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Illustrations: Xinmei Liu

The Covid Audit

This Executive Took a Road Trip. Then An Epidemiologist Rated Her Every Move.

In our new series, real life meets public health advice

Wouldn’t it be nice, as you go about your confusing, nerve-wracking, coronavirus-avoiding days, to have an epidemiologist on call to answer your many questions? Consider the Covid Audit the next best thing. This new project, a collaboration between Elemental and the Epidemiology Covid-19 Response Corps at the Boston University School of Public Health, asks real people to keep a diary about what they’re doing to avoid Covid-19 and gives friendly feedback from the response corps team on actions you can take to support public health — and your own. This week’s reviewer is Eleanor Murray, ScD, assistant professor of epidemiology and co-director of the response corps; follow her on Medium and Twitter at @epiellie.

Our first diarist is a nonprofit executive who lives in New York City with her husband and two sons; no one in the family has preexisting conditions that raise their risk for Covid-19. She kept a diary of a road trip over the July Fourth holiday weekend to check in on her parents in Kentucky. “My parents are in their eighties and the pandemic ability to work from anywhere — a privilege, I realize — has, oddly, made it somewhat easier to visit them for a weekend and help clean up, check on which meds need refilling, monitor their overall health, and break up the monotony of being locked inside with your life partner for months,” she says. “This last bit applies as much to me as to my folks, as I am leaving my husband at home.”

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DAY ONE, 12 P.M.

I always like to start a road trip with a full tank of gas, so I am dismayed to see, while stuck in traffic on the approach to the George Washington Bridge leaving Manhattan, that we are down to a quarter tank. I was really hoping to minimize stops on the 700-mile way from New York to Kentucky, and a quarter tank is the difference between one fuel stop and two.

We didn’t get tested before leaving. We had been very careful about exposures and the delay for test results at the time made it nonsensical. Also, it felt riskier to go to, say, an urgent care in New York and expose ourselves to everyone there.

Murray: Testing is most useful when the results can be obtained within 24–48 hours, and when you can quarantine until the test results are available. This is because any exposures you have after the test is taken can make the results outdated. So, unless test results are very rapid in your region, it may be more useful to simply reduce contacts as much as possible before a trip. When possible, a full 14-day quarantine before a trip is ideal, but about half of people with infections which will eventually result in symptoms start feeling sick by day five after an exposure. The diarist is also correct in noting that the testing site is a potential source of infection, but it’s also true that testing sites take very strong precautions. Overall, the diarist likely made a reasonable decision to forgo testing given long delay times for results.

Near the border between Jersey and Pennsylvania, I face the fact that I have no choice but to stop for gas. I pull in, asking one of my kids to pass me a fresh pair of disposable latex gloves from our stash of supplies, which also includes hand sanitizer and disinfectant wipes. But then I look up to be reminded that all pumps in New Jersey are full service. I never touch the dreaded handle. I tip the masked attendant gratefully.

Murray: New Jersey’s full-service gas stations means the diarist needed to touch fewer shared objects than she would have at a self-service gas station. Although she doesn’t describe in detail how she paid, she may have had to touch a payment terminal. This is not a big risk, especially since she had hand sanitizer readily available. On the other hand, a full-service gas station does mean that she was required to communicate with the station attendant. I’m glad to hear the attendant was masked, but reading the diary I am left wondering whether our diarist also donned a mask before speaking with the attendant. Tipping the attendant is certainly important, but doing so while not wearing a mask risks transmitting SARS-CoV-2 if you turn out to be presymptomatically infected.

“The place looks cleaner than my own home, but I wipe down everything with disinfecting wipes anyway… door handle, light switch, thermostat, every bathroom fixture and especially the remote even though I don’t even turn on the tv.”

DAY ONE, 6 P.M.

Somewhere in Pennsylvania, we stop for dinner. Five Guys. Mobile order. My oldest son goes in to pick up the bag. The cheeseburger I eat is probably the unhealthiest thing I encounter on the trip south and I enjoy it thoroughly. These days any meal I don’t have to cook or clean up after is a novelty. We drive on.

Murray: A mobile order at Five Guys eaten in the car is definitely a safe way to approach eating while traveling. I hope that the diarist’s son and the restaurant staff were wearing masks, and that he had the opportunity to sanitize his hands after being in the restaurant.

DAY ONE, 9 P.M.

Overnight at a Hampton Inn and the room is sealed with a Lysol-branded sticker to reassure us it is sterile. It has taken exactly three months for Covid to become a cross-marketing opportunity. The place looks cleaner than my own home, but I wipe down everything with disinfecting wipes anyway… door handle, light switch, thermostat, every bathroom fixture, and especially the remote even though I don’t even turn on the tv.

Murray: Staying overnight at a hotel has felt risky for many people, and, while it may not have been necessary to wipe down all the hotel surfaces, there’s no harm in doing so to reassure yourself that it’s safe to relax for the night. Opening the windows, when possible, for an hour or so can also be a good way to ensure that the air in the room is fresh.

A sign says the housekeeping staff will only enter and clean my room if I request it. Thoughtful. The only worry I have is… does the virus travel through AC vents? What if our unseen neighbor in 324 is a silent carrier?

Murray: It’s currently not known whether the virus can travel through any AC vents — although we do know that a HEPA filter should be sufficient to block the virus. Back in 2003, there was documented evidence that SARS could travel through vents. For those who are concerned about this mode of transmission, asking the hotel concierge about the type of filters in the AC system can be reassuring, but simply opening the windows to circulate fresh air is likely the most effective preventive measure.

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DAY TWO, 12 P.M.

New Jersey, Pennsylvania, Maryland, West Virginia, Kentucky. Five states in 11 hours, and at two stops for food we see very different behavior. In a semirural area of Eastern Kentucky, where we stop for barbecue on Day Two, diners are eating inside the restaurant. I stare at them as if they are animals in a zoo. They stare back at me — maybe it’s my mask? The woman who takes my to-go order is masked but no one else in the restaurant is wearing one. We eat in the car, as we have eaten every meal on this trip.

Murray: The diarist’s description of feeling out of place in states where people eat inside restaurants is a telling example of how fractured the public health response to Covid has been in the U.S. While the precautions needed will naturally vary from place to place, depending on the level of infection in a given location, there’s also a large variation in the risk level that state and local governments are willing to accept. Taking at minimum the same precautions you would at home is therefore the best advice when traveling.

DAY TWO, 5 P.M.

On arrival in Kentucky, we don our masks and say hello to my parents. There are no hugs… just a pat on the back, some elbow bumps from the kids. The children and I run to Trader Joe’s and luxuriate in the fact that there is no line outside the store, which is good because it is a humid 90 degrees. We grill dinner outside so that I spend minimal time in my parents’ kitchen and although we eat indoors, we crank up the AC and the kids and I sit on the sofa in the living room while my parents eat opposite us at the dining-room table. We can talk but it is challenging to carry on a real conversation.

Murray: The diarist takes some good precautions to physically distance while allowing social interaction. One potential concern is the positioning of the diarist and her kids relative to the AC unit. If this is central air (which often has HEPA filters), then it’s not important, but if the AC is a window unit then it’s important that people not sit or stand within the path of airflow from the unit toward other people. In many homes, the AC will be installed in a window behind the couch. If that was the case here, then the AC could potentially blow infectious droplets further than the roughly six feet we usually expect them to travel.

“Never before have I been so grateful for a clean public toilet with a lid that you actually must close in order to flush it.”

DAY TWO, 8 P.M.

After dinner, we retreat to our Airbnb. As we enter, we find the owner, who has been cleaning the apartment, just finishing cleaning. It is one thing to enter a rental apartment and find it empty and clean, altogether another to be reminded that there was another couple or family there mere hours before.

Murray: While the diarist finds this a cause for concern, it could actually be viewed as a positive thing — confirmation that the apartment has indeed been cleaned thoroughly since the last visitor.

I had pondered renting the unit for an extra two nights prior to our arrival just to ensure some separation between us and other guests but I couldn’t stomach the added expense. I get out my disinfectant wipes and go to work.

Murray: Giving the main surfaces another wipe down is probably unnecessary, but as with the hotel, can ensure peace of mind. On the other hand, the diarist’s musing about renting the unit for two nights before their arrival is definitely excessive caution. On surfaces and in the air, the virus decays rapidly over time. Hard and smooth surfaces, like metal and plastic, support survival of the virus for the longest but these are also typically the easiest to clean. For travelers that need to be extra cautious due to underlying health concerns of themselves or people they will be in contact with, booking a unit for a single extra night before arrival could provide some extra protection.

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DAYS THREE–FOUR

The weekend flies by. I marvel at little things people can do in Kentucky (eat indoors at restaurants, go to the post office without waiting in line for half an hour), and things some people do there (go maskless). Somewhere along the way, I learn that hand sanitizer takes the itch out of mosquito bites. On Sunday, my sister has booked us a canoe/kayak trip on a remote river in the country. We drive for almost an hour, venture down a dirt road, and find ourselves in a beautiful oasis where for a couple hours no one thinks about hand sanitizer or masks and we just drift on a river where the greatest risk we face is sunburn. It is almost possible, for an hour, to forget what is going on.

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DAY FIVE

Soon we are back on the road again, New York-bound. Somewhere in Maryland near the Eastern Continental Divide, we stop at a rest stop that boasts great views but even more impressive toilets. Never before have I been so grateful for a clean public toilet with a lid that you actually must close in order to flush it.

Seems like a simple, almost accidental, feat of engineering but given what we have all read about toilets spraying germs into the air, it is genius. In a world where the misguided government is trying to legislate women’s access to contraception and force schools to open, perhaps they could focus on a little thing we could all get behind, like safer toilets?

Murray: It’s a sign of our times that it’s quite exciting to hear of a rest stop bathroom equipped with lidded toilets. There is strong scientific evidence that SARS-CoV-2 virus is found in fecal matter — indeed, some places like Cambridge, Massachusetts, have started routinely monitoring sewage water to detect changes in the prevalence of the virus within the community. We also know that when toilets are flushed, tiny particles of water containing fecal matter can spread six feet or further into the air — closing the lid blocks that spray entirely. What we don’t know for sure yet is whether people can get infected by inhaling the particles sprayed out by a toilet plume. We also don’t know how long infectious particles (if there are any) would stay in the air after flushing a toilet. So, while it’s definitely a good safety tip to close the lid before flushing, we don’t really know how risky flushing an open toilet is.

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DAY SIX

In no time, we are home in New York again, welcomed by signs in New Jersey reminding us that we should call 511 to learn if we need to quarantine for two weeks. On the radio as we approach the city, we learn that New York has added another three states to the list of states that pose a risk. Idaho. IDAHO?! I am thankful to live in New York and to be arriving from Kentucky where the governor, Andy Beshear, responded swiftly and smartly to the pandemic and flattened the curve. But I can’t help but feel the second wave (or really isn’t it still the first wave?) of this pandemic lapping at New York’s shores. Six states, four days, one virus, no borders.

Murray: Overall, the diarist’s description of her travels paint a picture of a cautious but not overly anxious individual, who is well aware of the mechanisms of Covid transmission and does a good job of protecting herself and her family. My closing question: After returning home, did the diarist quarantine for two weeks? Given the number of states they passed through, quarantine was likely warranted even if not mandated.

Note: The information contained in this document constitutes recommendations for actions individuals can take to support public health, but should not be construed as medical advice.

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Written by

Sara Austin is a writer and editor in New York. She has held senior editorial positions at Real Simple, Cosmopolitan, Self, and Marie Claire.

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