Many questions continue to swirl regarding what it will look like when we are no longer living in the shadow of COVID-19. Many states have begun the “re-opening” process, some forging ahead despite an increase in numbers within their state.
So why are we in the reopening process? On the one hand, there’s a sense of urgency to return the economy to normal. On the other, there’s the very human desire to return to the life we lost in March.
Either way, it’s crucial to navigate reopening safely and protect yourself so that you can not only stay healthy, but also avoid putting your patients at risk.
Reopening vs. “Back to Normal”
The first thing to keep in mind as reopening begins is the simple fact that this virus has not gone away. The vast majority of people are still susceptible to contracting COVID-19. Simply designating a state or city as “reopened” does not mean that things are ”back to normal.” Rather, it is an effort to get people back to doing things they want to do and for businesses to do business.1
It’s truly going to be up to each and every one of us to determine what the reopening will look like. Individuals will have to weigh the risk versus benefit of resuming normal activities, along with their own tolerance for the unknown. The one thing all health experts do agree on is that we must remain vigilant: maintain social distance, wear masks, and wash your hands.1 We must all take responsibility for our own health and the health of those we need to be in contact with—like our patients.
Is It Safe Outdoors?
While there is nothing inherently risky about being outside or going to the beach, for example, it’s still necessary to avoid large crowds. Having as few people around you as possible will be your best defense. Outside—or even in the water—you should still be maintaining the six-foot spacing guideline.
It’s now better understood that asymptomatic people can infect others.2 If you are standing too close when interacting, there is a chance you can become infected and not know it.
While nature’s good air movement can help, this can only protect you as much as you are willing to let it by maintaining the recommended social distance.
What Role Do Masks Play?
Masks can reduce the number of droplets expelled from the nose and mouth, but they are not perfect. Droplets from sneezing, coughing, and even talking are considered to be the main mode of transmission, landing either on another person or surface.3 Those who touch a contaminated surface may be at risk if they then touch their face, especially their eyes or mouth.
It’s also important to recognize that masks do not protect your eyes. Since this virus can enter the body through the eyes, following social distancing protocols will reduce that risk.1
Reopening Healthcare Facilities and Practices
The primary role of a healthcare worker, in any setting, is to care for vulnerable people. Whether or not there is COVID-19 in the facility or practice, the fact does not change that patients are at risk for getting the virus from the healthcare providers they have contact.
The Center for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) have provided guidelines for reopening healthcare settings. While there are many details that need to be worked out at this point, there is enough guidance from both to capture what the future may hold for healthcare workers.
These areas are consistent throughout all planned phases of reopening:
- Screening of all healthcare workers will be done prior to beginning a shift. Although there has been speculation about this practice due to the evidence of asymptomatic carriers, it is still an expectation that will continue into future practice.
- All healthcare workers will wear a mask at all times, and social distancing with co-workers is recommended.
- There will be a heightened awareness and monitoring of good hand hygiene, which involves either the use of hand sanitizer or a 20-second washing of hands with soap and water.
- All healthcare workers will be expected to clean and disinfect their work area according to facility protocols, especially between patients.
- Healthcare workers will be expected to wear PPE during all patient encounters and interactions.
- In long-term care facilities, group activities as well as communal dining will not occur until Phase 3, and even then will still be limited.
- Healthcare workers will need to proactively inform their supervisor if they have any fever, new cough, new muscle aches, new shortness of breath, or new loss of sense of smell or taste.
There is little doubt that this virus has changed the world of healthcare forever. Until a vaccine is developed with proven efficacy, it is a safe assumption that the life of healthcare workers will remain under high scrutiny.
What About Restaurants?
Many states that are reopening restaurants and dining areas are doing so at limited capacity. While the CDC has devised guidelines recommending operating at limited capacity, setting tables well apart, using disposable menus and single-serve condiments, and requiring wait staff to wear masks, these guidelines were never made public, leaving many restaurant owners and operators at a loss with only recommendations that vary from state to state.4
Deciding whether or not to go to a restaurant is going to be a deeply personal choice. Many will just not be ready to risk it at this point. One good step to take is to call ahead or check the restaurant’s website to find out what precautions they are taking before you make your decision. Additionally, remember that those you’ve been in daily contact with at home should be the only ones with whom you dine out. As nice as dinner with friends might sound, during these early stages of reopening, be cautious regarding who is sitting at your table
Will Travel Be an Option?
Remember early on when the first question asked of anyone was whether they had recently traveled? That has become a moot point now that the whole of the United States is considered high risk.
Driving to your destination and staying in a hotel that has been adequately cleaned between guests may be the best option for many people. Bringing your own pillow and disinfectant wipes can help put you at ease if you choose this option.
Airlines are busy ramping up their effort to keep those who chose to or need to fly safe. They have added deep cleaning between each flight, fresh and recirculated air now goes through special HEPA filters, and many airlines are now requiring staff and passengers to wear a mask during the flight. Studies on respiratory and infectious diseases have generally concluded that the overall risk of flying is low, except for people within two rows of an infected person; therefore, maintaining distance on the plane and during the boarding process is key.1
As with everything else, if you must travel, plan ahead. How prevalent is the virus in the areas you are traveling to and from? Are there requirements that you self-isolate upon arrival? If so, is your travel truly required? Simply speaking, if it’s not essential, it might not be worth it.
Protecting Yourself and Others
As we move forward into the unknown with scientists warning us of a potential resurgence in the fall,5 what is our best defense going forward?
- The best way to prevent illness is to avoid being exposed to the virus.
- It is thought to spread mainly from person to person:
- Between people who are in close contact with one another (less than 6 feet apart).
- Through respiratory droplets produced when an infected person coughs, sneezes, or talks, which land in the mouth, noses, or eyes of people nearby, or may be inhaled into the lungs.
- Clean your hands often.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Avoid close contact with people who are sick.
- Stay home when possible.
- Put distance between yourself and others when you do need to go out.
- Wear a facemask when going out in public to protect other people in case you are infected and don’t know it.
- Continue to clean and disinfect frequently touched surfaces daily.6
The Bottom Line
As states move to reopen despite the ongoing spread of coronavirus, it is important that each of us determines what we accept as our new normal. Many businesses are conscientious about following the safety guidelines while others fill to capacity with little regard or concern.
Know what is acceptable for you. Call ahead and find out what is being done to protect the consumer in the various establishments you plan to visit. Remember that as a healthcare provider, the decisions you make will also affect your patients.
Life will return to something more normal; we are just not there yet. We have to be patient and knowledgeable about the challenges still facing us.
In his book, The Great Influenza: The Story of the Deadliest Pandemic in History, John Barry wrote:
“By 1918 humankind was fully modern, and fully scientific, but too busy fighting itself to aggress against nature. Nature, however, chooses its own moments. It chose this moment to aggress against man, and it did not do so prodding languidly. For the first time, modern humanity, a humanity practicing the modern scientific method, would confront nature at its fullest rage.”7
Nature has again chosen its moment. It is now up to us to decide how we face it while moving forward into our new norm.
- Appleby, J. (May 8, 2020). Reopening in the COVID era: how to adapt to a new normal. Kaiser Health News. Retrieved May 15, 2020 from https://khn.org/news/reopening-in-the-covid-era-how-to-adapt-to-a-new-normal/?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&utm_source=hs_email&utm_medium=email&utm_content=87630108&_hsenc=p2ANqtz--sEeM36_Qsm_uVYEelnjvizeOhNqlVAG1ER0ievroRlRP1fUNXv2_u5Bz9FzLd0GJcTyBd7WKAqe0mAB19QZbBQWMSuK1tBYdZ4bBF3BL5oFrQaS0&_hsmi=87630108
- Zandonella, C. (May 12, 2020). COVID-19’s silent spread: Princeton researchers explore how symptomless transmission helps pathogens thrive. Princeton University. Retrieved May 15, 2020 from https://www.princeton.edu/news/2020/05/12/covid-19s-silent-spread-princeton-researchers-explore-how-symptomless-transmission
- Asadi, S., Bouvier, N., Wexler, A. S., & Ristenpart, W. D. (2020). The coronavirus pandemic and aerosols: Does COVID-19 transmit via expiratory particles? Aerosol Science and Technology, 54(6), 635–638.
- Dearen, J. & Stobbe, M. (May 6, 2020). Trump administration buries detailed CDC advice on reopening. Associated Press. Retrieved May 15, 2020 from https://apnews.com/7a00d5fba3249e573d2ead4bd323a4d4
- Chavez, N. (May 2, 2020). Another wave of coronavirus will likely hit the US in the fall. Here’s why and what we can do to stop it. CNN. Retrieved May 15, 2020 from https://www.cnn.com/2020/05/02/health/coronavirus-second-wave-fall-season/index.html
- Centers for Disease Control and Prevention. (n/d). How to protect yourself and others. Retrieved May 15, 2020 from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
- Barry, J. M. (2009). The Great Influenza: The Story of the Deadliest Pandemic in History. New York: Penguin.