Infectious disease physician sorts through what’s safe and what’s risky
They’re among the most-asked questions of the COVID-19 era: Should we go? Is it worth the risk? Sorting through what is risky is not easy, especially when you’re battling COVID boredom.
The coronavirus is again mushrooming through communities, but we’re in summer, normally time to get out and play a little. Opinions about risk – many from non-scientists – ricochet through the culture. Meanwhile, warnings from health officials about COVID-19 dangers get jumbled because businesses remain open in some places and are closed in others.
Dean Blumberg, chief of pediatric infectious diseases at UC Davis Children’s Hospital, has become one of the most trusted voices in Northern California on protecting yourself and others against COVID-19. He provides guidance about the relative risk of a range of activities.
The big picture hasn’t changed: stay outside, keep your distance, wear a mask
For most activities, being outdoors reduces your risk tremendously. On the other hand, being indoors with people not in your household greatly increases the risk of transmission – although keeping a 6-foot distance and wearing a mask will help mitigate some of that.
“There is a much larger volume of air outdoors. That dilutes the virus,” Blumberg said. “We saw that with the recent protests. I’m not aware there were outbreaks related to the protests, but there were big spikes from bars and social events in people’s homes.”
Whether you’re outdoors or inside, keeping your distance is still crucial.
“We need to keep reminding people that anytime you’re not social distancing, you’re increasing your risk,” he said. “The most common transmissions come from droplets, which we expel when we talk, cough, sneeze and sing. They generally don’t travel more than 6 feet. That’s the reason for the distancing.”
Masks provide a barrier and protection, which is especially important indoors, when people tend to be closer. But they’re needed outdoors, too, when there is not enough social distance.
“Not only do masks prevent you from spreading the virus, now we have research that shows wearing a mask also decreases the risk of infection to the wearer by 65 percent,” he said. “If everybody wore a mask, we could get this whole thing under control within a few weeks.”
The riskiest activities: Bars and indoor gatherings
“The riskiest thing I can think of is a bar,” Blumberg said. “You’re inside, you can’t wear a mask when you drink, you’re getting close to people, they’re raising their voice because it’s loud which increases the droplets they expel. On top of that, you’re drinking and your judgment is impaired.”
Indoor social gatherings are close behind, for many of the same reasons.
“Most people don’t have houses large enough to allow 6-foot social distancing,” he said. “There is usually food and drink and people aren’t going to keep masks on. Contact tracers have found that these gatherings are one of the main reasons for the current spike of cases.”
The least risky: Outdoor activities
Most outdoor activities when you keep 6-foot spacing is low risk. That includes walking, running, biking and workouts in a park.
“If you’re hiking or jogging and you pass someone on a narrow trail, there is not much risk,” Blumberg said. “It’s all a matter of the concentration of the virus. In those cases, you won’t be exposed to many virus particles.”
What about sports
The closer you are to someone – and the longer you’re there – the more the risk.
So golf is relatively low risk if you keep your distance and either walk the course or avoid carts with someone outside your household. Tennis is also low risk.
Baseball or softball has some risk, but it can be reduced with masks. Basketball is higher risk because it’s a prolonged semi-contact sport.
“Stopping and having a close conversation with someone on the trail or after a round of golf creates a high risk because of the time together and the amount of virus that can be transmitted,” Blumberg said. “It’s easy to forget to distance in those situations.”
Dining out – it depends
“There are a lot of factors to take into account,” Blumberg said. “Handled correctly, it can be relatively low risk, but you need everything done right.”
Handled correctly means:
- The tables are spaced at least 6 feet apart.
- Your server wears a mask.
- You wear a mask when you’re not eating.
- People waiting for tables distance themselves and wear masks.
- You’re not dining with people outside your household.
“I don’t know how often everyone gets it all right,” Blumberg said. “At the table, you’re probably not going to be 6 feet away from people, so if you’re dining with another couple, that’s a large risk.”
Takeout is relatively low risk.
“There is no evidence that the virus is transmitted through food,” Blumberg said. “So, the main risk is your interaction with another person. If you both wearing masks, you’re in pretty good shape.”
Paying with a credit card does not add much risk.
“The major risk is how close you are to the cashier and for how long.” he said. “The virus is not primarily transmitted by contact, so wear a mask and don’t worry about that.”
Shopping – an uncontrolled environment
The problem, especially in grocery stores and big box stores, is not all are enforcing requirements that employees and customers wear masks.
“Someone not wearing a mask to the store is just selfish and petulant,” Blumberg said. “Not only do they put themselves and many other people at risk, they force employees into the difficult position of having to confront them to protect their customers. How self-centered can you get?”
Another issue in some stores is that narrow aisles make it tough to maintain a 6-foot separation.
“You have to pay attention,” he said. “It’s much easier in the big box stores where the aisles are really wide. In a crowded aisle, it’s best just to wait for it clear. And give anyone without a mask a wide berth.”
Smaller retail stores have pluses and minuses. They’re generally small indoor spaces but owners may be better at making sure everyone wears a mask.
“If their windows and doors are open with air flow, that helps a little,” he said. “But there is still some risk.”
Medical and dental offices
“All health care facilities should be able to maintain social distancing, and everybody wears a mask,” Blumberg said. “The only time you’re not distancing is when you’re getting examined. But everybody has been screened. It’s a very controlled, safe environment. There is no reason not to go see your doctor.”
A visit to the dentist is more complicated.
“It is potentially high risk because you are in close proximity,” he said. “But when I went, the dentist and hygienist both wore masks, which decreased risk. Since I obviously was not wearing a mask, the risk was more for them than me.”
Hotels, motels and rentals
The hotel lobby is the riskiest part of a visit.
“If the lobby is crowded, it’s a high risk, so try to check in when it’s not crowded, if that’s possible,” Blumberg said. “The elevators are also a risk. A motel when you don’t go through a lobby removes some risk.”
The rooms themselves are less risky.
“It very unlikely the virus is lingering in the air, and it’s unlikely the virus will be transmitted by touching the light switch or the remote,” he said. “A rental house or cabin is even safer. There’s no check in and you have your own kitchen.”
While not the safest activity, visiting a casino might be less risky than it seems, if the casino does everything properly.
“They have very high-volume air systems, partly to get rid of the smoke, so there is a good air exchange that should dilute the virus,” Blumberg said. “They’re required to block off every other slot machine and a lot of them are putting up plastic barriers.”
Gaming tables for card and dice games are also required to spread people 6 feet apart.
“If you’re careful, I suppose there are riskier things you could do,” he said.
Final advice: Mail and packages
“Don’t worry about them,” Blumberg said. “A very, very small percentage of transmissions come from mail or package deliveries.”