For many of us, it’s been months since we started sheltering in place. And it’s exhausting. Now, as states begin to reopen and social distancing rules are relaxed, how do we decide what is safe to do and what isn’t? And what about those of us who haven’t had the luxury of staying at home? CNN Chief Medical Correspondent Dr. Sanjay Gupta speaks to experts about quarantine fatigue and how we should move forward with our daily lives.
You can listen on your favorite podcast app or read the transcript below.
Dr. Sanjay Gupta: For many of us, it’s been months since we started sheltering in place. Our homes have become our gyms, our offices and our classrooms.
It’s exhausting. I feel it, too. Days seem to blur together. My kids keep asking me when are they going to get to see their friends again. We’re all craving some measure of normalcy.
Now as states are reopening and we’re preparing to gradually step out of our homes, how do we decide what is safe to do and what isn’t?
I’m Dr. Sanjay Gupta, CNN’s chief medical correspondent. And this is “Coronavirus: Fact vs. Fiction.”
The advice we’ve been hearing, whether we like it or not, has been to stay home, unless absolutely necessary to leave.
But all that time inside is creating a sense of restlessness and a desire to start socializing again with friends and family.
Julia Marcus, an infectious disease epidemiologist at Harvard Medical School, calls this “quarantine fatigue.”
Julia Marcus, assistant professor, department of population medicine, Harvard Medical School: I think it’s just the general sense that we cannot stay indoors forever. I think we all know that. And for the past few months, we have been contending with this message of stay home, except for essential activities. And that starts to wear on people. The overall message here is this is just not something we can sustain for many, many months on end.
Gupta: And a lot of people have said that until a vaccine comes about, that life’s going to be different. Is that’s what you hear a lot? Is, is that your impression as well?
Marcus: Yeah, I can’t imagine that we’re going to go back to business as usual until there is an effective vaccine.
Gupta: It does seem that in, in medicine, maybe even more so than in public health, recommendations do tend to be pretty absolutist. How do, how do you sort of apply, I guess, what you call and others have called the harm-reduction model to something like this? What does that look like?
Marcus: Yeah, you’re right that public health messaging and clinical practice recommendations are often very black and white. And one of the clearest examples of this is abstinence-only messaging around sex. We tell people, “Here’s the safest thing you can do.” And then we, we’re afraid to tell them about the next-safest things, like, “OK, if you do have sex, here’s what you can do to protect yourself.” We’re afraid to do that because we’re afraid that that’s permissive and that that’s going to promote risky behavior.
But the reality is some people are going to have sex, whether we like it or not, and we’re missing an opportunity to give them tools to reduce any potential harms, if they do choose to have sex. And that same model applies here. If we don’t tell people, “OK, if you want to expand your social contacts, here’s the safest ways to go about it. Think about creating a pod with another family. Think about getting a sex buddy like they’re recommending in the Netherlands.”
You know, these harm-reduction approaches that give us a sense of, all right, this is not zero risk, but if you’re going to do this, here’s a way to do it as safely as possible. If we don’t do that, we’re missing an opportunity, and people are already making those decisions. We need to support them in doing it as safely as they can.
Gupta: When, when you think about the messaging around harm reduction, take a scenario like what we saw with the spring break groups going down to the beaches and things like that. How do you strike the right message?
Marcus: Yeah, it’s a great question. I, I think it needs to start from a place of empathy. Let’s take those kids who were out on spring break. It could start from a place of, look, we understand that you need social contact. And then say, “Here are safer ways to do this.” Like “OK, gather on the beach, but try to maintain some distance.” And what are the highest-risk activities in that setting? It’s probably not being on the beach. It’s probably going back to your hotel room and having a crowded party in your hotel room.
So can we advise people, “All right, fine. Here’s the lowest-risk thing you can do while you’re on spring break in Florida. And here are the higher-risk things that you may want to avoid”? And that message may be here, heard more clearly and maybe more effective than simply saying, “Look at these reckless, irresponsible kids and what they’re doing.”
Gupta: Yeah, I think, I think that’s right. I mean, I’ve struggled. I’ll be honest with you. And I have three teenage daughters as well. And, you know, sometimes I think they blame me for this whole thing because they see me on TV talking about it, so they figure it must be my fault. Makes perfect sense to them.
But, you know, I do, I do get friends of mine who will call us up and say, “Hey, do you want to go out to dinner tonight?” And we have always said no. And because we think it’s not worth the risk at this point. And we also think it may set a bad example. And we’re not through this yet. But how about you? As someone who gives this a lot of thought, how do you think about that?
Marcus: I’m navigating these situations as well with two kids who’re 3 and 6. And with neighbors who I share a household with, in a duplex. And we’ve tried to make some decisions based on the risk-benefit calculation. We are not going out to restaurants and we’re not meeting up indoors with people.
But we have decided to share our porch with our neighbors, and we’ve decided to have a part-time babysitter because we were losing our minds. And, you know, it’s about making these decisions where we think carefully about the risk. We communicate with our social contacts about our risk and their risk, and then we make decisions based on what’s really going to benefit our family.
And I think that’s what everybody is trying to do on a daily basis. And that’s where public health guidance, I think, can help people with the risk-assessment part of that equation.
Gupta: Yeah, I think that’s a really good point. And more currently, you know, you see these protests around the country. And I got to tell you, it’s been, it’s been inspiring, frankly, to see some of that just because of the messages that are being delivered during these protests.
And yet, you know, from a public health standpoint, you also see very large gatherings of people. They are outside, mostly, as you mentioned. But how much does that worry you?
Marcus: Yeah, I think it will be surprising if we don’t see some infections attributable to these protests. They’re not only large mass gatherings of people and yes, outdoors with masks, but still very difficult to social distance in that setting.
But there’s also ways that the police, I think, are contributing to transmission risk by promoting crowding, detaining people on crowded buses and keeping hundreds, actually thousands now at this point, of people overnight in jail, where we know that, in fact, the virus can be transmitted easily.
But that said, systemic racism is a public health crisis that has been around for far longer than the coronavirus. And these protests are not optional for the people who are out on the streets. And so as a field, I think public health understands that we need to address multiple public health crises at once.
And so harm reduction really is our best approach here, which is giving people the tools they need to protest as safely as possible.
Gupta: You have said as well that what Americans need now is a manual on how to live life in a pandemic. What sort of things do you think should be in this manual?
Marcus: Well, clearly, staying at home alone or with your household members is going to be the safest thing to do right now in terms of viral transmission.
But we also know that going outdoors seems to be fairly low risk. Especially if you’re maintaining distance from people and wearing masks. Things like biking with somebody, running with somebody else, going for a stroll with someone. Those are all fairly low-risk activities.
Once you’re sitting with somebody with prolonged face-to-face contact, even outdoors, then your risk is a little bit higher. So let’s say having a picnic, you’re sitting on the same blanket, having a long conversation. But again, still lower risk than having that conversation indoors. We know that indoors is higher risk for transmission. And the more people you have in that room, the higher risk it’s going to be.
And for all of these settings, there are harm-reduction strategies you can use: trying to maintain some distance, wearing a mask, keeping your hands clean. Those are all tools that we can use across settings to minimize harm.
Gupta: If we were to talk again at the end of the summer and it started to feel like a situation where, we just became comfortable as a country with, you know, 30,000 people being infected every day and hundreds of people dying every day. And that just became the way that it was. Would that surprise you?
Marcus: I hope that we don’t become inured to the amount of death that is happening every day. I also think we have to find a way to live with this virus. And, you know, we have to find some way to continue to find joy in our lives. In the same way that in the early days of AIDS, people had to adapt. Gay men in particular had to adapt to a now deadly virus in their community. We are now doing that as a globe.
And what worked in the early ’80s was safer sex guidance. And that’s kind of what we need here is guidance on how to live our lives with this new deadly virus that isn’t going anywhere for some time.
Gupta: We all need to figure out how to live with this virus. But that guidance might look different for those who don’t have the luxury to stay at home.
Mienah Sharif, post-doctoral researcher, Center for the Study of Racism, Social Justice and Health, UCLA: Being forced to stay at home and tired of Netflix options is not necessarily the reality in a lot of communities of color. For example, less than one in five black workers and approximately one in six Latino workers report even being given the option to work remotely.
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Gupta: That’s Mienah Sharif, a researcher at the Center for the Study of Racism, Social Justice and Health at UCLA.
She says that for some communities, combating quarantine fatigue may be more challenging. And those communities tend to be occupied by people of color.
Take public parks for example.
Sharif: First of all, there’s fewer access to a lot of green space where people can meet. And there is also the increased presence of law enforcement. This may prevent people from wanting to congregate in public spaces, as we’re seeing in light of recent events.
Gupta: Mienah wants to make sure that when we think about strategies for helping people who feel stuck at home, that these differences are taken seriously.
Sharif: A lot of the coping strategies that are being suggested are really problematic and maybe even be irrelevant for a lot of these communities. So from a health equity perspective, our hope is that when things reopen and we go back to quote unquote what was normal, we go to a, a different normal, a better normal.
Gupta: We know this disease isn’t going anywhere anytime soon. And the longer it’s here, the more important it is to find ways that we can live our lives alongside the virus, as safely as we can.
We’ll be back Monday. Thanks for listening.
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