Harvard epidemiologist says think of ‘risk as a spectrum’ in quarantine

While the shutdown has undoubtedly saved lives, as many listeners have agreed, we can’t continue to be locked in our homes forever.

Dr. Julia Marcus, an infectious disease epidemiologist and professor at Harvard Medical School, published a feature in the Atlantic acknowledging, as others have, that the quarantine fatigue is real. In an effort to find a middle ground that allows us to stay safe while leading a semi-normal life, KIRO Radio’s Gee & Ursula Show reached out to Dr. Marcus.

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“We’ve been thinking about this as public health versus the economy, but there’s a lot more going on,” Marcus said. “People are experiencing real mental health effects of being isolated, being separated from extended family, from grand-kids. And it’s not something that we can really sustain in the long term.”

When stay-at-home orders started in early March, it was only going to be for a few weeks and most people thought, “we can do this,” Marcus recalled. Since then, it’s become clear that social distancing measures will need to remain in place for months, if not longer.

“So we have to figure out a way to have enough human contact that we avoid those psychological effects,” she said. “But, you know, not so much contact that we’re really increasing the risk of coronavirus transmission.”

Marcus drew a comparison between stay-at-home messaging and abstinence only messaging, suggesting we find a way to think about risk that’s less binary and more of a spectrum.

“Instead of saying we’re either going to stay home or all is lost … we can think about risk as a spectrum and try to identify lower risk activities that we can engage in that will allow us to live our lives in a sustainable way, but not go back to the normal as we knew it before COVID,” she said.

The idea of harm reduction is a public health approach that meets people where they are, Marcus explained, by acknowledging that there is no way to eliminate all risk.

“If you think about abstinence only messaging, we tell, for example, teenagers: Don’t have sex,” she said. “… But the reality is we all know that some teens will have sex. And if we don’t give them tools to reduce any potential harms, if they do choose to have sex, then we’re missing an opportunity.”

If we think about the coronavirus pandemic from a harm reduction perspective, it allows us to accept that there will always be some risk, Marcus said.

“We can’t ask everyone to just stay indoors until we have a vaccine,” she said. “And so how can we support people in reducing harms as much as possible when they do engage in activities that have some risk?”

While the science around this virus continues to evolve rapidly, Marcus says we know more about the risks of transmission than we did even a couple weeks ago.

“From what we can tell right now, there’s a much lower risk of transmission outdoors than indoors,” she said. “And so, for somebody who has been isolated for a couple months and really needs some social contact, we can help people identify a low-risk way to interact with other people by supporting outdoor activities, which we know are lower risk than indoor, and making sure that people know about the ways that they can protect themselves if they do meet up with people outdoors, like wearing a mask and keeping 6 feet of distance.”

That being said, there needs to be an understandable, consistent message shared with the public in terms of what is or is not a low-risk activity.

“Unfortunately, we haven’t really been hearing much from our national public health agency, the CDC,” Marcus said. “And so it’s made the messaging a bit more fragmented because it’s coming from all these different places — state health departments, local health departments, individual epidemiologists like me — and we end up with some confusion, … maybe even a lack of trust, when really what we need is … a unified message that’s easy to understand about where the risk lies, where we don’t need to be as concerned, and ways that people can live their lives while maintaining a fairly low risk.”

Somewhere between never leaving our homes and going to a crowded, indoor location, there are activities that are relatively low-risk and can even have lower risk if we take additional precautions.

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Walking, jogging, or biking by someone outside has a very low risk of transmission as a fleeting interaction, Marcus explained. An outdoor gathering has a bit higher risk, but is better than indoors as there is more ventilation and the conditions are just not as conductive to spreading the virus. Then, there’s even higher risk in spending time inside, in a crowded place, like a bar or restaurant.

“So there’s a spectrum from being at home to being in that crowded bar and a lot in between that we can be thinking about doing, with these harm reduction strategies that we can apply to every setting — wearing a mask, making sure you have six feet of distance, keeping your hands clean, not sharing food or drinks,” she said. “Just kind of the messages that we’ve been hearing all along, but applying those to the spectrum of risk and trying to keep our activities as low-risk as possible.”

Listen to the Gee and Ursula Show weekday mornings from 9 a.m. – 12 p.m. on KIRO Radio, 97.3 FM. Subscribe to the podcast here.