The Covid Audit
This Lawyer Ran Errands for His High-Risk Wife. Then an Epidemiologist Rated His Every Move.
Real life meets public health advice
Wouldn’t it be nice, as you go about your confusing, nerve-wracking, Covid-19-avoiding days, to have an epidemiologist on call to answer your many questions? Consider the Covid Audit the next best thing. This project, a collaboration between Elemental and the Epidemiologic Covid-19 Response Corps at the Boston University School of Public Health, asks real people to document what they’re doing to avoid Covid-19 and gives friendly feedback on actions you can take to support both public health — and your own. This week’s reviewers are response corps members Sarah Lincoln and Ivanna Rocha, graduate students in the Master of Public Health program at BU.
Our diarist is a lawyer who normally lives in Maryland with his wife and their school-aged daughter. His wife is both a busy, high-powered lawyer and a breast-cancer survivor undergoing treatments, putting her at higher risk for Covid-19. In March, her physician suggested she’d be safer in a less-populated area, so the family decamped to their small vacation condo in South Carolina.
There, our diarist has been going on the vast majority of the household errands — a few days of which he documented for us earlier this summer. “It’s been a roller coaster in terms of getting through this whole thing,” he says. “We’ve had sleepless nights wondering if this is just going to come for us anyway, no matter what we do. But after about two months, it became the new normal. As long as no one in your sphere has Covid, you go about doing your daily business.”
Day one, 9 a.m.
With both my wife and me working remotely, most of the day is spent at home. Our family has been coming to this spot for many years for vacations, and coincidentally, at the end of last year, we happened to purchase a vacation property here. Little did we know how much we would be using it! When the things began in the spring, my wife’s doctor recommended that, given the worsening situation in the Northeast corridor at that point, if we had an opportunity to get out of town we do it.
Ivanna Rocha: It’s a sensible idea to remove yourself from a high-risk area if you have the ability and resources to do so. Keep in mind, however, that if you’re traveling from an area with a high number of Covid-19 cases to one with less, you are posing a risk to the locals themselves. When doing this, make a point to safely quarantine before interacting with the community.
We packed up the car and I drove down, stopping only for rest stops and food. My wife and daughter and the cat flew down. There were stories in the news about flight attendants getting sick and there was a slight bit of nervousness on the day of the flight. But it turned out there were four people on the plane and a cat — total. So at least her exposure was minimal on the way down. We only expected to stay two to four weeks, but we’ve been here all summer.
Sarah Lincoln: In general, travel raises your chances of getting Covid-19 because it increases the frequency of close contact with others and with shared surfaces. Both air and car travel can be more or less risky depending on the circumstances. Air travel is thought of as risky because of time spent in airport terminals and security lines. There is also the potential for crowded flights where social distancing isn’t possible. As for the flight itself, airplanes usually have proper ventilation that circulates and filters the air so that viruses can’t spread as easily. Car travel can be risky if making more frequent stops because again, it is increasing the interaction with others and shared surfaces. In this case, flying seemed to be safer than driving because the flight was a shorter trip and there were very few people on the plane.
Ivanna Rocha: Cases of infection arising from plane travel have been few and far between. Still, if you really are worried about it, do a little bit of research and travel with an airline that’s committed to passenger safety. Some things to consider: Are they filling every seat? Are masks required or optional? Are they serving food and drink? Try to not eat or drink in an airport or on a plane, because that would require you to remove your mask.
Day one, 2 p.m.
I walk to the beach, which is less than five minutes away. Our house is in a group of homes, about 40 properties in total, that share a beach access point. It’s not gated, so anybody could just walk onto the beach, but it’s not overrun because there’s no public parking.
Today I have a mask in my pocket, just in case, but I don’t encounter anyone on the way. At the beach, it is sparsely populated. There are small groups, family units, at least 50 yards apart. In the ocean, there are about a dozen people. I see a group of eight teenagers (clearly, not a family unit) frolicking in the waves.
I see groups of 10–20 teenagers on the beach all the time now. I’ll joke to my daughter, “Look, it’s the infectious teenagers!” And one of our teenage neighbors did end up getting sick, and his whole family got Covid as well. Thankfully everyone is recovering, but the meetups are still going on. I make a point of moving farther away, and upwind, when they drift toward me.
Sarah Lincoln: The bigger the gathering and the longer the duration of the event, the more risk there is. We’re already seeing outbreaks of Covid-19 linked to gatherings of people from different households. Since there isn’t much to be done about stopping people from meeting up, the diarist and his family were smart to move far away from these groups.
Day two, 8 a.m.
I go biking in the morning. Right away when we got down here we bought bicycles, which turned out to be really lucky because within a few weeks they were completely sold out. I don’t wear a mask while biking since I’m not within six feet of anyone for more than a couple of seconds. The main path is somewhat crowded, so I switch to a less populated one. Even with this precaution, I hit a backup of seven bikers at a stop sign for about 30 seconds. I stay 10 feet behind the biker in front of me. As the path clears for us to move ahead, I hold my breath as I pass through the area once occupied by the stopped bikers. I find the first opportunity to pass the group and get back in front, and then speed up to leave the group well behind.
Ivanna Rocha: The diarist’s protocol sounds okay, if a bit excessive; breath-holding is likely not necessary. Being on the bike, it’s unlikely for surrounding air to pose any real danger, but if it helps the diarist feel more confident about getting exercise, there’s no harm in taking this precaution. As for mask use during exercise, it is not well understood, but it would be a good idea for anything easy-going, like walking through a populated area or a yoga class. The trade-off comes from whether a mask then becomes a source of oxygen deprivation to the person working out. If a workout is cardio-intense — like biking — the person should try to do it without a mask, but also do it someplace that makes it unlikely to come in contact with other people.
Day two, 1 p.m.
That afternoon, I went to the grocery store. I have on a mask as I enter, as does everyone else I see. We’ve also used a meal delivery service and Instacart orders. When I go to the store, I try to go in the middle of the day during a workweek, when there won’t be as many people there. Even before it was required, we wore masks and sanitized the hell out of everything when we got home. It’s always very targeted when my wife goes out, but it is not like she’s never left the house. She probably goes on errands 30% of the time. And I go 100% of the time.
A grocery clerk points to a rack of carts, and he tells me that all of them have been cleaned. Even with this assurance, I grab a sanitizing wipe from the complimentary dispenser and wipe down the handle. Going through the aisles, I never follow anyone else down a row, and when I pass people coming toward me, I do so with as much speed and space that I can provide. When checking out, I choose the self-service lane. When punching in my customer ID number and using my credit card, I use my knuckle on the touch screen. As I exit, I grab one of the sanitizing wipes for my hands. After I get to my car, I use hand sanitizer again before pulling down my mask and starting the car.
Ivanna Rocha: If they’re both available, it’s ideal to use a wipe as the diarist does versus just alcohol gel when sanitizing your hands due to friction. But it doesn’t make a difference for the diarist to sanitize immediately after leaving the store and then again before getting in his car; he can sanitize his hands once after loading up his purchases into the car. It seems as though the family also sanitized groceries once he got home. In general, experts advise against using soap or other chemicals on fruits and vegetables because they can make you sick. Wiping down plastic, glass, or metal containers might be helpful, but simply washing your hands well after handling the groceries is likely sufficient. It’s also interesting that as careful as the diarist seems to be, he’s opting for a knuckle on a touch screen rather than a stylus or alternative tool that removes his hand from the equation altogether. Transmission from surfaces seems to be less likely than from close contact, though, so a tool is not a necessity.
Day three, 8 a.m.
I take a walk in the morning. Again, I have a mask with me, but I don’t wear it since there is nobody around. Every five to 10 minutes, I pass another walker (coming toward me) or a biker who passes around me, but in each instance, there is always at least six feet between us, with each encounter taking less than a second. On the final turn of my route, I do see a large group of people at the corner, none of whom have masks. I go off the path to make a large semicircle around them.
Sarah Lincoln: The diarist knows that he will not be in close contact with others and doesn’t necessarily need to wear a mask. I commend him for bringing along a mask anyway and being careful to remain at least six feet away from the people he did encounter. It’s a good habit to slip on your mask when circumventing people, even if you’re able to do so at a generous distance like the diarist does.
Even though there are a lot of older people in this resort town, there is still that Southern independent streak. Very few people were wearing masks until the mandates began from chain stores like Target and Walmart, and then eventually the town put out its own rule. It made a difference because the stores and restaurants can be fined if customers are in violation. Still, there are always people who put their masks on in a half-assed fashion or down below their chin.
Sarah Lincoln: The diarist is right to call out the people who are wearing their masks in a “half-assed fashion” or under the chin. The main purpose of wearing a mask is to reduce the transmission of respiratory droplets from yourself to those around you. Masks are only effective if worn properly, which means completely covering both the nose and mouth at all times. Covering just the mouth, just the nose, or neither, could potentially allow droplets to spread both from you and to you.
Day three, 12 p.m.
Later, we do take out for lunch. Since the day we got down here, we have not gone to a restaurant to eat either indoors or outdoors. Even though South Carolina allowed for it earlier than most, we just decided not to. We want to take every precaution with my wife’s higher risk.
Sarah Lincoln: Even though restaurants are allowed to be open, it is reasonable for the diarist to be wary of eating there, regardless of his wife’s condition. There is always some level of risk to any activity during the pandemic, but in terms of eating out, getting takeout is the safest option. It’s good practice to wash your hands after handling takeout containers and before eating, but otherwise takeout is a reasonably safe activity. It’s particularly a good idea for high-risk individuals and their household members to avoid eating at restaurants, even if they have outdoor seating. There is no way to guarantee that the establishment is fully on top of all the necessary safety measures and there is also no way of knowing what other customers have been doing in their daily lives.
As I do every time we do get food outside the house, I order ahead and stop by the restaurant wearing a mask. There is indoor and outdoor dining. The pickup window is in the outdoor seating area, adjacent to the bar. Most of the patrons do not wear masks, but most of the waitstaff does.
Ivanna Rocha: The public should be aware that in a dining room situation, whether indoors or out, the waitstaff is actually the group at highest risk of infection. Servers will have to come in contact with all patrons whether tables are six or 12 feet apart. As well-intentioned as a restaurant may be in staying open, safety precautions are upheld to make their customers feel safe, not so much for their employees. It’s best to keep away from on-site dining as much as possible, but if you do choose to stay for your meal, wear a mask in the presence of staff and only remove it when eating.
Given the environment of lots of people expelling breaths without masks, I’m anxious to get in and out of the restaurant as quickly as possible. My food is ready, but the woman taking payment at the window disappears into the back with my credit card to run it through. One minute passes, then two. I think about every minute I stay standing there as a percentage increase in my chance of catching something. I seriously consider just leaving the food behind and canceling my credit card. Thankfully, the attendant returns with my card. I take my food and quickly leave.
Sarah Lincoln: It’s only natural to feel anxious during these times, given the unknowns of the virus. However, even though the diarist was surrounded by maskless diners, the fact that he was outdoors and spent minimal time at the window, means he did not have a high chance of catching Covid-19. Being outdoors, in general, allows for respiratory droplets to disperse or get carried away by constantly moving fresh air.
Ivanna Rocha: All of our decisions these days feel like a mind game. Being overcautious is generally better than a false sense of security, but at what point does it become paralyzing fear? I understand the diarist’s panic at the restaurant, but there are ways to avoid these feelings altogether. Weigh out your options beforehand, pick a restaurant that you know handles takeout apart from dine-in areas, or consider ordering for delivery. Anxiety can come from having to make decisions on the fly. Before you go out, make a backup plan in case you encounter situations that are at odds with your self-enforced safety precautions.
Day three, 4 p.m.
In the late afternoon, I go to the library to check out some books for my daughter. I enter wearing a mask, and everyone in the building is also masked. A librarian (masked) attends the main counter behind a plexiglass stand. He has the books I previously reserved and hands them to me through the hole in the plexiglass. After taking the books, I use hand sanitizer before returning to the car.
Ivanna Rocha: My family has been checking out books and movies from our local library as well. We follow a similar procedure as the diarist did, but we also leave our haul in the car to quarantine for a couple days before bringing it in the house just to be safe.
Right now I’m the primary educator, IT consultant, and playmate for my daughter. That can be exhausting. She is a good kid but these are skills I haven’t been trained for. And when it’s just you and your child, It makes it all the more difficult. She can’t really meet new kids in this situation. I know some families in Maryland have planned play pods, and I wonder if we might have joined them if we had been home. My wife’s higher risk factors into every decision we’ve made, but sometimes you have to make a calculation. Maybe for your own mental health, you take a chance.
Sarah Lincoln: Caregiver advice: The diarist puts it well by saying it is a calculation. If you think it’s important for your child to be able to interact with others, think about how much risk you and your family can handle. Be open and transparent about communicating your boundaries and risk level with those you’re considering creating a play pod with.
I want to reiterate that it is impossible for anyone to have zero risk of infection. There is only more or less risk, so it’s important to be aware of the risks associated with various activities. This will allow you to make informed decisions about what you’re comfortable doing while following best practices — meaning social distancing and mask use — for staying safe.
