Although it’s hard to believe, many of us are in our 10^th week of sheltering at home. Restrictions in other countries and many states have already begun to lift. This has brought about mixed emotions for many of the people we’ve spoken to.   

People tend to fall into two categories: those who are happy to (or need to) remain home until risk is minimized even further—and those who are simply ready to tear off the “Band-Aid” and go back into the world they once knew.

The two of us are fairly calculated and risk-adverse by nature, and neither end of the spectrum has felt quite right for us personally. We believe that staying safe from this virus is one part of maintaining our health. However, there is also a need to regain connection and foster our social and emotional well-being—both for us and for our children.

While we certainly don’t claim to have all the answers, we’ve put a lot of time and thought into understanding if there is a middle road—a way to safely re-enter the world while respecting and minimizing our risks. As a result of our research, our discussions as a couple, and the fact that Dr. Roy has worked around infectious disease for nearly 20-years, we have some resources to share with you today.

Dr. Erin Bromage, a Comparative Immunologist and Professor of Biology (specializing in Immunology) at the University of Massachusetts Dartmouth, has written a detailed article on the conclusions drawn from the COVID-19 outbreaks.

He explains that the risk of acquiring COVID-19 can be expressed with a simple formula:

Infection = Exposure to Virus x Time

This simply means that the greater degree of exposure to the virus you have, and the longer amount of time you are exposed, the higher your risk of infection will be.

First, let’s understand how we are exposed. We may be exposed to COVID-19 in two ways:

1. Surface exposure—touching a contaminated surface and then touching your nose, eyes or mouth
2. Airborne exposure—when someone who has the virus coughs, sneezes, sings, speaks or breathes near you

Surface exposure

Let’s begin with surface exposure. An example of surface exposure would be if someone with COVID-19 sneezes into their hands and then touches a door knob or a package that you then touch. Most studies suggest that surface exposure accounts for only about 10% of cases.

Public bathrooms, because they contain a large amount of high touch surfaces, seem to pose a significant risk.

We suggest that you minimize your risk of surface exposure in the following ways:

• Wash your hands thoroughly & frequently; carry hand sanitizer for when you cannot wash your hands.
• Minimize touching your face; teach kids to keep their hands off their faces and out of their mouths.
• Reusable masks and/or face coverings should be washed after each day of use and/or anytime they become soiled; wash and dry on a high heat setting for best disinfection.
• Change your clothing and shower after returning home from grocery shopping, work, and other public places; have your kids do the same and do not let kids sleep in their daytime clothing (as many kids like to do).
• Do not share your food and beverages—even within a family. We see this ALL the time, even between parents who have a child in our office for a sick-visit.

Airborne exposure

Airborne exposure poses a greater risk for COVID-19 but, as mentioned already, seems to be greatly correlated to the degree of exposure and the length of time exposed.

When someone coughs or sneezes, for example, their respiratory secretions are emitted from their mouth and nose.  Some of these droplets quickly fall to the ground (or a surrounding surface); other smaller particles may be aerosolized, and can remain suspended in the air.

Dr. Erin Bromage’s article goes into great detail about the number of viral particles needed to cause an infection. While this science is greatly appreciated and is useful in understanding disease transmission, for the average person it will likely create anxiety and fear.

This is where we step in to remind you that being exposed to a disease does not directly equal contracting a disease! We work in an office where people with infectious disease routinely enter, and by taking good precautions, and good care of ourselves, we reduce our risk. Of course, we do get sick sometimes—but not from every exposure we have.

Many of you have already witnessed this in your own life. Most parents do not get sick every single time they care for their sick child. And, many of us have gotten the call (or made the call!) that a child was playing with someone who came down with an infection a few hours later. Sometimes that infection is contracted by the other child, other times it is not. Not everyone in a class where a child has strep throat (or COVID for that matter) will get it.

Our point in sharing this is that infectious disease is always around us. While we need to stay safe, we also need to stay calm and sane! People fearing people is not good for anyone! There may actually be more fear in the air than viral particles, from what we have personally been witnessing.

So, with all of this in mind, here are what we believe to be the important takeaways from Dr. Bromage’s research:

• The risk of infection in the outdoors is very low.  The effects of sunlight, heat, and humidity all serve to minimize the risk to everyone when outside. This includes taking walks, hikes, and exercising outdoors. This article explains the low risk of contracting COVID-19 from runners and cyclists, despite the flack that many have been getting here in Boulder. This article discusses why “the air is not infected”.
  
  Outdoor activities would also include spending time with others in small groups outside, especially with others who are being equally cautious. This is very significant for all of us—especially younger kids who are yearning for play and social connection. Maintain adequate physical distancing and wear a mask if physical distance cannot be adequately maintained or if you are higher-risk.

• Short trips to the grocery store and other retail locations seem fairly low risk.  In most stores, the volume of air is large and you are only there for a relatively short period of time. Many stores are limiting the numbers of people entering at any given time. Furthermore, maintaining physical distance and wearing a mask decreases your exposure even more. Adequate hygiene (washing hands, changing clothes afterwards, not touching face) further reduces your exposure. See what we wrote above for reducing your risk of surface exposure.
• Indoor workspaces have varying risk levels. If the workspace is larger and/or well-ventilated, there are only a small number of employees, people have their own offices and/or adequate physical distancing is maintained, and masks are worn, then the risk is likely on the lower end. But if the opposite is true, then the risk in those workspaces will be higher. A call center with 200 employees on each floor is very different than seeing your acupuncturist, chiropractor or massage therapist in his/her private office….or visiting a small doctor’s office, such as ours, where we only schedule only one patient at a time.
• Gyms and other indoor exercise locations have varying risk levels. If the location is limiting the number of members present, the ventilation is good, and they are regularly cleaning surfaces and taking other precautions, the risk is lower (although outdoor exercise still likely poses a lower risk). Busy, crowded locations and indoor team sports seem to pose a higher risk.
• The highest risk of infection occurs when spending long periods of time with large groups of people indoors, with people closely-spaced, and lots of talking, singing, or yelling. Limited air exchange or recycled air compounds the threat. Indoor parties, funerals, weddings, restaurants, offices, conferences, churches, choirs, and theaters have all been sources of significant outbreaks. 
  
  We personally would have thought that airplane travel would fall in this category, however, this article explains that airplanes have substantial air-filtration and air-exchange, despite the enclosed space. Large amounts of touch surfaces in airports and airplanes and transmission from close contact with people are still significant risks.
• Your home is high risk for your other household members. If a household member contracts the virus and brings it into the home, sustained contact between household members (both surface and airborne exposure) leads to greater risk of contraction by others.This is a direct exposure over a sustained duration of time, and therefore, minimizing both types of exposure (as best as possible) would be advisable.

However, please remember what we stated above: exposure does not always equal infection. Additionally, this last point offers a perfect segue to our next resource for you.

According to Dr. David Katz MD, a graduate of Dartmouth, the Albert Einstein College of Medicine & Yale School of Public Health, there is research coming out of Germany, Sweden, Iran, and the Diamond Princess Cruise Ship and Navy Ships that suggest that in contained populations that have been widely exposed to COVID-19, it seems that 8 out of 10 people will not get the infection.

We appreciate Dr. Katz’s educated and thoughtful perspective. His science-based and data-driven approach, which he calls vertical interdiction, seeks to protect those groups at elevated risk while encouraging the rest of us to slowly return to our normal lives.

He explains the statistics that we now have about COVID-19 (such as a mortality rate similar to the seasonal flu) and eloquently explains how for many of us there are greater risks than COVID-19 that “hide in plain sight”, but we accept them because we are used to them and we view them as “culturally acceptable” risks.

Like the two of us, Dr. Katz believes that there are things that we can do now—such as dietary protocols and lifestyle practices—that greatly influence our risk of contracting COVID-19 and/or how sick we may become if we do get it.  

We encourage you to tune in for yourself below.

We hope that these resources help to keep you and your family informed and safe so that you can minimize the risk of contracting COVID-19 as you slowly venture back into the world. As always, do your own research, assess your personal risk factors…and above all, listen to your gut. 

We’d love to hear from you!

We miss you all! If you’ve stuck with us this far, we’d love for you to connect with us below in the comments. Please say “hi”, let us know how you are doing, or what your feelings and fears are about entering this next phase.

Debbie & Dr. Roy Steinbock