The Four Safety Dimensions for Covid-19 Prevention–Staying Safe Out There

world with covid-19

There are four simple concepts which will help you stay safe and avoid contracting Covid-19 as you begin to reenter society, and as things begin to open up.

  1. Proximity or closeness to other people outside your own household. A very safe distance is 10 feet, and adequately distance is 6 feet, and anything less than 3 feet of social distance is probably risky.
  2. How long you are in contact with those people. Studies of transmission suggest that a contact time of 30 minutes or more is risky, but in situations of close social distance anything more than five minutes may be risky. (If everyone is wearing a mask, safe contact times may be somewhat longer.)
  3. Whether the environment is confined or open, inside or outside, and if inside how large is the inside environment and is there good air circulation? Outside is almost always better than inside, and inside environments which are larger and have good air circulation are probably less risky than small and sealed environments like elevators. (Or small public restrooms.)
  4. Whether or not everyone is wearing a mask. Studies suggest that the use of masks can reduce transmission by 80 or 90%. That is why doctors and nurses always wear masks when treating sick Covid 19 patients. They also wear eye protection. The use of masks protects you from spreading coronavirus to other people, and also protects you from them spreading coronavirus.

When the more dangerous options among these four factors overlap, you are in peril.

For example, let’s say you decide to get a massage. The massage room is inside, very small, and the massage takes 90 minutes. This is a high-risk situation even if you and the masseuse are both wearing a mask. (And even higher risk if either is not wearing a mask.) You have close social distance, extended exposure, in a small and poorly circulated room, and perhaps the only safety factor is the wearing of masks.

In contrast, you go for a walk in your neighborhood. Other people are out walking but everyone respects at least a 6 foot social distance, and you do not stop to talk with people. Any contact is 6 feet away and lasts only a few seconds. This is a relatively safe situation regardless of the use of masks.

Let’s look at each factor separately.

Indoors versus outdoors

Japanese researchers looked at 110 people who had Covid-19. Only 12.5 percent passed the illness on if their only interactions with people were outdoors. But of those who interacted with people indoors, 75 percent infected other people. Out of the 22 people who met people indoors only six did not infect anyone else. But of the 88 people who met people only outdoors, 77 did not infect anyone. The reason for this appears to be that the tiny droplets that can infect you disperse very rapidly outside. So it appears that outdoor contact is not perfectly safe, but is six times safer than indoor contact.

Duration of contact

There is some interesting data from China and France in terms of likelihood of catching Covid-19 in various different indoor settings. The worst setting was the household where 13 percent of people contracted Covid-19 if someone in their household had it. The next most risky type of environment was public transport, which ranged from 2% to 12% depending on whether or not there was a super spreader event. (Super spreader events are those rare people that seem to be very efficient at spreading the virus.)

Particularly relevant was the finding that 7% of people who came into contact with an infected person in a restaurant dining environment contracted Covid-19. That’s pretty risky to avoid cooking at home! (Note that 85 coronavirus cases were linked on 6/28/20 to a SINGLE restaurant in Michigan, in a single week of operation! The restaurant had poor circulation, poor social distancing rules, and no air filters on ventilation.)

All the other indoor environments had about the same risk, 2%, and this included shared work or study spaces, schools, healthcare settings, and all other settings. The better the ventilation was the less likely transmission.

What about masks?

 

Masks are particularly helpful in high risk indoor situations, where they block the spread of droplets that can transmit Covid 19. Because the risk of infection is lower outdoors, especially if people are properly socially distancing, they may add very little benefit. But if you are in close contact with other people outdoors, masks may help significantly. This may be why in cities that had large Black Lives Matter demonstrations, there were relatively few outbreaks, as many of the protesters wore masks.

Large Events

Large events are particularly problematic because of super spreader individuals. Research from China and Hong Kong showed that 80% of new infections came from about 20% of people. These are called super spreaders, and we don’t really fully understand why some people are so infectious. But being in a large event such as a sporting event or concert makes it highly likely that there will be one or many super spreader individuals. Avoid these even if they reopen. (As reported on 6/28/20, Swiss authorities had to quarantine 300 people who attended a Zurich nightclub on 6/21/20 because of a super spreader individual.)

High-risk versus low risk situations

Here’s the deal with viral particles. We still don’t really know how many Covid-19 infectious viral particles it takes to get you sick. But some experts estimate that the threshold may be about a thousand particles. A cough releases 3000 droplets and a sneeze releases about 30,000 droplets. These droplets can contain 200 million viral particles, which explains why symptomatic people can spread Covid-19 indoors so easily.

In contrast a single breath releases about 50 to 100 droplets, which fall to the ground quite quickly. Although we don’t know the exact data it’s reasonable to assume that a person breathing may release 30 viral particles per minute. Speaking may change that to 300 per minute. So, this tells you that it would take perhaps 40 minutes of someone breathing near you, or about five minutes of someone speaking with you face-to-face in order to risk infection, assuming it takes 1000 viral particles to contract coronavirus.

This is important because it tells you that if you walk by someone outside or even inside in a grocery store, your risk is low. But let’s say you see a friend of yours in the grocery store, and you spend 15 minutes talking with them. That’s pretty high risk especially if you are face-to-face and not wearing a mask.

Where have most infections occurred?

  • Prisons
  • Long-term care facilities
  • Meatpacking plants
  • Business networking and conferences such as the Biogen conference in Boston in late February
  • With more relevance to most of us, weddings, funerals, birthday parties which make up about 10% of the early super spreading events

Most of us aren’t in prison, we don’t live in a nursing home, we don’t work in a meatpacking plant. But many people have lately been tempted to go to parties which are clearly a high risk situation.

Finally, don’t forget to wash your hands or use alcohol gel. Don’t touch your face which includes your eyes, ears, nose, or mouth. When you get home wash thoroughly, and you may want to even jump in the shower and wash your hair, as some studies in medical settings have found that hair is particularly good at holding viral particles.

Here’s a good way to think about risk. It comes from advice about sexual health. If you have sex with someone, you are being exposed not just to them but to all their prior sexual partners. In a similar way, let’s say you get together with her friend who is not part of your household. You’re not only being exposed to them, but to every person they have had contact with in the last 14 days or so. The clerk in the store who didn’t wear a mask and stepped close to them, the UPS guy who knocked on the door and asked a question from 2 feet away, all the friends that they have had contact with, the people they live with, and all the people that those people have had contact with. As you can see one of the reasons coronavirus spreads so much is that the larger our social networks are the more risk there is.

Finally, be aware that many coronavirus infections are asymptomatic meaning that the people who have coronavirus are neither coughing or sneezing. Some studies suggest that as many as half of the cases are asymptomatic. This means you can’t depend on people knowing that they might be sick. The Center for Disease Control released data on June 26, 2020 that suggests that the real number of coronavirus infections is perhaps 10 times what has been reported. As of today, there are about 2.5 million cases reported in the United States, which means we may have had 25 million cases! That is 7.5% of the US population. This sounds like a lot, but it also means that 92.5% of the United States population is still in danger of contracting the coronavirus.

And that is why I’ve been practicing virtually since early March, and will continue to do so until there is either an effective treatment or a vaccine for the coronavirus. Be safe out there, and ask yourself about each activity if it is worth the risk not only to yourself, but also to all the people you might come into contact with including older parents and grandparents. We are all in this together, and even the young and healthy can transmit coronavirus if they get sick. Yes, we all miss going to restaurants, movie theaters, bars, parties, concerts, and sporting events. But it’s not permanent. I suspect that within the next six months will have much more effective treatments, and within 12 months we will have a vaccine which will let us get back to normal.

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

Some Useful Tips from the New York Times on Navigating Risk as States Start Opening

The New York Times has an excellent article about how to navigate risk as things begin to reopen: How to Navigate Your Community Reopening? Remember the Four C’s

Because New York Times articles are behind a paywall, and I think this is important information, I have summarized the guidelines below

The Four C’s

Contact

Maintain social distancing. Stay 6 feet away from other people and do not hug or handshake.

Make sure that any places you go also maintain social distancing measures. If you go to a restaurant make sure that patrons are spaced out. For shops and stores,  make sure they limit the number of people inside the shop. Preferably anyplace you go conducts frequent cleaning and disinfection.

Be careful with high touch objects and surfaces. This means tables, light switches, doorknobs, phones, toilets and faucets, any touchscreen, ATMs, and especially gas pump handles. Use disposable gloves, wash hands, or disinfect hands with alcohol gel after touching.

Any 15 minute face-to-face conversation between people who are within 6 feet of each other is considered close contact. Avoid if possible. If talking to someone at a store step back so you maintain the 6-foot social distance. Especially if the other person is not wearing a mask you are at risk even during a normal conversation without coughing or sneezing. Wear a mask to protect yourself and others.

Confinement

Avoid indoor settings if it all possible. Keep working from home if possible. Stagnant air inside leads to infected droplets persisting much longer than you expect and there will also be contamination on surfaces.

Crowds

Avoid crowds if it all possible. Large crowds increase your risk of infection even outdoors. 100 people are always going to increase your risk of infection over 30 people. If you are involved in large outdoor protests, be sure to wear a mask, maintain as much social distance as possible, and consider self quarantining or being tested for COVID-19 once you are done protesting.

Choices

For eating there are various options. The CDC has ranked different ways of getting food from low risk to high-risk.

Lowest risk: food service from a drive-through, delivery, take-out and curbside pickup

More risk: drive-through delivery, take-out, and curbside pickup are emphasized. On-site dining is limited to outdoor seating only.

Even more risk: on-site dining with indoor and outdoor seating. Tables 6 feet apart.

Highest risk: on-site dining with indoor and outdoor seating with full capacity and tables not spaced 6 feet apart.

Make smart choices about risk. If you are at high risk meaning that you are over 65, have chronic health conditions, have immune compromise, are severely obese, or have chronic lung or kidney disease or heart conditions, then you should take the maximum precautions. (Recent research suggests if you have Type A blood you may also be at risk of more serious disease.)

Even if you personally are at low risk you have to remember that you can infect people you love who are at higher risk. Be altruistic and protect yourself to protect the people you care about.

Be safe out there!

 

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

How to Meditate

Meditation is simple but not easy.

Meditation and balance

Meditation: Simple But Not Easy

  1. Sit comfortably, in a chair or on a pillow on the floor. Don’t lie down because most of us sleep deprived human beings will fall asleep very rapidly if we try to meditate lying down.
  2. Turn off your phone and other devices that might interrupt you. Close your eyes or at least let your gaze fall so that you’re not looking at anything in particular.
  3. Take several deep breaths and focus on the breath either where the breath comes in or out of your nose or on the rise and fall of your chest. This will be the primary focus of your mindful attention during meditation. Watch your breath in either of those two places.
  4. Your mind will wander away from your breath. Be gentle toward yourself regarding your wandering mind. I often suggest to people that they simply note, in a gentle internal tone, the type of distracting thought. If it’s a thought you can say to yourself “thinking thinking”. If it’s a sound you can say to yourself “hearing hearing.” If it’s a sensation, you can say to yourself “feeling feeling.” Once you have gently noted the type of distraction then simply refocus your attention on the breath. Just watch your breath, don’t try to change it or modify it.

When To Practice and For How Long

With meditation practice the key is to actually do it so the when to doesn’t really matter as long as the time is convenient for you and encourages you to practice. Some say that after a big meal is not ideal, and I’d probably agree, but other than that it doesn’t matter whether you practice early in the morning, late at night, or in the middle of the day.

In terms of how long you should practice, I would say start small. I’d start with 10 minutes a day, and once you get comfortable with that push that time up to 15 or 20 minutes. I suspect that beyond this there are diminishing returns, but up to 30 minutes a day is probably beneficial. Experiment with different time frames and see what works for you.

What you will find as you practice is that initially your mind is a “drunken monkey.” It wanders more than it focuses on the breath. This is completely normal and you should not allow yourself to get frustrated by it. Meditation is a learned skill and as you continue to practice you will find it easier and easier to focus on the breath, to notice distracting thoughts, and then to return to the breath. Eventually, you will be able to mostly hear silence in your mind which is a very peaceful feeling.

You can also practice mindfulness in other situations without doing formal meditation. For instance, when you take a shower, just feel the water on your body. Don’t think about your to do list. Or you can be mindful even when doing mundane tasks like washing dishes; feel the water on your hands, notice the shape and the sound of the dishes, and be completely immersed in the present moment.

That’s it, meditation practice made simple. Happy meditating!

 

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.