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Trying to strike a balance epidemiologically, and perhaps politically, the Centers for Disease Control and Prevention (CDC) has issued guidelines for people wanting to leave home and attend gatherings as COVID-19 cases generally have plateaued nationally.
However, this pandemic has been marked by sudden changes, and some states were reporting spikes in cases even as the new guidelines were released at a June 12, 2020, press conference. One unknown is how levels of the novel coronavirus in various communities will be affected by social protests in many cities nationally. Accordingly, the CDC released the guidance with a considerable caveat.
“We are not out of the woods yet,” said Jay Butler, MD, who is leading the CDC pandemic response. “In the coming weeks, we could see increases in the number of cases of COVID-19 as states reopen and as there is an increase in public gatherings as we move into the summer across the country.”
The CDC released two online guidelines, one for people going out in the community and another on large and small gatherings.1,2
Both urge the now-established measures of frequent hand hygiene, masking, and social distancing. The agency appears to be trying to afford some respite before the onset of a looming flu season that likely will include a resurgence of the novel coronavirus.
“In addition, we must look ahead to the fall and winter,” Butler said. “If anything, we must be overprepared for what we might face later this year. Getting a flu vaccine will be more important than ever, as flu and COVID-19-could be circulating together as we move into the fall and winter months.”
There are three key variables that provide a general rule of thumb for community activities.
“The more closely you interact with others, the longer the interaction lasts and the greater the number of people involved in the interaction, the higher the risk of COVID-19 spread,” Butler said. “Understanding these risks and how to adopt different prevention measures can help you protect yourselves and others against the virus.”
For example, when dining out, consider restaurants where you can sit outside or choose a table that is at least six feet away from other diners.
“If your local library is open, see if curbside pickup is available,” he said. “If you want to gather with friends for a cookout, as much as possible use single-serve options and remind guests to wash their hands before and after eating. Maintain social distancing, wear cloth face coverings when possible, practice hand hygiene, and avoid sharing frequently touched items.”
According to the CDC, ask the questions summarized below before you go out into your community, consulting local health department data to inform decisions:
“While COVID-19 is still making headlines everywhere, we know that the pandemic hasn’t affected everyone everywhere in the same way,” Butler says.
“The good news is, nationally, we have been successful in flattening the curve. The number of new cases each day has been relatively plateaued over a prolonged period of time. But, right now, communities are experiencing different levels of transmission, and this is occurring as they gradually ease up on some of the community mitigation efforts and gradually reopen.”
In general, indoor spaces with less ventilation where it might be harder to keep people apart are more risky than outdoor spaces. Interacting without wearing cloth face coverings also increases your risk, the CDC notes.
“The whole goal here is to continue to keep that curve as flattened as possible to delay onset of cases for two reasons,” he said. “We want to make sure that critical infrastructure that is important for societal function as well as the availability of healthcare services is maintained and that none of these services are overwhelmed by a sudden increase in the number of cases.”
As some communities in the United States begin to plan and hold events and gatherings, the CDC offers the following considerations for enhancing protection of individuals and communities and preventing the spread of COVID-19.
“Because COVID-19 virus circulation varies in communities, these considerations are meant to supplement — not replace — any state, local, territorial, or tribal health and safety laws, rules, and regulations with which gatherings must comply,” the CDC states. “Organizers should continue to assess, based on current conditions, whether to postpone, cancel, or significantly reduce the number of attendees for gatherings.
In general, the risk of COVID-19 spreading at events and gatherings increases as follows:
Lowest risk: Virtual-only activities, events, and gatherings.
More risk: Smaller outdoor and in-person gatherings in which individuals from different households remain spaced at least six feet apart, wear cloth face coverings, do not share objects, and come from the same local area.
Higher risk: Medium-sized in-person gatherings that are adapted to allow individuals to remain spaced at least six feet apart and with attendees coming from outside the local area.
Highest risk: Large in-person gatherings where it is difficult for individuals to remain spaced at least six feet apart and attendees travel from outside the local area.
Butler was asked the inevitable question about whether rallies for President Trump, who has declined to wear a face mask for most public events, would be safe.
“The guidelines speak for them-selves, and they are not regulations,” he said. “They are not commands. They are recommendations or even suggestions, is I believe how it is titled, of how you can have a gathering that will keep people as safe as possible.”
In general, the “degree of adherence” to the recommended measures will determine the course of the pandemic and future mitigation actions, if warranted.
“If cases begin to go up again, and particularly if they go up dramatically, it’s important to recognize that more intensive miti-gation efforts, such as what were implemented in March, may be needed again,” Butler says. “And that is a decision that really needs to be made locally, based on what is happening within the community regarding disease transmission. We know this pandemic is not over. Looking at some of the serology data, the vast majority of Americans still have not been exposed to this virus.”
The increase in cases reported in various areas could be driven by the increased availability of testing.
“It’s important to know, of course, that a certain proportion of people who become infected never develop any symptoms,” he added. “So, as testing has become more widely available, some people are tested without any symptoms.”
The CDC is looking at hospital-izations as a key indicator of whether COVID-19 is increasing in a given area.
“We are also looking at emergency department utilization for COVID-19-like illness, because the test results in and of themselves only reflect a bit of the transmission that’s occurring,” Butler said. “Right now, the [national] hospitalization rates are going down, and in most of the places where we have looked at the increase in the recent week or two in the number of cases diagnosed, we are not confirming dramatic increases in the number of hospitalizations.”
Financial Disclosure: Peer Reviewer Patrick Joseph, MD, reports that he is a consultant for Genomic Health, Siemens, and CareDx. Senior Writer Gary Evans, Editor Jason Schneider, Executive Editor Shelly Mark, Nurse Planner Patti Grant, RN, BSN, MS, CIC, and Editorial Group Manager Leslie Coplin report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study