are safer than contact sports such as basketball and football. "I would personally avoid contact sports until we have a better sense of transmission risk here," Karan says.
And running? "If you're not on a crowded path where people are brushing past each other, then I think that's a great form of exercise right now," says Powers.
What alters risk?The more people involved in the activity, the higher the risk. It's possible to spread the virus when you're in close proximity to others — even if you're asymptomatic — so it's best to wear a mask if you can't stay socially distanced.
The risk depends on the sport. A game such as basketball is tricky, Landon says. "You're touching the ball and you're going to be breathing in each other's faces," so she suggests playing only with people in your household. Tennis carries a much lower risk. "You're far apart on either side. That's definite social distancing," she says.
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