There's a whole new world under that rock.
Summer is here, and the coronavirus remains. As local jurisdictions slowly reopen — and public health experts keep an eye on the nationwide surge in COVID-19 cases — Washingtonians are being forced to find their own methods of risk assessment. Can I see my family for a barbecue? Or head out on a camping trip with friends? Is it okay for children to play together again? How safe is it to go swimming in a pool, lake or ocean? Are kayaking and biking okay as long as I social distance? How do I “reopen” my own life while still valuing the safety of others?
In times of uncertainty, we look to medical professionals for guidance. Emergency physician and public health expert Dr. Leana Wen joins us to share her expertise and answer your essential questions.
Produced by Julie Depenbrock
- Dr. Leana Wen Emergency Physician, Visiting Professor, George Washington School of Public Health
KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on WAMU 88.5. Welcome. Later in the broadcast Sportswriter John Feinstein joins us on the latest Kojo for Kids. But first, summer is officially here, and the coronavirus remains. As the Washington region reopens and public health experts keep an eye on the nationwide surge in COVID-19 cases, we're being forced to make our own risk assessments. Can I have family over for barbecue or go to the gym? Is it okay for kids to play together? How safe is it to go swimming, kayaking or biking? How do I reopen my own life while still valuing the safety of others?
KOJO NNAMDIJoining us to discuss summer in the time of coronavirus and as always to answer your questions is Dr. Leana Wen, Emergency Physician, Professor of Public Health at George Washington University, Columnist for The Washington Post. She formerly served as Baltimore's Health Commissioner. Dr. Wen, thank you for joining us.
DR. LEANA WENAlways good to be with you, Kojo.
NNAMDIDr. Wen, certain states have seen a new surge in coronavirus cases compared to the rest of the world. What's happening here and how do we get back on track?
WENYeah. I think a lot of people are talking about whether we're in a second wave. And frankly we are not anywhere close to being out of the first wave. If you look at the waves so to speak of what's happened in other countries, you actually do see a rise, a peak and then you see a fall. That's what would be a first wave. But unfortunately in this country while we did have a rise, we had a peak. We didn't have a steady decline. Actually we've had a plateau. And the plateau is really at a untenable place where we are still having hundreds of deaths of Americans every single day.
WENAnd now we're seeing a resurgence in cases particularly in the south and southeast. We have rising number of not only infections, but also hospitalizations in Arizona, in Alabama, Texas, Florida. There are parts of those states that are reporting that their ICUs are near capacity. And patients are now having to be transferred to different hospitals. So it looks like there are parts of the country that are getting to what the New York area actually looked like back in March. And that's extremely concerning, because that's the exponential spread that really could herald a new wave, another surge and unfortunately in deaths.
NNAMDIIt's summertime. We're four months into this pandemic. Many of us are facing quarantine fatigue. The idea of eating out at a restaurant, going camping or having friends over for a backyard barbeque is all very tempting, but I'm wondering if you could help us assess the risks of various summer activities. Let's start with dining out at a restaurant.
WENYeah, so everything that we're going to talk about today, Kojo, everything has some element of risk. Any time you're going out and interacting with others there is going to be risk involved. But that said we also know that we are nowhere near getting a vaccine. And it's not feasible for everyone to remain inside and not see anyone for many months or even years. And so I think it's -- at this point we need to be thinking about our own values and what are the things that are the most important and how we can weigh that against the risk, and then if we choose to do that thing anyway, how could we reduce that risk as much as possible?
WENSo going out to a restaurant, takeout is going to be by far the safest. If you do need to go and sit at a restaurant outdoors is much better than indoors. Actually some studies show that being outdoors reduce your risk of transmission by as much as 18 to 19 times. And then if you're going to go to a restaurant too, whether it's outdoors or indoors also do your best to try to stay physically distanced from people who are not in your immediate family. So the more distance you have, the better, and try to wear your mask except obviously while you're eating or drinking, but also look to see whether the other patrons and the waiters and waitresses are doing their part to protect you too.
NNAMDIGwen emails us, "I've seen people wearing cloth masks with valves that apparently allow the wearer's breathe to be exhaled. Doesn't this defeat the purpose of the mask?"
WENYes. And actually there are not only these cloth masks with valves, there are actually construction masks that have one way valves. And I just want to talk about how dangerous that is actually, because the one way valve may protect you, but it doesn't protect other people. Your droplets are still being secreted. And that's not what we should be doing at this time of collective responsibility. So the best thing to do is wear a face covering whether it's a surgical mask or a cloth mask or a bandana. Make sure that it covers your nose and your mouth. Wear it consistently especially if you're going to be around others in an enclosed space.
WENSo if you're walking outside and I live in a neighborhood where I can go outside and take a walk. And I'm not going to see very many people at all. I may go for an entire walk for 20 minutes and not see anyone. I don't need to wear a mask during that type of walk, but I'll always have a mask with me in case people are going to be around. And certainly if you're going to be going shopping, to a café, somewhere indoors where you probably cannot keep that six foot distance at all times. Make sure to wear that mask.
NNAMDILet's stay with mask. Here's Tony in Falls Church, Virginia. Tony, you're on the air. Go ahead, please.
TONYI just want to ask if these three layer cloth masks that you buy, you can buy through the mail are effective to keep other people's germs from getting to you? Thank you.
WENYeah, so our recommendations around masks has changed a lot since the very beginning of the pandemic. And that's because of asymptomatic transmission. We know that people who do not have symptoms can still be transmitting the virus to others. And I mention all of this, because initially and when we started recommending masks, we were saying you wear a mask to protect others from you if you are an asymptomatic carrier. But now we know that if everyone wears masks we also protect ourselves. There was a lancet study that was published that found that wearing a mask can reduce your risk of acquiring COVID-19 by about five fold. And so that's important to keep in mind that, yes, we're wearing a mask to protect others from us, but we're also doing it to protect ourselves too.
WENAnd, again, this is a newer recommendation just, because of new research that's happened. But I think we should think about a mask as being protective for all of us. And frankly if there was a medication that reduced your risk of transmission of COVID by five times, we would all be taking that right now. So let's think about the masks the same way.
NNAMDIDr. Wen, as the summer temperatures rise swimming pools have always beckoned. But how safe is it to go swimming in a pool, lake or ocean, right now?
WENYeah. So bodies of water are not the problem. You're not going to get COVID-19 from swimming in a pool or ocean or anything else. The problem is who else is around you and how close are they getting. And so if you're in a lake or an ocean and there aren't that many people around you where you can easily keep that six foot distance outdoors, there is no concern really for acquiring COVID-19. But on the other hand if you're indoors at a pool and you can't keep that six foot distance.
WENAnd also think about the other things that are happening in the pool area especially if you have little kids too. Maybe at the pool there's a restroom that's a public restroom. Maybe there are surfaces, there's a lounge chair and a table and drinks and people are touching all these shared surfaces. That's where that risk is. It's not the swimming itself. It's the proximity to other people.
NNAMDIWell, speaking of swimming, here is Chez in Columbia Heights. Chez, you're on the air. Go ahead, please.
CHEZThank you, Kojo. I wanted to ask about -- I'm a swim coach, an instructor and I wanted to be able to talk to the parents about the risk their children may face in case they allow teaching swimming this summer and even if it's outdoors. My concern is if they allow lap lanes when you're swimming, you're breathing hard. You're using all your limbs and you're exhaling and you're exhaling as well as inhaling, you know, rather strong breathing. And so I'm wondering if -- especially if it's enclosed, but even if it's outside what do you suspect would be the risks involved in swimming in lap lanes?
WENYeah, so it's a really good point, and a couple of things. One is that outdoors, again, versus indoors does make a big difference, again, because of the dispersal of the droplets outdoors when there is open air compared to indoors. So outdoors would certainly be safer. Then you'll have to think about two factors, distance and time. So how close are you to someone? I could see a situation where maybe every other lane is closed. And then you're pretty far separated from somebody else as they're swimming by. And then the other factor also is time of exposure.
WENThe chance of you acquiring COVID-19 -- let's say you're running and somebody passes you. Even if you are exhaling and breathing heavily the time of exposure is less than a second. And the chance of you acquiring COVID that way is very low. And I think the same thing would apply to something like swimming as well. So I'm actually less concerned about the lap lanes that people swim past each other. I'm more concerned if these are young kids, who may want to -- understandably they may want to play with one another, and they may be breathing on each other and interacting with one another. I'm much more concerned about that than people swimming laps for exercise.
NNAMDIThank you for your call, Chez. And in D.C. and elsewhere gyms are slowly reopening with limited numbers and cleanliness protocols. What would you say to people who are eager to get back to their prepandemic exercise routine in a gym?
WENYeah, I very much understand. I used to go to the gym five days a week. And certainly it's something that I miss very much. I think it depends again on people's values. There are some people for whom the gym is extremely important and that's one of the first things that they want to bring back into their lives. And which case I would say you should go because that's for your emotional wellbeing. But maybe if you go to the gym don't also go eat indoors at a restaurant. Don't also go get your hair done for six hours. I mean, there are -- I mean, just because you can do something doesn't mean you should. You can limit your cumulative risk. That's number one.
WENNumber two is look for the things you can do that are safer. Again, outdoors better than indoors. And when you go to the gym ask about the cleaning protocols. Make sure that things are being wiped down. Make sure that there are machines that are spaced well at least six foot apart. Also you can take matters into your hands too. If it looks like it's getting too crowded don't go, go during off times. Clean all the surfaces yourself and disinfect them yourself even if they say that other people have been doing it anyway.
WENWhat out for spaces like public bathrooms where there could be a lot of people congregating in a small space, and I think also the weather is getting really nice. I know that for me I've been able to get outdoors and walk and run in my neighborhood instead of going to the gym. So I would encourage people to, again, do what you need to do to feel sane during these times, but also try to do the activities that are the lowest risk possible.
NNAMDIHere's Star in Washington D.C. Star, your turn.
STARThank you very much for taking my call. I have a concern that many of the doctors and I think Dr. Wen would agree with this. Many of the doctors that we are hearing interviewed in the media are saying that testing needs to be far more aggressive on the order of five million tests today versus the half million that's being done now.
STARHowever, the reason as I understand it that the aggressive testing that's been pursued by the Asian countries have been successful is that the second part of the practice is that they will send people who are thought to be infected to separate quarantine quarters where all of their needs for board, food, whatever are met, and where they have emergency medication present. We don't have any that whole second component.
NNAMDIWell, allow me to have Dr. Wen respond after a short break, because we are right up on a break, right now. Dr. Wen, hold your thoughts on that for me, please. I'm Kojo Nnamdi.
NNAMDIWelcome back. We're talking with Emergency Physician and Professor of Public Health at George Washington University, Dr. Leana Wen, about reopening during this coronavirus and safety measures that one might be able to take. Dr. Wen, when we took that break, Star was asking a question about more aggressive testing in some countries accompanied by quarantines.
WENThat's right. We know that testing itself is necessary, but not sufficient. And she brings up a good point that you do need the entire trifecta if you will. You need the testing, because without testing the disease is still there. We're just not picking up on it. And then you need to have contact tracing to identify those who tested positive and their contacts. Then those individuals need to self-isolate or self-quarantine. Basically not be around others to prevent the infection from spreading.
WENAnd I think she brings up a good point about the need for these facilities and actually I've argued for this along with multiple other public health experts. That especially for individuals who come from underserved vulnerable communities whom live in crowded multigenerational housing, you tell someone to self-isolate for 14 days and they're saying, well, I can't literally do that. And also I'm going to lose my job and my wages. And so we need to do a lot more when it comes to, for example, converting unused hotel rooms and dormitories into these facilities.
WENNow all that said, we cannot let perfect be the enemy of the good either. I don't want people to use the excuse of not having enough of contact tracing or isolation to say, well, that's why we can't have enough testing. That's not right. We need to have far more testing while at the same time we ramp up these other critical capabilities as well.
NNAMDIWithout summer camps, daycare or organized sports, many families are struggling and children are getting restless. What would you recommend for parents particularly working parents, who may not be able to supervise their kids 24-7?
WENYeah, I very much understand that having two little kids of my own that it's very challenging to be working and watch your kids who are getting very restless at this time. A couple of things here, one is that there are a lot of activities especially given the nicer weather that families can do safely, hiking, camping. There are a lot of things that families can do together. And I would also encourage for families to start thinking about, who else they may want to associate with. Maybe there are a few other families, who are also keeping their same level of risk. So who are also not seeing a lot of people, who are taking every precaution. Maybe these families can get together and you can start having small groups of playdates. That's something that can take some of the pressure off.
WENAnd then I think when it comes to things like daycare, families just really have to weigh their own values and needs at this time, because there are going to be families that have to go back to work and need to go to daycare, need to send their kids to daycare. There is going to be risk. The risk is probably low, because kids tend to be healthier and are shielded from the more severe effects of COVID-19 for the most part. But they still could spread it to other people. And so that needs to be weighed very carefully with the needs of the family.
NNAMDIJennifer emails, "This is the period when many offices in the D.C. area are starting to reopen. However, there has not been very clear guidance about how to stay safe while working in an office. Contaminated surfaces seem to be less of a concern than was first thought, but I'm worried about airborne and droplet transmission."
WENYeah, it's a really good point. And actually this is one of my concerns about reopening. It's not really so much when reopening occurred, as how it occurred. The CDC did put out guidelines about ways to keep workplaces safe, but it was so much under the radar and frankly the guidelines were pretty watered down. They said things, like, we should be encouraging social distancing or encouraging the use of masks or doing certain cleaning if feasible.
WENWhen actually they should have been much more explicit. I mean, I and I think many business owners and employees would feel much better if we had a list of let's say, the 20 things on a checklist that employers have to do before reopening were to occur in office settings or in meat packing plants or in whatever setting. In the absence of that kind of explicit guidance you can still take matters into your own hands. So if you are a business owner or if you're an employee, make sure that you have protocols that are very clearly communicated with your employees.
WENI would make sure that there is something clear about physical distancing. So trying to keep people physically separate is the most important thing, because it is that in person contact that spews those droplets. And so keep the desks at least six feet apart. You can stagger work shifts. You can require masks and also not have these shared spaces. Like lunch rooms should not be open at this time to avoid people congregating.
WENAnd surfaces, that's something that you can take matters into your own again. Even if you think that other people have cleaned a surface, if you share a computer with someone, share a desk take matters into your own hands and make sure to wipe down those surfaces. And I would also encourage employers and employees alike to continue teleworking and allowing teleworking whenever possible.
NNAMDIDr. Wen, when did mask wearing become politicized and what effect does that have on public health?
WENYeah, it's a major issue, Kojo. I mean, frankly it's inexplicable to me how something that is a clear public health mandate is something that has growing scientific evidence from around world, how that has become a partisan issue rather than the public health issue that it is. And I really worry about this. I mean, this is a disease that knows no political affiliations or boundaries. But what it does know is that we need everyone to take part in the solution.
WENUniversal mask wearing is what will reduce the rate of transmission in a community in a society. And I hope that everyone can help us to turn down the temperature so to speak and really follow the advice of public health experts and not talk about masks or any other aspect of COVID-19 as a political issue.
NNAMDIChris emails, "I'm visiting family later this summer for an outdoor barbecue. I'll be seeing parents and nephews for the first time since Christmas. All these folks are big huggers, but am I right to assume that we should probably not do that? I'd like to know whether I have a good reason for disappointing my mother."
WENWell, I understand how this is very challenging and, you know, my husband and I have just started seeing good friends in our yard appropriately socially distanced. But it feels very strange to not greet them with a hug as we normally would, but that's what we need to be doing at this time. And I think the reminder to everyone is we're still in the middle of a pandemic. It's really wonderful to see everyone. Let's virtually wave. And I think if hugs have to happen, there are still ways to make that safe. You can wear a mask, turn our head away. Little kids can maybe hug the legs of grandparents instead of them to their face and wash your hands afterwards. But not hugging at this time is definitely the safest thing to do.
NNAMDIAs we've said, coronavirus has already had a disproportionate impact on people of color. And here again we have many black and brown and white people taking to the streets to protect systemic racism and police violence. As far as you know, have there been any spikes in COVID cases as a result of these demonstrations?
WENSo we've certainly seen individual cases and even clusters of infections in different parts of the country. But we have not seen outbreaks as a result. And I think that has a lot to do with the precautions that people did take in being outdoors and wearing masks and getting tested and isolating from vulnerable individuals after they come back from these protests. And I think that people should continue to keep up and abundance of caution while following their own values and principles about going to these protests.
NNAMDIHere is Karina in Arlington, Virginia. Karina, you're on the air. Go ahead, please.
KARINAHi. I have a question about going to the beach. I wanted to know if the breeze from the beach influenced the six feet distance. Like if we should be farther away, because the particulates can travel with that sea breeze. Thank you so much.
WENYeah. It's a really good question and it stands to reason that if the wind is blowing that maybe it could travel even further than six feet. Let's keep in mind, though, that six feet is a broad generalization. It's not as if you're standing at five and a half feet, you're going to get COVID. And at seven feet, you're not. This is a rule of thumb. And whatever that wind is going to be at the beach is going to be offset also by the benefit of being outdoors. So my general advice is better be -- the greater distance you have the better, although six feet should be fine if you're outdoors.
NNAMDII'd like to wrap up this conversation the way we always have since this pandemic started with a bit of hope. How close or how far away are we from a vaccine?
WENWell, we are not close to getting a vaccine. There are dozens of candidates that are being studied and there is good news coming out a bit about treatment and potential treatment that could reduce the severity of the disease. But we're still looking at least a year or two, maybe even a year and a half or longer before we get a vaccine. Now the good side of this, though, is that we now know a lot more about what it takes to prevent getting COVID-19. And as we are reopening, just keep in mind that it is really up to each of us to watch our own risk. That there are a lot of things we can do to go back to normal and start seeing our loved ones, but keep in mind that reopening does not mean that everything is safe. The virus is still out there.
NNAMDIDr. Leana Wen is an Emergency Physician, Professor of Public Health at George Washington University, Columnist for The Washington Post. She formerly served as Baltimore's Health Commissioner. Dr. Wen, thank you so much for joining us.
NNAMDIGoing to take a short break. When we come back Sportswriter John Feinstein for kids only. Adults can listen, but we are only taking communication from kids. Only kids can join the conversation. I'm Kojo Nnamdi.
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