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May 05, 2020

Is it Safe to Go Out? Helping Hoosiers Navigate Reopening

Is it Safe to Go Out? Helping Hoosiers Navigate Reopening

For many Hoosiers, the slow reopening of our society began this week. In limited capacities, malls and retail stores began opening and many restaurants can reopen as well starting next week.

But now that more “Open” signs are turning back on, you may have many more questions:

  • Is it safe for me or my family to go out? How do I decide what activities are safe for me?
  • What does the group size limits mean for me? Can I visit family and friends now?
  • What is my role to make sure this reopening plan works?

Dr. Cole Beeler is an infectious diseases specialist with IU Health, and he answered several of these questions and more in a conversation about how Hoosiers can navigate these reopening phases. He also discussed what each individual Hoosier’s responsibility is in ensuring that this plan works.

“We all have a responsibility to each other to make sure Indiana is able to get through this effectively,” Beeler said.

Learn more in the Q&A:

Q: Stage 1 was straightforward—essential activities only. But now things are starting to open up. The shopping malls are open, retail stores are open. Soon restaurants are going to open and people can go back to church or places of worship. As places open up, what are tips you would give Hoosiers who are trying to think through “Should I do this activity?” or “Should I go to this place?”

It’s going to be different for each Hoosier and different based on where you’re living, so I think the most important thing that you can know is what your local numbers look like. The Indiana State Department of Health website puts out a list of how each of the different counties are doing as it relates to infections and how they’re being transmitted.

The other thing I’d mention is that certain counties are more delayed than others, like Marion County is not yet in Stage 2. Knowing what the infection rate and where the rates are in your county is the first step.

As you’re approaching considering whether you should go out and do something, I would suss it out a little bit. Do a little spy work ahead of time. Right now the recommendation is that groups of more than 25 are discouraged from meeting, so if something looks like it could turn into a group of more than 25 people, I’d be a little bit more hesitant at this point to get involved in those areas. If you are in a vulnerable patient population, I’d also be hesitant to start mingling even if there is lower risk, since you could still get infected.

Plan and ahead and do some scouting. Make sure there’s a rule to wear masks. Masks protect you from spreading the infection; they don’t protect you from getting infected, but we have to have a community approach to wearing masks. Make sure in your scouting that you have the ability to physically distance yourself. If you’re going somewhere, make sure they have plans in place to provide for adequate physical distancing so that you can be safe.

Q: There’s definitely a difference between places being able to be open and people willing to go to a restaurant or wherever is open. How should individuals approach these new opportunities? Just because things are open, should people be ready to go out or should people still be hesitant at this stage?

The State Department of Health is releasing these guidelines after synthesizing all the data, and I would trust them.

I would say from a hospital standpoint, most hospitals are ready to accept more patients. So if patients do get sick, we are ready for them and we can take care of them. From my perspective, I’m a little bit more cautious at this point because I’m anticipating seeing a second spike.

I’m watching the numbers pretty close to see if there is a second spike to understand how tall it’s going to be. I’d recommend every Hoosier approaching each new opportunity for interaction cautiously.

The take-home point is that it comes down to your level of risk tolerance. If you are a vulnerable patient or around people who are vulnerable to having severe manifestations of the disease, then I’d have a hard time recommending going out at this point.

But if you’re otherwise healthy and you’ve got young healthy kids and are around healthy people, I think it’s probably OK to obey the guidelines and do what you want to do within the confines what the state health department is recommending.

Q: The social gatherings are increasing to 25 and then in each later phase, the number keeps going up. What kind of gatherings could those be or should those be? Or maybe, what kind shouldn’t they be? The state guidelines still say to practice social distancing at those gatherings.

The Back on Track Indiana plan has examples of what these gatherings should be and what they shouldn’t be. For instance, right now, restaurants and bars that serve food can open at 50% capacity, but in general bars that don’t serve food are supposed to remain closed. There are certain areas that they’ve assessed as being riskier than others.

To me, in general, if it’s a situation where you can adequately separate yourself and are pretty confident that the majority of people are wearing masks and there are going to be less than 25 people around, I don’t think it matters what those particular things or activities are. It’s really just about the ability to protect yourself in those functions.

Q: If it’s an informal setting, not necessarily a restaurant or a bar, but 25 people coming together in an informal setting. Maybe a family is saying, “The number is 25, we can meet again” or friends saying the same thing. What would that look like to provide that safe environment?

It’s going to be tough maintaining a 6-foot radius around yourself at all times when you’re hanging out with your friends and your family. In general, if it’s friends and family that only hang out together, that’s a little bit safer than friend groups where friends are hanging out with a bunch of different people just because there’s more unknowns, there’s more chances of asymptomatic infections in that scenario.

The only advice I can give is: Do the best that you can. Masks, certainly, are thought to help in this situation and the big thing is space. If you can give people a wide berth at about six feet, that’s probably the best thing you can do for yourself.

And I’d recommend abundant hand hygiene and to make sure the things you’ve touched get wiped down with cleaning agents so they don’t affect the people around you.

So when you start getting together with your friends and family, just try and build in some of these things. Space out when you can. If you can’t, wash your hands and disinfect areas and do the best you can at all times.

Nothing ever is going to be perfect. There are no rules that we can build that will 100% protect people because there are so many unknowns with this virus, but what we do know is that it does seem to be extremely infectious. The general rules that I’ve discussed here are really the best that we can do in all circumstances where we are interacting with others.

Q: As society opens up, it might be easier for adults to know how to physically distance and make other good practices. What advice might you give to parents helping kids and young ones to practice good social distancing?

I wish I had the answer to that. I’ve got 4 kids and if I could get them to listen to me in public and you had some sort of magic trigger word that I could use to get them to obey, that would be great!

I think it’s the same thing – do the best you can. Try to keep them close to you. If they’re older, have them wear a mask. I would say the risk to kids is probably minimum for having bad outcomes with this infection, but they can spread it to other people. Masking adolescents seems reasonable to me, making sure kids’ hands are clean and trying to limit the amount of time they are close to people. If you have one kid who is a straggler and goes up and starts talking to strangers, my recommendation is to catch that and limit it.

We think that this infection is transmitted most effectively within that 6-foot radius but over prolonged periods of time. It should take 10-15 minutes for the virus to transmit itself from person to person. As long as you catch your kid as they are getting close to other people, I think that’s the best you can do.

But that’s a really hard order trying control how and where kids are moving!

Q: When a state provides a roadmap, a reopening plan, what are going to be the keys to success? What are those keys to make sure this works?

I think the best thing that I could tell you is to go slow. We’re not out of the woods. As a matter of fact, we’re seeing increasing cases, and there’s always the possibility we will have to shut things down again if things get out of control. This is not back to business as usual. This is a very slow reduction of social isolation measures.

Part of that process is the request that each person should plan ahead, getting information about their social interactions just to be smart about what they are doing, wearing masks, keeping a 6-foot radius, washing hands, avoiding large groups, disinfecting- these are all important things that you can do to help protect yourself.

This is an assumption that is being taken into account as it relates to how we are reopening. We will only reopen successfully if people follow those general guiding principles.

The worst thing that could happen is if we see a little bit of light at the end of the tunnel, which is what I think we’re seeing right now, and everyone starts sprinting to the end of the tunnel and tripping over themselves and no one makes it out of the tunnel because there’s a pileup.

From my perspective, I’d really recommend keeping up with what the state health department is saying, making sure you understand your local numbers and you are doing the best to protect yourself and your family.

Q: The governor in his press conference and in the Back on Track plan cited the four principles they are tracking – hospitalized patients, surge capacity, testing and contact tracing – what are ways each of us can do our part to help keep those in check?

A lot of this stuff is out of an individual’s control. For instance, surge capacity is really going to be based on volume in the hospitals, testing capacity is really going to be based on a hospitals’ ability to acquire testing reagents and appropriately utilize tests, contact tracing is dependent on workforce in the public health department.

But all of these factors are contingent on the individual being protecting themself, being able to decrease the overall rate of transmission to what we’ve done previously.

The first pillar is improving the total number of COVID diagnoses. The best way an individual can help improve the total number of COVID diagnoses is by doing the things we’ve talked about, keeping a radius, wearing a mask, avoiding groups more than 25, disinfecting after yourself.

All those things should help slow the spread of infection. If we slow the spread of infection, that will retain capacity in the hospitals. If we slow the spread of infection, that will make it easier for public health departments to do contact tracing and it will open up tests for people.

Q: Do you see this, during these phases, that it does come to each individual’s responsibility? Especially as society reopens, does each individual’s ability to make decisions and be safe with what they are doing – is that what this boils down to?

It’s a team sport. So, yes, each individual is responsible for the success of the society, but at the same time we also have a major responsibility in the healthcare setting to make sure it’s safe for patients who do get sick. We see it as a two-way street. There’s individual responsibility and there’s also our responsibility. I know the state health department feels the same way and the government feels the same way. We all have a responsibility to each other to make sure Indiana is able to get through this effectively.

Q: What’s the key message to Hoosiers as things start to reopen?

The main point to me is that this will only work if everyone is in it together, if we’re all following the same rules. It’s really easy to assume, you know, everyone else will be good guys and I’ll be able to go and do this extra stuff because I haven’t seen someone that’s sick. I think that’s really dangerous. If that philosophy propagates itself, if you’re doing more, then people feel like they can do more, and it can snowball.

From my perspective, I would really encourage everyone to take the advice of the public health department as well as the government to really slowly roll this out so we can eventually get back to a more normal practice. That’s the goal here. We want to get back to how we were living and what we were doing before but this is going to be contingent on everyone working together.

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