Reducing COVID-19 Risk

Mary-Claire Roghmann, M.D., M.S.


As an infectious disease doctor and epidemiologist, I find myself getting many COVID-19-related questions from my family and friends: Can I get a haircut? Can I eat out or go out for a drink? Can my soon-to-be 85-year-old mother celebrate her family birthday party at our house?

I tell family and friends that, as a general rule of thumb, they should avoid the three C's: crowds, closed spaces with poor ventilation and close contact with anyone outside their household. Crowds bring you into contact with many people who could have COVID-19 even if they're asymptomatic. The more people around you, the greater your chance of getting infected, particularly if you're in a hotspot area with a rising number of cases.

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COVID-19 is primarily a respiratory pathogen that spreads through droplets from infected people who talk, shout or sing. Closed spaces make it more likely you could inhale these droplets because the droplets are not diluted.

Close contact through a hug or close conversation, for example, also enhances this risk. The risk of COVID-19 spread is greatest when the three C's converge: chatting with a group in a crowded indoor bar is one of the highest risk activities.

Your COVID-19 prevention efforts should focus on moderating the three C's. When socializing with others outside your household, wear a mask. Avoid groups of more than 10 people and stay 6 feet apart. Enhance ventilation by gathering outdoors. If that's not possible, choose the largest space possible indoors, and try to keep the door and windows open to allow air to circulate.

My approach to whether to do a face-to-face activity with a friend or co-worker involves asking four crucial questions.

1. How much of a risk is the activity, and has the risk been minimized as much as possible?

2. What are the consequences of COVID-19 if I become infected?

3. Is there an acceptable alternative to the activity that is safer?

4. What is the activity worth to me?

Can I get a haircut?

I got a haircut as soon as I could. My stylist has her own business. She and I were the only people in her salon. We both wore masks, though I put a towel over my face during the shampoo. I am not at high risk for severe COVID-19, nor is anyone in my household. I have short hair that needs to be cut frequently. I live with my husband and son, who I would never let cut my hair. I felt much happier with a haircut. That said, I don't feel as strongly about getting a pedicure.

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Can I eat out or go out for a drink?

I have not gone out to eat or for a drink. I would not rule it out for a special occasion under the right circumstances: Eating with household members at an outdoor restaurant with plenty of space between tables. Right now, I'm happy with takeout and wine delivery.

Can my soon-to-be 85-year-old mother who does not live with me have an extended family birthday party at our house?

This is a tough question I've had to recently consider. My mother, due to her advanced age, is at substantial risk of having complications from COVID-19 if she gets infected. She would be eating with people outside of her household. The gathering would be 10 people from three separate households. There is an outdoor seating area that allows for each household to sit at least 6 feet apart from others. When talking and socializing as a larger group, we would all wear masks.

Those precautions minimize the risk of spreading COVID-19 in any party goers who are infected, but they do not bring the risk down to zero. The only way to do that would be to have a video-conference party, which my mother would enjoy far less.

Ultimately, the choice comes down to an individual decision: This activity is worth a lot to her, but enough for her to be willing to take the risk? That's up to her to decide.

[Read: Nurse at New York's Elmhurst Hospital Leads COVID-19 Testing Program.]

It's also up to each of us to decide how much risk we're willing to take to get infected or potentially spread the disease to others. We need to assess our own individual health risks, as well as our willingness to accept safer alternatives vs. missing out on a "once in a lifetime" event like a wedding, 50th anniversary party or baby shower.

What's clear is the importance of following the three C's to protect yourself and others from infection while the pandemic continues.



Mary-Claire Roghmann, MD, MS, is a Professor of Epidemiology and Public Health and Medicine and Associate Dean for Physician Scientist Training at the University of Maryland School of Medicine. She is also a Staff Physician and Epidemiologist for the VA Maryland Health Care System.