How to play it safe as society starts to re-emerge
Experts say be aware of your surroundings and look for ‘fewer faces … bigger spaces’
We’re really ready to be done with COVID-19 by now. But that doesn’t mean it’s done with us.
After weeks of lockdown, officials across the country are taking the first steps to cautiously reopen the economy. And as the public health guidelines start to move from black and white to grey, we’re going to have to start navigating risk ourselves and be more vigilant than ever.
The virus is only a few months old, and the science is still emerging. But here’s what we know so far about how and where COVID-19 is transmitted, and how to stay safer as many of us take our first steps out into the world.
The first thing to consider, said Colin Furness, an infection control epidemiologist at the University of Toronto, is the community spread of the disease where you are. A small town in northern Ontario may have virtually no cases, but right now “downtown Toronto is a pretty scary place,” he said.
Depending on the situation, you can assess your individual risk and adjust your behaviour accordingly. In general, outside is safer than inside.
“Being outdoors is ideal,” Furness said. “If you’re indoors, the more people in a smaller space the riskier it is,” Furness said. “I’m terrified of elevators.”
That’s because of the way COVID-19 is spread, primarily through droplets expelled when people cough, sneeze, laugh, sing or even talk. There’s growing evidence that even people without symptoms can spread the disease this way. Don’t forget these droplets can fall on surfaces and live on them, and that’s why you have to keep washing your hands and avoid touching your face.
Outside there might be a breeze, as opposed to indoors where if someone coughs they’ll leave a kind of cloud, said Furness.
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“It’s really hard to tell if someone’s got bad breath outdoors,” he added. “If you can smell someone’s breath, you’re too close.”
The virus travels in “nanodroplets” said Andrew Halayko, a University of Manitoba physiology professor who specializes in respiratory illness and environmental pathogens. “Those droplets are sort of the carrier, like the airplane for its passengers.”
It’s still not known how much virus you need to become infected with COVID-19, but in general the longer you are exposed, the greater the risk.
In a recent viral blog post, Erin S. Bromage, an associate professor of biology at the University of Massachusetts Dartmouth, wrote that he regularly hears people worrying about getting COVID from bike rides, the grocery store, and runners passing them on the street.
“Are these places of concern? Well, not really,” wrote Bromage, who did not respond to a request for an interview. “Remember the formula: Successful Infection = Exposure to Virus x Time.”
One pre-print study from China — meaning it hasn’t been submitted for publication or is still under review — analyzed over 7,000 cases in that country and found almost 80 per cent of outbreaks occurred at home. Transport was the next biggest source of outbreak (34 per cent; some involved more than one category). Only one, two-person outbreak occurred outside, during a conversation.
A new study published in The Proceedings of the National Academy of Sciences journal found talking produces thousands of tiny droplets that can stay in the air for up to 14 minutes. The study still needs to be replicated in real-world conditions, but it suggests face-toface conversations, especially in small enclosed spaces, can be risky, even if a person doesn’t have any symptoms.
“I’m sure you’ve met wet talkers in your time,” Halayko said. “Sometimes you notice something comes shooting out of your own mouth that was unintended, and the droplets we’re taking about are not necessarily droplets you can see.”
And an early release in the U.S. Morbidity and Mortality Weekly Report, about a COVID-19 cluster that started at a choir practice in Washington state, suggested singing might have contributed to the spread.
Choir members were aware of the virus and took precautions like not hugging or shaking hands. But following a two-anda-half-hour practice in midMarch that 61 people attended, 32 were infected, 20 had probable cases but didn’t get tested, and two died.
“Any environment that is enclosed, with poor air circulation and high density of people, spells trouble,” Bromage wrote.
That’s also why dining at a restaurant patio is safer than being inside, said Halayko.
Of course, that is if the restaurant keeps tables six feet away from each other. There also shouldn’t be any shared items on the table, like a water jug or basket of bread.
“There are a lot of things that we take for granted at a restaurant that have to stop,” Halayko added. And “the longer you’re talking the higher the risk goes.”
One early release article about a COVID cluster that originated at a restaurant in Guangzhou, China, found the air conditioning flow may have facilitated the spread of infected droplets from one table to two others. Events where family and friends have gathered indoors, like birthday parties and funerals, have also been hot spots for transmission. One man in Chicago accidentally passed on the virus to two others at a dinner where they shared food from the same serving dishes over three hours.
The next day he went to a funeral, where he hugged several people. The day after that, he went to a birthday party with nine people, where they hugged and shared food over three hours. The man later died of COVID-19, as did three of the 16 people he infected.
That’s why officials have been so strict about social distancing and asked people not to see anyone outside of their households.
In B.C., people are now allowed to do this in small groups, with the province’s health officer Dr. Bonnie Henry stressing “fewer faces” and “bigger spaces.”
Ontario is not there yet. But even when it is allowed, Halayko said there are things you can do to cut down on risk.
For example, when having a relative outside of your household over, don’t hug, sit outside on the lawn or a porch if possible, don’t share food. Ask where those people have been, whether they’re at risk, and how many people are in their household.
Of course, that gets to the question of bathrooms. An unedited manuscript study of two hospitals in Wuhan, China, found virus particles, possibly from fecal matter after flushing, in the air.
But it didn’t prove those particles were infectious. So the science is still not settled, but there are a lot of surfaces in a bathroom — from toilet seats, to flushers, to sinks and door handles — where the virus could be lurking.
“Practise really good hand hygiene, you want to be mindful,” said Furness.
Of course, there are businesses where close contact is almost inevitable.
Ontario is not ready to open hair salons and spas just yet, but some owners are already thinking about ways to keep customers and employees safe.
The hair salon chain Civello will require patrons to wait outside until their appointment, wear masks and get temperature checks at the door.
At the Ten Spot chain of spas, staff will be wearing masks — and face shields for some services — and they’ll also limit the number of people inside.
Nail or hair salons may also consider the Plexiglas barriers already seen at grocery stores, said Victoria Arrandale, an assistant professor at the Dalla Lana School of Public Health, as a way to “maintain the physical distance that allows them to operate.”
That can make things “safer — we can’t guarantee safe anywhere,” she said.
Employers in office settings should also think about “who absolutely needs to be present” even if they’re allowed to reopen, she added. An early release contact tracing study in South Korea of an outbreak at a call centre showed that the coronavirus can be extremely contagious in crowded office settings.
“Basically, as the work closures are loosened, and we start to venture out more, possibly even resuming in-office activities, you need to look at your environment and make judgements,” wrote Bromage in his blog.
“How many people are here, how much airflow is there around me, and how long will I be in this environment?”
And now is the time to step up, not forget the things we’ve been doing throughout the pandemic said Halayko. That includes handwashing, avoiding touching your face, socially distancing, and wearing a cloth mask or face covering when that’s a challenge.
“You don’t have to be terrified, you can control your exposure,” Halayko said.
“This is not out of our hands. Pardon the pun.”
“Any environment that is enclosed, with poor air circulation and high density of people, spells trouble.”
ERIN S. BROMAGE ASSOCIATE PROFESSOR OF BIOLOGY, UNIVERSITY OF MASSACHUSETTS DARTMOUTH