social distancing
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It’s been many months since COVID-19 upended our lives. We’ve adjusted to wearing masks, social distancing, constantly our washing hands, and working and learning remotely. But what do we really know about how to prevent COVID-19 infection?

Scientists, doctors, and are still trying to fully understand how the virus spreads, what to do to prevent it, and the best ways to treat it. New findings sometimes lead to advice that conflicts with what we’ve been told previously—and it can be a challenge to keep track of it all. Fortunately, there is plenty of solid advice we can still follow.

“It can be really exhausting to be constantly vigilant and to take precautions, like wearing a mask and physically distancing, which may be physically and emotionally uncomfortable,” says Jaimie Meyer, MD, MS, a Yale Medicine infectious disease expert. “But sustaining these types of behaviors is really key to curbing this pandemic, especially before a vaccine is available.”

Plus, cooler weather is bringing more of us indoors, which is riskier than being outside because there is less airflow and it can be more difficult to keep people 6 feet apart. What’s more, says Dr. Meyer, there’s the possibility that SARS-CoV-2, the virus that causes COVID-19, is airborne, making ventilation even more important.

The upcoming months also bring seasonal respiratory viruses, like cold and flu, leading to concern about the possibility of a “twindemic” that may overwhelm health care systems already spread thin by COVID-19. These other illnesses can bring confusion because symptoms are very similar to those of COVID-19.

Meanwhile, COVID-19 remains with us, resulting in more than 210,000 deaths in the U.S. to date. As we leave a chaotic spring and summer behind and head into fall, now is a good time to check in with Yale Medicine experts and review the standard—and most recent—advice on how to stay safe.

Wear your mask

Wearing a mask that covers your mouth and nose can prevent those who have COVID-19 from spreading the virus to others. Recent evidence suggests that masks may even benefit the wearer, offering some level of protection against infections.

The Centers for Disease Control and Prevention (CDC) recommends that everyone age two years and older wear masks in public settings and around people who don’t live in the same household—when you can’t stay 6 feet apart from others.

Masks should be made of two or more layers of washable, breathable fabric and fit snugly on your face. “A quick and easy test is to hold your mask up to the light. If light passes through, it’s too thin,” Dr. Meyer says. “Masks only work when they cover the nose and mouth because that is where infected droplets are expelled and because the virus infects people through the mucous membranes in their nose and throat.”

Stay socially distant

COVID-19 spreads mainly among people who are within 6 feet of one another (about two arms’ length) for a prolonged period (at least 15 minutes). Virus transmission can occur when an infected person coughs, sneezes, or talks, which releases droplets from the mouth or nose into the air.

People can be asymptomatic and spread the virus without knowing that they are sick, which makes it especially important to remain 6 feet away from others, whether you are inside or outside. Plus, the more people you interact with at a gathering and the longer time you spend interacting with each, the higher your risk of becoming infected with the virus by someone who has it.

If you are attending an event or gathering of some kind, it’s also important to be aware of the level of community transmission. One method of estimating how high the risk may be is referred to as R0.

“Pronounced ‘R naught,’ and also known as the reproduction number, this is a measure of how fast a disease is spreading,” explains Onyema Ogbuagu, MBBCh, a Yale Medicine infectious disease expert. “If the reproduction number is 5.0, that means one infected person will spread the virus to an average of five people. Therefore, the lower the rate, the safer it is.”

The R0 for COVID-19 is believed to be in the range of 1.4 to 2.9. For comparison, measles, which has the highest reproduction number known among humans, ranges from 12 to 18. Seasonal influenza is around 0.9 and 2.1.

While R0 refers to the basic, or initial, reproduction number, there is another measurement called Rt, which is the current reproduction number and is the average number of people who become infected by an infectious person. If Rt is above 1.0, it spreads quickly. If it’s below 1.0, it will eventually stop spreading. You can check the number for each state here.

Keep washing your hands

Washing your hands—and well—remains a key step to preventing COVID-19 infection. Wash your hands with soap often, and especially after you have been in a public place or have blown your nose, coughed, or sneezed, the CDC recommends.

You should wash your hands for at least 20 seconds and lather the back of your hands and scrub between all fingers, under all fingernails, and reach up to the wrist, the CDC advises. After washing, dry them completely (with an air dryer or paper towel) and avoid touching the sink, faucet, door handles, or other objects. If no soap is available, use a hand sanitizer with at least 60% alcohol content, and rub the sanitizer on your hands until they are dry.

Though the CDC states that the primary way the virus spreads is through close person-to-person contact, it may be possible to become infected with COVID-19 by touching a surface or object that has the virus on it and then touching your own mouth, nose, or eyes.

Therefore, you should also wash your hands after touching anything that may have been contaminated—such as a banister or door handle in a public place—and before you touch your face.

While the virus can survive for a short period on some surfaces, it is unlikely to be spread from mail or from products or packaging, the CDC says. Likewise, the risk of infection from food (that you cook, is prepared in a restaurant, or is ordered via takeout) is considered to be very low, as is the risk from food packaging or bags.

Still, there is much that is unknown about the virus, and it remains advisable to wash hands thoroughly after handling any food or products that come into your home.

Keep holiday gatherings small

Fall and winter also bring holidays, when many families get together. This can be especially tricky for those of us who live in parts of the country where it will no longer be easy to gather outside. “After months apart during this pandemic, families may be less willing to do a group Zoom call,” says Dr. Meyer. “This may be a year where we need to get creative and rethink how to celebrate together.”

That may simply mean more planning for the holidays, Dr. Meyer says. “Consider quarantining for 14 days prior to the event and/or having everyone get tested for COVID-19 if tests are available in your community,” she suggests. “If possible, limit gatherings to as few people as possible—perhaps just immediate family and close friends. When it is not possible to be outside, encourage your guests to wear masks indoors. Consider spreading out food and eating areas so people are distanced while eating with their masks down.”

Remember that your elderly family members and those with other medical conditions are most vulnerable to COVID-19, so take extra measures to protect them, says Dr. Meyer.

Dine out carefully

Although many restaurants offer outdoor dining, which experts say is the safer option, a recent CDC study showed that adults with COVID-19 infections were twice as likely to have visited a restaurant in the two weeks preceding their illness than those without an infection.

The study did not distinguish between indoor or outdoor dining, or consider adherence to social distancing and mask use. (Those with COVID-19 infections were more likely to report having dined out at places where few other people were wearing masks or socially distancing.)

“If you are meeting with others at a restaurant and sharing tables while eating, which does not allow for appropriate social distancing and mask use, it provides opportunities for the virus to spread from person to person,” Dr. Ogbuagu notes. “The probability of spreading infection is higher with each additional person you are in contact with, especially when people congregate.”

Travel safely

While you should avoid traveling if you can—as the CDC says staying home is the best way to avoid COVID-19—sometimes, it is necessary. But before you leave, you can check to see if the virus is spreading at your destination. More cases at your destination increases your risk of contracting the virus and spreading it to others. You can view each state’s weekly number of cases here on the CDC web site.

“Also, don’t forget to check the regulations for quarantining or testing at your destination or for when you return home,” says Dr. Meyer. Whether you are traveling by car, plane, bus, or train, there are precautions you can take along the way. The CDC has a detailed list of recommendations for each mode of transportation that mostly follows the advice listed above of practicing social distancing, wearing a mask, and washing hands, but also includes specific advice for various scenarios.

Get your flu shot

Health officials are concerned about an influx of flu and COVID-19 cases overwhelming hospitals. In the 2018-2019 flu season, 490,600 Americans were hospitalized for the flu, according to the CDC.

Public health experts say this is not the year to skip the flu vaccine. While measures to prevent COVID-19, including mask-wearing, , and social distancing, can also protect against the flu, the vaccine is especially important—and safe, doctors say.

Though many people claim that the flu shot “gave them the flu,” it is not possible to get infected with the influenza virus from the vaccine itself, Dr. Meyer says. “The vaccine is made up of inactivated virus and is designed to ‘tickle’ the immune system to respond to the real thing when it sees it,” she explains. “The most common side effect from the flu shot is soreness or redness at the site of the injection, which resolves within a day or two.”

The flu vaccine is recommended for everyone 6 months old and up. Talk to your doctor about finding a vaccine near you.

How to differentiate between flu, colds, and COVID-19

Many people will likely struggle to differentiate between the flu, the common cold, and COVID-19, all of which have similar symptoms.

For example, both COVID-19 and the flu can cause fever, shortness of breath, fatigue, headache, cough, sore throat, runny nose, muscle pain, or body aches, as well as vomiting and diarrhea (though these last two are more common in children). Meanwhile, colds may be milder than the flu and are more likely to involve a runny or stuffy nose. One difference, however, is that COVID-19 is associated with a loss of taste and smell.

So if you or someone in your family comes down with any of these symptoms, what should you do?

“First, you should stay away from others as much as possible and perform hand washing before you make contact with your face,” Dr. Ogbuagu says. “And certainly go see a doctor or to the hospital if you have serious symptoms, such as a high fever or shortness of breath. Otherwise, getting a COVID-19 test at a testing facility near you would help to define what type of respiratory illness you have and also how to advise people you had been in contact with.”

Parents, Dr. Meyer adds, will need to contact their children’s pediatricians about these symptoms because otherwise their children likely won’t be able to return to school.

“I would also add that people who are older and have underlying medical conditions should have a low threshold to seek care for any of these symptoms,” she says. “Earlier is better, especially for influenza, as we have antiviral medications that work if given within 72 hours of the onset of symptoms.”

Seek routine medical care

You should continue to seek any routine or emergency medical care or treatments you need. Many health centers and doctors are offering telehealth appointments (via video or phone) and most have protocols to minimize risk of exposure to the coronavirus.

Getting emergency care when you need it is especially important. Earlier in the pandemic, pediatric and adult physicians reported fewer emergency department visits, leading to a concern that patients were avoiding seeking care due to fears of contracting COVID-19.

“As important as it is to continue to engage in care for known medical issues, there is also a concern that people are falling behind on their preventive healthcare, like getting routine procedures including colonoscopies and pap smears, as well as vaccines,” Dr. Meyer says. “Those other health issues don’t go away just because there is a pandemic. Reach out to your primary care doctor if you’re unsure what you are due to receive.”

Be mindful of your mental health

Many people are experiencing anxiety, depression, and other mental health issues during the pandemic as it is a time of stress and uncertainty. All of this is normal, say mental health experts, who recommend that you allow yourself to embrace all emotions, including those that are unpleasant, in order to better manage them.

Experts advise limiting exposure to news if the events of the world are too much right now, practicing mindfulness (even just breathing exercises), eating healthy, and remaining physically active.

For kids, who are still adjusting to a lack of play dates, canceled activities, and different school schedules, parents can help by fully listening to their concerns and providing age-appropriate answers to their questions. By talking with kids about what they know and how they are doing, parents may be able to determine if further emotional support is needed.

Watch your weight

At a time when routines are disrupted and many people are working at home—where snacks are readily available—some may be gaining weight (the so-called quarantine 15). Now more than ever, Yale Medicine doctors recommend that you focus on eating a healthy diet, incorporating regular exercise, getting good sleep, and finding healthy ways to manage stress.

Meanwhile, obesity is emerging as an independent risk factor for severe COVID-19 illness—even among younger patients. One study, which examined hospitalized COVID-19 patients under age 60, found that those with obesity were twice as likely to require hospitalization and even more likely to need critical care than those who did not have it. Given that an estimated 42% of Americans have obesity (having a body mass index equal to or more than 30), this is important.

Keep up the good (safety) work

It is likely that COVID-19 will be with us for a while. “But with good efforts to continue to follow the public health measures to protect each other, and, hopefully, a successful vaccine in the future, there is a light at the end of the tunnel,” Dr. Ogbuago says.

But even before a safe and effective vaccine is available, COVID-19 is a preventable disease, Dr. Meyer points out. “It just requires all of us to do the hard work of practicing the behaviors—described above—to keep our communities safe and healthy.”


How can I tell the difference between the flu and COVID-19?


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The 12 best COVID-19 prevention strategies (2020, October 13)
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