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Months into the coronavirus crisis in the U.S., quarantine fatigue has set in. Social distancing guidelines to prevent the spread of COVID-19 remain in place, and distancing continues to be recommended, even in states that have loosened some restrictions. All of this has created difficult situations that can put a strain on individuals, families, and friends.
“We cannot expect families not to interact with each other in person for a year or two. I find that too difficult an ask of people,” says William Moss, M.D., the executive director of the International Vaccine Access Center and a professor in the departments of epidemiology, international health, and molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health. “But what people will have to do is figure out how best they can do that safely.”
Some measure of social distancing will likely be in place indefinitely, at least until there's an approved vaccine that's widely available. In the meantime, Americans want to know how they can see each other. For some, trying to meet up with a relative, another family, or a friend is a matter of coordinating childcare; for others, it’s a matter of how to get grandparents to see their grandchildren. For almost everyone, there’s an aching need for human connection, to see friends or family members who aren’t part of their own household.
"We can’t sustain extreme isolation indefinitely. People are already making choices to expand their bubble to another family or to share some childcare, because they need to live their lives sustainably,” says Julia Marcus, Ph.D., an infectious disease epidemiologist and assistant professor in the department of population medicine at Harvard Medical School.
Public health authorities should consider providing guidelines that help people make lower-risk choices as they figure out how to interact with others and decide what to do as businesses reopen, says Marcus. That could help people make safer choices, even if those choices aren’t as safe as staying home.
“If we don't give them tools to reduce their risk in those situations," she says, "we’re missing an opportunity.”
Merging Your Household Bubble
One of the first ways that social distancing guidelines have been loosened in parts of Canada has been to allow two households to agree to join their isolated “bubbles” together. In New Zealand, where May brought the first days with no new coronavirus cases, recently relaxed social distancing guidelines allow people to add another person or two to their bubble.
There’s no official policy about merging bubbles in the U.S., where the daily count of new cases is still high and COVID-19 is still spreading in many communities. But the concept is something people are still considering, Marcus says.
In some cases, people may want to merge their households together, say, if a couple with children wants to move in with grandparents. In other cases, people may want to pick another household to team up with to provide childcare or just to have others to socialize with.
“That’s not a zero-risk decision, and at this point it goes against any public health guidance that’s out there, but that is something that people are already choosing to do,” Marcus says.
There’s no manual for how we should live under pandemic conditions. But there are ways to lessen the risk of merging household bubbles. Here are some steps to take if you're thinking about it.
Communicate about potential exposure: You need to be aware that every household brings its own network of contacts, Marcus says. If one person in a household has a job that requires regularly interacting with people, that could significantly increase the risk of exposure to the coronavirus for everyone. Or if people in a household go to the grocery store regularly while people in another household get their groceries delivered, merging those households means everyone now takes on the elevated risk associated with visiting the grocery store.
Keep in mind that about 25 percent of people infected with the coronavirus are asymptomatic, says Amanda Castel, M.D., a professor in the department of epidemiology at the George Washington University Milken Institute School of Public Health. That means that if one person in a set of merged households is exposed to the virus while at his job or at a store, he could infect the rest of the household bubble, even if he's not showing symptoms.
Agree on your interaction “contract”: If people do get to the point of merging household bubbles, “you almost have to have a code of conduct with that other person or family,” says Castel. That requires all parties to make a commitment to abide by the same social distancing rules. “If they’re exposing themselves to other people, we see how rapidly and how easily this virus is transmitted,” she says. Everyone should be on the same page about things like how they interact with people while shopping, the frequency of grocery store runs, the protocol for accepting deliveries, and the rules about mask wearing.
Assess risk levels: When considering interacting with another household, it’s also important to consider whether anyone in either household is particularly vulnerable to the virus (if they’re older or immunocompromised, for example). If so, that household needs to take extra precautions before any interaction with others—and might not want to take on any additional risk, even if it's minor.
Merging households isn’t the only way that people are going to want to interact in the coming months. They may want to see friends occasionally or visit family members.
While doing so won't be risk-free, there are safer ways to have these interactions.
Moss says that outdoor interactions are probably much less risky than indoor ones. That's because when outdoors, viral particles disperse in the air, making it much harder for people to be exposed to an infectious dose of the coronavirus. It's easier to breathe in those particles indoors, where there’s less ventilation.
So if your family or close friends are going to get together, consider doing so outside, at least 6 feet apart, while wearing masks and washing your hands as often as possible. You should also avoid sharing food, Marcus says.
“We have to accept that people are going to start taking some risks,” she says. “Suggesting that people have these gatherings outdoors is a way to mitigate those risks while allowing people to live their lives in a sustainable way.”
It's possible to lower the risks associated with indoor gatherings, too. The fewer people from different households involved, and the more distancing and mask wearing there is, the lower the risk will be.
It may also be possible to plan a lower-risk visit with another household if both groups maintain a strict stay-at-home quarantine for two weeks before getting together, and if no one in either household shows any signs of illness.
By carefully considering the people we interact with and doing so in the safest way possible, we can start to envision the new normal of social interaction, one key part of how we’ll live in a world transformed by the coronavirus pandemic.
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