5 Rules to Live By During a Pandemic

By Tara Parker-Pope

There’s no playbook for living through a pandemic, so we decided to create one. With some basic rules to guide you, everyone can lower risk and live a full life while we wait for the virus to get under control.

Abby Fisher, a hostess, prepares a table at Lindey’s restaurant in Columbus, Ohio on June 5.
Abby Fisher, a hostess, prepares a table at Lindey’s restaurant in Columbus, Ohio on June 5.Credit...Maddie McGarvey for The New York Times
Tara Parker-Pope

While it might feel as if the coronavirus crisis is over, it’s not. The virus is still out there.

But some things have changed. To start, lockdowns are ending because cases are low or falling in some areas or because state leaders have decided to move ahead despite the risk. Testing has increased, giving us more indicators of community health. Plus we know a lot more about how the virus behaves and what activities pose the highest risk.

And because life on permanent lockdown isn’t sustainable, public health experts are beginning to embrace a “harm reduction” approach, giving people alternatives to strict quarantine. These options — like forming a “bubble” with another household or moving social activities outdoors — don’t eliminate risk, but they minimize it as people try to return to daily life.

Nobody knows exactly what will happen as communities open up. The most likely scenario is that virus cases will continue to surge and fall around the globe for the foreseeable future.

“It’s hard to imagine how we will avoid another surge in infections, which is why these harm reduction approaches that keep people away from much higher risk situations are so important,” said Julia Marcus, an infectious disease epidemiologist and assistant professor in the department of population medicine at Harvard Medical School. “If someone expanding their bubble keeps them from having crowded dinner parties or going to bars, then that is a success.”

While we’ve learned to live with masks and social distancing, as well as new rituals of hand-washing after handling packages and touching surfaces, we need some basic rules to minimize risk and still have a life going forward. We’ve consulted with several public health experts and scientists to give you the tools you need to make your own decisions, whether it’s dining at a restaurant, going to church or simply getting a haircut.

To gauge your risk of coming into contact with an infected person, pay attention to two important indicators of Covid-19 in your area: the percentage of tests that are positive, and the trend in overall case rates.

Start by learning the percentage of positive Covid-19 tests in your state, which tells you if testing and contact tracing are finding mild and asymptomatic cases. When positive test rates stay at 5 percent or lower for two weeks, that suggests there’s adequate testing in your state to get virus transmission under control, and you’re less likely to cross paths with the virus. The closer the number is to 2 percent, the better.

“It doesn’t mean you have total freedom,” warns Erin Bromage, a comparative immunologist and biology professor at the University of Massachusetts, Dartmouth. “It means there’s enough testing going on there that you can feel confident that your interactions in society are going to be of much lower risk.”

If the percentage of positive tests starts to rise, you should take more precautions.

To find out whether your state is meeting the testing criteria, go to your state health department website. Or you can use this chart from Johns Hopkins University The website Covid Act Now allows you to see positive test rates by county.

Next, use our maps and case count pages to stay informed of the Covid-19 trends in your area. When the number of overall cases is low or falling, you should feel safer, but you still need to be vigilant. Be more cautious when case counts start rising.

You’re safest with members of your household, but if you want to widen your circle to extended family or friends, keep the number of close contacts as low and as consistent as possible. One way to do this is to form a “corona bubble,” which happens when two households form an exclusive social circle, agreeing on safety guidelines and to see only each other. The arrangement allows people to visit each other’s homes and lead a somewhat normal, if limited, social life. It may be particularly helpful for families with similar structures — such as those with young children longing for playmates or teenagers seeking in-person contact.

The arrangement requires a high level of trust. How does each family define reasonable precautions? Count the number of potential “leaks” for each member of the bubble — such as trips to the store or office, play dates, children and teens who see friends, or housekeepers and nannies who may visit multiple homes.

Keep communication open and without judgment, so people feel comfortable disclosing new exposure risks and potential “leaks” in the bubble.

“People’s activities are going to change every day — schools may reopen, someone may decide to go to protest,” said Dr. Marcus. “This is not just a one-time agreement. The communication about risk needs to be ongoing and open.”

Risk is cumulative. Going forward, you’ll need to make trade-offs, choosing activities that are most important to you (like seeing an aging parent) and skipping things that might matter less (an office going-away party). Think about managing virus risk just as you might manage a diet: If you want dessert, eat a little less for dinner.

During a pandemic, every member of the household should manage their own exposure budget. (Think Weight Watchers points for virus risk.) You spend very few budget points for low-risk choices like a once-a-week grocery trip or exercising outdoors. You spend more budget points when you attend an indoor dinner party, get a haircut or go to the office. You blow your budget completely if you spend time in a crowd.

“Moving into a long-term management phase, we have to start thinking like this,” says Johannes Eichstaedt, a computational social scientist and psychology professor at Stanford University. “Don’t take risks where it’s not needed, and make trade-offs that are congruent with your larger health needs and priorities. If seeing my grandchild in the park means, to balance this, I can only go to the supermarket every other week, maybe that’s a trade-off I’m willing to make for my mental health and well-being.”

  • Updated June 5, 2020

    • So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

Unfortunately, there’s no magic number to determine your personal exposure budget and the exposure “costs” of different actions. But think about your overall exposure budget when you make decisions to spend time with other people, particularly older people and those with high-risk conditions.

Every time you make plans, ask yourself, “If an infected person happens to be nearby, how much time could I be spending with them?” It takes an extended period of close contact with an infected person, or extended time in a poorly ventilated room with an infected person, to have a substantial risk of catching the virus through the air, said Linsey Marr, an aerosol scientist at Virginia Tech.

When making decisions, keep indoor events brief and move social events outdoors. Wear a mask and practice social distancing. Here’s some guidance about time of exposure.

Brief exposure: Brief encounters, particularly those outside — like passing someone on the sidewalk or a runner who huffs and puffs past your picnic — are unlikely to make you sick.

Face-to-face contact: Wear a mask, and keep close conversations short. We don’t know the level of exposure required to make you sick, but estimates range from a few hundred to 1,000 copies of the virus. In theory, you might reach the higher estimate after just five minutes of close conversation, given that a person might expel 200 viral particles a minute through speech. When health officials perform contact tracing, they typically look for people with whom you’ve spent at least 15 minutes in close contact.

Indoor exposure: In an enclosed space, like an office, at a birthday party, in a restaurant or in a church, you can still become infected from a person across the room if you share the same air for an extended period of time. There’s no proven time limit that is safest, but based on contact tracing guidelines and the average rate at which we expel viral particles — through breathing, speaking and coughing — it’s best to keep indoor activities, like shopping or haircuts, to less than an hour. Even shorter is better.

As you make decisions, Dr. Bromage suggests you consider the volume of air space (open space is safer than a small meeting room), the number of people in the space (fewer is better) and how much time everyone is together (keep it brief). To learn more about timing and risk, read Dr. Bromage’s blog post on the topic, which has been viewed more than 18 million times.

Already some people in many communities have stopped wearing masks, suspended social distancing and returned to their pre-pandemic socializing. Time will tell if case counts start to rise as a result, but in the coming months you would be wise to adopt the following habits.

  • Keep a mask handy. Wear a mask in enclosed spaces, when you shop or go to the office and anytime you are in close contact with people outside your household.

  • Practice social distancing — staying six feet apart — when you are with people who live outside your household. Keep social activities outdoors.

  • Wash hands frequently, and be mindful about touching public surfaces (elevator buttons, hand rails, subway poles, and other high-touch areas)

  • Adopt stricter quarantine practices if you or someone in your circle is at higher risk.