Reopening when we’re not quite ready to thwart covid-19 means managing risk, and there are four types, health expert writes

No state “has met the metrics to safely reopen,” so the nation “needs to move to the public health strategy of harm reduction,” says former Baltimore health commissioner Leana Wen. “So what does that mean in terms of choices each of us makes — what’s safe to do and what’s not?”

Wen, an emergency physician and visiting professor at George Washington University‘s Milken Institute School of Public Health, offers four concepts from other harm-reduction strategies: relative risk, pooled risk, cumulative risk and collective risk.

Relative risk depends mainly on three variables: proximity, activity and time. “The highest-risk scenario is if you are in close proximity with someone who is infected, in an indoor space, for an extended period of time,” Wen writes, noting that gatherings where people hug, such as funerals and birthdays, can be “superspreader” events.

“You can decrease your risk by modifying one of these three variables,” Wen writes. “If you want to see friends, avoid crowded bars, and instead host in your backyard or a park, where everyone can keep their distance. Use your own utensils and, to be even safer, bring your own food and drinks. Skip the hugs, kisses and handshakes. If you go to the beach, find areas where you can stay at least six feet away from others who are not in your household. Takeout food is the safest. If you really want a meal out, eating outdoors with tables farther apart will be safer than dining in a crowded indoor restaurant.”

Pooled risk “is particularly relevant for separated families that want to see one another,” Wen writes. “I receive many questions from grandparents who miss their grandchildren and want to know when they can see them again. If two families have both been sheltering at home with virtually no outside interaction, there should be no concern with them being with one another. Families can come together for day-care arrangements this way if all continue to abide by strict social distancing guidelines in other aspects of their lives. The equation changes when any one individual resumes higher-risk activities — returning to work outside the home, for example.”

Cumulative risk means that your risk of infection increased with every person you come into close contact with. “Many people must return to work, but they can still reduce their risk overall by not having social gatherings outside of work,” Wen writes. “Choose the activities most important to you. If you must have your hair cut, don’t also go out to eat in restaurants. How much you do should also depend on your personal health. By now, we know that those most vulnerable to the severe effects of covid-19 are older people with chronic medical conditions. These individuals should aim for lower cumulative risk to best protect themselves.”

Collective risk means that “The higher the rate of covid-19 in a community, the more likely any one individual you come into contact with has the virus and the riskier your interactions become,” Wen writes. “This is why mask-wearing is important: If most people wear a mask, it reduces the amount of virus that we will transmit. Local and state policymakers should continue to ban large gatherings and follow the CDC guidelines for gradual reopening. They must have surveillance systems in place to detect if and when infections rise and be willing to reimpose restrictions.”

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