As the weather gets colder, many Americans have no idea whether hanging out with other people inside is risky. That’s a big problem. OLGA KHAZANOCTOBER 12, 2020
For months now, Americans have been told that if we want to socialize, the safest way to do it is outdoors, the better to disperse the droplets that spew from our mouths whenever we do anything but silently purchase grapefruit. But in many parts of the country, this is the last month that the weather will allow people to spend more than a few minutes outside comfortably. And next month, America will celebrate a holiday that is marked by being inside together and eating while talking loudly to old people. Federal and local officials have offered little guidance on whether and how people should be socializing this winter. That has left even medical experts confused about what’s safe, and what’s not. About a month ago, Megan Ranney, an emergency physician who teaches at Brown University, was trying to decide whether to take her son to his favorite restaurant for his ninth birthday. The family has not dined out since the pandemic hit the U.S. But Ranney’s son really, really wanted to go.
“And I was trying to think in my brain, Is it safe for us to go outside? What if we’re inside and we’re in a private room?” Ranney told me. “It’s just, it’s too complicated to figure it out on your own.” No indoor gathering will be perfectly safe. Although many states have allowed indoor public settings such as gyms and restaurants to reopen at least in some capacity, experts don’t recommend spending a lot of time indoors with others, especially in situations where masking isn’t possible. The odds of catching the coronavirus are about 20 times higher indoors, and private, indoor gatherings have been linked to several coronavirus outbreaks. In June, a surprise birthday party in Texas resulted in 18 coronavirus cases. In July, a house party in Michigan led to 43 cases, and a family gathering in North Carolina led to 40 cases because the attendees “went about their daily lives” before they started showing symptoms. In some places, in-home gatherings are now responsible for the majority of new coronavirus cases. A recent Centers for Disease Control and Prevention report showed how a chain of family gatherings in Chicago led to three deaths. But it’s unrealistic to expect Americans to stay inside all winter without seeing anyone. Even if people could do that without going batty, it’s likely that, with January feeling endless and no stay-at-home order in place, people will take their chances. “Making a rule that says zero indoor gatherings until we have a vaccine is totally impractical,” says Julia Marcus, an infectious-disease epidemiologist at Harvard Medical School. In the absence of such a rule, “we have a mishmash of risk communication and guidelines from different entities,” Marcus told me, “and people are continuing to muddle through. It’s funny, because now I’m sitting here thinking, What are the rules in my city? I actually don’t know.”
Beyond “stay at home” and “it’s okay to go out now,” government officials aren’t explaining the relative risks clearly and widely enough for everyone to understand. Ever since states publicized their “reopenings,” some people have seen unrelated people only from a six-foot distance and outside. Others are throwing indoor weddings. Often, these people live in the same city. Given this information vacuum, researchers like Ranney and some public-health workers have launched their own efforts to help people decide what types of social activities are safe, based on where they live.
In a few phone calls, I too was able to figure out whether socializing indoors is okay. But not everyone is a health reporter..
Here’s what to consider before you host that dinner party inside your dining room on a nippy October day: If you make it small, and primarily comprising people under 60, that’s safer. If your guests can stay six feet apart, even better—though consider that this is not likely to happen once they have had a few glasses of wine and the board games come out.
Perhaps the most important factor is the level of so-called community transmission: how many new COVID-19 cases are in your immediate area. Caitlin Rivers, an assistant professor at the Johns Hopkins Bloomberg School of Public Health, told me she wouldn’t be comfortable at an indoor dinner party right now, no matter what. But if you were going to risk it, it’s safer in areas that are seeing only five to 10 new cases a day per 100,000 people, and have a test-positivity rate less than 5 percent. Tom Tsai, a health-policy professor at Harvard, puts this number slightly higher, at 25 cases per 100,000. But this community-transmission number is hard for most people to keep track of. Part of the problem is that Americans no longer have a centralized source for news. Though interest in TV news has picked up recently, the three major evening newscasts get only about half the viewers today as they did in the 1980s. Some newspapers run transmission numbers on their front pages, but many Americans live in news deserts, and only 29 percent of Americans get a newspaper either digitally or in print. People tend to get news from social media, which will often circulate stories of national interest but not, say, the case numbers in a given county. Health departments can post things on social media, but how many people follow their local health department on Facebook?
Rivers told me that to find the community transmission rate and other information, people should be checking their local public-health department’s website. But after more than a decade of severe budget cuts, many health departments don’t have the money to make snazzy, user-friendly websites with constantly updating figures. For instance, Wisconsin is currently erupting into a COVID-19 hot spot, and one county, La Crosse, had 41 cases per 100,000 people as of this writing—four times the rate Rivers said is safe for indoor gatherings. But La Crosse County’s health-department website is rudimentary, offering a link to a separate COVID-19 website in a small font. That site says, “Personal social gatherings are not recommended,” and notes that the “new case rate” is 97, with a red arrow pointing up. A layman in La Crosse County is unlikely to know the meaning of this rate. Another Wisconsin county, Kewaunee, which also had 123 new cases per 100,000 people, has a health-department website on which the number of cases is not displayed anywhere. (In a response to a request for comment, the Kewaunee County Public Health Department said it posts its total number of coronavirus cases on the county website. In an email, Maggie Smith, a health educator with the La Crosse County health department, said, “As a public health department, we are limited in both funds and capacity and rely heavily on free and low cost tools to support our communication efforts.” Smith added that the department has used Facebook, Instagram, and local celebrities in its outreach.) “A lot of local health departments in the United States don’t even have an epidemiologist,” says Albert Ko, a professor at the Yale School of Public Health. “When a local health department doesn’t have the capacity to use 21st-century technology to disseminate important public-health information, that’s a real challenge. And that’s what puts us behind other countries that have had successful responses.”
A number of websites show the levels of community transmission by county, such as one Tsai worked on, at GlobalEpidemics.org, but they are not widely known among the general public. (According to this map, in the county where I live, for example, it would be safe to gather indoors according to Rivers’s standards, because there are only eight new cases a day per 100,000 people. But in my parents’ county in Texas, which has just over 10 cases, it would be less safe.) To check these types of websites, “you have to be interested,” says Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security. “And if you’re already someone who thinks this is important, and you’re checking out your numbers of cases per 100,000,” you’re probably already doing all the right things when it comes to social distancing. Some health departments are stepping up their communications, holding Facebook Live events and press conferences in which they urge people to avoid indoor gatherings. The Kansas City, Missouri, health department has produced videos showing how easily the coronavirus spreads. (Still, illustrating the limits of social media, the first reply to a tweet with one of its videos is: “Masks don’t do anything.”) In Chicago, the public-health department has developed a tool that can help people decide whether a gathering is safe through questions such as “Is everyone healthy?” and “Can you always keep a 6-foot distance?” Commissioner Allison Arwady has also been hosting regular Facebook Lives in which she answers questions from the public, and she hosts a weekly press conference in which she often highlights stories of individuals who caught the coronavirus at a small gathering. She’s running focus groups with Black and Latino Chicagoans to test messages that might resonate with them. But, she acknowledges, not every health department has the money or manpower to do all this. Together with her colleagues at Brown-Lifespan Center for Digital Health, Ranney has developed a free app called My COVID Risk that will allow users to input the type of activity they want to do, whether it’s indoors or outdoors, how many people will be there, what protective measures they’ll take, and where they live, along with other factors. The app will then generate a relative risk of catching the coronavirus during that activity—from “very low” to “very high”—using community-level data from The New York Times’ coronavirus map. People can modify their risk level by reducing the number of people, for example, or adding a mask requirement. “Given the lack of clear national guidelines on what’s safe and not safe, our hope is that this will fill a void for the average American who’s really struggling to judge the safety of various activities,” Ranney told me.
Still, Ranney says, this app is the kind of thing the federal government really should have developed by now. It’s odd that in a wealthy, industrialized country, a random researcher is the one designing a tool to keep citizens safe from public-health threats, using data she scraped from a newspaper. These efforts are commendable, but experts agree that they should be publicized by officials at the federal level, so that all Americans know how to find and use them. Some have even advocated for a national system of COVID-19 risk levels that could tell Americans when it’s safe to, say, visit with friends outside, versus shelter in place, versus live normally. In response to a request for comment, a spokesperson for the U.S.
Department of Health and Human Services said that the agency “consistently educates the public on the three W’s, advising Americans to: Watch your distance, Wear a mask when you can’t watch your distance, and Wash your hands.” Sell says the government should team public-health departments with influencers, faith leaders, and celebrities to make people aware of how to gauge the risk of indoor gatherings, before it’s too late. “Public health can make a message, but we want people to hear it,” she says. “It should be centrally led and pushed for by the federal government.” Instead, Sell says, officials have veered between over-reassuring and over-worrying people. The Trump administration has undermined its own scientists, making people unsure whom to trust. “I’ve never had to deal with so much misinformation and, frankly, sometimes just unpredictability of the messaging that’s been coming out, especially at the federal level,” Arwady said.
With Americans befuddled as to which risks are acceptable, social media has overflowed with posts shaming people who appear to be in the company of other people. But these witch hunts miss the point that people generally don’t want to kill their friends and relatives. Most people want to do the right thing. But they can’t do it if they don’t know what it is.