Here is where I stand on this: I think that, if a person is really trying to minimize their risk—like, let’s say they are older, or have a respiratory or cardiovascular condition, and they’re trying to minimize all possible risks, then not taking out from restaurants and minimizing that chain of people touching your food might be a good idea. What I am saying is it is not standard practice, but there have been no public-health guidelines for restaurants that remain open to basically have all of their chefs and cooks and people who handle the food wear masks. And so, given the fact that that is not a guidance, there is at least a theoretical, if not probable or likely, somewhat increased risk of transmission from food delivery. I am also a realist and a pragmatist, and I get that, especially in dense urban areas, it is not practical for everybody to cook every meal on their own. And so this is where we have to make our best guess and judgment about that titration of risk and benefit. It’s not about doing everything a hundred per cent all the time. It’s about doing as much as you possibly can and contributing your own personal discomfort or inconvenience to protect yourself and to protect others.
One thing I have been saying, and maybe this is wrong, since I am not a doctor, is that this is not binary. It isn’t that you have been exposed to the virus or not, and if not, who cares. There is about risk mitigation, and, if you do ninety-eight per cent of the smart things, that is better than two per cent. Not everyone will be at a hundred per cent. We are human. But we have to get as close as we can.
All of the infectious-disease modelling would suggest that something is better than nothing, and a lot of somethings are better than fewer nothings. In some ways, this is akin to voting. In a lot of states and cities, especially ones with predominant parties, people say, “Well, what does my vote count?” If everyone thought that way, we would have a more dysfunctional democracy. Your vote does count. A couple of years ago, we had a local town election here where I live decided by one vote. The way I look at it for social distancing is that you never know what your individual action, especially a preventive action, can and will do. It is very hard to quantify a negative of something bad not happening.
But we do have good evidence of what doing nothing will cause to occur. That has become really stark. There are curves and numbers, but you can look at that video that came out from Northern Italy, where, in the newspaper L’Eco di Bergamo, on February 9, 2020, the obituary section was about as long as usual, a page and a half. On March 13th, the obituary section was ten pages long. That is ten pages of people’s real lives affected and ended by this thing. We need to drive home the idea that this is not some fanciful or theoretical social construct. This is really a reality, and we all have a role to play in mitigating worse spreads.
What should people do as soon as they get home? Should they wear certain clothes in and certain clothes out?
Like if they go to the grocery store?
Or even take a walk.
I think there is a distinction. If you take a walk in an open, airy park environment or down a not-too-crowded street, I don’t think you need to rip off your clothes and jump in the shower. If you had contact with anybody within your personal radius of space, or anyone bumped into you, or you were in a crowded environment like a grocery store or pharmacy, and you had to touch grocery carts and credit-card pads, you should immediately wash your hands for thirty seconds. By the way, people should look at videos for how to wash hands. This is a nerdy but important thing. They teach us this in medical school. It’s not just keeping your hands in water with a little soap. There is a method. And there are some great videos.
Would you mind sending me one?
You will never wash your hands the same way after seeing this video.
How often would you recommend showering?
Normal, if you are not going out a lot. One thing that comes to mind is if you are going to go out, maybe take a shower after. Can I point to an evidence guideline that supports that? No. But let’s say you are going out for your morning walk. I don’t see how it could hurt to shower after, and perhaps it can help.
What about behavior with the people we are quarantined with? Even though we are exposed to those people, should we still be trying to have less physical contact? Does that matter? Should people sleep in separate beds when possible, or have less sex?
I think that, if you have been living with your family or housemates and have been interconnected for a long time, there is no way to disconnect, especially if you are sharing the same living space. I don’t think we should be sleeping in separate beds right now, with a couple of exceptions. And this is emerging in some of the medical reports right now. We are still trying to figure out what to do if one person in a household is in a high-risk health-care environment, like E.R. physicians and nurses. A lot of people are separating. But I think, if you are not in medical environments or high-risk environments, look, social connection is already challenged so much in these crazy times. Let’s not overly disconnect.
You write, “If you are sick, you should try to isolate yourself from the rest of your family within your residence as best as you can.” If someone in your quarantine feels a little sick, what action would you take? I don’t mean sick with coronavirus symptoms—maybe just a sore throat.
If your space allows—and I am very sensitive that a lot of the guidance today assumes a certain household space and living circumstance that a lot of people don’t have—but if you start to become symptomatic, then separation within the household is recommended, especially if you have been out and about and there is at least a theoretical chance you might have been exposed. So separation within houses when possible, and more intense hand-washing and wiping down shared surfaces, especially kitchen and bathroom, would be recommended. And contact your primary-care team or heath provider, but don’t just walk in. We are quickly flipping to a virtual or telephonic model. You are going to see more and more drive-through testing clinics or centralized cough-and-fever clinics, where the workers have the gowns and protective equipment and are prepared for you. But a lot of small practices are not, and just walking in, particularly with respiratory systems, is not a good idea for you, for other patients, or for the staff.
I do want to say one thing about health-care workers. It has been wonderful that there is an appreciation of especially E.R. and I.C.U. physicians and nurses and the incredible courage and fortitude they are showing. And I also want to acknowledge the people we always forget about that are just as heroic and critical in this battle. There are people like the janitors, the patient-care attendants, the phlebotomists, the lab techs, the people who make food in a hospital, radiology techs. All these people that a hospital doesn’t function without are critical, and are taking risks to do the right thing. They are often underpaid, and work really hard shifts. I just want everyone to remember them and the sacrifices they and their families are making to keep the system going.
Absolutely. Anything else?
I just want to add that I think social distancing resonates as a concept with families and middle-aged and older adults. I worry it is not resonating enough, or that there is an understandable pushback among younger adults, or people whose lives have been upended if they work in the gig economy, or who don’t necessarily relate to the whole social-distancing thing. This is a real opportunity to be a hero by doing almost nothing.
I get that it is uncomfortable, and I want people to get more comfortable being uncomfortable for a while. And I get that it is annoying. Think of your aunt, your grandparents, and people you don’t even know. If you are young and you get it—yeah, you probably will have a mild case, although don’t be so confident of that, because there are certainly a number of sick young folks across the country. The key is that this is really a time to form a new social compact where everyone is giving up a little something. My maternal grandfather fought in the Battle of the Bulge. My grandmother was at home contributing to the war effort and trying to care for a baby. That’s hard. And I get that social distancing will also be hard. But I am always impressed with people’s capacity to respond to adversity.