As we enter the third month of social distancing and living with the COVID-19 pandemic, we are facing more and more questions about responsible behavior moving forwards. What follows is a longer than usual e-mail that strives to provide the clearest and most succinct advice possible.

Please note that this is a very complicated subject with many variables and even more unknowns – there are few straightforward answers! These are just our suggestions based on current epidemiological data. Any discussion about possible “reopening” and loosening of social distancing is ultimately about how much risk you and your family are willing to accept. 

When trying to decide whether or not an activity is safe enough to be worth the risk, we recommend asking yourself the following four questions:

  1. What is the risk?
  2. Is there anything that can be done to lessen the risk?
  3. What is the perceived benefit?
  4. Is the activity socially responsible/does the activity put other people at unacceptable risk?

In an attempt to simplify this discussion, here are some known facts.

  1. You don’t want to get sick with COVID-19! While most pediatric patients and healthy adults have a low risk of life-threatening symptoms, some healthy people (including kids) are dying and many are serving as vectors who further spread the disease in the community. In addition, even among people with “mild” illness, the symptoms can be quite bothersome and disturbing and can go on for a long time – people are describing very uncomfortable experiences.
  2. The most likely way to prevent contracting COVID-19 is to stay home! Social distancing is by far the safest option.
  3. While anyone can get critically ill from COVID, risk factors include age > 65 years, diabetes, heart disease, obesity, moderate or severe asthma (mild asthma is NOT thought to increase risk), immune compromise, chronic kidney disease, and liver disease. There are some thoughts that smokers/vapers may be more susceptible as well.
  4. If you must go out or be around other people, wearing a mask (both to protect you and, more importantly, to protect others) is important for minimizing COVID transmission.
  5. Wearing a mask, while helpful, does not entirely prevent COVID transmission (do not feel a false sense of security).
  6. Maintaining a distance of six (or, preferably ten) feet from other people will help minimize disease spread.
  7. Being outdoors decreases the likelihood of transmission. This is especially true if all people are wearing a mask and make sure to stay six (or ten) feet apart.
  8. Risk of disease transmission is increased with increased time of close contact.
  9. Washing your hands frequently and every time you return home helps prevent transmission.
  10. If you are even the least bit sick, stay home (but, remember, people can still transmit COVID-19 when they are without any symptoms)!

We know that the emotional toll of isolation has been significant. We all miss the human connection of our friends and family. How then, can we balance the risk of exposure to others with the psychological benefits of seeing loved ones?

This is where the conversation really begins to be about risk acceptance and perceived benefit. Referring to the information above, the safest way to see family or friends is virtually utilizing FACETIME or ZOOM (or old-fashioned phone calls). If this is not sufficient, then consider an outdoor, socially distanced get together in the yard or driveway. This enables people to see each other while minimizing the likelihood of viral spread. Remember, stay at least six feet away, all people should wear masks, and do not share food. 

Visiting with grandparents is a particularly delicate subject as, generally speaking, the elderly population is the most vulnerable to complications of COVID-19 and the most likely to die as a result of infection. Many grandparents may feel that the risk of infection is worth a visit with their grandkids. If you feel that a visit is worth the risk, again, consider having a visit outdoors and keeping the visit brief. Masks should definitely be worn by everyone (by the grandparents as well as the grandkids). Advise the grandparents to wear a sweater or jacket that can be removed and washed immediately after the visit. Frequent and thorough handwashing is also helpful. 

Visiting with friends or neighbors present other challenges. Outdoor, socially-distanced, get-togethers (in which all people remain masked and 6-10 feet apart) are generally relatively low-risk. Some families have taken this a little further and begun to “Quaranteam” – the practice of choosing one friend or family and incorporating them into your closed-social group. This is also probably reasonably low risk, provided that both families have truly and completely stayed home and continue to socially-distance. When choosing to be with other people, it is important to be fully aware that other people’s actions become your liability – if they are not following the rules, you assume the risks of their irresponsible behavior and exposures. 

Remember, the COVID virus can live on and be transmitted by chalk, sports equipment, and other objects. Having a catch, playing basketball, or play tennis should be avoided (kicking a soccer ball or having a lacrosse or hockey catch without using your hands is probably ok). 

Teenagers and young adults getting together without supervision depend entirely on whether or not you trust your child to follow the rules. Adolescence is a time during which kids feel invulnerable. Also, adolescent brains are wired to favor socialization. The innate impulsivity and risk-taking of teenagers also contributes to an increased likelihood of them violating social-distancing. Unfortunately, this is why older kids present certain difficulties during the current pandemic as they possess the drive to see their friends while at the same time not fully appreciating the risk that this brings (to themselves and to others).

If you feel like your teenager will wear a mask and maintain social-distancing guidelines, then perhaps it is ok for them to see a friend. If you do not trust your child to be able to follow through with this, then consider having them get together chaperoned or in your yard. Obviously, kids should not be in cars with their friends.

Is it safe to send children to summer camp? Like so many questions, this one is also complicated by numerous variables. What type of summer camp? Overnight camp? Sports camps? Robotics or arts camp? Parks and Rec Camp? Each of these presents different challenges. Right now, any camp experience should be one in which kids are able to remain six feet apart and wear a mask. While some camps (Robotics? Theater?) may be able to do this, for an overnight camp if would be nearly impossible. For many of the camp experiences, the policies put in place to help with safety would also change the very nature of summer camp.

How about swimming? As with the other questions, the same principles apply. According to the CDC, you should avoid swimming if social distancing of at least six feet between people who don’t live together cannot be maintained. They also state that, while swimming, masks SHOULD NOT BE WORN due to potential difficulty breathing should they get too wet. 

What about going to a store? Again, this all comes down to your level of risk aversion. The most important thing is to consider if you NEED TO GO or if it would just be nice to go. If you must go to a store, you should make sure to wear a mask and gloves (and wash your hands when you get home). Go to the bathroom before going out to decrease the likelihood of you needing to use a public bathroom. Choose a time to go to the store when the store is likely to be less busy. Importantly, do not linger in the store – get in and get out as quickly as possible. Remember, the transmission is greater indoors and with increased time spent in close proximity. Less is better!

Should we travel out of state? The DPH is still instructing people who arrive in Massachusetts to self-quarantine for 14 days. This is true for people from Massachusetts who leave and then re-enter the state (even if just going to New Hampshire or Maine). With the upcoming holiday weekend and summer, if you visit other states, you will need to plan to self-quarantine when you return. In addition, since individual states have different guidelines you may expose yourself to a higher level of risk than you would be at home as the general public may not be following the same safety measures that you and your community have grown accustomed to.

In conclusion, in spite of state re-openings and quarantine fatigue, it is important to remember that the risk of COVID-19 is still present and that the safest thing to do is to remain socially-distanced. If you must see other people, doing so outside, wearing masks, and staying 6-10 feet apart will help minimize the risk of transmission. Teenagers and young adults present unique challenges as the drive for socialization, impulsivity, and feeling of invulnerability make them particularly susceptible to violating social distancing guidelines. Ultimately, each family will need to determine their own comfort level for how much risk they are willing to assume, knowing that asymptomatic individuals are capable of spreading COVID-19 and that spread within families and communities is ongoing. 

For more information, please visit the following references:

Wondering What’s Safe as States Start to Reopen? Here’s What Some Public Health Experts Plan to Do.
Washington Post article (posted on Boston.com) with suggestions from public health experts on risk

On Point: How to Fight Quarantine Fatigue
NPR Podcast about quarantine fatigue and harm-reduction during the current pandemic.

When Can I See My Grandkids?
New York Times article about when (and how) it might be okay to visit with grandparents.

The Risks – Know Them – Avoid Them
Blog post with a detailed explanation of risks and viral spread.


Stay safe!

All of us at Westwood-Mansfield Pediatric Associates