In mid-March my high school son was scheduled to go on a school trip to Chicago the following week over spring break. I was starting to get nervous. Was it really wise to let him go on this trip wise with the virus starting to spread? I expressed my concerns to some of my friends and to other parents. The general consensus was that it would likely be fine. I was probably overreacting. This was probably just like a bad flu.
That was on Wednesday. By Friday the trip was cancelled, all the schools in our state were closed, and both my daughters were home from college. It took fewer than three days for us to go from “Should we be worried?” to “Life as we know it has drastically changed.”
We were not prepared for this
Needless to say, we were not prepared for pandemic life and for what that meant for our family as the children and I settled into online schooling, and my husband, the owner of an essential business, continued going to work.
At first we just washed our hands a lot and watched the news constantly. But as cases of the illness began to rise and information provided by the media and federal officials was confusing and contradictory, we decided to take drastic measures. To avoid bringing anything home to us, my husband packed a bag and went to stay at our cabin on the river.
My husband is now home. And thrilled as I am to have him, living with someone who spends his days “out there” makes me nervous. And since it looks like my children will be going to work at their summer jobs soon, I decided that for the reopening phase of our community, I want to be more prepared. I want to know how to live safely and happily with my family now that most of us will be working outside the home.
To that end, I have scoured the internet in search of the best practices for living with an essential worker and been surprised to find there is little information available for families like mine. Fortunately, Dr. Tim Lahey, infectious disease specialist at the University of Vermont Medical Center, agreed to answer a few of my questions.
Dr. Tim Lahey, infectious disease specialist: Q&A on living safely with an essential worker
LCH:Let’s start with when a family member gets home from work. Most people know the importance of taking off their shoes before entering the house. Are there other things we should be doing? Do I need to ask my husband to disrobe in the garage and head straight to the shower?
Dr. Lahey: If it amuses you to make your husband disrobe in the garage, don’t let me stop you. Just don’t tell him I said so.
The non-sadistic, scientific answer is it’s optional every day, and whether to take that option depends on how exposed your husband is and how risk averse you are.
Some clinicians who care for patients with COVID-19 all day long are wearing scrubs that they take off with their shoes before walking into their own homes. The idea is to reduce the chance they bring SARS-CoV-2-contaminated items into the home. This isn’t tin-foil-hat stuff, but we don’t know if it’s really necessary. That’s particularly true if the essential worker has adequate personal protective equipment (PPE) at work, meaning the likelihood their clothing gets soiled is quite low.
Whether to have a sort of sartorial airlock between the hospital and your home probably depends on whether it helps them, or you, sleep better at night. It may take a very, very low of SARS-CoV-2 transmission from health care worker clothing and make that risk – forgive the scientific jargon – very, very, very low. There is no way to get to zero, though, we all have to find the happy medium for ourselves.
For what it’s worth, as an infectious diseases doc, I do wash my hands after touching the last door on the way out of the hospital but I don’t disrobe in the garage or take my shoes off before giving my wife a kiss at the end of the day.
LCH:I’ve read that ventilation is important when it comes to minimizing the spread of covid_19. Now that the weather is warmer, do you recommend families spend the majority of their time together outdoors if possible? Should we return to the days of evenings on the front porch instead of nights in front of the T.V.?
Dr. Lahey: It’s easier to maintain adequate physical distance from strangers outdoors, and it’s easier there to avoid touching potentially contaminated objects than in the home. Plus, we should not underestimate the importance of feeling the sun on your cheeks.
LCH: What about indoors? Should people who are working outside the home try to maintain some physical distance from the rest of the family? Do you recommend separate bathrooms and bedrooms for working family members when possible?
Dr. Lahey: Some health care workers have been living apart from their families in order to protect them. With rare exceptions, I think this is a bad idea. We shouldn’t deprive essential workers of time with their families. They are humans living their lives in the middle of circumstances-that is important healing time. To me, I don’t think it’s a good idea to break apart families in order to shave a tenths of a percent of risk off the already low likelihood that families will get infected by health care workers.
Exceptions exist: If the health care worker can’t access adequate PPE and so is more likely to get sick, then perhaps more draconian measures make sense. Certainly if the health care worker contracts COVID-19 then living apart for a couple of weeks or at least exercising some physical distancing in the home makes sense.
What about the gray area in which an essential worker lives with someone who has high risk of severe COVID-19 as a result of advanced age or medical fragility? We don’t really know but perhaps extra care with handwashing and disrobing in the garage would be reasonable in that case. Maybe.
LCH: I know it’s important to wipe down frequently-touched surfaces often. What about soft surfaces? Should we worry about the virus lingering on furniture or clothing?
Dr. Lahey: Most transmission of SARS-CoV-2 happens when someone who’s infected has hours and hours of contact with someone who is vulnerable. That means low risk short-term PPE-protected contacts at work are unlikely to be followed, hours later, by transmission via objects at home. As a result, I don’t put a lot of effort into radiating my briefcase or putting my Amazon boxes through a carwash before bringing them into the house. Some easy measures make sense. I (still) wash vegetables from the grocery store. I wash my hands after running errands or reading the mail. I’m really careful not to touch my face after patient care or after handling objects out in public. Otherwise, I accept that living a good life requires us to accept some level of risk. So I take a deep breath, and let common sense and denial do their jobs.
LCH: What about those of us living with teenagers? I am a teacher, so I know firsthand that teenagers are not great about hand washing (at least not for 20 full seconds) or social distancing. And they can’t seem to stop touching their faces. Do you have different or additional advice for families whose teens and college students are returning to work? Or is good old fashioned nagging our best option?
Dr. Lahey: Kids are less likely to be meticulous handwashers than adults and probably less likely to be compulsive about distancing measures. That’s why school closures have been a pivotal piece of distancing measures. From there, parents should model good hygiene and distancing behaviors to their kids, and I’m no stranger to hygienic nagging. I try to balance my role as Handwashing Nagger In-Chief with the desire to preserve a supportive relationship with my kids. The last thing I’d want them to experience in the middle of a stressful pandemic is that I prioritized hygiene over being loving or supportive or just entertaining as the world changes frighteningly around them.
LCH: Also, what if a family member works in retail or in another job that requires frequent contact with the public but does not involve the use of PPEs like scrubs, gloves, or masks? Any extra precautions at home?
Dr. Lahey: Non-health care workers whose jobs put them in frequent contact with the public – for instance grocery store workers – should invest in the safety of themselves and their loved ones by investing in handwashing, mask wearing and physical distancing as appropriate. Having done so to a reasonable degree, I think they should be able to follow the same home safety rules as everyone else.
LCH: Do you have any recommendations about the kitchen? When our younger daughter first came home from college with what we hoped was just a bad cold, we asked her to stay out of the kitchen and to avoid preparing her own meals for the first couple of weeks. Was this overkill? Or is it a good idea if people exposed to the public stay out of the kitchen at home?
Dr. Lahey: What you did wasn’t totally unreasonable, and also it was more aggressive than what we did when my son returned home from a COVID-19 hotspot.
When he came home, not having had any known COVID-19 exposures, we avoided eating off the same plate as him and kept a close eye on whether he developed symptoms for about 2 weeks. We encouraged him to wash his hands strategically. That might have left some room for asymptomatic transmission to occur, but I figured the low low risk was worth taking so we could give him a hug. Had he gotten sick in the two weeks after returning from a COVID-19 hotspot, we would have instituted some more intensive measures to reduce the risk of transmission in the home.
LCH: Are there any potentially risky at-home behaviors that even extremely careful families might not have thought of?
Dr. Lahey: To balance personal safety with personal sanity, I focus on two things: a historical perspective on ambient risk and intervening at transmission bottlenecks.
Historically, humans have lived good lives with higher levels of ambient infectious disease risk than we are comfortable with now in 21stcentury United States. Having eradicated smallpox and nearly wiped polio off the map, and benefiting from highly successful vaccines, we are incredibly risk- averse. Much as I take measures to protect myself and my family, and am deeply eager for a COVID-19 vaccine, I also remind myself that what makes us feel so distressed is how things have changed and not necessarily that living in these conditions is impossible to live joyfully.
To stay safe livably, I focus on preventing the highest risk forms of transmission. I wear PPE at work, I wear a mask in public, I stay 6+ feet away from strangers, and I avoid touching my face and wash my hands after coming into contact with public objects. Beyond that, I cross my fingers that lightning will not strike, and I feel grateful for the many people who are pitching in to keep each other safe.
In my correspondence with Dr. Lahey, I mentioned a book I read last summer about a deadly cholera outbreak in London in the 1850’s. The author pointed out that when you look at the literature of this era, it deals with a wide range of human emotions–passion, love, sorrow, anger–but there is very little about fear. Even during a time when death and disease were so much a part of life, the fear of death wasn’t a big theme in 19th century literature.
Will this pandemic give us a more casual attitude about the risks of infectious disease? I hope not. I hope more people will, as Dr. Lahey advises, wear masks in public and continue to practice social distancing and that we always take the potential loss of life seriously. But I also hope that one of the lessons of this pandemic is that we all learn to live with more joy, gratitude, and peace–regardless of the risks.
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