Toolkit: Safe or Not Safe?

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It’s time for another Monday Toolkit episode! This week, Andy feeds your questions and real-life situations to Johns Hopkins epidemiologist Caitlin Rivers and former New York City epidemiologist Farzad Mostashari. This conversation aims to help us bring normality back into our lives, and they’ll offer up advice about traveling, kids, school, socializing and more. You will need to vote after the episode: Team Caitlin or Team Farzad?

Show Notes 

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

Follow Caitlin Rivers @cmyeaton and Farzad Mostashari @Farzad_MD on Twitter.

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[00:44] Andy Slavitt: Welcome to In the Bubble. This is Andy Slavitt. We have our third Toolkit episode today, and this one is what we are going to call safe or unsafe, where we’re going to take the situations that you sent us and ask two experts whether or not those are safe activities, or unsafe and how so. In order to do this, we’ve invited on two great people, both epidemiologists and both are really fun, interesting people. And so we’re going to do this in a way that hopefully is lively and interesting. 


[01:21] Andy Slavitt: The first is Dr. Caitlin Rivers. She’s a senior scholar at Johns Hopkins Center for Health Security. She’s an assistant professor at the Department of Environmental Health and Engineering at Hopkins Bloomberg School of Public Health. And she’s been all over this, solutions that are going out around coronavirus around the country, you’ll really enjoy her. And the second is Dr. Farzad Mostashari, who served along with me in the Obama administration. He is the CEO and co-founder of a company called Aledade. But he was the national coordinator for Health Information Technology. He worked in the New York City Department of Health, where he established the Bureau of Epidemiology Services. So this is our third Toolkit. Our first was on how to talk about masks and social distancing. Our second was on vaccines. I hope you enjoy our third. We are going to try to give you general answers. Please don’t take anything you hear as medical advice, but hopefully they will be good ways to guide you forward. So let’s ring up Caitlin and Farzad. 


[02:33] Andy Slavitt: Hey, guys. Let’s begin. I have with me two of the most esteemed epidemiologists in the country who I know I’ve just introduced to you in the introduction. Caitlin Rivers from Johns Hopkins and Farzad Mostashari, who worked, among other places for the state of New York, for the federal government. And these two are very active in what’s going on right now with COVID-19. And we’re going to play a little bit of the game of is it safe or is it not safe? So welcome. What we’re going to do is we’re going to go through emails that were submitted to us and voicemails that came in where people were asking very specific questions, they want to know what are the dos and don’ts? Is it safe? Is it not safe? We’re going to go through a few categories. And I may ask you, on a scale of one to 10, how safe something is, with a 10 being my 100 year old, immunocompromised grandfather could do this, to one being I wouldn’t do this under any circumstances. So we’ll see what the questions lend themselves to. And much like Jeopardy!, the first category is travel. Before you get into the questions, Farzad, do you have any overall philosophical tips for how people should be thinking about traveling during coronavirus? 


[04:05] Farzad Mostashari: Yeah, for me — and we played this game with my son — and I tried to get it down to how many breaths do you share with someone else? Like, literally how many? Like count the number of breaths. You breathe 18 a minute. How long are you sitting next to someone for where you might share their breath? And so I think implicit in that answer is also I’m more worried, relatively speaking, about respiratory routes of infection, whether it’s airborne or aerosol, than I am about fomites, meaning surfaces. They’re both theoretical ways of transmitting it. But for me the heuristic is more respiratory. And then thinking about the type of exposure, the duration of the exposure. And the third factor is the risk of the people who you’re with, how likely is it that one of them is infected, which gets to the community prevalence and so forth? So those are the three factors I think about. 


[05:03] Andy Slavitt: OK, Caitlin, any overall thoughts on traveling before we dig in? 


[05:10] Caitlin Rivers: All of the principles that we’ve all learned these last few months of social distancing, hand hygiene, masks, those are all going to be extra relevant while traveling and so definitely continue to be fastidious about keeping those in mind. 


[05:21] Andy Slavitt: OK. First question for you, Caitlin. How dangerous is air travel? Given that vaccines aren’t a panacea, when can we consider it reasonably safe? So how safe is air travel on a scale of one to 10? And when do you think it will be reasonably safe?


[05:38] Caitlin Rivers: I would give it a five. I think it’s probably not an activity that I would do with great enthusiasm, but with masks, hand hygiene and doing your best with social distancing, I think it can be incorporated relatively safely. 


[05:52] Andy Slavitt: When do you think you’ll be flying in the air again, if you had to pick a date? 


[05:55] Caitlin Rivers: Completely voluntary travel, I don’t expect to fly this year. 


[05:58] Andy Slavitt: Not this year. OK, Farzad, one to 10. Air travel. 


[06:03] Farzad Mostashari: Yeah, let’s tare ourselves to the same metrics. I’ll give it a five and then we’ll be able to do relatives up and down from there. And for me, part of the concern with air travel is it is really confined, particularly if you have someone in the seat next to you. There’s a lot of breaths that you might be sharing with someone in the middle seat. And so that’s what I worry about. So if there’s ways of minimizing that — and I applaud airlines for saying we’re not going to sell middle seats, that’s a great thing. So I think that that’s a factor. And also, you don’t know, it’s not like you can say, well, I know I’m in this community in Vermont and I know that the risk of infection in Vermont is low. Air travel brings in people from all over the place and puts them in close proximity to people. I don’t think I’ll travel this year by air. 


[06:55] Andy Slavitt: OK. Farzad, let me stick with you and another travel question, from Janet. “My daughter is about to give birth to her first child in London.” Congratulations, Janet. “I was supposed to be there but have canceled due to the pandemic. I cannot fly there and quarantine for 14 days before visiting their home due to the expense and work commitments here. When will it be safe to travel to visit the new baby?” Give us a month in a year when you think it’ll be safe for her to go visit her brand new baby. 


[07:23] Farzad Mostashari: First of all, the rest of the world doesn’t want us. I mean, it is sad how having a U.S. passport now is like, I don’t know, 150th in the world in terms of places you can go because we have so failed the response in this country that other countries don’t trust us to visit them. So you cannot go to London, even if you wanted to, because they won’t let you in if you have a U.S. passport. When is that going to change? And I think I am of the school of thought that it is the fact that we can’t seem to get a grip on this outbreak during the summer months bodes very poorly for the late fall and winter. I think that we are going to see seasonality on this. And if there’s people left to be infected, I think it’s going to get hairy in like fall and through February, March. So I would expect it to be April, May of next year. 


[08:18] Andy Slavitt: April, May. Caitlin, how old will Janet’s grandchild be before she can see? 


[08:24] Caitlin Rivers: Yeah, this one makes me sad. I’m worried it’s not going to be in 2020. I hope I’m wrong, but I feel it’s not imminent. 


[08:31] Andy Slavitt: This is from Ralph. “I would love an in-depth exploration of how to travel safely in an airplane for those that must do it because of a family necessity.” So if you have to travel, I think you answered this one, Caitlin, you gave a few tips. Is there anything we didn’t cover ranging from the airport, transportation, to the hotels? Any other tips that you would add? 


[08:52] Farzad Mostashari: I think the basics are exactly as Caitlin said. The one thing I will introduce here is all masks are not equal. And I think that we have settled on fabric masks out of necessity, not because the evidence shows that they’re so awesome. And I would say if you can get during that intense exposure period, high-risk on the airplane or whatever, if you can get your hands on and N95 masks, I think it is better. And if you can make sure that they’re nice and tight and you can’t smell someone, you know, smoking next to you. Those are the kinds of things that I think do make a difference in. As you know, early on in the outbreak, I was among the people saying, listen, we got to save these for the health care workers. You don’t need it. And I think we got caught up in the messaging a little bit, Andy, in those early days to deny that it is probably safer if you have a high-risk exposure to have an N95, or even a surgical mask, even though they seem flimsy and papery, they’re built with a non-woven fabric to trap the stuff and have the electrostatic charge and all that. They are better than wearing a scarf or, you know, a fabric mask. 


[10:06] Andy Slavitt: Yes. It’s certainly nice when the airline requires everyone to wear a mask. Caitlin, anything else? 


[10:11] Caitlin Rivers: Two extra comments. I think if you want a little something extra, eye protection would be the next step, which could include a face shield or goggles. I don’t think it’s critical, but if you’re nervous, that would be the next level. And I would also encourage people not to just focus on the main event. Don’t just think about the flight. You also need to be thinking about security and waiting at the gate and picking up your luggage, a cab on the way there and back. It’s really the whole event that you should be sort of preparing for and thinking about. 


[10:37] Andy Slavitt: OK. Sandra wants to know if a smaller inn is going to be safer than a larger hotel with a bigger cleaning staff. What do you think, Caitlin?

[10:45] Caitlin Rivers: Not necessarily. I think I would be comfortable with either. 


[10:48] Farzad Mostashari: For me, just some places offer contactless check-in and I would call and ask about that versus big or small. 


[10:56] Andy Slavitt: Yeah, there’s also some hotels advertise room rotation, meaning that they won’t put you in a room that someone’s been in for 24 hours before. As Farzad said, the contact isn’t as much of an exposure as the aerosol, but every little bit probably helps. So it’s a question worth asking. A question about public transportation from Sarah. “For those who live in big cities who don’t have a car typically rely on public transportation. What is the safest way to commute when you need to get further than a distance, you can walk or bike?”

[11:27] Farzad Mostashari: What distance can you possibly have that you cannot bike? I’m an inveterate bicycle commuter and I would say bike, but OK, go on. 


[11:36] Andy Slavitt: Fair enough. OK. We’ve got Farzad registering with bike. Caitlin, maybe you could be more cooperative. Between bus, car ride with a friend or family, your Uber/Lyft ride, what feels safest. 


[11:50] Caitlin Rivers: Oh gosh. I think the car probably, but it is still an enclosed space, particularly if you don’t know the other person, you don’t know their habits. I would put on the windows and choose the car.


[12:00] Andy Slavitt: Roll out the windows. OK. I’m going to play a voicemail, then we’re gonna move on to the next topic. And here’s the voicemail.


[12:06] Caller: Ron from Burke, Virginia. My family and I have thought about taking a short road trip locally here, a couple hours away, and maybe staying at an AirBnB or something like that. Wondering if that’s safe to do. Thanks.


[12:22] Andy Slavitt: OK. Scale of one to 10. Is Ron’s trip safe or unsafe?

[12:29] Caitlin Rivers: Seven. Eight. I think that sounds lovely and safe as far as travel and getting out of the house goes.


[12:35] Farzad Mostashari: Yeah, eight. This is like, are you old or not? If you’re older than me, then you’re older. If you’re not as old as me, then you’re young. To me, I’ve done that. So it must be safe. 


[12:46] Andy Slavitt: OK. Next category. And by the way, you’ve both earned five points. 


[12:50] Caitlin Rivers: I didn’t know there were points! 


[12:55] Andy Slavitt: I have a made-up system. Second category is school, from Ali. Ali’s husband teaches middle school special-ed. They live in a rural county in northern California where cases are exploding, but are not yet on Governor Newsom’s watchlist. They’re still open. What are some practical steps, other than masking, hand washing, etc. — good thing she knows the basics — that my husband can take to reduce his chances of contracting COVID-19. We cannot afford for him to stay home or use up his sick leave. 


[14:26] Farzad Mostashari: Yeah, this is a huge issue, and I think it’s no surprise that we’re seeing teachers and teachers unions also weighing in on the school reopening thing. It’s a risk to them. And, you know, we can all say that children tend not to get as sick, but it’s undeniable that children can spread it. And the teachers and faculty and staff and so forth are at risk. So, you know, I think it’s the basics, right, that we all talk about. It’s trying to keep distance, trying to wear masks, trying to do hand washing and all that. And anything that the schools institutionally can do to make that better and easier is great. I’m a huge believer in outdoor stuff. So to the extent that schools — I know that it’s a little bit extra work to figure out the stuff — but to that extent that we can figure out how to do classes outdoors wherever possible, I think that’s good. And then another good suggestion is to keep the kids staying in their rooms, and have the teachers rotating, or even having the teachers on a college setting, having the teachers do it via remote while having the students in school. 


[15:42] Andy Slavitt: I agree with all that. It’s all the principles we use in all other settings. I know it’s particularly tough in school settings because we value our kids so much and we value our educators so much. But those are really the best tools we have to slow transmission. 


[15:54] Andy Slavitt: And I would add, if you can, open the windows, it keeps the ventilation going.


[15:58] Zach Slavitt: When do the two of you think that in-person classes for high school and college and younger are going to be a safe enough activity?

[16:08] Farzad Mostashari: Depends on where. And I think we really have to consider the community spread in making those decisions. I like Tom Friedman’s formulation of this, which is not we just like it is so important, so we have to open no matter what. I like his formulation that we adults have to do what we can to bring down the community prevalence so that our kids can go back to school. 


[16:32] Caitlin Rivers: I agree with that. I think it all will be a lot easier to reopen up in Vermont, for example, than it will be in Texas. So it depends on what’s happening locally.


[16:40] Farzad Mostashari: And then maybe we’ll get to this, Andy, but I think college is an interesting thing. Where you can’t really sequester elementary school kids away from their families, but there may be — and I have a college student and a graduating senior, so I’ve thought a lot about this.  Maybe there is a way to sequester, you know, close the college doors and sequester the college population where they’re more likely to be OK within that context. So maybe we’ll talk about that. 

[17:17] Zach Slavitt: Do you think there’s anything with a vaccine or treatment that could allow — would that expedite the timeline for that stuff?


[17:25] Caitlin Rivers: I think certainly when a vaccine becomes available, it’ll make a lot more sense to reintroduce those kinds of activities. I think a treatment is a little bit more difficult. I think if we have a prophylaxis that can be given to people even before they get infected, that would be great. But it’s hard to imagine that it would be available on a big enough scale to really enable these kinds of changes to our risk calculus. 


[17:44] Farzad Mostashari: I do think that part of what we worry about is what’s the worst thing that can happen? And, you know, young people can get super sick, too. It can happen. So to the extent that we have treatments that can make the worst-case scenario not so bad, if it cuts the death rate in half or a third, I do think it would shift my calculus somewhat if we can reduce the case fatality rate significantly. 


[18:11] Andy Slavitt: So, Kathleen is sending her kids to college, as we are in the Slavitt household, and apparently the Mostashari household as well. Planning to go to a school with all undergrads. There’s no regular testing to catch asymptomatics at the school that her child is going to be attending. No quarantine for kids from hotspots. And they’re on the verge of telling their son, who they say is going to be a freshman like Zach, that he’s going to have to go remote. This is, by the way, the parent as the bad guy phenomenon that a lot of parents are complaining about. But it says the prospect of leaving his safety up to how responsible his roommate is just seems insane. So I know there’s a lot of issues here. So I want to just start with a one to 10 number. In a situation like that where they’re not doing asymptomatic testing, and you’ve got a roommate and you’ve got no isolation, on a scale of one to 10, how safe is it for Kathleen to send her son to college? 


[19:09] Farzad Mostashari: I think the likelihood of infection spreading in those congregate settings is extremely high, extremely high. But the chance of them suffering severe consequences is very low. So when I think about the college — and I was alluding to this earlier — when I think about the college issue, I’m thinking not only can we separate out the safety of the kids from the safety of the staff, the teachers, the workers there, the community at large, and their families. If one way is to — and I think it’s the best way — is to make sure there’s lots of testing, all the different stuff people are doing to reduce the likelihood of those kids getting infected, infection spreading and contact tracing, which apparently this school is not doing. So my first choice would be that they do all those things. But then the second consideration is, can we wall off the risk from the students to the community at large, their family members and their teachers and professors? 


[20:12] Andy Slavitt: Would you send your child to this college in person or make them go remote? 


[20:18] Farzad Mostashari: I probably would not. I would say no.


[20:26] Caitlin Rivers: I don’t feel great about it. I agree with everything Farzad said. I think the risk of infection in congregate settings is quite high. But children, or I guess adults at that age, are at lower risk of severe illness. And so that doesn’t mitigate it somewhat. But the setup is not great. 


[20:41] Andy Slavitt: OK, we’re going to go to our third category: kids. In the second category, seven points for Caitlin. Three points for Farzad. I just made that up. 


[20:50] Caitlin Rivers: I like this game. 


[20:55] Andy Slavitt: Is it safe to take my kids to a pool? The pools here limit the number of people, but it seems very risky to me.


[21:04] Caitlin Rivers: I think, yes, it’s on the safer side, if you keep your distance and if you’re careful about the locker rooms. A seven.


[21:13] Farzad Mostashari: Yeah, I agree. I think we need to do some things. We need to be able to give people the scale of what’s safer and what’s less safe. And I think outdoor activities and pools can be safer if you do the right things. 


[21:28] Andy Slavitt: Got it. OK, we have a voicemail that I’m going to play. And here it is.


[21:35] Caller: Hey, Zach and Andy. This is Matt in St. Paul. My son, Charlie, is gonna play high school soccer this fall. How safe is that? How worried should I be?


[21:49] Farzad Mostashari: It depends on how you play soccer. I mean, it can be pretty intense and pretty up close. And then the teammates tend to share water and space and locker rooms and cars and all that kind of stuff around it. I saw a video of where people are playing a game like foosball variant of soccer where everyone stayed in their own grid. That would be safe. But I think that your average high school sports with everything around it is going to be pretty high risk for spread. 


[22:35] Caitlin Rivers: I think four, as a default mode of business, but I think with mitigation measures, you can edge it up to six.


[22:44] Andy Slavitt: OK. Hope that’s helpful. All right. Question is coming from Jennifer. So she says, I have a question about the risk of infection from touching surfaces. I ask because I have a son who has a developmental disability. If I were to take him out in the community, he would touch everything. He would touch things people would never think to disinfect. He would likely touch his face and not properly wash his hands for 20 seconds. With that information, what is the level of risk of taking him out into the community if we can keep distance from others? I’m specifically thinking of someplace outside. What is the risk of infection from going to a playground or the pool or the zoo, assuming he will touch his face before his hands have been properly cleaned? I am confident we can keep the distance from others, so I’m just asking about the risk from touching surfaces. I think it’s a great question. 


[23:35] Farzad Mostashari: I am going to say that that’s pretty safe. I’m going to say eight. To my knowledge, there’s only been one case, which is this elevator in China where it’s pretty clear that it was surface. Maybe not even that case. I mean, so I think it’s pretty safe. And, you know, you can’t squirt some alcohol on his hands now and again. But I think it’s pretty safe outdoors playground.


[24:04] Caitlin Rivers: I agree with that. And one other thought, if you haven’t already is if he has an occupational therapist or someone who helps him, if there are some behavioral cues or some sort of routine that you can work in that helps with touching contact surfaces. But even if you’re not able to do that, I still think that those activities are pretty safe. 


[24:21] Andy Slavitt: Well, I think that’s great news. All right, onto the next category, which is social. And that one, unfortunately, was six for Farzad. So, Caitlin, you’re still winning by one. OK, from Victoria. I’m engaged and I’m looking for a way to safely gather my immediate family and my family in law for a small outdoor ceremony in the spring of 2021. How many people is safe? Four parents, two siblings and us is a minimum of eight, plus we need someone to marry us. Can I safely get professional makeup done before a vaccine is released? And what about dress shopping in the next few months? Any advice you can share is welcome. Farzad, you look like you might have been a marriage counselor, a specialist in a former life. So we’ll start with you. 


[26:21] Farzad Mostashari: I have been an officiant at a wedding. And that would be my advice, is to have one of the family members get state permission to be the officiant as well. It’s a wonderful thing to do. It’s a pretty small gathering and I think people — it’s your wedding, so I would say less than 10 people, if you can be careful with the mask and the distance, you can have a wonderful ceremony and make it a special moment. The bubble concept, I think, is also interesting. If people can stay within their bubble mostly, and maybe leading up to this, you know, spending a lot of quality time in a bubble with your family members. I don’t know if that’s good advice or bad advice right before a wedding, might be a stressful time. But I think you can do that in a pretty low-risk way. But you may have to give up some stuff. Do you really need the makeup artist in your face for, you know, half an hour beforehand? I don’t know. I would put that lower on the priority list. 


[27:26] Andy Slavitt: By the way, you get a point for saying In the Bubble. Well done. I think that’s a challenge to you, Caitlin. OK. What do you think? Anything you would add?


[27:37] Caitlin Rivers: I agree with that. I think the ceremony sounds low-risk, especially if you’re able to do it outside with social distancing. If you want the full experience of the reception and the party and the breakfast before, that’s gonna be a little bit harder to pull off. But it might be worth going the extra mile by doing a two-week quarantine before everyone arrives, or maybe getting a diagnostic test and combining that with some sort of quarantine to help buy down the risk. Because unfortunately, we do know those family gatherings can be very high-risk and have been linked to outbreaks before. But it sounds lovely and I hope you’re able to find something that works.


[28:07] Andy Slavitt: Yes. And best wishes, Victoria. OK. From Martha. Big question. When will it be safe to date again? What precautions need to be taken beyond the usual precautions, I mean. And by date, I mean everything about dating, meeting, making out, having sex. All right, Caitlin, one to 10. And there’s also a when.


[28:30] Caitlin Rivers: So that’s not going to be safe because social distancing isn’t possible. But you’ve got to get on with your life. And so what I would recommend is adding yet another dimension to the dating game by making sure that your risk-profile matches the people that you’re dating. So if you are very careful, you’re probably not going to want to go out with someone who is also at the bar every weekend. And you’re gonna want to find someone who is well-matched with you in terms of risk. 


[28:51] Andy Slavitt: So that’s a good tip. And if what you want to know is when, let’s say that Martha is willing to wait but only wait so long. What should she have in her head in terms of when it’ll be safe to date again? 


[29:02] Caitlin Rivers: We don’t know because it’s really a vaccine or therapeutic that’s going to change that calculus. And we don’t know what’s going to happen, unfortunately, but not soon, not in the next couple months.


[29:12] Andy Slavitt: All right. From Tamara, I’m curious about having one to four people over to the home at a time. Is outside safe? Does everybody need to wear a mask? Can we eat? Can we drink, and is inside safe at all without masks? Farzad, one to 10.


[29:36] Farzad Mostashari: Yeah. I mean, I think if the air travel was a five, this is like a seven. If you do it right and do it right is outdoors definitely much better, outdoors with distance if you’re going to take your mask off to eat. So, you know, we were up visiting my in-laws and like we would be outside, you know, ten, twelve feet apart. I think that’s pretty safe. So I think that you can do it if you have the space to space out and, if you’re going to be closer than six feet and definitely masking. 


[30:08] Caitlin Rivers: I agree. I think you should definitely be outside. I think seven or eight. I think that’s completely reasonable.


[30:18] Andy Slavitt: All right. You guys are tied, now going into some speed rounds. These are quick questions on the leisure side. Movie theaters, safe or unsafe? 


[30:28] Farzad Mostashari: Stay home. 


[30:29] Andy Slavitt: Type one diabetic wants to go on a mountain bike ride with a group. Does need a mask? Yes or no. 


[30:33] Caitlin Rivers: Safe with a mask. 


[30:36] Farzad Mostashari: With a mask. 


[30:37] Andy Slavitt: Gyms: safe or unsafe? 


[30:39] Farzad Mostashari: Pass.


[30:40] Caitlin Rivers: Outside. Do outside.


[30:41] Andy Slavitt: OK, you guys both did a good job in that round by being very quick with some very sharp answers. Hard to pick a winner. Work settings. Someone has their own individual office and everyone is wearing masks, there’s hand sanitizer around and encouraged. There’s HVAC filtration systems put in. But all the doors and windows are closed. How safe is that? 


[31:05] Caitlin Rivers: Seven. 


[31:08] Farzad Mostashari: Yeah, I’ll go along with that. 


[31:08] Andy Slavitt: How about if you’re sitting in a cube all day, like in a call center setting? 


[31:12] Farzad Mostashari: Yeah, I mean, we saw specifically the call center outbreak in Korea, where there was just such a huge number of people infected. And it is a lot because they’re talking all day long and they’re crammed in close to each other and they had incredible attack rate there. So I think that specific scenario is very risky. If, on the other hand, you know, you’re in cubicles that are, you know, whatever, 12 feet apart and you have plexiglass and whatever, that could be fine. A lot of the workplace exposures, though, are around the shared areas, and the going and coming, and the bottlenecks in the flows. So particular attention would have to be paid because people don’t just, like, sit in their seat all day and apparate out of nowhere into their seat. So those are the things that I think there has to be a lot of attention to.


[32:00] Andy Slavitt: OK, I’m going to ask you a slightly different way for you, Caitlin, which is to say, let’s say someone has no choice but to go to work in a cube setting, or in a call center, or something that they deem to be or you deem to be not very safe, but their employer is requiring it and they rely on the income. We’ve got a number of questions like that. Not everybody has the luxury of working from home. Obviously, we can talk about how to report and get assistance for people’s employers to make the workplace safer, but put that aside. What tips or what advice would you say, Caitlin, are two or three things you do to make someone safer in that kind of situation? 


[32:38] Caitlin Rivers: Physical distancing, if you can, if you can move your workstation just further away from everyone, I think that’s going to be great. Wearing masks, particularly if everyone can wear a mask. I think that should be a policy within the workplace. And if possible, ventilation, open a window, try to get some fresh air in there. All of those things will help to reduce risk. 


[32:57] Andy Slavitt: OK, so the final category we’re getting to is family and miscellaneous. Camping. Camping with a newborn is the question. What do you think, Farzad? 


[33:11] Farzad Mostashari: Nine.


[33:12] Andy Slavitt: Nine. You’re only going to give biking a 10.


[33:17] Caitlin Rivers: That’s brave with the newborn, but mostly because of the baby, not because it’s COVID. I think 10, nine. 


[33:21] Andy Slavitt: All right. Visiting your grandchild and holding your grandchild briefly, if you’ve done isolation in advance.


[33:38] Caitlin Rivers: Again, that’s prolonged close contact. So that interaction will not be safe. But if you have done the right things leading up to it, and both families have been very careful, I think you can reduce risk in a meaningful way. 


[33:48] Farzad Mostashari: I generally agree. But the holding the baby briefly part, I think it is the number of breaths. So if you’re gonna be spending 30 minutes in close proximity to someone, it really is different than if you’re wearing a mask and you hold the baby briefly. You know, one of the things I sometimes do — maybe I’m crazy — is like I’ll all even, like, hold my breath as I’m passing by or someone coughs or whatever. 


[34:17] Andy Slavitt: Are people crazy to think that that would help?


[34:31] Caitlin Rivers: It’s not going to hurt. So if it gives you a little something extra, sure. 


[34:35] Andy Slavitt: I tell you, the number one thing people miss by far, according to the very unscientific texts and emails and tweets I get, is hugging. Hugging is by far the thing people miss the most, although some people miss singing. Any circumstances under which outdoor worship singing makes sense?


[34:55] Caitlin Rivers: It’s better than indoors. I think if you’re physically distancing and you’re singing outside.


[35:02] Farzad Mostashari: I wouldn’t do it. I don’t know. Singing is so designed to create these clouds and plumes of particles of various sizes. And, you know, we’ve seen the choir practice stuff, the outbreaks. I wouldn’t do it. I think it’s high risk. I think four. Even if it’s outdoors. 

[35:25] Caitlin Rivers: I think if you’re in the stands and it looks just like your choir practice, but you put it outside. I still wouldn’t do it. But if you can spread out and there’s plenty of ventilation and space between you, I think it’s safer. 


[35:36] Andy Slavitt: OK, I want to give you each a chance for a closing statement. And your closing statement is to answer the following question. It’s not how do I stay safest. It’s not how do I do the most things. It’s how do I enjoy my life to the largest extent possible, and reduce the risks so that I can feel safe. So this is a bit of an essay question, but let’s see if we can do kind of a brief essay. And Caitlyn’s in the lead, so Farzad, you’re first.


[36:07] Farzad Mostashari: All right. Outdoors. My God, it’s so great to be outdoors, be outdoors as much as you can. It’s so good for the soul and it’s low-risk. The other thing is take the respites. When community prevalence comes down, grab those chances. And then we got to be able to modulate when risk goes back up to climb back down. But I would say do those things. And if we can find ways to be in the bubble with people — extra point — then I think we should. 


[36:41] Caitlin Rivers: It’s undignified. 


[36:42] Andy Slavitt: You know, Farzad, no matter how many times you say that Caitlyn’s going to win. But I do appreciate it. It’s been cooked. This was cooked before it started. 


[36:58] Caitlin Rivers: I wouldn’t have it any other way. I would say that I try not to think of it as finding poor substitutes for the things that we used to do and the ways that we used to be. Try to find new ways to incorporate outside and ventilation and socially distant activities into your life. So it’s not about the poor substitute, it’s about really exploring new opportunities. Someone tweeted me over the weekend that she and her husband went stargazing, and that I don’t know if they do that normally, but I thought it was such a sweet activity that’s perfectly safe. So I love the idea of finding new ways to make our lives special.


[37:30] Farzad Mostashari: Throughout this whole thing, we’ve been talking about individual people and individual actions. But I think it’s worth zooming out a little bit, just for people’s frame of mind, when we’re seeing what’s happening in Arizona or Florida right now, the reproductive number, there might be like 1.1, 1.2. And that means exponential growth for sure. But the difference between that and a reproduction number of 0.9 or 0.8, where you start to get asymptotic decline is really pretty small changes in behavior. So if we go from having five contacts of a certain duration and risk, to having three, as a community, we will conquer this thing. People oftentimes don’t take the big picture risk-reduction  understanding of this, that you’re either safe or you’re not safe. But if we can all just reduce our risk by like 20, 30, 40 percent. that alone will extinguish this outbreak. 


[38:31] Caitlin Rivers: I’ll concede my victory. I thought that was really good.


[38:35] Andy Slavitt: Well, I’ll tell you what, we’re going to let the audience on Twitter respond, and you can either say Caitlyn or Farzad, and we’ll let the audience decide. And I think it’s important to point out that this is not going to be forever. We are talking about the level of adjustments, the level of concern. And I really appreciate that both of you had legitimate levels of concern at certain activities. But those are not forever. The risks will continue to go down. They won’t go down at a pace we can predict. They won’t go down at the same pace for everybody. And so everybody needs to keep that in mind. But the thing that I guess I would overlay from a less scientific standpoint is just finding the ways to connect, and make connections to your family and friends, and then keep enhancing those, some of which can be done over distance, some of which can be done by occasionally getting in the bubble. And some of which can be done by taking slight risks, but doing it intelligently. And people on the show know that Zach and I went and drove to Chicago to visit my mother and had a very safe and really rewarding trip. And it meant the world at this point in time. And so depriving yourself of the relationships that keep you going is something that I think you can find a way around and you need to try. Those are the ones that are going to try the hardest to find a way around. Anyway, thank you both for being on the show. 


[40:06] Andy Slavitt: Well, that was good. Hopefully that was helpful. I’m just going to tell you what’s coming up next on In the Bubble. We have a great episode coming up on Wednesday. Ambassador Susan Rice, who is in the running for the vice presidential ticket with Joe Biden, but also just a tremendous leader in the world of national security. And so much that’s going on in this country. Next week we’ve got a couple more great episodes with Scott Galloway and with Andrew Yang. So I think you’ll enjoy those. Don’t forget to go back and listen to Larry Brilliant if you haven’t and some of the other fun episodes that we’ve recorded.


[40:57] Andy Slavitt: Thanks for listening In the Bubble. Hope you rate us highly. We are a production of Lemonada Media. Kryssy Pease is our producer. Ivan Kuraev is our editor. Jessica Cordova Kramer and Stephanie Wittels Wachs executive produce the show and run our lives. My son Zach Slavitt is my cool co-host and onsite producer. Music is by Dan Molad and Oliver Hill. You can find out more about our show on social media @LemonadaMedia. And you can find me at a @ASlavitt on Twitter or @AndySlavitt on Instagram. If you liked what you heard today, please, please, please tell your friends to come listen, but from a distance. And for now, stay safe. Share some joy. And we will get through this together. And #StayHome.


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