Since COVID-19 struck America, most of us have stopped lots of heretofore normal activities in an effort to limit the spread of SARS-CoV-2. The curve has been flattened in most states and now the burning questions relate to when we can get back to normality.
Health care facilities have made the decision to resume most elective diagnostic procedures and are gradually moving from telemedicine to real in-person office visits. Hair stylists have gone back to cutting and colorizing hair.
For most activities, however, the decision to resume normality remains intensely personal and complicated.
For example, the skeptical cardiologist really wants to visit his 94-year-old father on Father’s Day weekend.
Pops Pearson lives in Tulsa, Oklahoma some 400 miles away, and I haven’t seen him (excluding Facetime sightings) since Christmas of last year.
How do I balance the risk of giving him COVID-19 versus the benefit of us spending time together? Would the risk/benefit change in 3 to 12 months? In a year or two?
There is no CDC or state or WHO guidance on whether I should make this trip. However, the NY Times published a piece today which sampled the opinion of 511 “epidemiologists,” which offers some perspective on when it is right to resume certain activities.
The majority of the 511 epidemiologists who responded to the survey felt comfortable currently bringing in the mail and getting a haircut.
My wife (the ex-eternal fiancée) and I still put the mail in quarantine and treat all packages as potentially contaminated. The epidemiologists were split on visiting hair salons or barber shops with 41% comfortable now and 39% in 3 to 12 months.
We have acquired hair cutting equipment for her to use on me and home hair colorizing stuff (not for me) and neither of us has seen a barber for 3 months. We plan to continue that for the foreseeable future.
It is interesting that 60% of epidemiologists are comfortable seeing a doctor for a non-urgent appointment. My patients also seem comfortable now coming into the office. We take a lot of precautions, but ultimately exposure risk for both patients and physicians is higher than if they had both stayed at home.
Resuming Activities in 3 to 12 Months
The majority of epidemiologists felt comfortable resuming ten activities in 3 to 12 months although a substantial minority were OK with doing them now.
Two of the activities above are relevant to my “Pops Pearson visitation” decision.
Only 20% of the respondents felt comfortable visiting an “elderly relative or friend in their home” now, but this increased to 41 % by 3 to 12 months. This surprised me and suggests that most Americans may not be going into their relatives’ homes and/or spending significant time with their elderly parents.
Similarly, only 20% of respondents would travel by airplane now, but 44% would in 3 to 12 months.
A substantial minority of the respondents felt they would not be comfortable visiting relatives in the home (39%) or flying (37%) until over a year from now.
Of the other activities on the above list, I am uncomfortable right now with all except a “hike or picnic outdoors with friends.” We have had close friends over to our house for outdoor socially distanced gatherings, two at a time. We have gone for bike rides with friends outdoors.
I’m not sure when I will feel comfortable attending an indoor dinner party, exercising at a gym, or eating at a dine-in restaurant.
To Visit Or Not To Visit?
After much discussion with family and rumination, I have decided to drive to Tulsa and stay with Pops Pearson for Father’s Day.
The decision to drive was an easy one. Although we usually choose the one-hour SouthWest Airlines flight from St. Louis to Tulsa we still consider flying a COVID-19 a high-risk activity. The airlines have made considerable strides in reducing the possibility of transmission in flight, but we still hear that it is not mandatory for fliers to wear masks.
The CDC website confirms that flying increases the risk of contracting COVID-19:
” Air travel requires spending time in security lines and airport terminals, which can bring you in close contact with other people and frequently touched surfaces. Most viruses and other germs do not spread easily on flights because of how air circulates and is filtered on airplanes. However, social distancing is difficult on crowded flights, and you may have to sit near others (within 6 feet), sometimes for hours. This may increase your risk for exposure to the virus that causes COVID-19.”
For those of you with more distant relatives, the decision to fly or drive is more complicated. I know that when we visit my wife’s relatives in Wilmington, NC in August (which will be a 14 hour drive) we are still planning on driving.
To minimize the risk of me transmitting coronavirus to my dad, I have put myself in a modified quarantine. I will be conducting office visits by telemedicine and one of my partners has kindly offered to cover my hospital patients during this time. In the two weeks leading up to the visit, I and my wife have agreed to avoid any activities which might increase our risk of exposure to SARS-CoV-2.
Resuming Activities in > 1 year
When will it be safe to attend a large wedding or funeral service, go to church or attend a baseball game? Definitely not now.
Of note, the majority of epidemiologists did not respond to this survey and were uncomfortable making such predictions:
About 6,000 epidemiologists were invited to participate in the survey, which was circulated to the membership of the Society for Epidemiologic Research and to individual scientists. Some said they were uncomfortable making predictions based on time because they didn’t want to guess the timing of certain treatments or infection data. “Our concern is that your multiple choice options are based only on calendar time,” 301 epidemiologists wrote in a letter. “This limits our ability to provide our expert opinions about when we will feel safe enough to stop social distancing ourselves.”
I, too, am uncomfortable making predictions and doling out advice on behaviour during COVID-19. There is much uncertainty as evidenced by the reluctance of 90% of scientists to answer this survey. The pace at which important data emerges is dizzying. For many personal decisions like mine, we must make critical decisions based on imperfect guidance.
Epidemiologically Yours,
-ACP
14 thoughts on “Father’s Day Visits and Flying During Covid-19: What Activities Are Safe To Resume?”
Good discussion. Will you wear a mask when you are there? Trying to decide for my own upcoming dad’s day visit.
I’m staying with my dad, my sister and her husband for 3 days. Based on our successful mini-quarantine over the last 14 days I think we have almost zero chance of carrying SARS-CoV-2. I also can’t stand wearing a mask as they tend to horribly irritate my cheeks. So, no masks. If we were planning on going into a public place we would definitely wear masks but plans are to chill at home the whole time.
The results would be more enlightening if the questions were not posed in terms of absolute time, but in terms of possible future events. For example,in which actions would they feel safe after a reasonable treatment or vaccine was available?
I’m sure those epidemiologists would have preferred to answer the survey by adding on lots of ifs and other qualifiers. I’m guessing you don’t consider remdesivir a reasonable treatment? Hydroxychloroquine is definitely not a reasonable treatment at this point and I would only advise taking it in the setting of a clinical trial.
Timely article! But one observation. Since your Dad is 94, I’m assuming you’re likely 60+. What about the COVID-19 related risks that traveling and visiting pose for you and your wife? Agreed; air travel is out. But will you be stopping for food or restroom breaks during the drive? Will you be staying with relatives or in a hotel? Is your Dad social distancing or does he still see friends, family, or leave the house? Sometimes while protecting our parents and older relatives it’s easy to forget that we’re also older and may be at higher risk ourselves. Take care and stay safe.
Great questions.
We have already decided to pack sandwiches for the trip. I’m OK with using a bathroom at a rest stop with mask on (as man it is easy to walk in, do your business, wash your hands and get out without touching anything) but the wife has purchased some sort of bottle for peeing in.
No hotel. We are staying with Pops and my sister and brother-in law (who are also >65) . Another calculation involved there.
Dad totally socially distanced except for the family in house. Only exposure for family is an occasional visit to grocery store by brother-in-law who has been termed “the sacrificial lamb.”
My assessment is that the Tulsa three are lower risk than us but you are correct that it is still theoretically possible for me or the wife to get exposure from them.
I’m counting on my biological age of 45 years (determined by the COVID-19 bioage calculator) to get me through any infection that develops
You mentioned calculating your adjusted risk using a COVID-19 bioage calculator. Is there a version available to the general public that you could recommend? PS: Enjoy your visit with your Dad.
Ask the docs again in 3 months. I’ll bet there answers haven’t changed much absent an effective treatment and/or vaccine.
A very interesting column, thank you. I empathize with you about visiting an elderly parent and only from my own experience can say that looking back at the effort I put in to visit my mother, who suffered from Alzheimer’s years ago, I am very glad I did it. I’ll never get that time again, and it appears that you are being as cautious as you can possibly be to protect him. I hope you have a wonderful visit with him.
I really like this blog! It is assurance to me that my husband and I are not being overly concerned especially since we live with your 94 year old father ? Thank you dear brother very helpful!!
Perhaps it’s too simplistic, but in these times of plague, why don’t we have a green/yellow/red light system with icons for people & places?
Set acceptable risk level for each person (red, yellow, green), then classify each location or activity by risk level & icons.
Classify the personal risk level by the usual factors: age, health conditions, blood type if that turns out to be a factor.
Classify the locations with light icons, slashed for those who should stay out, and appropriate safety requirements: mask icon for mask required, hands icon for gloves, sanitizer bottle for use sanitizer or wash hands. Maybe add a duration icon where needed – <50 for grocery stores, <30 for hair stylists, <10 for bathrooms.
Examples:
Hair Stylist: red light icon with slash over it, yellow light, green light, plus mask icon <30 = safe for anyone but red, masks required, no more than 30 minutes.
Grocery Store: red light, yellow light, green light plus mask icon <50 = okay for everyone, masks required, no more than 50 minutes
Parks and bike trails: red, yellow & green light plus social distance icon = safe for everyone keep your distance
Public bathroom: red light with slash, yellow light with slash, green light, with mask icon, hands icon <10 = only safe for greens, wash hands or wear gloves, no more than 10 minutes.
Fast food restaurant: red, yellow, green, social distance icon, <30
Slow food restaurant: red, yellow, green, social distance icon <90
All locations would be required to post prominent signs based on this system.
Surely there could be an app for that!
Extremely helpful, clear, and informative, even given that so many parameters remain unknown. I so appreciate all your blogs.
I have a very high calcium score without symptoms or apparent artery stenosis, now on 40 mg pravastatin, 70 LDL, very high HDL, well controlled BP, very borderline PRE-diabetes, 200 pound, solitaire 73-year old man, quite heavy drinker (which Covid isolation hasn’t helped), still walk one or two miles daily. Probably a very common pattern amongst your patients.
Having discovered your blog, I find it so measured and reassuring. Because of Covid, I’m overdue for a check-up with my cardiologist, who I feel approaches things not much differently from you. But having been diagnosed with CHD (primarily because of the calcium score) obviously made me much more aware or the issues, protocols and treatments. Your blogs are always not only a help, but a kind of reassurance that I’m basically being treated appropriately locally (Houston Methodist DeBakey). So — sincere thanks!
Hello,
Oops! There is an error in this sentence, the chart shows 44%, not 56%: Only 20% of the respondents felt comfortable visiting an “elderly relative or friend in their home” now, but this increased to 56% by 3 to 12 months.
You might clarify that 41% were ok getting a haircut, but there were 39% who said they would wait. The way this reads now the haircut decision is lumped in with categories that a ‘majority’ would do… as in over 50% when it is more nuanced.
I enjoy your column!
Donna Winham
Donna,
Thanks for catching my error. Somehow I moved the 56% for dine in restaurants to the visit relative category.
I added the nuance you suggested. Perhaps you’d like to be my editor?:)
Dr P