As you know, case counts are rising across the country, at last count, in 23 states, with 15 states showing their highest case counts since before they shut down. In some places, hospitals are days away from being overwhelmed. And yet, no one is planning on new lockdowns, most are planning further re-openings. To be fair, Oregon and Utah are pausing moving forward.

There is no national policy on what to do, nor how to handle things, so states are left on their own. In some states, governors say things like “we expected that there would be more cases” as hospitals implement emergency plans. That gem is courtesy of Doug Ducey of Arizona. In addition, if you are one of those who go out, you’ve indubitably seen fewer people wearing masks and observing social distancing.

WHAT IS A PERSON TO DO???

There are three major groups of people at this juncture. First, the people who believe that it’s all over, and it’s safe to go out, and if people end up sick or dead, so be it. If you’re one of those people, stop reading now, this article is not for you. At the other end of the spectrum, there are those who, due to physical condition and/or financial ability, are committed to staying in until there’s a vaccine. But most people either have to go out because they need to work, or are at the point where they need to find a way to negotiate living in a world where they just cannot stay cooped up in their houses for the next several years.

For those who are working outside your home, keep doing what you’re doing. Wear your mask AT ALL TIMES, observe the best amount of social distancing you can, wash those hands for a minimum of 20 seconds every chance you get, and use hand sanitizer if you can’t get to a sink. Your hands cannot be too clean. And THANK  YOU!

For those of you who are business owners desperate to get back to your shops, practices, offices, job sites, farms and plants, you have required rules and guidance from your individual states.

But what about those people who can work from home, or are retired, but want to get out a bit?

First, assess the risks. You know your personal risk: it’s either “average” or “high”. Then, know your community risk. You can access some amount of data about your area, and from that data, assess how prevalent coronavirus is in your immediate area.

There are a number of ways to do this, but the best way is to READ several legitimate sources. There is a lack of both transparency and consistency between sources, so it’s best to have a system that will give you the best possible information. If you live in New York, read the NY Forward dashboards at the bottom of the main screen. This is the best, most transparent site around. And it’s a shame that more states (Or Hey! The Whole Country) doesn’t adopt the same system.

If you don’t live in NY, you’ll need multiple sources. Below is my system, in the order that I check it every day.

1. Worldometer – this site has higher numbers than everyone else. Their data sources are as local as they can get. Throughout the day, the chart of states will update as they collect the data from the individual states. Some states link to their data.
2. CNN – while their data sources vary, scrolling down to look at the 7-day averages by state is a quick and easy way to view statewide trends.
3. Effective Transmission Rate – This site will show you the transmission rate for a state. It’s a similar metric to the infection rate shown in the site below. It’s instructive because you can see quickly who’s red and green, and scroll down to see your state over time. However, it is only statewide, and as we know, local is everything, which brings us to….
4. Covid Act Now – This site is well sourced, but dependent on state data, which varies by state. Some states are still conflating PCR and antibody test rates. But they provide several stats that are hard to find elsewhere, and you can see the data by county, which will help you assess your local risk.

The Covid Act Now site shows data by both state and county. While often the hospital rate is inaccurate since in some places hospitals are more regional than county, the infection rate and positive test rate are what you want to look at.

An infection rate UNDER 1 means that coronavirus is not spreading as each infected person is infecting LESS than one person. Above 1 means that each infected person is infecting MORE than one person. Once you hit 1.2, the rate of infection is increasing, and it’s BAD.

You also want to look at the positive test rate. The lower the number, the better. This tells you what percentage of people who are tested are positive. If the number is 50%, it means that half the people tested are positive, and likely they are only testing symptomatic people — when there was a dearth of tests, and the only people tested were, say, in hospitals, that number in some areas approached 80% positive. The goal is a positive test rate of 2% or under — at that rate ENOUGH people are being tested.

5. Finally, Google your county to see what data is available for your locality. Some of this may come from your county (or city, if you live in a large enough one) but also newspapers which have dug around for hyper-local information. In addition, many county sites allow you to view data by city/town or zip code.

What you will now know is how safe or unsafe your particular area is at the current point in time, and then you can decide what you want to do, and how you want to approach those activities. The infographics show some macro information: outdoors is better, fewer people are better. But they don’t answer the specific questions of what is safe and what is risky.

Before anything else, remember to prioritize what you are going to do. The fewer things you do, the lower your chance of exposure. So if you want to go to the supermarket, don’t go out to eat that night. If you need to go to the doctor, don’t put gas in your car on the way home. Pick one thing per day. This article has polling and comments from over 500 epidemiologists about when they will undertake certain activities, and doesn’t account for a surge, which would shift everything right.

Next, assess WHY you want to do something. A lot of people want to go out to eat. I get more questions about this than anything else. There are two general reasons: first, to support the local restaurants. If that’s your reason, go with curbside pick-up and tip really well. The other reason is that people just want OUT and going out to eat is something they’re used to doing and they miss it.

If you must, go with outdoor dining, and only at a place with strict mask protocols in place, and one where the tables are well separated. The safest are those restaurants that have reservation only dining, where people’s contact information is recorded at the time of reservation,  and the restaurant is as touchless as possible. For example, ordering off cell phone menus, food delivered on carts wheeled to the table, and cashless payments. Again, remember to tip really well, and do not go inside to use the bathroom.

The second most common question I get relates to whether kids should go back to school. Here is the best advice I’ve found on the issue. It’s not a clear yes or no, but rather things to consider predicated on your location, case counts and the needs of your children.

If there is something that you want to do that is a need, as opposed to want, prioritize that. For example, if you need to go to the doctor, dentist, chiropractor (for something other than coronavirus) – GO! Your health is important!

If you want to purchase something, use curbside pick-up. The benefit to the vendor is the same as if you go into the store and it’s as safe as you’re going to get in these times. Many vendors now have websites, even if they were bricks and mortar prior to lockdown. If you are trying to buy clothing, and you’re unsure of sizing, call the store, tell them the item you want, and ask them to use a tape to measure the width and height so you will know what size to buy.

Want to visit with people? For some people, this means parents, grandparent, or grand kids. And trust me, I get the “I want to hug” thing. For this, you need to assess not only your risk, but the risk of the people you are visiting. You can certainly visit with people from a 6’ distance. OUTSIDE! It’s a good policy to assume that you are infected, and they are infected. If you need to hug, follow these instructions.

What if you want to eat with people? Follow these rules:

1. Party outside.
2. Have an outside trash can with a garbage bag in it.
3. Space tables 6’ feet apart. (Use a tape, don’t guess.)
4. Have everyone bring their own plates, cups and utensils (or use disposable). If you use disposable, everything goes in the trash can once it’s used.
5. Best: have everyone bring their own food. If you can’t do that, grill and use tongs to place food on a plate, step back, and have each person take their plate. NO SHARED FOOD!!! Remember, this is about having some food secondary to enjoying the company. The simplest thing to do is to grill hamburgers and veggie burgers, and potatoes chopped with onions and peppers wrapped in foil, or corn in foil. Then it’s easy to use tongs to put things on plates.
6. Place condiments in individual serving cups on the tables ahead of time. (Think paper cups.)
7. Serve drinks in bottles/cans.
8. Serve individually packaged desserts.
9. And everything goes in the trash can. If you insist on recycling, have people put everything recyclable in a second bag, and then wash everything at once before putting it in the bin. Remember, if you’ve got food/drink in the can/bottle, it cannot be processed at the recycling plant and they’ll landfill everything in that load.
10. Someone needs a bathroom? One person at a time in the house, to the bathroom and back outside. Have them bring their paper towel from drying their hands outside and place it in the trash. Then, the homeowner goes in and disinfects everything immediately afterward: remember toilet, sink, faucet, counter, door handle, light switch. If you have a “no shoes” policy in your house, provide socks that then become party favors.

When making your decisions, remember that the more people you come in contact with, and the closer you are to them, the greater the risk. Therefore, going to a Farmer’s Market where everyone has pre-ordered, prepaid and you’re assigned a pick-up time, and you can easily maintain 6 feet of distance is much safer than, say, getting on an airplane, which is one of the most dangerous things you can do. If you do undertake something risky, wait 7 days and then get a PCR test. They are available in most places for people who have been exposed to someone who is infected, and doing something like going to a protest (which is a righteous risk) means you were exposed.

And now for masks. The latest CDC guidance says that most people should wear cloth masks, but people over 60 and those who are at high risk should wear N95s. As an aside, CDC posts all sorts of information that doesn’t get disseminated unless you go look for it – and when it’s repeated, often it’s topline and not the nuances. You can see their information here. My gut says that the mask guidance will expand as we get into the autumn, and N95s will be recommended for more and more people. While the current administration will never recommend them, EVERY reliable and honest epidemiologist, virologist and doctor says you should wear a mask at all times when you are outside.

Since it’s not that easy to get N95s, and with the rise in hospitalizations, they’re more needed by medical personnel and first responders, here is my advice. First, if you wear a cloth mask, make it a minimum of 3 layers, or 2 layers with a filter. Cotton is your best choice. These are now readily available from a number of places. If you wear glasses, make sure the mask has a nose wire, to help prevent your glasses fogging. If you can afford it, look for cloth masks with breathing vents.

Consider a respirator. These are very hard to get, but you can get on a wait list. Look for NIOSH certified respirators, with replaceable filters. When you order, check the sizing. Too small and you won’t be able to wear it, too big and it will fall off.

Get goggles. These will help you in two ways: first, we know that viruses and other pathogens can infect you through your eyes. Second, it’s one more area of your face you won’t be able to touch without thinking. Goggles are available for both those who wear glasses, and those who don’t. Read descriptions carefully. Look also for air holes in the goggles that are angled back. You want the air holes to prevent fogging. Some respirators are “full face” and have integrated goggles, but you can only use this if you don’t wear glasses or you won’t be able to get the proper seal.

Consider a face shield for over your mask (they won’t fit over goggles).

Finally, hand hygiene. You know that you should be washing your hands as often as possible, but if you’re out and about, you’ll need hand sanitizer. The easier it is to use, the more likely you are to use it. My personal favorite is to order the little sanitizers from Bath and Body Works, and keep them in a case that hangs on a lanyard on my neck. Thus, always accessible. They’re often sold out of the lanyards, but keep checking. They also sell holders that will clip to a belt loop. I’m sure there are other, similar vendors. If you carry sanitizer in your pocket, purse or pack, remember that once you touch that to get at the sanitizer, you need to wash the item once you get home. Risk of infection is low, but not zero.

We are all humans. And humans make mistakes. Coronavirus mistakes can be fatal to you, or those you love. Set up as many protocols as you can, and use “muscle memory”. So – keep your supplies by the front door: get in the habit of grabbing your sanitizer and putting on your mask before you walk outside. It becomes as much a habit as grabbing your car keys. Stay home as much as possible, and pick your outings carefully. You can’t choose when your employer says you need to come to work, but you can endeavor to do your grocery shopping when stores are less busy. Above all, if someone is getting near you who is not wearing a mask: BACK AWAY!

Do the best you can to stay safe. As cases rise over the summer in places where people aren’t careful, it becomes extra important to be aware of your surroundings (both via data and keeping an eye out). We’ll need to reassess as summer turns to fall and the seasonal flu starts rearing its ugly head.