In response to the rising Covid-19 death toll and case counts in the U.S., calls for a national lockdown have been escalating. In an open letter to America’s decision-makers, more than 150 medical professionals urge them to “shut it down now, and start over.” In the letter, they argue that people should “stay home, going out only to get food and medicine or to exercise and get fresh air.”

I empathize with the urgency in their plea for people to stay home. I felt helpless watching patient after patient die from Covid-19 while working in a New York hospital in April. In the Northern California Covid-19 clinic I work in, I continue to see patients infected with and harmed by the virus. I, too, am desperate for this pandemic to end.

But I believe that telling people to stay home and avoid all nonessential social interactions is the wrong way forward. We should instead focus on educating people and helping them socialize safely. Lessons from sex education indicate that this will be a more effective approach.

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A national lockdown is politically impossible today given widespread unemployment and the deepening recession, not to mention the federal government’s failure to coordinate a national response and the extreme politicization of the pandemic.

Telling people to stay home will worsen the mental health epidemic brought on by Covid-19. Michelle Obama recently admitted that “there have been periods throughout this quarantine, where I just have felt too low.” She is not alone. Since the pandemic started, loneliness has increased by 20% to 30%, and emotional distress has more than tripled. This is not surprising: Numerous studies have demonstrated deleterious effects of social isolation on physical and mental health.

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Without widespread understanding of how to socialize safely, the cooped-up need for social connection will lead to surges of long-awaited get-togethers and new infections when lockdowns end. We have already seen this phenomenon in Florida and Arizona. It is happening across Europe. In the urgent care clinic where I work, I have seen an increasing number of people who developed Covid-19 symptoms after attending an indoor get-together following months of judicious social distancing.

If telling people to stay home isn’t the answer, then how do we slow this pandemic? By helping them socialize safely.

Several months into the pandemic, we know more about SARS-CoV-2, the virus that causes Covid-19, how it spreads, and how to reduce its transmission from person to person. We know that infection via surfaces is uncommon, and that outdoor transmission is even rarer. We know that face coverings and physical distancing significantly reduce the virus’s spread. At a hair salon in Missouri, for example, two stylists with Covid-19 interacted with more than 100 clients and infected none of them, thanks to the salon’s policy of having stylists and clients wear face coverings.

Instead of insisting that people stay home and indefinitely postpone seeing their loved ones and friends, we should be helping people socialize in ways that minimize the risk of spreading Covid-19.

At an individual level, socializing safely means taking into consideration various factors that determine the risk of coming in contact with SARS-CoV-2: wearing a face covering; frequently washing your hands; being aware of how close you are to others, and for how long; the number of nonhousehold contacts you are with; and ventilation.

Putting that into practice looks like this: Hang out outdoors with a few people instead of indoors with many. Wear a face covering when physical distancing is not possible. Stay home at the smallest hint of fever, fatigue, or cough. Don’t share food or drinks. Limit your social circle and consider creating a “Covid-19 bubble” with one or two close households. These relatively simple steps can help us meaningfully connect with one another without significantly increasing the risk of developing Covid-19.

At a community level, people should be educated about the Covid-19 risks associated with various social activities. Going to the grocery store or playing a noncontact sport like tennis are low-risk activities, while going to a bar or attending a crowded indoor religious service are high-risk activities. Such information, though available, is far from being commonplace knowledge.

It is also essential to enable safe socialization by both making it easy and enforcing it. Closing off streets to cars and painting reminders for physical distancing in public parks and stores are a start, but we can do more. Just as lifeguards at a beach or pool monitor swimmers and discourage them from behaving unsafely, public officials should be deployed in crowded places to remind people to socialize safely and make face coverings freely available to those who need them.

And until the pandemic is under control, the highest-risk activities, such as indoor dining or large concerts, should be discouraged, if not banned.

Some may argue that this “socialize safely” message will backfire and lead to more risky social interactions. There are a few reasons that likely won’t be the case.

One comes from another field of public health: sexual health. Proponents of “abstinence only” education worry that comprehensive sexual education, which covers sexually transmitted diseases, condom use, and safe sexual practices — along with abstinence — leads to increased sexual activity among teens. Yet studies have repeatedly shown that the safe-sex curriculum actually reduces rates of unprotected sex, sexually transmitted diseases, and unwanted pregnancies.

In the context of this pandemic, the “safe socialization” approach has proven successful in other countries. In Japan, people are asked to avoid the 3 C’s — closed spaces, crowded places, and close contact. Instead of self-isolating at home, Canadians are encouraged to exclusively hang out with another household in a “double bubble.”

Telling people to stay home backfired early in the pandemic, resulting in protests, premature reopenings, risky social activities, and the worst Covid-19 pandemic in the world. We can avoid making the same mistake if we choose to accept our social and political realities, heed the latest scientific evidence, and help people socialize safely.

Jason Bae is an internal medicine physician in northern California and medical director of Prealize Health, a company that uses machine learning to power proactive health care.

  • Seriously? We have had the message of social distancing, washing hands and wearing masks shoved down our throats every single day. Who has not been exposed to those messages constantly? BTW the WHO recommends social distancing at 1 meter (3.28 ft) and masks IF you cannot social distance.

    The issue in my view are the masks and I have observed this myself over and over, as I’m sure you have.

    How many people wear a clean mask EVERY single day? They don’t! They wear the same nasty, bacteria ridden traps on their face for weeks, even months. The same contaminated mask day in and day out, While lying their masks about every where on every surface.

    #1 RULE: Do not touch your face! – People with masks are constantly touching their faces with their hands, scratching, pulling and adjusting the masks, where all these germs and fabulous bacteria are brewing, and then touching everything around them. It’s disgusting. How many people have seen with the same mask hanging on a rear view mirror? So now the A/C in the car can spread it around to everyone in the vehicle. How about women carry the used masks in their purses contaminating everything in it, including wallets, keys, money and credit cards? You should easily know the reason are reporting faces breaking out in Maskacne. Why? Read above…I am all for clean, safe masks. I am not for the way masks are being used on the regular.

    WHY is this not shouted from the rooftop of CDC and publicity seeking Fauci?????? A report just came out and finally said neck gaiters and bandanas are worse than wearing NO mask at all. If they ever did a random test on people walking around with their contaminated masks, I sure it would blow up in everyone’s face. And this report tested clean masks, can you imagine if they tested what is really our there?

    Although this is common sense to me, it is not so for the majority of people.

    It’s too bad Fauci and the FDA who is 75% funded by Big Pharma (did you know that?) BANNED a proven safe drug that has been around for at least 50 years. Strange that people who take hydroxychloroquine for lupus and rheumatoid arthritis for the rest of their lives are not experiencing heart and renal issues and death. Strange that this drug that has been give out like candy to our military and ANYONE visiting countries with malaria have had a very safe experience. Can anyone explain that to me? Can you tell me why that decision is not left up to you and your doctor? Can you tell me why legitimate studies on the drug that have proven it to be safe and effective for covid are pulled from all social media platforms?

    Could it be because it costs $4-5 and Remdesivir that Fauci pushed through by continuing to move the goals posts to get it approved costs $4-6,000? Do you know how much this would help those less fortunate? ….and there is plenty of it. Trump bought millions of doses to be given out for free, only to be shut down by the FDA and Fauci.

    Is the hate for Trump so strong that we have allowed politics to harm and much worse, kill innocent family members, loved ones, neighbors and first responders? If you would like to read real studies and FACTS that were not manipulated by the press and media and the medical profession, just google PalmerFoundation.com/au (located in Australia) and make up your own mind without censorship.

    Let’s love and support each other, instead of finding fault and pointing fingers when you have no suggestions.

    Let’s try and save people and let them live their lives to the fullest and be d____ politics.

    • MK,

      Re: masks. I do agree that there is an increasing call for people to wear a mask, which is great. The point that I made in this article is that when the message focuses solely on what not to do, then people don’t quite understand how to interact with each other safely, and this leads to unsafe interactions. So people can be bombarded with calls for universal masking while also not understanding how to socialize safely.

      Re: mask and hygiene. Epidemiologic studies have shown that infection via touching a contaminated surface is rare. Most people seem to get infected from large droplets expelled from another person in close proximity, and in some cases by breathing in aerosols in an indoor setting. Bacteria live everywhere on, inside, and around us, and most do not cause harm. A serious complication due to wearing a mask, even if used repeated without washing, seems rare, if not unheard of. And, a virus like SARS-CoV2 that causes COVID-19 is NOT bacteria, and scientific evidence shows that viruses do not survive on masks for too long.

      Re: hydroxychloroquine. Teasing apart causation from correlation is at the core of medical research. The best way to see if a drug works is not by saying “hey look, these people received these drugs and did better.” One can almost always find such scenario. Rather, scientists carefully design studies that try to eliminate any factor that could be confounding (i.e. contributing any bias to the outcome) by “double-blinding,” which means those who give an intervention (a pill in this case) don’t know if it is hydroxychloroquine or placebo, and those who receive the intervention (patients) don’t know what meds they are getting. Then, statisticians analyze data NOT knowing which is which, and then after the analysis, “unblind” things, and that’s when we know if the drug works.

      Multiple of such “randomized double-blind placebo-controlled trials” have been conducted on hydroxychloroquine and they all failed to show that hydroxychloroquine leads to any meaningful difference in the hospitalization length or mortality. Another very cheap and widely available drug called dexamethasone, on the other hand, has been shown to be beneficial for those suffering from severe COVID-19 cases, and since has been widely adopted.

      So, it is not for reasons of politics, but based on best available scientific evidence that the scientific and medical communities have moved away from unauthorized use of hydroxychloroquine.

      Hope this information helps.

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