Weighing the risks as you have fun socializing

The neighbor has invited you trick or treating but she is not vaccinated. Your uncle wants to come for Thanksgiving, but he has just recovered from COVID. A friend wants to meet for lunch and you don’t know whether you should eat inside or outside.

The COVID-19 pandemic, including the rise of the delta variant, has changed our relationship with risk. If the goal is to stay healthy and avoid infection or reinfection from the highly contagious coronavirus, then understanding who poses a threat and calculating the probability of transmission becomes important.

There’s a lot of misinformation about COVID out there and the situation continually is changing. Still, the medical knowledge available can guide your choices in an informed way.

“It comes down to where does this all stop, who is at risk, and how do we get back to normal?” says Dr. Dushyantha Jayaweera, a professor of medicine and researcher at the University of Miami Miller School of Medicine.

A big factor to consider is the case count in your community. Your risk of developing COVID19 — regardless of vaccination status — rises when the positivity rate and cases count is high. However, the risk always is higher for the unvaccinated, who are five times more likely to be infected and to spread COVID, according to CDC data from a study in Los Angeles County. When making daily choices, consider this simple fact: To spread the coronavirus, you have to have the coronavirus and vaccinated people are far less likely to have the coronavirus and therefore spread it to others.

Valerie Reyna, who studies risk and uncertainty at Cornell University, said there are a variety of psychological risks and biases that affect how people behave during a pandemic. People’s comfort level with health risk varies. If you repeatedly take risk, your probabilities go up exponentially ... faster than you think,” Reyna said.

Best-case scenario

In gauging risk, the safest scenario is to be fully vaccinated, around others who are fully vaccinated — and be outdoors.

When faced with whether to attend a Halloween party, an indoor wedding, a concert or simply gather around the family table, the risk comes is in not knowing when someone is infectious. Just over 35 percent of all COVID-19 infections are people without symptoms, according to an analysis by a group of U.S. medical researchers who considered more than 350 existing studies.

That’s why your risk of contracting the virus is lower around people who are vaccinated. Multiple research studies show people who are fully vaccinated are less likely to infect others.

“If you are around unvaccinated people and the community transmission level is high, that’s a lot of exposure you are putting yourself in front of and a greater opportunity for vaccine protection to falter,” said Dr. Jason Lane, an infectious disease specialist with ChenMed senior medical centers.

Even if you get a breakthrough case after being vaccinated, you are contagious for a shorter period of time and harbor less infectious virus overall than someone who is unvaccinated.

In trying to go back to pre-pandemic routines, Floridians may be willing to calculate risk from a different perspective, says Jayaweera at UM. “If you are fully vaccinated and have no co-morbidities, you can get infected but it’s unlikely you will end up in the ICU.”

Since the introduction of delta, vaccine effectiveness against hospitalization ranged from 75% to 95% and effectiveness against infection ranged from 39% to 84% — depending on the region where you live.

For the vaccinated, those at greatest risk of contracting the virus and being hospitalized are the elderly or immunocompromised who may not build the same level of immunity from vaccines. That’s why the Food and Drug Administration authorized a third dose of the mRNA vaccines.

Children, particularly those under 12 who are not vaccinated, can get infected with COVID and pass it on, something to consider when planning events.

“Children could be carriers of the virus. Even if they don’t have symptoms, it doesn’t mean they are not going to transmit it. They can,” said Dr. Aarti Raja, a professor in the Health Science department at Nova Southeastern University.

Whether or not you are vaccinated, she said, “When there are lots of kids around, it’s a good idea to take precaution and try to maintain distance.”

Multiple contact

When making pandemic choices, consider how many people you are going to be around, how close in distance, and for how long.

Randy Gilbert rides an elevator to his Hollywood office every day. He is vaccinated and doesn’t wear a mask. He typically encounters a handful of people who ride up with him, unsure of their vaccination status. Gilbert says he has debated whether he should walk up the stairs, or wear his mask. Often, he holds his breath.

“If you are around multiple people who are unvaccinated — in an elevator, at a concert, in a nightclub — your chances of getting infected rise exponentially,” infectious disease experts say.

“It’s not just how many people you are exposed to, it’s also about the duration of the exposure,” Jayweera says. “If you are meeting a bunch of people at an indoor restaurant and you talk with them for half an hour, your chance of getting infected is higher than if you are around them for 10 minutes. From what we know, it takes about 15 minutes of exposure to get infected.”

Jayweera says the more people inside an indoor venue, the more risk. “If you are in an air-conditioned room with 100 people, and two or three are infected and spewing viruses, it’s a lot more likely you could get infected.”

How natural immunity factors in

More than 3.6 million Floridians have caught COVID-19 over the past 20 months. It’s not clear how soon someone can get infected with COVID-19 a second time. People who had mild or no symptoms may have less protection than those who had severe cases, and no one knows how long any natural immunity lasts.

“Since this is novel, we are still debating how long antibody protection is after COVID. Someone who had it six months ago, or a year ago could catch it again,” said Dr. Adekunle Bamgboye, an internal medicine physician and program director for the internal medicine residency program at Northwest Medical Center in Margate.

And of course, anyone with a higher probability of getting COVID has a greater opportunity to transmit it. The difference would be whether someone has had COVID and received at least one dose of a vaccine. “A growing body of research suggests infection plus vaccination provides the strongest protection against the coronavirus and variants,” Bamgboye said.

Inside vs. outside

In recent months, scientists have learned the virus is evolving to spread more efficiently through air — through large droplets that sink to the floor and smaller ones called aerosols that can float over longer distances indoors.

So, being in a crowded indoor, poorly ventilated space can increase your risk of getting infected from someone with COVID. Outdoors, airflow does a better job dispersing pathogens, but there is a chance of getting COVID if you have prolonged contact with someone who has it.

Experts say you also want to consider the type of conversation going on. In a sports arena where people are shouting and screaming more aerosol is coming out and that means the risk of breathing the virus in is higher.

Andrea Ugarte’s boyfriend wants her to go to an outdoor football game. Ugarte, a 23-yearold Davie resident, is hesitant. “People are going to be screaming all around me.”

“It’s always going to be a cost-benefit analysis,” Jayweera said. “You are going to have a heck of a good time, so if you are fully vaccinated, take a mask and if people get too close, put it on.”

Masks and risk

In certain situations, masks can lower your COVID risk.

The Centers for Disease Control and Prevention (CDC) says in general, you do not need to wear a mask in an outdoor setting. However, health officials encourage people to wear masks in crowded places or indoor environments with little airflow. This is even more important for lowering your risk if you are immunocompromised or have co-morbidities.

“If you are vaccinated and around someone unvaccinated, masking helps,” Raja said. “If they are harboring the virus it won’t release all on to you. If you are both masked, that provides even more protection. If you are in a scenario where you are not sure who is vaccinated around you, put barriers up. Wear a mask or keep distance.”

For example, during an elevator contact, an individual with a mask would be highly unlikely to become infected — even if other passengers were unvaccinated and unmasked.

“In general, I think it’s safe for us to say you should wear a mask in an enclosed space, but outside you can take it off,” Jayweera said.

If you are in a category at higher risk of getting infected, wearing a mask becomes more important.

Reyna at Cornell University, said most people are fighting pandemic fatigue.

“That puts them in a bad psychological position. They perceive risk but they don’t’ feel they can cope with it,” she said. “I think we can give people hope that there are things they can do to make a difference.”