We spoke to a diverse group of medical experts to get a sense of which activities and spaces are the safest, and which ones should absolutely be avoided.
It’s been more than two months since the United States went into lockdown to slow the spread of the novel coronavirus. The stay-at-home orders and social distancing guidelines implemented in March have helped prevent America’s already grim death toll—which as of Saturday morning had surpassed 102,000—from being even worse.
But as the calendar ticks toward June, Americans are increasingly restless and experiencing what many have dubbed “quarantine fatigue.” A majority (60%) of Americans still favor requiring people to stay at home, except for essential errands, according to an AP-NORC Poll released last week. But that figure—driven primarily by a 25% drop in support among Republicans—is down from 80% in April.
In recent weeks, all 50 states have lifted at least some coronavirus restrictions, despite warnings from leading public health officials that reopening too quickly could lead to a surge in COVID-19 cases and deaths.
As more businesses and public spaces reopen and Americans feel increasing social isolation, many are wondering which activities might be safe to resume and which are the most dangerous. It’s an understandable impulse, one that’s likely to increase as time goes on. Recognizing that reality, COURIER spoke to a diverse group of medical experts to get a sense of which activities and spaces are the safest, and which ones should be avoided.
Every medical expert we contacted advised Americans to wear a face mask in any setting outside of their own home—studies have shown that wearing a surgical mask can reduce transmission by as much as 75%—and to continue practicing social distancing, hand-washing and sanitizing, avoiding large crowds, and ideally, limiting contact with people outside of their household.
The key takeaways from these recommendations were reflective of a growing consensus that being outdoors in open spaces is safer than being indoors in enclosed spaces. A new paper awaiting peer review out of Hong Kong found that of 7,324 documented cases in China, only one outbreak occurred outdoors. Another study from Japan concluded that the risk of infection in a closed, indoor environment is nearly 19 times higher than in open-air environments.
Our experts also advised that when making decisions of which activities to pursue, Americans who are older, have one or more pre-existing conditions such as heart disease or obesity, live with older family or more vulnerable family members, and live in areas with a high rate of infections ought to be particularly cautious.
With that in mind, let’s jump in and look at which activities our panel deemed the safest and the least safe. Some things to keep in mind:
- We asked these health experts to rate each activity from 1 to 10, with 1 being the least safe, and 10 being the safest.
- Unless otherwise noted, these activities were rated and judged under the premise that participants would be wearing masks and practicing social distancing as much as possible.
- Given the informal and unscientific nature of this survey, these ratings should all be taken with a grain of salt.
Outdoor Activities Are The Safest Things To Do
Our experts unanimously agreed that walking and biking with someone outside of your household are reasonably safe (8/10)—as long as you wear a mask and follow social distancing guidelines.
Beaches, trails, and parks scored slightly lower (7.8/10), owing to the fact that they’re likely to have more people present, and could require the use of public spaces.
“The big risk here comes from public spaces, like restrooms and other gathering areas, where you may be in close contact with others,” said Dr. Robbie Goldstein, a physician and infectious disease specialist at Massachusetts General Hospital.
These places become far less safe if you’re around large crowds or not following guidelines, said Dr. Pritesh Gandhi, associate chief medical officer for a community health clinic in East Austin, Texas. “Partying on a crowded beach offers quite a different level of risk than taking a walk with your partner on an isolated beach.”
An outdoor gathering with a few friends in someone’s backyard or public park was also collectively rated generally safe (7.4/10). But “sharing items such as plates, food, cups, etc., can lead to potential contacts,” said Eleanor J. Murray, assistant professor of epidemiology at Boston University School of Public Health.
Dr. Goldstein, who gave it a 5/10, was less certain. “What worries me here are all of the surfaces that exist in the backyard, on the park bench, and throughout the environment, which you can’t monitor,” he said.
One important caveat: All of our experts recommended keeping the groups as small as possible: fewer than 10 people was the general consensus.
“I would limit gatherings to the least number of individuals as possible. Each individual you have increases the risk you may be exposed to coronavirus,” said Dr. Krutika Kuppalli, an infectious diseases physician and vice chair of the IDSA Global Health Committee (Dr. Kuppalli did not partake in the ratings).
As for playing sports outdoors, our experts largely agreed that outdoor, individual, or small group, non-contact sports such as golf and tennis are safe, as long you’re not sharing equipment and are wearing masks and social distancing (7.4/10). Some also raised concerns that using a public restroom or locker room and breathing heavily or yelling increases the risk of virus spread.
And for those of you who might want to move from FaceTime or Zoom dates to in-person meet-ups, our experts were largely in agreement that while going on an outdoors, socially-distanced date might be OK, kissing a stranger was a really bad idea. “Once you’ve kissed somebody, it’s 100% risk,” said Dr. Dara Kass, associate professor of emergency medicine at the Columbia University Medical Center. “On a scale of 1-10, it’s a 0.”
Indoor Gatherings & The Safety of Forming a Pod
Being indoors around people outside of your household, even when wearing a mask, carries a fair amount of risk, according to our experts: On average, they gave it a 5.4/10 safety score—a full two points below the same activity outdoors.
“Indoor contacts are potentially more likely to lead to transmission, and when you’re in someone’s home, there are lots of potential shared surfaces and objects to touch which can all lead to transmission,” Murray said.
If you insist on indoor gatherings, keep the groups as small as possible and only see close contacts that you trust.
“This is very dependent on how much people have isolated, what people’s symptoms are, and what distance you can maintain,” Dr. Goldstein added. Wash your hands immediately upon arrival, he advised, and be aware that you are putting yourself at risk of spending time with and touching the same surfaces as someone who could be asymptomatic and contagious.
Murray noted that this activity could be made safer by choosing friends from a “pod” or “bubble” you create whose contact history is known and low risk. This idea of a social pod or bubble has gained traction in recent weeks as states have relaxed restrictions. Whether or not you should form one depends on your tolerance for risk, weighted against the reward of social interaction.
Dr. Gandhi agreed that while not the safest idea in general, a “pod” could make hanging out indoors a safer activity: “It is far less risky for you to form a ‘pod’ where each person makes a concerted effort to limit their other interactions than for you to go to a crowded bar on a Friday evening.”
The other experts we interviewed were more supportive of the general idea, so long as everyone involved knew they were part of the pod and followed the same set of guidelines—such as washing their hands, avoiding the sharing of utensils or meals, limiting outside contacts, and avoiding large groups. Murray also cautioned that forming a pod should wait until the number of cases in your area are on the decline and stay-at-home orders are officially lifted.
But Dr. Kuppalli was less convinced of the wisdom of forming a pod. “I don’t think this is a good idea because you never know what the other individuals’ exposures are. For example if people A, B, and C have a pod with each other, that seems great, but what if person C decides to go out for a quick meet up with person D? This would potentially put patient C and the rest of the individuals in their “pod” at potential risk for Coronavirus.”
Outdoor Restaurant or Bar (No Mask)
As more and more states lift restrictions, restaurants and bars are once again beginning to serve patrons. Understanding that many Americans are nervous to dine out, some cities are only allowing restaurants to operate at 25%, 50%, or 75% capacity, while other localities are allowing restaurants to set up tables in streets and parking lots to try to make the experience as safe as possible.
Despite these precautions, our experts remain wary of going to restaurants or bars and collectively rated dining at an outdoor restaurant or drinking at an outdoor bar a 4.8/10 in terms of safety.
Dr. Ali Khan, the executive medical director of Oak Street Health in Illinois—who scored it a 3/10—urged anyone who chose to go to any restaurant or bar to take every precaution possible. “This is slightly less risky than indoor seating, but keep those masks on when you’re not eating, and please space out at the table. I’m seeing pictures of many people not doing this outdoors and sharing a ton of food,” he warned.
Churches, Synagogues, Mosques And Other Houses of Worship
Although President Trump has demanded governors lift restrictions on churches, synagogues, mosques, and other houses of faith “right now” because they are “essential services,” our experts unanimously agreed that visiting such spaces is dangerous, especially if they’re crowded or in regions with high rates of coronavirus infections.
“Religious functions are high risk because they typically involve crowded indoor spaces, contact between individuals from multiple households, sharing of items, and high-transmission risk activities like singing,” Murray said.
Dr. Kass agreed. “A crowded church singing gospel is as risky as a bar. Functionally for the coronavirus, they’re the exact same thing.”
The overall verdict on churches and other houses of worship? A 3.3/10 in terms of safety.
Taking A Plane or Train to Visit Family/Friends
Few industries have been as hard hit as the airline and transportation sector, and many airlines have made a concerted effort to implement serious safety and social distancing protocols in order to try to ease the concerns of passengers. But our experts remain worried, giving this activity an abysmal 3.2/10 safety score.
“Being in a confined, crowded place for hours with no control who sits next to you isn’t the best option in a time of continued COVID transmission,” said Dr. Gandhi, who scored it a 1/10.
“The travel may be safe if you can physically distance yourself and wear a mask (as well as guarantee that the plane or train was cleaned), but traveling from one area to another risks exposing yourself to an area with a high prevalence of the virus, or bringing the virus to an area of low prevalence,” said Dr. Goldstein.
If you must travel, Murray, the epidemiologist, advises self-quarantining for 14 days afterward to ensure that you don’t unknowingly spread the virus.
Indoor Public Places
The riskiest activities on our list all earned an average between 2.5 and 3. In fact, not a single one of these four earned above a 5 from any of our experts:
- Movie theaters, bowling alleys, or other indoor entertainment venues – 2.9/10
- Hair and nail salons – 2.8/10
- Indoor restaurant or bar (no mask) – 2.7/10
- Indoor gyms/workout classes – 2.5/10
The reason for the low scores were the same: They’re all public, indoor spaces that can get crowded and where social distancing is difficult, thus increasing the risk of transmission.
Restaurants are particularly unsafe, Dr. Goldstein said. “There are a lot of risks to restaurants right now—from the food preparation to the surfaces on the table and the menus that you use. It is hard to guarantee that everyone working at the restaurant, everyone else dining at the restaurant and all of the people who came in and out are asymptomatic and not infected.”
The volume of the indoor space, especially if it’s a bar, also matters, according to Dr. Kass. “Do not go to a loud bar. And it’s the loud part of the bar, not the bar,” she said. “Don’t go into a loud, closed space. It requires you to be up close with somebody and speak with them in close proximity. Close proximity talking without a mask on is the worst thing you can do.”
As for indoor gyms or workout classes, many of these facilities have limited space and require the sharing of equipment. “Even with extensive cleaning, it is very hard to know who has been present,” said Dr. Goldstein. “And because these activities require vigorous activity, it makes wearing a mask difficult, which further increases the risk.”
The only one of these activities that our experts said could be made genuinely safe was going to a hair or nail salon—but only if businesses take certain precautions, such as installing plexiglass shields as barriers, to limit the physical proximity between client and stylist.
Final Recommendations And Warnings
Although they participated in ranking the safety of these proposed activities, the experts we talked to also agreed that the safest course of action right now is still to continue only seeing people in your household and to refrain from social and public activities as much as possible.
“The more interactions we have, the more likely we are to have spread of the virus. We’ve already seen in other countries that when social distancing ends, there are new outbreaks often from asymptomatic individuals who are now interacting with others,” Dr. Goldstein said.
But they also acknowledged that it was likely that people would start to engage in some of these activities anyway, and reiterated the importance of taking proper hygiene and safety measures.
If you decide to venture out, the best thing you can do is wear a mask and wash your hands as soon as you get home, Dr. Kass said. “Anything with a mask gets three extra points.”
But what if you take all these precautions and wake up one day and think you’ve contracted COVID-19? In that case, our experts advised staying calm, seeking out medical help, and not going through it alone.
“The symptoms of COVID19 are vast in number and more and more atypical—it’s popping up in all sorts of forms,” Dr. Khan said. “So, if you’re noticing a new symptom or problem, ask for help—from your primary care physician, from other trusted health sources, from your local department of health— and we’ll help set you on the right path.”