It’s time to shrink your COVID ‘bubble’—now

With cases surging across the country this fall, now is a good time families to hunker down. (Yes, again.)

shrink covid bubble for fall
@rohane / Twenty20

Over the summer, many families took the opportunity to gather safely with others—getting together for outdoor play dates, "quaranteam" vacationing with other families, eating out on restaurant patios and perhaps even traveling to see friends and family while observing as many public health guidelines as possible.

But saying goodbye to summer means saying hello to the reality of colder weather and the viral infections that come with it. As fall and winter approach and kids embark on blended or in-person learning at school, more activities move indoors and cold and flu season gets into gear, it's a good time for families to think about a return to stricter precautions. How might we need to adapt our behaviors to keep ourselves and our communities safe?

Here's why right now is the time to start thinking about how big our "bubbles" really are, and what we can do as the weather gets cooler to keep our families healthy.


Why fall 2020 calls for more precautions than summer 2020

Inevitably, when we spend more time indoors, we spread more viruses. This year that means coronavirus. However, if we are masking and social distancing, there's every reason to believe these precautions will help reduce our risk of all viruses including coronavirus, influenza, RSV and stomach bugs.

As we settle into our school year routine, whatever that entails, now's the time to be most protective of our bubbles. If we've introduced our children to in-person school, pods or daycare, we have more responsibilities than ever.

Over the summer, when I made decisions about our choices, I did so with my family and my community in mind. As a low-risk family in an area where coronavirus has been well controlled, this felt easy. But now I have an additional layer to consider.

Both my children are attending school in person—and it's going great. But their classmates and teachers are depending on me to make responsible choices and not increase the risk of coronavirus entering our community. Anyone who gets sick will cost all of us extra visits to the doctor, isolation time and testing.

I get it—it's getting colder out and we're all tired of being so isolated. But when I read about schools (and parents) gaining confidence after a few weeks of being open successfully and considering decreasing the precautions, I get concerned. Now is not the time to let our guards down—in fact, we have to remain vigilant.

What history + science tell us about viral spread

We know from prior pandemics that as seasons change and as individuals change their behavior in response to "caution fatigue," new waves of viral infections can occur. During the influenza pandemic of 1918, the second wave that occurred in the fall was worse than the first wave, resulting in the majority of fatalities attributed to the pandemic.

While we've already seen over 7 million cases in the U.S., protective "herd" immunity from infection is incomplete and for many may not be permanent. It may help that in some communities, large numbers of people have already been infected, but we are far from achieving the kind of large-scale immunity that would make it safer for us to let down our guard against infection.

We also know that coronavirus has an intrinsic lag period which we have to remember when considering our exposure risks. Most people once infected don't show symptoms for at least five days, and even once they obtain testing it may take time to know the result.

Most individuals hospitalized may not be hospitalized until 10-14 days into their illness. Deaths in impacted communities can lag even further, up to six to eight weeks from the peak of cases. So while following the number of cases and percent positive tests in your community can be helpful, it likely takes a minimum of two months to understand the true impact of behaviors on your community. If you wait to see a change in numbers before you change behavior you may get exposed in the meantime.

What does being careful mean in fall 2020?

While staying at home is the easiest way to be safe, for many families social contact is essential to our mental health during this marathon of a pandemic. We have many needs, whether related to work, school, physical activity, preventive health and dental care, that require us to leave our homes. As parents, you know best what's important to your children and your family.

When making choices about your activities, there are seven factors to remember.

  1. Keep your "bubble" small. By keeping our activities confined to our own small social circle or pod we decrease the likelihood of introducing new infections to the group.
  2. Stay outdoors. If you've always embraced the adage that there's no such thing as bad weather (only bad preparation), great! But if not, this is the year to stock up on appropriate apparel and stay outside even when rain or snow come. Outdoor time is particularly important for those involved in virtual school.
  3. Mask up. When doing something indoors or not distanced, it's especially important to wear a mask. Children can do it! Changing masks frequently can improve comfort.
  4. Clean hands. While we know most transmission comes from breathing the same air as others infected with coronavirus, clean hands will also prevent transmission of other diseases that can cause false COVID-19 alarms, such as common colds and flu.
  5. Protect the parents. As a pediatrician, I know how careful parents are about their children and how motivated we are to protect them, but please remember for most families the risk of bad outcomes from coronavirus is much higher in the parents.
  6. Track the numbers. Once a week check in with your community dashboard. Know the numbers required to keep things open in your community and consider how the numbers in your area might impact your family plan.
  7. When in doubt, check it out. If anyone in your family has symptoms, please isolate yourself and get the test. It's worth the extra caution to protect our communities.

With appropriate precautions, we can make it through this winter without major surges in coronavirus, colds, and flus. As Dory said in Finding Nemo, "just keep swimming"—the only way out is through.

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