Should You Stay or Should You Go?
By Andrea Klemes, DO, FACE, CMO MDVIP

As COVID-19 cases surge in more than half the states, the question for many is when is it safe to go out? This is a tough decision especially if you're in a high-risk population (over 65, have a chronic condition, etc.). The less you go out, the less chance you'll be exposed to the virus which has killed more than 130,000 and infected nearly 3 million in the U.S.

The increase in cases is happening at the same time that vacation spots, restaurants and movie theaters are reopening after states loosened social distancing restrictions. So how do you safely go out?

First, if you’re not sure about your risk for becoming ill with COVID-19, talk to your primary care doctor. They’ll have good advice on whether you should go out and what precautions you should take.

Second, the Centers for Disease Control and Prevention recently updated suggestions for safely going out in public. Here are some of the CDC's recommendations along with what we've learned from recent studies:

Indoors vs. Outdoors
There is growing consensus among experts (including the CDC) that being outside is safer than being inside. This bodes well if you want to play golf, walk your dog in a park or even go to the beach or the mountains. Why do scientists consider outdoors safer? There's more air to dilute coronavirus, meaning your exposure is less. Second, there's usually more space and it's easier to maintain six feet of distance.

In fact, in a Chinese study of 7,324 coronavirus cases, only one traced back to an outdoor encounter. But that doesn't mean the risk is zero. Crowded outdoor spaces carry risk as do long conversations with other people in close quarters.

Interacting with People
Leaving the house doesn't increase your risk. It's interacting with people -- who may have COVID-19 -- that raises your risk. When you go out in public, you increase your exposure because you're interacting with others.

So what raises your risk when you interact, according to the CDC?

• Socializing with more people
• Being in a group of people who aren't maintaining a six-foot distance or wearing masks
• Seeing new people with whom you haven't been socially distancing

Crowds were initially banned because social distancing was hard to practice, but also because people came into contact with so many others, increasing their risk of contracting COVID-19.

Time and Intensity
Infection doesn't just occur because you've been exposed to one particle of virus. Scientists don't know exactly how much COVID-19 virus you need to be exposed to to become sick. But a low dose over a long time or a high dose over a short time can both cause an infection with traditional coronaviruses. Think of this as the difference between having a short conversation with someone who sneezes (high dosage) or a long conversation (lengthy exposure) with an infected person.

Masks and Social Distancing
Although early in the crisis, the CDC was reluctant to encourage people to wear masks, the agency says they're essential to lowering transmission rates.

A recent study published in the Lancet summarized a ton of research around face masks and social distancing (172 studies in all) and concluded that masks and social distancing prevent transmission. While none of the studies were randomized (a measure of their quality), the conclusion was in line with what epidemiologists and the CDC have been recommending for months: Face masks can reduce the risk of transmission.

In the study, the type of mask mattered. N95 and medical-grade masks like surgical masks showed greater protection over cloth masks.

Is it safe to travel? If you’ve been dying to get on the road or visit friends and relatives, this is a complicated question. The decision probably comes down to what level of exposure you’re comfortable with.

First, is where you’re traveling experiencing a resurgence of COVID-19 infections? You can look for hot zones on this map from Johns Hopkins.

Second, how do you plan to get there?

For example, air travel requires spending time in security lines and airports, in situations where social distancing may be a challenge. On crowded flights, you may have to sit near others for hours, which can increase your risk for contracting the virus. The same is true for bus or train travel.

With car travel, you may be able to control who sits next to you (especially if you’re traveling with people you’ve been quarantining with), but you still have to make stops for food, gas and bathroom breaks, where you will come into close contact with others.

The CDC recommends the following when you’re going to travel:

• Take alcohol-based hand sanitizer
• Bring a face mask to wear in public
• Prepare food and water for your trip so that you can avoid eating out – especially if restaurants in airports, for example, are closed or overcrowded

Finally, consider who you are visiting, their exposure and their risks. You may unintentionally bring COVID-19 along on your trip with you and expose the people you’re visiting. Or you may expose yourself to someone else who may have the disease.

These are all important risks to consider before you venture out.