The New Normal

by Jennifer Ashton, M. D.

  Finally, consider what all good doctors analyze about all our patients: the mental and emotional side. Ask yourself how important it is to you to do X, Y, or Z—mentally and emotionally. Personally, as much as I enjoy doing so, eating at a restaurant is not important to me, but getting a pedicure or having my hair done is. Both activities are part of my self-care and make me feel good. For others, going to church, seeing art, or traveling to an event is worth the risk these activities involve.

  When people ask me if it’s safe to do something, they often want to know if it’s safe to do that activity as they would have in B.C. (before coronavirus) times. But you can’t gauge the safety of any activity in our new normal using an old-normal filter—that’s why we call it the new normal. So, if you’re wondering whether it’s safe to host a dinner party, for example, the answer would be no if you plan on sitting a bunch of unmasked people around a small table inside your home like we would have in 2019. But if you intend to hold a dinner party outside where you distance the chairs and everyone wears masks except while eating, then you can likely make it safe—or as safe as possible.

  This last caveat is important: As you know, you can never remove risk entirely. When it comes to an infectious disease like COVID-19, whenever you have more than one person in a room, you have a risk. You can choose to live alone and never leave your house, but by doing so, you could also fall down the stairs, get struck by lightning, or develop heart disease—a real risk factor associated with social isolation. I’m not trying to scare you or be melodramatic, but I do want to remind you that perspective matters. In our new normal, we should keep living our lives, but simply try to do so as safely as possible.

  Is It Safe to Go Back to Work?

  We all have really different jobs, in really different job environments. Some people work in an office with ten people, others work in an office with a thousand people, and others don’t work in an office at all but deal with the public all day. When we talk about whether it’s safe to go back to work and/or how to lower your risk at work, the answer partly depends on your particular job. The other part of the answer doesn’t, which is the part we’ll talk about here.

  To begin with, I can’t tell you whether it’s safe for you to go back to your work without knowing what you do for a living, how healthy and old you are, and the four factors we already outlined for situational risk: the time, place, people, and space of your work. In other words, how long will your workdays be? Will your environment be well-ventilated and/or can you open windows and doors? How many people will you be working with, and will they all be wearing masks? How densely populated is your working environment? I suggest you weigh these considerations alongside your own health, risk factors, and risk tolerance. At the same time, I realize many people don’t have a choice whether they return to work. Either way, whether you’re already back at work, have decided that you will go back to work, or have no choice in the matter, I suggest you do everything you can to make your working environment as safe as possible.

  Before I went back to seeing patients in person at my medical practice in New Jersey, I intentionally strategized with my staff on how to make it as safe as possible. Sure, I had safety guidelines from the state, but guidelines are like medical textbooks: They’re great to consult, but ultimately you have to diagnose and treat the patient or situation based on individual symptoms or signs. So before we reopened, I met with my clinical assistant, Ana, and my practice administrator, Carole, to come up with a plan to increase safety within the parameters of our practice without interfering with our quality of care. As it turns out, there were a number of small modifications we could make that have provided big benefits in the pandemic age.

  Today, for example, we don’t use a waiting room or reception area, but instead ask patients to wait in their cars until we’re ready to call them by phone and escort them inside directly to an exam room. We also ask patients to fill out a questionnaire (with a disposable golf pencil!) to help assess whether they may have been exposed to COVID-19 after running through a list of questions with them by phone. (Our office is 99 percent paperless, but our patient software is not adaptable to online or mobile questionnaires.) Everyone wears a mask and we purposefully leave the door to the exam room open, along with windows when possible, to improve ventilation throughout the practice.

  We take other precautions, too, like limiting how long I speak with new patients in my office and shortening the appointment time for existing patients. Before the pandemic, I typically spent one hour with new patients and thirty minutes with established patients. In our new normal, I have shortened those times considerably. These modifications don’t reflect how I prefer to practice medicine, but I try to see both as necessary sacrifices. While I may be able to extend appointment time in the coming years, other modifications will remain in place for the foreseeable future. The pandemic has permanently altered many aspects of our world, so it’s not surprising that going to work—or going to see the doctor, if you’re one of my patients—has been permanently altered, too.

  My return-to-work story is unique, as is everyone’s, but it shows some of the universal truths we now have to contend with in our new normal. Here are some of the strategies I recommend to make work as safe as possible for everyone involved:

  Start with words, then actions. Talk with your employer first about what safety measures are in place. If you believe your company could be doing more, speak up—and don’t worry about being the squeaky wheel. Health safety on the job has become the equivalent of sexual harassment in the workplace: If someone says they don’t feel comfortable, your employer has a responsibility to do something about it.

  Adhere to COVID-19 101. Everyone should be doing the same things at work that they do everywhere else: Wear a mask. Respect each other’s space. Wash your hands regularly. Just because you’re spending up to eight hours at work doesn’t mean you can pull down your mask—if anything, the longer you spend in one location, the more important it is to wear a mask over your nose and mouth.

  Come in late or leave early. Talk with your employer about staggering work hours to lower the number of people in an office or business at one time.

  Avoid extra steps. We’ve all heard that we should walk to a colleague’s office instead of sending an email or calling in order to spend less time sitting. But in our new normal, the fewer face-to-face interactions you have, the safer it’ll be for everyone. For extra steps, head outside and take a walk around the block.

  Open windows and doors. When possible, open windows to help ventilate rooms and reduce the risk of exposure to possible viral particles. Leaving doors open between rooms will also increase ventilation and airflow.

  Drop the in-office coffee habit. Common kitchens, coffee stations, and eating areas shouldn’t exist in our new normal. If they do at your job, avoid them.

  Give up being Mr. or Ms. Martyr. I can’t tell you how many times I’ve overheard people at work almost bragging about how sick they were the night before. I understand that some people don’t get paid if they don’t go to work and that others feel like they have too many responsibilities to stay home. Either way, no amount of money or number of responsibilities is a reason to endanger someone else’s health. Admittedly, I used to be guilty of thinking I couldn’t take a day off, but then I stayed home a few times and a shocking thing happened: The world continued to rotate on its axis. Yours will, too, I promise.

  A Note to All Our Essential Workers

  To all the grocery-store clerks, bus drivers, mail-delivery people, pharmacists, healthcare workers, restaurant staff, and other essential employees: You know who you are. America now knows just how essential you are and how risky your jobs can be, especially for many black and brown people, who are at a higher risk of being exposed and developing severe complications from COVID-19. I want to acknowledge that you didn’t have control over when you went back to work and that many of you haven’t been able to significantly reduce the number of risk factors you face while ther
e. For all these reasons and much more, our country owes you a massive debt of gratitude. From Dr. Jennifer Ashton to you: Thank you.

  Is It Safe to Travel?

  People are eager to travel—I hear it every day from viewers, patients, family, and friends who want to know whether it’s safe to fly, take a road trip, or stay at a hotel. Since every trip is unique to begin with, I suggest filtering your intended excursion through our four fundamental factors: time, place, people, and space.

  Time: How long will you be traveling for?

  Place: Are you traveling by air, car, train, or bus? And will you also be in an airport, train terminal, or bus station?

  People: Who will you be traveling with? For example, are you taking a cross-country drive with someone from your household or four friends from separate households? Will everyone be wearing masks or does your intended air/train/bus carrier have a good reputation for enforcing its mask policy?

  Space: How crowded will your means of travel be? Does your intended air/train/bus carrier limit capacity or have an open-seat policy?

  Now, think about your destination. Are you traveling to a place with a high incidence of COVID-19 or other illnesses? Remember not to overlook other destination-specific ailments like traveler’s diarrhea, which can be more of a likely risk than the coronavirus. Also, what will you do while you’re there? For example, will you be camping in the woods with your family where you may be exposed to tick-borne illnesses like Lyme disease or babesiosis, or are you planning on sightseeing through a major city with thousands of other people? While many get hung up over fretting whether to fly or drive, the variables of your destination are just as important as how you’ll get there.

  The Truth About Air Travel

  While many are fearful to fly, the truth about air travel in our new normal is that it may be one of the safest means of public transportation. While outbreaks of COVID-19 have happened from cruise ships, personal parties, and business conferences, there hasn’t been one published report to date of an outbreak occurring from an airplane.

  Air travel, in general, is also safer than taking a train or bus. Why? As Captain Tajer explained, commercial airplanes have HEPA air filters, which help to clean the cabin’s air of particles the same size as, and even smaller than, the coronavirus.1 HEPA filters also circulate air through the cabin once every several minutes, providing a degree of ventilation you won’t usually find on trains, buses, or other forms of public transport.2 Most airlines also have strict mandatory mask polices that are enforced by flight attendants (compared to trains or buses, where employees may not have the same oversight over passengers). Some airlines also block the sale of the middle seats on planes, which significantly helps reduce density and risk.

  For these reasons, it’s estimated that airline passengers have a 1 in 4,300 chance of catching COVID-19 during a two-hour flight if everyone is wearing masks, according to a study from MIT.3 These odds drop considerably—to 1 in 7,700—on flights where the middle seat is left open.4 Compare that to the 1 in 5,900 odds you have of catching COVID-19 by going about your daily business in the United States, according to the researchers. As for your odds of dying from COVID-19 if you do become infected with the virus on a plane, the MIT study put the risk of death at 1 in 400,000 for full flights and 1 in 600,000 if the middle seat is left open.5

  Bottom line: You can feel pretty safe about flying in our new normal. You can also increase the safety of your trip by following these tips:

  Choose an airline that blocks the sale of middle seats.

  Book a window seat to keep your distance from people moving up and down the aisle.

  Check in online to minimize personal contact.

  Immediately upon boarding, wipe down the tray table, armrests, and anything else you might touch, primarily to prevent the spread of other infectious illnesses like the flu and norovirus.

  Consider wearing eye protection. While it’s not an official CDC recommendation, Dr. Anthony Fauci and other infectious disease experts say wearing some kind of eye protection like eyeglasses, reading glasses, sunglasses, or face shields can help shield the mucous membranes in your eyes from possible exposure to viral particles. While you don’t need to wear eye protection in your day-to-day life, I’d suggest adopting the habit whenever you’ll be inside an enclosed space for a prolonged period of time. Just remember that wearing eye protection like a face shield is NOT a substitute for a mask.

  Of course, a plane isn’t the only space you’ll be inside during an air-travel trip. The good news is that most major airports are big, and you can easily find space at least six feet away from others—something that’s a little more difficult to come by in busy train stations and bus terminals. Remember to always wear your mask and stay moving to prevent breathing in the same air from one person for a sustained period of time.

  One advantage to traveling by plane in our new normal: Fewer people may get sick from colds, stomach bugs, the flu, and other infectious disease, thanks to new mask policies and less crowded flights.

  The Safest Way to Go: Your Own Automobile

  The safest way to travel anywhere in our new normal is by yourself in your own car, where you can’t possibly breathe in anyone else’s respiratory droplets. That said, few people take long road trips all alone—we like to go with family and friends.

  Perhaps unsurprisingly, the safest person to road trip with in a pandemic is someone you live with. But doing so isn’t a fail-safe. Because you’ll be spending hours in a very small space with the same person, you’ll be exposed to their respiratory droplets directly and for a longer period of time than you may be by going about your daily life together in the same household. For these reasons, you may want to both consider getting tested for COVID-19 or quarantining at home for fourteen days before you jump in the car together for hours on end. If you choose to ride with someone outside your household or immediate pandemic pod, I suggest everyone get tested or self-quarantine for two weeks (or as long as possible) prior to the trip.

  If you want to increase everyone’s safety while in the car, keep windows rolled down as often as possible and wear masks. If you stop for gas or food, be sure everyone washes their hands thoroughly before getting back into the car.

  Hotels: Probably Safer Than You Think

  A lot of people have asked me whether it’s safe to stay at a hotel or a motel. Personally and professionally, I believe the answer is yes. While we don’t understand how easily the coronavirus can or can’t be spread through heating, ventilation, and air-conditioning (HVAC) systems (see box here), it appears right now that ventilation systems don’t pose a significant threat of COVID-19 transmission.

  Another reason that hotels may be safe: You’re likely staying by yourself or with one other person. While a hotel room isn’t equivalent to a negative pressure room inside a hospital, you’re still in relative isolation. The room was cleaned beforehand, and you have the ability to take additional disinfection measures by wiping down high-touch surfaces when you first arrive. Better still, if possible, open the windows as soon as you check in and head out for a walk while fresh air circulates through the room. If you feel uncomfortable or aren’t able to take a walk, wear a mask for the first few hours to prevent breathing in the respiratory droplets of the cleaning staff (who were most likely wearing masks) or the room’s past occupants (who likely checked out hours before you arrived).

  All in all, staying at a hotel may be safer than staying the night with friends or family who aren’t part of your pandemic pod. When you stay with other people, it’s very difficult to avoid breathing in their respiratory droplets. Not only will you be immersed in the same indoor air for hours at a time, you’ll also not be able to wear a mask while eating, drinking, and sleeping. You also may have less control over whether you can open windows and doors.

  If you choose to stay at a hotel, keep in mind that it’s not just the room, but the entire hotel that will be part of your experience. Opt for contactless check-in and checkout,
avoid getting into elevators with other people, and stay away from breakfast buffets and common coffee areas.

  Can COVID-19 Be Spread Through HVAC Systems?

  All the infectious disease experts I’ve spoken with say they don’t believe at this time that the spread of COVID-19 through heating, ventilation, and air-conditioning (HVAC) systems poses a significant risk. While studies suggest the virus can survive in air ducts, detection doesn’t mean infection, and there’s inconclusive evidence showing whether the disease can be readily spread through HVAC systems.6 HVAC systems by nature remove particles and exchange indoor air for outdoor air, which may even help reduce the risk of COVID-19 spread.7 To increase the efficacy of your HVAC system in pandemic times, the World Health Organization recommends boosting the percentage of outdoor air it uses, along with its filtration potential.8 The WHO also suggests running an HVAC system for two hours before or after occupancy. For this reason, you may want to consider switching on the heat or A/C when you check in and leave your hotel.

  Is It Safe to Go to the Gym?

  Because you know I love the gym, you probably won’t be surprised to learn that this topic has been a HUGE question mark for me. I’ve missed my regular gym routine every single day since the pandemic began, as have many fellow exercise enthusiasts. You might not love to work out, but for many people, not being able to go to a gym or take a fitness class has created a significant amount of physical and psychological stress.

  Despite my mental and emotional distress, I haven’t jumped at the chance to lift weights inside a club or take a spin class in the city with friends. Gyms have always been prime places for infectious illness, given the number of people sweating, breathing hard, touching equipment, and also touching their faces inside a confined space. They’re often crowded, and people tend to stay there for up to an hour or more at one time. Add in a contagious respiratory virus that’s easier to contract through forceful breathing, and you can understand why I—and many others—have thought twice about this popular pastime.