vox--2020-07-10--Why extreme heat is so alarming for the fight against Covid-19

A heat wave is baking much of the United States this week , with some of the highest temperatures forecasted in Southwestern states battling some of the most troubling coronavirus outbreaks in the country .
Arizona , for instance , is currently suffering from one of the worst outbreaks of Covid-19 with the highest daily reported cases per capita in the country .
Meanwhile , Phoenix hit a high of 109 degrees Fahrenheit in recent weeks , and the National Weather Service issued an excessive heat warning for the region through the weekend .
Parts of Texas are also experiencing @ @ @ @ @ @ @ triple digits in cities like El Paso .
The Covid-19 outbreak in the state has also worsened in recent weeks , with more than 10,000 new cases reported on Tuesday , beating a previous record .
These states were among those that began relaxing some of their pandemic control restrictions , like closing non-essential businesses , before infection rate had a chance to decline .
Now , as the number of new infections and hospitalizations has surged , governors of these states have reimposed some measures and implemented new ones , like mandatory @ @ @ @ @ @ @ of extreme heat and a fast-spreading virus in the Sun Belt is now creating a new set of problems that could undermine efforts to control Covid-19 .
From hampering surge capacity plans for hospitals to increasing people ’ s likelihood of getting exposed to the virus while sheltering indoors from the heat , heat can make things harder .
And temperatures are poised to rise even higher in the southwest in the future due to factors like the urban heat island effect and climate change .
But there are ways to mitigate some @ @ @ @ @ @ @ tactics like increasing ventilation reduces the likelihood of transmitting the infection indoors .
These measures will be key to making schools , offices , and public spaces safe enough to reopen .
The many ways that extreme heat can worsen Covid-19 risks Early in the pandemic , many hoped summer weather would reduce the transmission of Covid-19 .
Based on patterns with past coronaviruses , some scientists suggested that factors like ultraviolet light on sunny days , humidity , and heat could potentially reduce the spread of Covid-19 by impairing the virus itself @ @ @ @ @ @ @ States and other parts of the world shows warmer temperatures have done little to curb the rise in new cases .
“ In the context of this escalating pandemic , weather is pretty far down on the list of things that influence spread , ” said Katherine Ellingson , an assistant professor of epidemiology at the University of Arizona , in an email .
However , there are several indirect ways that extreme heat can alter how Covid-19 moves through a population and potentially worsens the outbreak .
When temperatures get searingly hot @ @ @ @ @ @ @ spaces , which presents the greatest opportunity for infection if the virus is present .
“ I ’ m actually really worried about indoor transmission , ” said Davidson Hamer , a professor of global health and medicine at Boston University .
“ It ’ s so hot in the Southwest US that people are not outside .
They ’ re being driven inside , so then you have all the issues of aerosol transmission and recycled air , a lot of which honestly we don ’ t fully understand yet.
” For @ @ @ @ @ @ @ be difficult to go outside at all for days at a time .
But it ’ s not clear yet whether this will raise or lower the transmission rate of Covid-19 .
“ Most of us are indoors , and that in some ways is good because it encourages people to stay home , but it some ways it ’ s also very challenging because people want to go be around others , ” said Saskia Popescu , an infection prevention epidemiologist at George Mason University based in Arizona .
If the heat @ @ @ @ @ @ @ the pandemic .
However , if parks and open air cafes are uncomfortable in the heat , people are likely to hop from one air-conditioned space to another — from a house , to a car , to a store , to restaurant , and so on .
That ’ s why infection risk can remain high if people are frequently in groups , even small ones .
“ I think people assume , ‘ Oh , I ’ m not in a 50-person spin class inside , I ’ m just having @ @ @ @ @ @ @ s not as risky , ’ ” Popescu said .
“ When we focus solely on large gatherings , that can be a poor communications strategy.
” Another key concern is that with so many people infected now , there may be a rise in new Covid-19 infections within households as people shut doors and windows and switch on the A/C .
Workplaces for people with essential jobs can also become major sources of transmission as they switch on cooling systems and seal off the outdoors .
So many people can end up @ @ @ @ @ @ @ nearly impossible to avoid .
“ And this is where vulnerability to infection comes as a result of socioeconomic and occupational risk factors , not individual choices about where to eat , socialize , or exercise , ” Ellingson said .
Another issue during heat waves is that air pollution tends to get worse on hot days .
Pollutants like ozone form more readily in high temperatures , which in turn can exacerbate breathing problems .
That ’ s particularly troubling for a respiratory infection like Covid-19 that has shown a link between @ @ @ @ @ @ @ In poorly sealed buildings , that outdoor pollution can become indoor air pollution , often leaving the poorest residents of a city little respite .
Building surge capacity for health care becomes more difficult Extreme heat also poses problems for the response to Covid-19 .
As hospitals approach their limits of beds , they may struggle to implement their backup plans .
Things like outdoor tents and temporary clinics like those deployed in New York City are much harder to set up in the heat and more expensive to run when they have @ @ @ @ @ @ @ capabilities quickly go out the window , ” Popescu said .
Avoiding health impacts of heat can create opportunities for transmission Heat itself is a potent health threat and is the deadliest form of extreme weather , according to the National Weather Service .
High temperatures make it harder for the body to shed excess heat , straining breathing and circulation .
That can then lead to potentially fatal conditions like hyperthermia and heat stroke .
While most people can avoid the most extreme heat , not everyone has access to air conditioning @ @ @ @ @ @ @ pay for it .
Places like Maricopa County in Arizona do operate public cooling shelters for people who don ’ t have access to their own cool spaces .
But that also creates another opportunity for people to gather in an enclosed space .
The Centers for Disease Control and Prevention has issued Covid-19 guidance for cooling centers that include social distancing , as well as calling on local governments to assist low-income residents with utility bills so they can pay for cooling in their own homes .
Improving indoor air could help @ @ @ @ @ @ @ now , scientists are still reckoning with how the virus spreads between people .
Initially , the main modes of transmission were thought to be surfaces and also respiratory droplets that usually fall out of the air within 3 to 6 feet of their origin .
That ’ s what informed guidance to wear masks , sanitize surfaces , and stay 6 feet away from others .
But a group of more than 200 scientists this week have called on the World Health Organization to recognize aerosols — tiny particles that can stay @ @ @ @ @ @ @ infections .
“ All the data over the last couple of months point to aerosols as a major mechanism for transmission of this virus , ” Hamer said .
That would mean that the virus could spread through the air to a greater degree than some previously thought .
This has important implications for strategies to control the spread of the virus , particularly indoors where it can circulate in the air .
One preprint study ( research that has not yet been peer-reviewed ) found that infectious virus particles could be found @ @ @ @ @ @ @ after the aerosol was formed .
The duration can change depending on how much air is circulated in the space , whether the air is filtered , and factors like temperature , humidity , and lighting .
But there is potential for Covid-19 to spread through ventilation systems .
“ Regarding the spread of the coronavirus via ductwork , the short answer is yes , it is plausible , ” said Parham Azimi , a postdoctoral researcher studying environmental health at the Harvard T.H .
Chan School of Public Health .
“ Definitely @ @ @ @ @ @ @ ventilation rates or without supplemental control strategies like air purifiers and filtration , we would face a lot higher risk of getting infected.
” In another preprint paper , researchers in the United Kingdom looked back at the Covid-19 outbreak on the Diamond Princess cruise ship where at least 700 passengers out of 3,711 tested positive for the virus .
The researchers concluded that inadequate ventilation was a key factor in the spread of the disease on the ship .
And another paper looking at a Covid-19 outbreak in a restaurant in Guangzhou @ @ @ @ @ @ @ of airflow from the restaurant ’ s air conditioner influenced which patrons ended up infected .
That means one of the more effective strategies for limiting the indoor spread of Covid-19 in places like classrooms would be to improve indoor air quality .
“ The easiest and fastest ways would be increasing ventilation or putting air purifiers inside of each class , ” Azimi said .
“ That would help reduce airborne transmission.
” Similarly , the CDC guidelines for reopening schools recommend that facilities “ increase circulation of outdoor air as much @ @ @ @ @ @ @ windows and doors.
” Increasing ventilation means that less air is stagnant in a given space , so a potentially infectious aerosol has less time to linger .
But opening windows during triple-digit temperatures can cause more problems than it solves .
And improper ventilation that doesn ’ t adequately cycle air out of a room could just end up spreading aerosols around .
Air purifiers can also clear out aerosols by using devices like HEPA filters .
However , purifiers are limited by how quickly they work since they can only process @ @ @ @ @ @ @ time , becoming ineffective in larger rooms .
There are also more sophisticated ways to improve air quality too , like ultraviolet germicidal irradiation , where ultraviolet light is used to sterilize air .
These devices can be integrated into HVAC systems to clean a large volume of air .
It ’ s effective , but expensive , requiring costly hardware and installation .
For schools and businesses struggling with their finances amid the pandemic , tactics like UVGI could be out of reach .
The lessons learned from fighting the pandemic during @ @ @ @ @ @ @ in cooler times of year , according to Azimi .
Improving ventilation would help reduce infection risks in the winter as people similarly spend more time indoors to avoid the cold .
But one side effect of many of these measures is that they increase energy consumption .
During a heat wave , running HVAC systems at a higher capacity or installing air cleaning devices adds to power demands .
For consumers , that raises their energy bills , and for utilities , that adds stress to the power grid .
Researchers have @ @ @ @ @ @ @ rises under extreme heat .
The Texas grid operator ERCOT said in May that it ’ s anticipating record electricity use this summer in the state , driven by heat .
While it has more reserve power this year than last , ERCOT says it may still have to issue energy emergency alerts if power demand rises too high .
So improving indoor ventilation during a heat wave isn ’ t simply turning fans on full blast .
It requires planning , balancing costs and benefits , and infrastructure to support it .
@ @ @ @ @ @ @ ’ t enough to reduce the risk of indoor transmission of Covid-19 ; it ’ s just one piece of a comprehensive strategy that includes measures like physical distancing between people and wearing masks .
It is possible to stay cool and stay safe from Covid-19 , but it requires anticipating risks and planning for them .
Every day at Vox , we aim to answer your most important questions and provide you , and our audience around the world , with information that has the power to save lives .
Our mission @ @ @ @ @ @ @ is in this moment : to empower you through understanding .
Vox ’ s work is reaching more people than ever , but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn .
Your financial contribution will not constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts at the quality and volume that this moment requires .
Please consider making a contribution to Vox today .

A heat wave is baking much of the United States this week, with some of the highest temperatures forecasted in Southwestern states battling some of the most troubling coronavirus outbreaks in the country.
Arizona, for instance, is currently suffering from one of the worst outbreaks of Covid-19 with the highest daily reported cases per capita in the country. Meanwhile, Phoenix hit a high of 109 degrees Fahrenheit in recent weeks, and the National Weather Service issued an excessive heat warning for the region through the weekend.
All-time record high temperatures always enter into the discussion when it gets as hot as it's going to get. There is a slight chance temperatures could reach as high as 120° in Phoenix Sunday. Temperatures this extreme have only happened 3 times before. #azwx pic.twitter.com/dC2oEuWDe9 — NWS Phoenix (@NWSPhoenix) July 9, 2020
Parts of Texas are also experiencing extreme heat, with temperatures rising into triple digits in cities like El Paso. The Covid-19 outbreak in the state has also worsened in recent weeks, with more than 10,000 new cases reported on Tuesday, beating a previous record.
These states were among those that began relaxing some of their pandemic control restrictions, like closing non-essential businesses, before infection rate had a chance to decline. Now, as the number of new infections and hospitalizations has surged, governors of these states have reimposed some measures and implemented new ones, like mandatory face masks.
However, the combination of extreme heat and a fast-spreading virus in the Sun Belt is now creating a new set of problems that could undermine efforts to control Covid-19. From hampering surge capacity plans for hospitals to increasing people’s likelihood of getting exposed to the virus while sheltering indoors from the heat, heat can make things harder. And temperatures are poised to rise even higher in the southwest in the future due to factors like the urban heat island effect and climate change.
But there are ways to mitigate some of these risks. In particular, tactics like increasing ventilation reduces the likelihood of transmitting the infection indoors. These measures will be key to making schools, offices, and public spaces safe enough to reopen.
The many ways that extreme heat can worsen Covid-19 risks
Early in the pandemic, many hoped summer weather would reduce the transmission of Covid-19. Based on patterns with past coronaviruses, some scientists suggested that factors like ultraviolet light on sunny days, humidity, and heat could potentially reduce the spread of Covid-19 by impairing the virus itself. But the evidence from the United States and other parts of the world shows warmer temperatures have done little to curb the rise in new cases.
“In the context of this escalating pandemic, weather is pretty far down on the list of things that influence spread,” said Katherine Ellingson, an assistant professor of epidemiology at the University of Arizona, in an email.
However, there are several indirect ways that extreme heat can alter how Covid-19 moves through a population and potentially worsens the outbreak.
People spending more time indoors
When temperatures get searingly hot, people spend more time in enclosed spaces, which presents the greatest opportunity for infection if the virus is present. “I’m actually really worried about indoor transmission,” said Davidson Hamer, a professor of global health and medicine at Boston University. “It’s so hot in the Southwest US that people are not outside. They’re being driven inside, so then you have all the issues of aerosol transmission and recycled air, a lot of which honestly we don’t fully understand yet.”
For a state like Arizona, it can be difficult to go outside at all for days at a time. But it’s not clear yet whether this will raise or lower the transmission rate of Covid-19.
“Most of us are indoors, and that in some ways is good because it encourages people to stay home, but it some ways it’s also very challenging because people want to go be around others,” said Saskia Popescu, an infection prevention epidemiologist at George Mason University based in Arizona.
If the heat keeps people isolated, that could slow the pandemic.
However, if parks and open air cafes are uncomfortable in the heat, people are likely to hop from one air-conditioned space to another — from a house, to a car, to a store, to restaurant, and so on.
That’s why infection risk can remain high if people are frequently in groups, even small ones.
“I think people assume, ‘Oh, I’m not in a 50-person spin class inside, I’m just having a few people over, that’s not as risky,’” Popescu said. “When we focus solely on large gatherings, that can be a poor communications strategy.”
Another key concern is that with so many people infected now, there may be a rise in new Covid-19 infections within households as people shut doors and windows and switch on the A/C.
Workplaces for people with essential jobs can also become major sources of transmission as they switch on cooling systems and seal off the outdoors.
So many people can end up in high-risk scenarios for Covid-19 that are nearly impossible to avoid. “And this is where vulnerability to infection comes as a result of socioeconomic and occupational risk factors, not individual choices about where to eat, socialize, or exercise,” Ellingson said.
Increased air pollution
Another issue during heat waves is that air pollution tends to get worse on hot days. Pollutants like ozone form more readily in high temperatures, which in turn can exacerbate breathing problems. That’s particularly troubling for a respiratory infection like Covid-19 that has shown a link between more severe illness and air pollution. In poorly sealed buildings, that outdoor pollution can become indoor air pollution, often leaving the poorest residents of a city little respite.
Building surge capacity for health care becomes more difficult
Extreme heat also poses problems for the response to Covid-19. As hospitals approach their limits of beds, they may struggle to implement their backup plans.
Things like outdoor tents and temporary clinics like those deployed in New York City are much harder to set up in the heat and more expensive to run when they have to be air conditioned. “Those capabilities quickly go out the window,” Popescu said.
Avoiding health impacts of heat can create opportunities for transmission
Heat itself is a potent health threat and is the deadliest form of extreme weather, according to the National Weather Service. High temperatures make it harder for the body to shed excess heat, straining breathing and circulation. That can then lead to potentially fatal conditions like hyperthermia and heat stroke.
While most people can avoid the most extreme heat, not everyone has access to air conditioning or can afford the power bills to pay for it. Places like Maricopa County in Arizona do operate public cooling shelters for people who don’t have access to their own cool spaces. But that also creates another opportunity for people to gather in an enclosed space.
The Centers for Disease Control and Prevention has issued Covid-19 guidance for cooling centers that include social distancing, as well as calling on local governments to assist low-income residents with utility bills so they can pay for cooling in their own homes.
Improving indoor air could help curb Covid-19 transmission during heat waves
Right now, scientists are still reckoning with how the virus spreads between people. Initially, the main modes of transmission were thought to be surfaces and also respiratory droplets that usually fall out of the air within 3 to 6 feet of their origin. That’s what informed guidance to wear masks, sanitize surfaces, and stay 6 feet away from others.
But a group of more than 200 scientists this week have called on the World Health Organization to recognize aerosols — tiny particles that can stay aloft longer— as a contributor to Covid-19 infections.
“All the data over the last couple of months point to aerosols as a major mechanism for transmission of this virus,” Hamer said.
That would mean that the virus could spread through the air to a greater degree than some previously thought. This has important implications for strategies to control the spread of the virus, particularly indoors where it can circulate in the air. One preprint study (research that has not yet been peer-reviewed) found that infectious virus particles could be found in an aerosol up to three hours after the aerosol was formed.
The duration can change depending on how much air is circulated in the space, whether the air is filtered, and factors like temperature, humidity, and lighting. But there is potential for Covid-19 to spread through ventilation systems.
“Regarding the spread of the coronavirus via ductwork, the short answer is yes, it is plausible,” said Parham Azimi, a postdoctoral researcher studying environmental health at the Harvard T.H. Chan School of Public Health. “Definitely, in indoor environments, with low ventilation rates or without supplemental control strategies like air purifiers and filtration, we would face a lot higher risk of getting infected.”
In another preprint paper, researchers in the United Kingdom looked back at the Covid-19 outbreak on the Diamond Princess cruise ship where at least 700 passengers out of 3,711 tested positive for the virus. The researchers concluded that inadequate ventilation was a key factor in the spread of the disease on the ship. And another paper looking at a Covid-19 outbreak in a restaurant in Guangzhou, China, found that the direction of airflow from the restaurant’s air conditioner influenced which patrons ended up infected.
That means one of the more effective strategies for limiting the indoor spread of Covid-19 in places like classrooms would be to improve indoor air quality. “The easiest and fastest ways would be increasing ventilation or putting air purifiers inside of each class,” Azimi said. “That would help reduce airborne transmission.”
Similarly, the CDC guidelines for reopening schools recommend that facilities “increase circulation of outdoor air as much as possible, for example by opening windows and doors.”
Increasing ventilation means that less air is stagnant in a given space, so a potentially infectious aerosol has less time to linger. But opening windows during triple-digit temperatures can cause more problems than it solves. And improper ventilation that doesn’t adequately cycle air out of a room could just end up spreading aerosols around.
Air purifiers can also clear out aerosols by using devices like HEPA filters. However, purifiers are limited by how quickly they work since they can only process a small volume of air at a time, becoming ineffective in larger rooms.
There are also more sophisticated ways to improve air quality too, like ultraviolet germicidal irradiation, where ultraviolet light is used to sterilize air. These devices can be integrated into HVAC systems to clean a large volume of air. It’s effective, but expensive, requiring costly hardware and installation. For schools and businesses struggling with their finances amid the pandemic, tactics like UVGI could be out of reach.
The lessons learned from fighting the pandemic during a heat wave could still be applicable in cooler times of year, according to Azimi. Improving ventilation would help reduce infection risks in the winter as people similarly spend more time indoors to avoid the cold.
But one side effect of many of these measures is that they increase energy consumption. During a heat wave, running HVAC systems at a higher capacity or installing air cleaning devices adds to power demands. For consumers, that raises their energy bills, and for utilities, that adds stress to the power grid. Researchers have found that the risk of power outages rises under extreme heat.
The Texas grid operator ERCOT said in May that it’s anticipating record electricity use this summer in the state, driven by heat. While it has more reserve power this year than last, ERCOT says it may still have to issue energy emergency alerts if power demand rises too high.
So improving indoor ventilation during a heat wave isn’t simply turning fans on full blast. It requires planning, balancing costs and benefits, and infrastructure to support it.
And Azimi cautioned that ventilation alone isn’t enough to reduce the risk of indoor transmission of Covid-19; it’s just one piece of a comprehensive strategy that includes measures like physical distancing between people and wearing masks. It is possible to stay cool and stay safe from Covid-19, but it requires anticipating risks and planning for them.


vox--2020-07-11--How to go out and not spread coronavirus this summer

As the coronavirus pandemic drags on , many of us are feeling desperate to see friends and family in person , keep kids busy , and get the heck out of town .
And it ’ s extremely tempting to shed our crusty quarantine skins of spring and seize a glorious , social summer .
But should we ?
It can be difficult to know since the situation across the US varies so much , as this map of county-level risk based on the number of new daily cases , from Harvard ’ s Global Health Institute and Edmond J.
@ @ @ @ @ @ @ Meanwhile , guidance on the safest way to enjoy socializing , playgrounds , and vacations is inconsistent .
States , towns , and cities are not uniformly enforcing — or even encouraging — safest practices as they lift ( or in some cases , reinstate ) coronavirus restrictions .
But one pattern is clear : As some places have relaxed social distancing measures before getting the virus under control , their case numbers have surged .
Which suggests that there are probably many things , like packing together in indoor bars , that @ @ @ @ @ @ @ even if they are technically permitted .
“ The Covid-19 situation in the US has changed over the past couple of weeks to the extent that no one should be out without a mask , and everyone should be trying to distance as much as feasible , even if retail [ and other businesses ] are opening up , ” Krysia Lindan , a clinical epidemiologist at the University of California San Francisco , wrote in an email to Vox .
Public health experts were particularly worried about the 4th of July holiday @ @ @ @ @ @ @ helped seed the current outbreaks in places like Arizona and Texas .
“ I ’ m very concerned ... that the same types of spikes and surges could be seen not just in the places that are currently experiencing surges but in places that have already experienced surges , and in ones that haven ’ t yet , ” Josh Barocas , an assistant professor of medicine at Boston University and an infectious diseases physician at Boston Medical Center , said in a recent Infectious Diseases Society of America briefing .
Getting out @ @ @ @ @ @ @ because “ people can transmit the virus before they start feeling symptoms , ” says Eleanor Murray , an epidemiologist at the Boston University School of Public Health .
By some estimates , about one in five people who get the virus never develop symptoms .
And for those who do end up getting sick , many have the highest level of virus in their bodies before they start feeling ill .
So , Murray says , “ we can ’ t just rely on how we ’ re feeling today.
” Or @ @ @ @ @ @ @ people around us are feeling .
If you ’ re in one of the higher-risk orange or red counties in the Harvard map above , sheltering in place is probably the safest move .
If you ’ re in a yellow or green county , you may be ready to venture out , and might be asking : What ’ s the safest way to have an outdoor get-together with some friends ?
Is it okay to travel this summer ?
I lost a tooth filling in April — is it safe to @ @ @ @ @ @ @ in with experts about the best and worst ways to do seven common things this summer , and here ’ s what they told me .
( Risk is ranked only for each category , so a “ moderate risk ” option for one category might not carry the same level of risk as a “ moderate risk ” option for a different category . )
Get out of town The first thing to know is that traveling from a high-risk area to ( or through ) a low-risk one increases the chances @ @ @ @ @ @ @ places where more people might be out and about .
“ I don ’ t want to encourage anyone to think that gallivanting around during the summer is a good idea , ” Lindan says .
Be sure to camp — and hike — at least 6 feet from others .
Make plans and reservations ahead of time , and bring disinfecting supplies .
To get there , “ drive with people in your household and who you know who are either uninfected or have been unexposed and/or safely practicing social distancing for @ @ @ @ @ @ @ Keep in mind that using public bathrooms , especially those that might not be cleaned super-regularly or those that are very busy , ups the risk for transmitting the virus .
“ Wash your hands after using the toilet , and always use a mask , ” Lindan notes .
“ Find out how long since the rental was last occupied and what type of clearing has been done between guests , ” Lindan says .
If other people were staying there more recently than 72 hours before your arrival , make sure @ @ @ @ @ @ @ The common booking site VRBO has detailed cleaning guidelines for property owners , and Airbnb has a cleaning commitment hosts can make — or opt for a 72-hour buffer window between guests . )
Also , drive there , using the above precautions .
“ Find out what precautions the hotel is taking , ” Lindan says .
Hotels should be using enhanced cleaning protocols ; staff should be wearing masks and being tested regularly , and if anyone has tested positive there , staff who were in close contact should follow local @ @ @ @ @ @ @ more item to your packing list : “ Bring your own disinfectant and use it , ” Lindan says .
The level of risk likely depends on several things , Lindan says : how crowded the plane is , how long the flight is , where you are traveling from and to , and how busy the airports are .
Before you fly , “ ask the airline how far apart the passengers will be seated , ” she notes ( ideally it would be at least 6 feet ) , as well @ @ @ @ @ @ @ doing between flights ( an industry group has released aircraft cleaning guidelines , but it is up to individual carriers to implement them and determine if every step is completed for each new group of passengers or just during longer stops ) .
Also , she says to aim for a window seat with no one next to you or behind you .
Although that might not be possible on all flights now , as some major airlines have announced that they will once again start booking entirely full flights .
Before you @ @ @ @ @ @ @ how much the virus is spreading there , where you are hoping to go , and any places you will pass through along the way .
Murray advises that no one should be traveling to or from the hardest-hit areas of Arizona right now , for example ( and probably Texas , Florida , and many other Sunbelt states ) .
Traveling from a low-risk area to ( or through ) a high-risk one means you will be more likely to pick up the virus , so not only will you be more @ @ @ @ @ @ @ might also bring it back to your community when you return home .
See older folks , like parents and grandparents , or other high-risk people “ Call , email , or communicate through one of the services that allow you to see and hear each other virtually , ” Nancy Nielsen , a dean for health policy at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo and former president of the American Medical Association , wrote in an email .
If you are wanting to connect with @ @ @ @ @ @ @ facility , inpatient facility , or hospital , many of those places can help you get set up with a virtual chat — in part because it also helps them keep risks lower .
Especially if you are visiting someone who lives in an assisted living facility , try to arrange a way to visit outdoors away from others who might be high-risk , such as people 65 and older .
But if you must visit near the facility , “ You would for sure always want to be wearing a mask and @ @ @ @ @ @ @ , ” Murray says .
This option depends a lot on how well everyone involved has been keeping up best practices of distancing ( and how widely the virus is spreading in the area ) .
“ This is the question you need to ask yourself , ” Lindan says : “ If you are not being safe by not wearing a mask and avoiding crowds , do you want to infect and potentially kill your grandmother ?
If you haven ’ t been very careful in the previous two weeks , then @ @ @ @ @ @ @ at risk — do a Zoom call.
” This one depends on the above factors but also on where people are coming from and going to , as well as how likely you ( or they ) are to have been exposed to the virus , Murray says .
For example , if you are an essential worker or health care professional , she advises a 14-day quarantine ( staying at home and avoiding contact with others ) first .
Or if traveling there involves contact with lots of other people , she @ @ @ @ @ @ @ ( no contact with others ) nearby before going to their home .
Lindan agrees : “ If you are visiting them for a long period , be sure to have self-isolated for two weeks beforehand or be very careful about your social distancing.
” “ The highest risk would be actually visiting a retirement home where there are a lot of elderly people in an enclosed space , ” Murray says .
Be especially cautious if you are seeing older people or others with higher risk for severe Covid-19 complications .
And @ @ @ @ @ @ @ connected with these folks that doesn ’ t involve being in the same room , says Nielsen .
“ Shop for them , depositing groceries outside their front door.
” Or say hi through a closed window .
And definitely skip large groups .
“ This is not a good time for family gatherings , ” says Nielsen .
And it ’ s something we will need to accept for many months to come .
“ Those may not be very safe until a safe and effective vaccine is available , ” Nielsen @ @ @ @ @ @ @ to the May surprise birthday party with 25 guests ( hosted by a presymptomatic carrier ) that ended up spreading Covid-19 to 18 people — including two people in their 80s and one person with cancer — and sent many to the hospital , to see how easily the virus can spread at a gathering , putting older relatives ( and others ) at risk .
“ If you need a physical exam or Pap smear , get one , ” Lindan says .
Make sure that the office or facility you visit @ @ @ @ @ @ @ using N95 masks , and screening patients for Covid-19 ( and keeping those who might be positive away from other patients ) , she notes .
“ Dentists have been using masks and eye shields for a long time , so going to a dentist is probably fine , ” Lindan says .
Especially for the patient .
( “ The risk is more to the dentist or dental hygienist than to you , because of aerosols and droplets that are inevitable during procedures , ” Nielsen says . )
“ It depends @ @ @ @ @ @ @ ” Lindan says .
If they are taking the best safety precautions , including disinfecting everything ( surfaces , instruments , etc . )
, and wearing gloves and an N95 mask , that makes it safer .
( The American Optometric Association has put out guidelines for best practices for the field . )
But “ given there is a lot of potential eye contact with the instruments , hands , etc.
, and that Covid-19 can be transmitted to the [ mucous membrane of the eye ] , this might be @ @ @ @ @ @ @ “ Of course , if you have an urgent eye problem , you [ will ] have to be evaluated.
” “ Go now for those medical and dental services you ’ ve been putting off , ” Nielsen says .
“ Medical and dental offices are acutely aware of risk , ” she says .
Everyone should be wearing a mask at all times — except for the time you might need to take one off to have your nose or mouth examined .
These visits should be safe and can be @ @ @ @ @ @ @ health .
For her part , Nielsen says , “ Go for the elective surgery , Pap smears , physicals , eye exams you ’ ve postponed.
” ( There is a chance , though , that as Covid-19 case numbers spike in some areas , elective procedures will be put on hold to maintain hospital capacity . )
You might have video chat fatigue by now , but it is still the absolute safest answer for socializing with those outside of your household , Nielsen says .
“ Getting together in person @ @ @ @ @ @ @ ” Nielsen says .
And you don ’ t need expansive empty parks for this .
You can sit on a friend ’ s porch or patio so long as you can safely stay at least 6 feet apart .
If there is food or drink , people should bring their own .
And definitely avoid anything shared or in a buffet style .
Also : “ No hugs or handshakes !
” Nielsen says .
If you ’ re considering ducking inside a friend ’ s home to use the bathroom , @ @ @ @ @ @ @ closely those in the home — and you — have been following physical distancing .
If you decide all have been adhering well , it should be okay — just wear a mask , wash your hands well , and thoroughly disinfect surfaces before you leave the room .
Should you wear masks when you see friends outdoors ?
Lindan says that “ if you ’ re outside with a friend who has been cautious and probably not exposed , you probably don ’ t have to wear a mask ” if you @ @ @ @ @ @ @ is something to be mindful of because staying physically far enough apart from someone you know well is difficult — even if you ’ re both trying your best .
“ It ’ s difficult to maintain these social distances , ” Lindan says .
“ It ’ s not how we live as humans.
” But distance and fresh air don ’ t necessarily prevent the spread of the virus .
“ Spewing respiratory droplets over a longer distance can occur if someone has a vigorous cough , ” Lindan says , @ @ @ @ @ @ @ singing — even outdoors .
The level of risk here is strongly tied to how careful you and your friend ( and whoever else you and they live with or see regularly ) are being .
If everyone has been extremely careful , you might be able to “ wear a mask until all are safely distanced , then don them again if you ’ ll pass people closely , ” Nielsen says .
( Lindan goes so far as to suggest that “ if they are not maintaining social distancing or wearing @ @ @ @ @ @ @ they are not your friends.
” ) But still no hugs , handshakes , or shared foods .
“ Sit outside if possible , ” Nielsen says .
The restaurant should have tables spaced at least 6 feet apart .
The staff should be masked , “ as should all guests until beginning to eat or drink , ” she says .
As far as bars are concerned , Lindan says , “ don ’ t go into them ... unless you can drink outside at a distance from others.
” Even if @ @ @ @ @ @ @ you and others will take masks off to drink .
“ Plus , getting intoxicated is likely to result in less ability to continue to be safe , ” she says .
“ It is likely that upticks in cases in some places are the result of parties and bars.
” Add to this that “ it ’ s more than the lack of social distancing , ” Nielsen says .
“ It ’ s that speaking loudly , shouting , cheering , etc.
, have much more potential for droplet spread ” @ @ @ @ @ @ @ Anthony Fauci of the National Institute of Allergy and Infectious Diseases echoed these sentiments at his June 30 Senate hearing : “ Bars : really not good , ” he said .
“ Congregation at a bar , inside , is bad news .
We really have got to stop that.
” The bottom line is that “ Nothing has changed about precautions to prevent yourself and others from becoming infected , ” Lindan says .
“ Wear a mask at all times that you are out , except when you are eating @ @ @ @ @ @ @ at least 6 feet away from others in your ‘ safe ’ group .
Clean/disinfect your hands .
Being outside for activities , for seeing friends , and for eating is better than inside.
” Everyone might be stir-crazy by now and very tired of one another .
But keeping children with members of the household is the safest for not just preventing them from getting sick ( which does happen ) but also to reduce the chances of their spreading the virus to others ( data on this is still evolving ) @ @ @ @ @ @ @ that has just been cleaned , could potentially be okay ( especially if transmission in your area is low ) .
Adults and children over 2 should wear masks and maintain physical distancing , and everyone should disinfect hands frequently .
“ You can try to clean off playground equipment before your child uses it , but it ’ s probably easier to periodically clean your child ’ s hands while they are at the playground , ” Lindan says .
To keep play dates safest , limit the number of kids and @ @ @ @ @ @ @ other family that you trust to be keeping up good distancing practices .
Perhaps most important is to “ be aware of what the parents are doing , ” Lindan says .
“ Parents pose the most risk .
So avoid kibitzing in close proximity with parents whose social distancing practices you are unaware of and who aren ’ t wearing masks.
” Also , ask other parents to wear masks when they are around your children .
Lindan recommends trying to avoid sleepaway camps for now because it is hard to be @ @ @ @ @ @ @ been distancing and wearing masks outside of their time with the children .
“ Camp experiences that are based outdoors and with smaller groups of children are better compared to an [ indoor ] computer camp , for example , ” she says .
Any activity with children is particularly tricky because , especially with very young children , they are unlikely to be able to follow all of the health recommendations ( staying away from other people , not touching common surfaces , wearing a mask correctly , etc. )
.
A @ @ @ @ @ @ @ rate at which children transmit the virus to one another and to adults .
And although children do not seem to experience more typical severe Covid-19 infections as frequently as adults do , they can still get very sick and die as a result of the virus .
Want a haircut ?
Manicure ?
Back massage ?
“ The safest thing to do would be to do it at home or have a roommate or housemate do it for you , ” Murray says .
Murray suggests this could be fairly safe “ @ @ @ @ @ @ @ haircut , especially if you ’ re all wearing masks and you ’ re 6 feet away from other clients , ” she says .
These should be done with a plexiglass shield between the client and aesthetician , Murray notes .
Also : Everyone should be wearing masks , and clients should be spaced far apart .
If you ’ re deciding between the two nail services , “ a pedicure may be somewhat safer than a manicure , since you ’ re not so close to one another , and you @ @ @ @ @ @ @ your feet , ” Lindan says .
But it ’ s not entirely about the extremity you choose .
“ Think about how long you are going to be there and in close proximity to other clients and staff , ” she says .
Dyeing , relaxing , and other longer-duration hair treatments up the risk simply because you ’ re spending longer indoors in a salon .
“ You might not be in such close contact with [ a stylist ] , but you are going to be in their studio for @ @ @ @ @ @ @ .
Murray also adds to this category of risk : massages and body waxing , like leg waxes ( “ if you yell when they pull the wax off , it ’ s more risky for the person doing the procedure , ” she says .
“ And it can take a long time.
” ) Nielsen also suggests tattoos are in this level of risk “ due to proximity and prolonged encounter time , even when masks are worn by all.
” “ I would discourage people from getting their face waxed @ @ @ @ @ @ @ Really any face-based treatment falls in this category , including other eyebrow services , facials , or a shave .
Regardless of the treatment , says Lindan , “ make sure that all instruments have been sterilized between clients ( which should be done regardless ) , that you and the staff are wearing masks properly and washing hands.
” Get around without a car The fresh air and not being in sustained proximity to others helps to minimize risk — especially if most everyone is wearing masks when passing close to others @ @ @ @ @ @ @ it ’ s just you and the driver , and you could wipe down surfaces that you would touch and wash your hands afterward — and both be wearing masks , ” Murray says .
You can also keep the windows open to increase air circulation .
“ They may be reasonably safe , ” Murray says .
“ If you ’ re the only person in the subway car , you ’ re probably fine.
” But follow the same good hygiene practices that you probably should use in public transportation anyway @ @ @ @ @ @ @ don ’ t absolutely have to , clean off your hands as soon as you can — and don ’ t touch your face before you can do so .
And when there are a handful of other people , “ sit far apart from other passengers , ” Lindan adds .
“ If it starts to look like commuting hours used to , where people are squishing in , you definitely don ’ t want to get in , ” Murray says .
Make the summer safer for everyone Most of these @ @ @ @ @ @ @ seeing and where you are .
“ It ’ s hard to make gradations of risk , ” Lindan says .
“ It depends on what your friends have been doing , and it depends on the transmission in the community.
” Before we see anyone these days , it should be part of the new routine to let them know if we are feeling well and if we have traveled in the past two weeks anywhere where Covid-19 cases are prevalent , Nielsen says .
It is easy to find out what @ @ @ @ @ @ @ by going to your local health department ’ s website , the Centers for Disease Control and Prevention ’ s Covid-19 Data Tracker , or checking the rate of positive tests available from Johns Hopkins .
“ Become informed !
” Lindan says .
“ It ’ s not difficult.
” The lesson is that life is very different this summer .
And even though some activities are allowed — and even if we see friends and family members engaging in them — that doesn ’ t mean we should take part .
@ @ @ @ @ @ @ The types of things people should be doing are the same things they should have been doing since February or March.
” These include keeping distance from others , wearing a mask , washing hands frequently with soap and water , and avoiding touching shared surfaces .
This isn ’ t just to help you avoid getting the virus , which , as Murray notes , “ sounds very bad even for mild cases.
” It is to help stop the spread of the virus to others and ultimately slow the runaway pandemic @ @ @ @ @ @ @ : “ You can not drive 100 miles per hour on the highway .
Even if you want to risk killing yourself , it ’ s not acceptable to kill others .
The same is true for Covid-19.
” So for everyone ’ s sake , try to summer safely .
Katherine Harmon Courage is a freelance science journalist and the author of Cultured and Octopus !
Find her on Twitter at @ KHCourage .
Every day at Vox , we aim to answer your most important questions and provide you , and @ @ @ @ @ @ @ information that has the power to save lives .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
Vox ’ s work is reaching more people than ever , but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn .
Your financial contribution will not constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts at the quality and volume that this moment @ @ @ @ @ @ @ to Vox today .

As the coronavirus pandemic drags on, many of us are feeling desperate to see friends and family in person, keep kids busy, and get the heck out of town. And it’s extremely tempting to shed our crusty quarantine skins of spring and seize a glorious, social summer.
But should we?
It can be difficult to know since the situation across the US varies so much, as this map of county-level risk based on the number of new daily cases, from Harvard’s Global Health Institute and Edmond J. Safra Center for Ethics, shows:
Meanwhile, guidance on the safest way to enjoy socializing, playgrounds, and vacations is inconsistent. States, towns, and cities are not uniformly enforcing — or even encouraging — safest practices as they lift (or in some cases, reinstate) coronavirus restrictions.
But one pattern is clear: As some places have relaxed social distancing measures before getting the virus under control, their case numbers have surged. Which suggests that there are probably many things, like packing together in indoor bars, that we shouldn’t be doing — even if they are technically permitted.
Related Just 2 states meet these basic criteria to reopen and stay safe
“The Covid-19 situation in the US has changed over the past couple of weeks to the extent that no one should be out without a mask, and everyone should be trying to distance as much as feasible, even if retail [and other businesses] are opening up,” Krysia Lindan, a clinical epidemiologist at the University of California San Francisco, wrote in an email to Vox.
Public health experts were particularly worried about the 4th of July holiday because they say Memorial Day weekend festivities helped seed the current outbreaks in places like Arizona and Texas. “I’m very concerned ... that the same types of spikes and surges could be seen not just in the places that are currently experiencing surges but in places that have already experienced surges, and in ones that haven’t yet,” Josh Barocas, an assistant professor of medicine at Boston University and an infectious diseases physician at Boston Medical Center, said in a recent Infectious Diseases Society of America briefing.
Getting out and about is risky in large part because “people can transmit the virus before they start feeling symptoms,” says Eleanor Murray, an epidemiologist at the Boston University School of Public Health. By some estimates, about one in five people who get the virus never develop symptoms. And for those who do end up getting sick, many have the highest level of virus in their bodies before they start feeling ill. So, Murray says, “we can’t just rely on how we’re feeling today.” Or, for that matter, how the people around us are feeling.
If you’re in one of the higher-risk orange or red counties in the Harvard map above, sheltering in place is probably the safest move. If you’re in a yellow or green county, you may be ready to venture out, and might be asking: What’s the safest way to have an outdoor get-together with some friends? Is it okay to travel this summer? I lost a tooth filling in April — is it safe to go to the dentist?
Related 8 ways to go out and stay safe during the coronavirus pandemic
I checked in with experts about the best and worst ways to do seven common things this summer, and here’s what they told me. (Risk is ranked only for each category, so a “moderate risk” option for one category might not carry the same level of risk as a “moderate risk” option for a different category.)
Get out of town
The first thing to know is that traveling from a high-risk area to (or through) a low-risk one increases the chances that you will spread the virus to places where more people might be out and about. “I don’t want to encourage anyone to think that gallivanting around during the summer is a good idea,” Lindan says.
Safest: Camp
Be sure to camp — and hike — at least 6 feet from others. Make plans and reservations ahead of time, and bring disinfecting supplies.
To get there, “drive with people in your household and who you know who are either uninfected or have been unexposed and/or safely practicing social distancing for two weeks,” Lindan says. Keep in mind that using public bathrooms, especially those that might not be cleaned super-regularly or those that are very busy, ups the risk for transmitting the virus. “Wash your hands after using the toilet, and always use a mask,” Lindan notes.
Next safest: Get a vacation rental
“Find out how long since the rental was last occupied and what type of cleaning has been done between guests,” Lindan says. If other people were staying there more recently than 72 hours before your arrival, make sure surfaces have been wiped down. (The common booking site VRBO has detailed cleaning guidelines for property owners, and Airbnb has a cleaning commitment hosts can make — or opt for a 72-hour buffer window between guests.) Also, drive there, using the above precautions.
Moderate risk: Hotels
“Find out what precautions the hotel is taking,” Lindan says. Hotels should be using enhanced cleaning protocols; staff should be wearing masks and being tested regularly, and if anyone has tested positive there, staff who were in close contact should follow local health department instructions. And add one more item to your packing list: “Bring your own disinfectant and use it,” Lindan says.
Riskier: Traveling by plane
The level of risk likely depends on several things, Lindan says: how crowded the plane is, how long the flight is, where you are traveling from and to, and how busy the airports are. Before you fly, “ask the airline how far apart the passengers will be seated,” she notes (ideally it would be at least 6 feet), as well as what type of cleaning they are doing between flights (an industry group has released aircraft cleaning guidelines, but it is up to individual carriers to implement them and determine if every step is completed for each new group of passengers or just during longer stops). Also, she says to aim for a window seat with no one next to or behind you. Although that might not be possible on all flights now, as some major airlines have announced that they will once again start booking entirely full flights.
Takeaways
Before you leave your area, look to see how much the virus is spreading there, where you are hoping to go, and any places you will pass through along the way. Murray advises that no one should be traveling to or from the hardest-hit areas of Arizona right now, for example (and probably Texas, Florida, and many other Sunbelt states). Traveling from a low-risk area to (or through) a high-risk one means you will be more likely to pick up the virus, so not only will you be more likely to get sick, but you might also bring it back to your community when you return home.
See older folks, like parents and grandparents, or other high-risk people
Safest: Virtual visit
“Call, email, or communicate through one of the services that allow you to see and hear each other virtually,” Nancy Nielsen, a dean for health policy at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo and former president of the American Medical Association, wrote in an email. If you are wanting to connect with someone who is in an assisted living facility, inpatient facility, or hospital, many of those places can help you get set up with a virtual chat — in part because it also helps them keep risks lower.
Next safest: Outdoors
Especially if you are visiting someone who lives in an assisted living facility, try to arrange a way to visit outdoors away from others who might be high-risk, such as people 65 and older. But if you must visit near the facility, “You would for sure always want to be wearing a mask and keeping 6 feet of distance as possible,” Murray says.
Moderate risk: In-home visit
This option depends a lot on how well everyone involved has been keeping up best practices of distancing (and how widely the virus is spreading in the area). “This is the question you need to ask yourself,” Lindan says. “If you are not being safe by not wearing a mask and avoiding crowds, do you want to infect and potentially kill your grandmother? If you haven’t been very careful in the previous two weeks, then don’t put your elderly relatives at risk — do a Zoom call.”
Riskier: Traveling to stay
This one depends on the above factors but also on where people are coming from and going to, as well as how likely you (or they) are to have been exposed to the virus, Murray says. For example, if you are an essential worker or health care professional, she advises a 14-day quarantine (staying at home and avoiding contact with others) first. Or if traveling there involves contact with lots of other people, she suggests planning on a 14-day self-isolation period (no contact with others) nearby before going to their home. Lindan agrees: “If you are visiting them for a long period, be sure to have self-isolated for two weeks beforehand or be very careful about your social distancing.”
Riskiest: Indoors at a care facility
“The highest risk would be actually visiting a retirement home where there are a lot of elderly people in an enclosed space,” Murray says.
Takeaways
Be especially cautious if you are seeing older people or others with higher risk for severe Covid-19 complications. And you can do other things to stay connected with these folks that doesn’t involve being in the same room, says Nielsen. “Shop for them, depositing groceries outside their front door.” Or say hi through a closed window.
And definitely skip large groups. “This is not a good time for family gatherings,” says Nielsen. And it’s something we will need to accept for many months to come. “Those may not be very safe until a safe and effective vaccine is available,” Nielsen says. We only have to look to the May surprise birthday party with 25 guests (hosted by a presymptomatic carrier) that ended up spreading Covid-19 to 18 people — including two people in their 80s and one person with cancer — and sent many to the hospital, to see how easily the virus can spread at a gathering, putting older relatives (and others) at risk.
Get routine medical care
Safest: Routine medical visits
“If you need a physical exam or Pap smear, get one,” Lindan says. Make sure that the office or facility you visit is cleaning all surfaces, has providers using N95 masks, and screening patients for Covid-19 (and keeping those who might be positive away from other patients), she notes.
Safer: Dental procedures
“Dentists have been using masks and eye shields for a long time, so going to a dentist is probably fine,” Lindan says. Especially for the patient. (“The risk is more to the dentist or dental hygienist than to you, because of aerosols and droplets that are inevitable during procedures,” Nielsen says.)
Moderate risk: Eye appointments
“It depends on what the ophthalmologist is doing,” Lindan says. If they are taking the best safety precautions, including disinfecting everything (surfaces, instruments, etc.), and wearing gloves and an N95 mask, that makes it safer. (The American Optometric Association has put out guidelines for best practices for the field.) But “given there is a lot of potential eye contact with the instruments, hands, etc., and that Covid-19 can be transmitted to the [mucous membrane of the eye], this might be higher risk,” Lindan says. “Of course, if you have an urgent eye problem, you [will] have to be evaluated.”
Takeaways
“Go now for those medical and dental services you’ve been putting off,” Nielsen says. “Medical and dental offices are acutely aware of risk,” she says. Everyone should be wearing a mask at all times — except for the time you might need to take one off to have your nose or mouth examined. These visits should be safe and can be essential for maintaining other important areas of health. For her part, Nielsen says, “Go for the elective surgery, Pap smears, physicals, eye exams you’ve postponed.” (There is a chance, though, that as Covid-19 case numbers spike in some areas, elective procedures will be put on hold to maintain hospital capacity.)
See friends
Safest: Virtual hangouts
You might have video chat fatigue by now, but it is still the absolute safest answer for socializing with those outside of your household, Nielsen says.
Next safest: Outside gathering
“Getting together in person is more soul-satisfying, of course,” Nielsen says. And you don’t need expansive empty parks for this. You can sit on a friend’s porch or patio so long as you can safely stay at least 6 feet apart. If there is food or drink, people should bring their own. And definitely avoid anything shared or in a buffet style. Also: “No hugs or handshakes!” Nielsen says.
If you’re considering ducking inside a friend’s home to use the bathroom, the riskiness of that depends on how closely those in the home — and you — have been following physical distancing. If you decide all have been adhering well, it should be okay — just wear a mask, wash your hands well, and thoroughly disinfect surfaces before you leave the room.
Should you wear masks when you see friends outdoors? Lindan says that “if you’re outside with a friend who has been cautious and probably not exposed, you probably don’t have to wear a mask” if you keep up physical distancing. But that is something to be mindful of, because staying physically far enough apart from someone you know well is difficult — even if you’re both trying your best. “It’s difficult to maintain these social distances,” Lindan says. “It’s not how we live as humans.”
But distance and fresh air don’t necessarily prevent the spread of the virus. “Spewing respiratory droplets over a longer distance can occur if someone has a vigorous cough,” Lindan says, or if people are talking loudly or singing — even outdoors.
Moderate risk: Inside a home
The level of risk here is strongly tied to how careful you and your friend (and whoever else you and they live with or see regularly) are being. If everyone has been extremely careful, you might be able to “wear a mask until all are safely distanced, then don them again if you’ll pass people closely,” Nielsen says. (Lindan goes so far as to suggest that “if they are not maintaining social distancing or wearing a mask when outside, then maybe they are not your friends.”) But still no hugs, handshakes, or shared foods.
Riskier: Meal at a restaurant
“Sit outside if possible,” Nielsen says. The restaurant should have tables spaced at least 6 feet apart. The staff should be masked, “as should all guests until beginning to eat or drink,” she says.
Riskiest: Crowded bar or event
As far as bars are concerned, Lindan says, “don’t go into them ... unless you can drink outside at a distance from others.” Even if you enter with a mask on, you and others will take masks off to drink. “Plus, getting intoxicated is likely to result in less ability to continue to be safe,” she says. “It is likely that upticks in cases in some places are the result of parties and bars.”
Add to this that “it’s more than the lack of social distancing,” Nielsen says. “It’s that speaking loudly, shouting, cheering, etc., have much more potential for droplet spread” that could spread the virus.
Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases echoed these sentiments at his June 30 Senate hearing: “Bars: really not good,” he said. “Congregation at a bar, inside, is bad news. We really have got to stop that.”
Takeaways
The bottom line: “Nothing has changed about precautions to prevent yourself and others from becoming infected,” Lindan says. “Wear a mask at all times that you are out, except when you are eating or drinking, which ideally would occur at least 6 feet away from others in your ‘safe’ group. Clean/disinfect your hands. Being outside for activities, for seeing friends, and for eating is better than inside.”
Keep children busy
Safest: Home — or outdoors with household members
Everyone might be stir-crazy by now and very tired of one another. But keeping children with members of the household is the safest for not just preventing them from getting sick (which does happen) but also to reduce the chances of their spreading the virus to others (data on this is still evolving).
Safer: Playgrounds
A quiet playground, especially one that has just been cleaned, could potentially be okay (especially if transmission in your area is low). Adults and children over 2 should wear masks and maintain physical distancing, and everyone should disinfect hands frequently. “You can try to clean off playground equipment before your child uses it, but it’s probably easier to periodically clean your child’s hands while they are at the playground,” Lindan says.
Moderate risk: Play dates
To keep play dates safest, limit the number of kids and families involved — ideally to just one other family that you trust to be keeping up good distancing practices. Perhaps most important is to “be aware of what the parents are doing,” Lindan says. “Parents pose the most risk. So avoid kibitzing in close proximity with parents whose social distancing practices you are unaware of and who aren’t wearing masks.” Also, ask other parents to wear masks when they are around your children.
Riskier: Camps
Lindan recommends trying to avoid sleepaway camps for now because it is hard to be sure counselors and other staff have all been distancing and wearing masks outside of their time with the children. “Camp experiences that are based outdoors and with smaller groups of children are better compared to an [indoor] computer camp, for example,” she says.
Takeaways
Any activity with children is particularly tricky because, especially with very young children, they are unlikely to be able to follow all of the health recommendations (staying away from other people, not touching common surfaces, wearing a mask correctly, etc.).
A lot remains to be learned about the rate at which children transmit the virus to one another and to adults. And although children do not seem to experience more typical severe Covid-19 infections as frequently as adults do, they can still get very sick and die as a result of the virus.
Get a personal treatment
Safest: DIY
Want a haircut? Manicure? Back massage? “The safest thing to do would be to do it at home or have a roommate or housemate do it for you,” Murray says.
Next safest: Quick haircut
Murray suggests this could be fairly safe “if you’re getting a 15-minute haircut, especially if you’re all wearing masks and you’re 6 feet away from other clients,” she says.
Moderate risk: Manicure or pedicure
These should be done with a plexiglass shield between the client and aesthetician, Murray notes. Also: Everyone should be wearing masks, and clients should be spaced far apart. If you’re deciding between the two nail services, “a pedicure may be somewhat safer than a manicure, since you’re not so close to one another, and you are unlikely to touch your face with your feet,” Lindan says. But it’s not entirely about the extremity you choose. “Think about how long you are going to be there and in close proximity to other clients and staff,” she says.
Riskier: Lengthier hair treatments
Dyeing, relaxing, and other longer-duration hair treatments up the risk simply because you’re spending longer indoors in a salon. “You might not be in such close contact with [a stylist], but you are going to be in their studio for a long time,” Murray says.
Murray also adds to this category of risk: massages and body waxing, like leg waxes (“if you yell when they pull the wax off, it’s more risky for the person doing the procedure,” she says. “And it can take a long time.”) Nielsen also suggests tattoos are in this level of risk “due to proximity and prolonged encounter time, even when masks are worn by all.”
Riskiest: Eyebrow and face waxing
“I would discourage people from getting their face waxed at all,” Murray says. Really any face-based treatment falls in this category, including other eyebrow services, facials, or a shave.
Regardless of the treatment, says Lindan, “make sure that all instruments have been sterilized between clients (which should be done regardless), that you and the staff are wearing masks properly and washing hands.”
Get around without a car
Safest: Walking or cycling
The fresh air and not being in sustained proximity to others helps to minimize risk — especially if most everyone is wearing masks when passing close to others.
Next safest: Private ride-hail or taxi
“The idea would be that it’s just you and the driver, and you could wipe down surfaces that you would touch and wash your hands afterward — and both be wearing masks,” Murray says. You can also keep the windows open to increase air circulation.
Moderate risk: Quiet bus or metro
“They may be reasonably safe,” Murray says. “If you’re the only person in the subway car, you’re probably fine.” But follow the same good hygiene practices that you probably should use in public transportation anyway: Don’t touch anything you don’t absolutely have to, clean off your hands as soon as you can — and don’t touch your face before you can do so. And when there are a handful of other people, “sit far apart from other passengers,” Lindan adds.
Riskiest: Crowded bus or metro
“If it starts to look like commuting hours used to, where people are squishing in, you definitely don’t want to get in,” Murray says.
Make the summer safer for everyone
Most of these activity evaluations depend on whom you are seeing and where you are. “It’s hard to make gradations of risk,” Lindan says. “It depends on what your friends have been doing, and it depends on the transmission in the community.”
Before we see anyone these days, it should be part of the new routine to let them know if we are feeling well and if we have traveled in the past two weeks anywhere where Covid-19 cases are prevalent, Nielsen says.
It is easy to find out what case levels are like in your area by going to your local health department’s website, the Centers for Disease Control and Prevention’s Covid-19 Data Tracker, or checking the rate of positive tests available from Johns Hopkins. “Become informed!” Lindan says. “It’s not difficult.”
The lesson is that life is very different this summer. And even though some activities are allowed — and even if we see friends and family members engaging in them — that doesn’t mean we should take part. In fact, says Murray, “The types of things people should be doing are the same things they should have been doing since February or March.” These include keeping distance from others, wearing a mask, washing hands frequently with soap and water, and avoiding touching shared surfaces.
This isn’t just to help you avoid getting the virus, which, as Murray notes, “sounds very bad even for mild cases.” It is to help stop the spread of the virus to others and ultimately slow the runaway pandemic.
Or, as Lindan puts it: “You cannot drive 100 miles per hour on the highway. Even if you want to risk killing yourself, it’s not acceptable to kill others. The same is true for Covid-19.”
So for everyone’s sake, try to summer safely.
Katherine Harmon Courage is a freelance science journalist and the author of Cultured and Octopus! Find her on Twitter at @KHCourage.


vox--2020-07-12--I’m a doctor. I believe my patient got Covid-19 twice.

“ Wait .
I can catch Covid twice ?
” my 50-year-old patient asked in disbelief .
It was the beginning of July , and he had just tested positive for SARS-CoV-2 , the virus that causes Covid-19 , for a second time — three months after a previous infection .
While there ’ s still much we don ’ t understand about immunity to this new illness , a small but growing number of cases like his suggest the answer is “ yes.
” Covid-19 may also be much worse the second time around .
During his first infection @ @ @ @ @ @ @ and sore throat .
His second infection , in contrast , was marked by a high fever , shortness of breath , and hypoxia , resulting in multiple trips to the hospital .
Recent reports and conversations with physician colleagues suggest my patient is not alone .
Two patients in New Jersey , for instance , appear to have contracted Covid-19 a second time almost two months after fully recovering from their first infection .
It is possible , but unlikely , that my patient had a single infection that lasted three months @ @ @ @ @ @ @ “ long haulers ” ) do appear to suffer persistent infections and symptoms .
My patient , however , cleared his infection — he had two negative PCR tests after his first infection — and felt healthy for nearly six weeks .
I believe it is far more likely that my patient fully recovered from his first infection , then caught Covid-19 a second time after being exposed to a young adult family member with the virus .
He was unable to get an antibody test after his first infection , so we @ @ @ @ @ @ @ mounted an effective antibody response or not .
Regardless , the limited research so far on recovered Covid-19 patients shows that not all patients develop antibodies after infection .
Some patients , and particularly those who never develop symptoms , mount an antibody response immediately after infection only to have it wane quickly afterward — an issue of increasing scientific concern .
What ’ s more , repeat infections in a short time period are a feature of many viruses , including other coronaviruses .
So if some Covid-19 patients are getting reinfected @ @ @ @ @ @ @ not be particularly unusual .
In general , the unknowns of immune responses to SARS-CoV-2 currently outweigh the knowns .
We do not know how much immunity to expect once someone is infected with the virus , we do not know how long that immunity may last , and we do not know how many antibodies are needed to mount an effective response .
And although there is some hope regarding cellular immunity ( including T-cell responses ) in the absence of a durable antibody response , the early evidence of reinfections puts @ @ @ @ @ @ @ question as well .
Also troubling is that my patient ’ s case , and others like his , may dim the hope for natural herd immunity .
Herd immunity depends on the theory that our immune systems , once exposed to a pathogen , will collectively protect us as a community from reinfection and further spread .
There are several pathways out of this pandemic , including safe , effective and available therapeutics and vaccines , as well as herd immunity ( or some combination thereof ) .
Experts generally consider natural @ @ @ @ @ @ @ .
It requires mass infection ( and , in the case of Covid-19 , massive loss of life because of the disease ’ s fatality rate ) before protection takes hold .
Herd immunity was promoted by experts in Sweden and ( early on in the pandemic ) in the UK , with devastating results .
Still , the dream of herd immunity , and the protection a Covid-19 infection , or a positive antibody test , promise to provide , have taken hold among the public .
As the collective reasoning has @ @ @ @ @ @ @ a Covid-19 infection ( without debilitating side effects ) is twofold : Survivors will not get infected again , nor will they pose a threat of passing the virus to their communities , workplaces , and loved ones .
While recent studies and reports have already questioned our ability to achieve herd immunity , our national discourse retains an implicit hope that herd immunity is possible .
In recent weeks , leading medical experts have implied that the current surge in cases might lead to herd immunity by early 2021 , and a @ @ @ @ @ @ @ Street Journal was similarly optimistic .
This wishful thinking is harmful .
It risks incentivizing bad behavior .
The rare but concerning “ Covid parties , ” where people are gathering to deliberately get infected with the virus , and large gatherings without masks , are considered by some to be the fastest way out of the pandemic , personally and as a community .
Rather than trying to wish ourselves out of scientific realities , we must acknowledge the mounting evidence that challenges these ideas .
In my opinion , my patient @ @ @ @ @ @ @ sign on several fronts .
First , the trajectory of a moderate initial infection followed by a severe reinfection suggests that this novel coronavirus might share some tendencies of other viruses such as dengue fever , where you can suffer more severe illness each time you contract the disease .
Second , despite scientific hopes for either antibody-mediated or cellular immunity , the severity of my patient ’ s second bout with Covid-19 suggests that such responses may not be as robust as we hope .
Third , many people may let their @ @ @ @ @ @ @ they believe they are either immune or incapable of contributing to community spread .
As my patient ’ s case demonstrates , these assumptions risk both their own health and the health of those near them .
Last , if reinfection is possible on such a short timeline , there are implications for the efficacy and durability of vaccines developed to fight it .
I am aware that my patient represents a sample size of one , but taken together with other emerging examples , outlier stories like his are a warning sign @ @ @ @ @ @ @ patient is not , in fact , an exception , but instead proves the rule , then many people could catch Covid-19 more than once , and with unpredictable severity .
With no certainty of personal immunity nor relief through herd immunity , the hard work of beating this pandemic together continues .
Our efforts must go beyond simply waiting for effective treatments and vaccines .
They must include continued prevention through the use of medically proven face masks , face shields , hand washing , and physical distancing , as well as @ @ @ @ @ @ @ of new cases .
This is a novel disease : Learning curves are steep , and we must pay attention to the inconvenient truths as they arise .
Natural herd immunity is almost certainly beyond our grasp .
We can not place our hopes on it .
D. Clay Ackerly , MD , MSc is an internal medicine and primary care physician practicing in Washington , DC .
Every day at Vox , we aim to answer your most important questions and provide you , and our audience around the world , with @ @ @ @ @ @ @ lives .
Our mission has never been more vital than it is in this moment : to empower you through understanding .
Vox ’ s work is reaching more people than ever , but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn .
Your financial contribution will not constitute a donation , but it will enable our staff to continue to offer free articles , videos , and podcasts at the quality and volume that this moment requires .
Please consider making a contribution @ @ @ @

“Wait. I can catch Covid twice?” my 50-year-old patient asked in disbelief. It was the beginning of July, and he had just tested positive for SARS-CoV-2, the virus that causes Covid-19, for a second time — three months after a previous infection.
While there’s still much we don’t understand about immunity to this new illness, a small but growing number of cases like his suggest the answer is yes.
Covid-19 may also be much worse the second time around. During his first infection, my patient experienced a mild cough and sore throat. His second infection, in contrast, was marked by a high fever, shortness of breath, and hypoxia, resulting in multiple trips to the hospital.
Recent reports and conversations with physician colleagues suggest my patient is not alone. Two patients in New Jersey, for instance, appear to have contracted Covid-19 a second time almost two months after fully recovering from their first infection. Daniel Griffin, a physician and researcher at Columbia University in New York, recently described a case of presumed reinfection on the This Week in Virology podcast.
It is possible, but unlikely, that my patient had a single infection that lasted three months. Some Covid-19 patients (now dubbed “long haulers”) do appear to suffer persistent infections and symptoms.
My patient, however, cleared his infection — he had two negative PCR tests after his first infection — and felt healthy for nearly six weeks.
I believe it is far more likely that my patient fully recovered from his first infection, then caught Covid-19 a second time after being exposed to a young adult family member with the virus. He was unable to get an antibody test after his first infection, so we do not know whether his immune system mounted an effective antibody response or not.
Regardless, the limited research so far on recovered Covid-19 patients shows that not all patients develop antibodies after infection. Some patients, and particularly those who never develop symptoms, mount an antibody response immediately after infection only to have it wane quickly afterward — an issue of increasing scientific concern.
What’s more, repeat infections in a short period are a feature of many viruses, including other coronaviruses. So if some Covid-19 patients are getting reinfected after a second exposure, it would not be particularly unusual.
In general, the unknowns of immune responses to SARS-CoV-2 currently outweigh the knowns. We do not know how much immunity to expect once someone is infected with the virus, we do not know how long that immunity may last, and we do not know how many antibodies are needed to mount an effective response. And although there is some hope regarding cellular immunity (including T-cell responses) in the absence of a durable antibody response, the early evidence of reinfections puts the effectiveness of these immune responses in question as well.
Also troubling is that my patient’s case, and others like his, may dim the hope for natural herd immunity. Herd immunity depends on the theory that our immune systems, once exposed to a pathogen, will collectively protect us as a community from reinfection and further spread.
There are several pathways out of this pandemic, including safe, effective, and available therapeutics and vaccines, as well as herd immunity (or some combination thereof).
Experts generally consider natural herd immunity a worst-case-scenario backup plan. It requires mass infection (and, in the case of Covid-19, massive loss of life because of the disease’s fatality rate) before protection takes hold. Herd immunity was promoted by experts in Sweden and (early on in the pandemic) in the UK, with devastating results.
Related A vaccine may not be enough to end the pandemic
Still, the dream of herd immunity, and the protection that a Covid-19 infection or a positive antibody test promises to provide, has taken hold among the public. As the collective reasoning has gone, the silver lining of surviving a Covid-19 infection (without debilitating side effects) is twofold: Survivors will not get infected again, nor will they pose a threat of passing the virus to their communities, workplaces, and loved ones.
While recent studies and reports have already questioned our ability to achieve herd immunity, our national discourse retains an implicit hope that herd immunity is possible. In recent weeks, leading medical experts have implied that the current surge in cases might lead to herd immunity by early 2021, and a July 6 opinion piece in the Wall Street Journal was similarly optimistic.
This wishful thinking is harmful. It risks incentivizing bad behavior. The rare but concerning “Covid parties,” where people are gathering to deliberately get infected with the virus, and large gatherings without masks, are considered by some to be the fastest way out of the pandemic, personally and as a community. Rather than trying to wish ourselves out of scientific realities, we must acknowledge the mounting evidence that challenges these ideas.
In my opinion, my patient’s experience serves as a warning sign on several fronts.
First, the trajectory of a moderate initial infection followed by a severe reinfection suggests that this novel coronavirus might share some tendencies of other viruses such as dengue fever, where you can suffer more severe illness each time you contract the disease.
Second, despite scientific hopes for either antibody-mediated or cellular immunity, the severity of my patient’s second bout with Covid-19 suggests that such responses may not be as robust as we hope.
Third, many people may let their guard down after being infected because they believe they are either immune or incapable of contributing to community spread. As my patient’s case demonstrates, these assumptions risk both their own health and the health of those near them.
Last, if reinfection is possible on such a short timeline, there are implications for the efficacy and durability of vaccines developed to fight the disease.
I am aware that my patient represents a sample size of one, but taken together with other emerging examples, outlier stories like his are a warning sign of a potential pattern. If my patient is not, in fact, an exception but instead proves the rule, then many people could catch Covid-19 more than once, and with unpredictable severity.
With no certainty of personal immunity nor relief through herd immunity, the hard work of beating this pandemic together continues. Our efforts must go beyond simply waiting for effective treatments and vaccines. They must include continued prevention through the use of medically proven face masks, face shields, hand-washing, and physical distancing, as well as wide-scale testing, tracing, and isolation of new cases.
This is a novel disease: Learning curves are steep, and we must pay attention to the inconvenient truths as they arise. Natural herd immunity is almost certainly beyond our grasp. We cannot place our hopes on it.
D. Clay Ackerly, MD, MSc, is an internal medicine and primary care physician practicing in Washington, DC. He has served both as a faculty member of Harvard Medical School and as assistant chief medical officer at Massachusetts General Hospital. He has also held positions in the government and private sector, including the White House, the Food and Drug Administration, and, most recently, as chief medical officer of Privia Health. He can be reached at dclayackerly@gmail.com.