By now, you've heard the advice that to slow the spread of the coronavirus in the U.S., we need to practice social distancing. But if you're confused as to what that looks like in practice, we've got some answers.
On Monday, the White House announced new guidelines for the next two weeks, urging Americans to avoid gathering in groups of more than 10 people; to avoid discretionary travel, shopping trips, or social visits; and not to go out to restaurants or bars.
This guidance is based on new modeling on how the virus might spread, according to Dr. Deborah Birx of the White House coronavirus task force.
"What had the biggest impact in the model is social distancing, small groups, not going in public in large groups," Birx said at a White House press conference Monday.
Also critically important, said Birx, is a 14-day quarantine of any household where one person is infected with the coronavirus. In models, "that stopped 100% of transmission outside of the household," she said.
The federal government is urging older people and those with serious underlying health conditions — like lung or heart conditions or a weakened immune system — to "stay home and away from other people" because data shows that these groups are most vulnerable to developing a severe form of COVID-19, the disease caused by the novel coronavirus.
"Every single generation has a role to play," Birx said Tuesday at a White House press conference. "We're asking our older generation to stay in their homes. We're asking the younger generations to stop going out in public places, to bars and restaurants, and spreading asymptomatic virus onto countertops and knobs."
So what is and isn't OK in our new world of social distancing? Can I have people over or go visit Grandma? Here's what the new CDC guidelines and other health experts have to say.
Can I go to a restaurant, food court or bar?
According to Monday's new guidelines, no — at least not for dining in. The CDC says people should use drive-through, pickup or delivery options instead.
When you get home with your food, you could take it out of the containers, throw those out, and then wash your hands thoroughly before eating, says Drew Harris, a population health researcher at Thomas Jefferson University in Philadelphia. "We don't want to get too crazy about this, but taking reasonable precautions should be sufficient," he says.
Luckily, the food itself "is probably not a major risk factor here," Daniel Kuritzkes, an infectious disease expert at Brigham and Women's Hospital, told NPR. That's because most infections from the new coronavirus appear to start with the respiratory system, not the digestive tract.
On a grassroots level, people are also urging folks to support their favorite local restaurants and retailers by buying gift certificates that they can use later.
What about visiting Grandma and Grandpa?
The federal government is asking visitors to stay away from nursing homes and retirement or long-term care facilities unless they're going to provide critical assistance.
This one is tough, because social isolation is already a problem for many of the elderly. But as Birx noted Monday, "We know there is a large group [of infected people] — we don't know the exact percent yet — that actually is asymptomatic or has such mild cases, they continue to spread the virus."
That includes children. A new study in the journal Pediatrics finds that 13% of children with confirmed cases of COVID-19 didn't show symptoms.
Given all that, "we're recommending that older adults avoid contact with children," says Sean Morrison, a geriatrician with Mount Sinai Health System in New York. "We want to minimize the risk of that child passing on disease to their grandparents, who are at increased risk."
Of course, that can be tough for all involved, but now is the time to think about virtual visits with Grandma — whether it's Facetime calls or streaming movies that you all watch together, virtually, Morrison says. That doesn't mean no visits to the grandparents — but do keep younger kids away.
Drew Harris suggests now may be the time for care packages for elderly relatives, rather than in-person visits.
But I'm a healthy grownup, not a kid. Is it OK to visit my elderly relatives?
"Don't visit older relatives unless it's absolutely necessary — as in, they need food, they need help at home, they need supplies or they need their medications," says Morrison. He says every older adult needs to be staying at home right now with plenty of food and medication supplies on hand. And adult children should have back-up plans to care for older parents in case they get sick, since they're the ones at highest risk from the coronavirus.
But do try to stay in touch regularly so that older relatives don't feel too isolated. Now would be a good time to teach your mom and dad how to use video calling if they don't know already.
I still need to go to work. Is it OK to drop my kid off at day care?
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a lead adviser on the federal government's COVID-19 response, said the new CDC guidelines hadn't yet tackled that question. But a commentary in the journal Pediatrics does raise concerns about the spread of the virus in day cares. Pediatrician Andrea Tania Cruz of Baylor College of Medicine, who co-wrote the commentary, acknowledges that some parents, especially low-income ones, won't have the option of keeping their kids at home with them.
In that case, Cruz says, try to find a day care setting with a small number of kids, don't send them to day care if they're sick, and make sure kids have gotten their flu shot (it won't protect them against coronavirus but it is still flu season). And she says day care providers should wipe down toys, especially plastic ones, often with disinfecting cleaners such as Clorox wipes or a bleach solution. That's because evidence suggests that the coronavirus can live on surfaces like plastic for up to 72 hours.
So why the concern over day cares? Cruz says there's evidence that infected people can shed the virus in their stool for several weeks after diagnosis. The most common test for coronavirus can't distinguish whether the virus being shed is alive or dead, Cruz notes. But she says the finding does raise concerns that caretakers changing diapers for kids who aren't yet potty trained could potentially be exposed to the virus. "I think day care, if it's older kids who are all potty trained, it's less of a risk," Cruz says.
Are kids' play dates OK?
Millions of American parents are now trying to figure out how to work from home — while also tending to kids whose schools are closed to combat the spread of the coronavirus. Play dates seem like an obvious solution to help little ones burn off energy while you get some work done. But while the CDC didn't offer any official guidance here, several experts say play dates may defeat the purpose of everyone hunkering down.
"I'm personally taking a really strict line," says pediatrician Lindsay Thompson of the University of Florida. "I would say that play dates inherently have a risk — I don't know how big or small. But if we can put them off for a few weeks and replace it with family time, it would be better."
She notes that elementary school-age kids get about five viral infections a season on average. "If they're playing with three or four friends, each one would be about to have, had or is getting over a viral illness that they could then, unfortunately, share," she says. And at this moment, she says, it's not just the coronavirus that's a concern, but any virus that might lead a child to need medical attention. That's because you want to avoid doctor's visits if you can, both to avoid possibly getting infected with the coronavirus and to avoid overloading the health care system.
What's more, symptoms of COVID-19 on average take five days to show up from the time of infection — but a person can still pass it on to other people during that time. So while it might be tempting to have one or two kids over, don't do it, says Dr. Asaf Bitton, a primary care physician and public health researcher affiliated with Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health.
"Someone who comes over looking well can transmit the virus," Bitton wrote in a widely shared essay posted on Medium. But "even if you choose only one friend to have over, you are creating new links and possibilities for the type of transmission that all of our school/work/public event closures are trying to prevent," he wrote.
Dr. Jenny Radesky, a developmental behavioral pediatrician at the University of Michigan, says the goal is for parents to limit exposure, period. "My guidance right now to families is, as much as possible, do not have your kids in other people's houses. Do not have other people's kids in your house. There are times where for child care arrangements or for absolute necessity, you need to have one or two or more kids together. But if at all possible, really just keep kids at home."
What about playing outside with other kids or going to the park?
If you do let your kids outside to play with others, make sure the children keep at least 6 feet of distance from other children (which can be very hard for younger children to abide by). That's because the virus can be transmitted between people who are in close contact with each other -- about a 6-foot radius. "We're avoiding playgrounds and other places that germs can accumulate," Radesky says.
And for adults, what about having close friends over to visit?
The new CDC guidance is to avoid social visits for now. Once again, think virtual — maybe have a Facetime dinner party with friends.
Morrison says the answer depends in part on where you live. If there's widespread transmission of the coronavirus in your community, his advice is to skip the visitors altogether. But "if you're in areas where there is less community spread, then limiting visitors rather than eliminating them, in my opinion, is probably a reasonable approach." He advises limiting interactions to one friend at a time.
Can I travel? I'm seeing really cheap airfares now.
The CDC is telling people to avoid discretionary travel. Think about it: It can be hard to stay at least 6 feet away from other people on an airplane. And even if you're planning to drive to your destination, the whole goal of this 15-day hunkering down period is to keep your germs to yourself so we slow the spread of the virus — a concept known as flattening the curve. That means minimizing contact with others outside your immediate household.
I had a doctor's visit scheduled months ago. Should I still go?
If it's a nonessential visit to a doctor or dentist, reschedule it, Birx said Tuesday during a White House press conference. "Things that don't need to be done over the next two weeks, don't get it done. If you're a person with an elective surgery, you don't want to go into a hospital right now." She urged people to "be responsible" to free up hospital beds and space.
I need to go to the grocery store. How do I do that in a way that's safest for me and others?
This counts as an essential trip, of course. But try going to the grocery store during off-peak hours, when it's less likely to be crowded, says Dr. Sean O'Leary, an assistant professor of pediatrics and infectious diseases at the University of Colorado School of Medicine.
Harris says he wipes down the handles on the shopping cart or basket when he shops. The stores he visits offer wipes, but hand sanitizer should also work.
Both Harris and Morrison advise being careful not to touch your face with your hands while you're at the store, and washing your hands before and after going. And try to maintain a distance of at least 6 feet from others. "Social distancing .... doesn't mean no one ever sets foot out the front door," Morrison says. "It means being careful."
After you unpack the food at home, wash your hands again, Harris says. And if you're in a high-risk group like the elderly or immunosuppressed, he advises asking someone else to shop for you or having groceries delivered instead.
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