Coronavirus Pandemic: Faqs About the Reopening of Businesses

Vicki:

Welcome to an HMC Health Works podcast. I’m Vicki Putnam. And today we’re joined by Dr. Chris Valerian. Chris is the Chief Medical Officer for Agency Health Works, and he’s also been working on the front lines during the Coronavirus pandemic. Thanks for being with us, Chris. Today, I wanted to focus on questions that people may have regarding steps that they need to take for the process of the reopening amid the COVID-19 pandemic.

Chris:

Sure. Thanks for having me and my pleasure.

Vicki:

So let’s talk about some of the questions people have and the decisions that folks are going to face and the actions maybe they should take, as they start leaving their homes and returning to work, some people are required to do that already, but for some, it will be new. I guess the first question I have is who are still considered vulnerable and should continue to shelter in place?

Chris:

Sure. So, the vulnerable population hasn’t really changed since, we defined it earlier on in the pandemic, which essentially is two groups of people. One is the over 65 population. So, that’s what we’re calling the elderly population. And then the second population would be anyone who has a chronic underlying health condition, such as high blood pressure, diabetes, chronic lung disease, asthma, emphysema, something like that, or a compromised immune system of some sort, whether that’s because of a disease or because they’re undergoing chemotherapy or on a medication that causes their immune systems to be compromised.

Chris:

The one chronic illness, if you will, that’s been described is obesity. And many people that have become severely ill have been identified as being obese. But I think it’s not the obesity itself. It’s more the other conditions that go along with obesity that are actually the issues such as high blood pressure, diabetes, et cetera, which are commonly found with obesity. So, long answer. Those are the two categories, are over 65 population and then those with chronic health problems.

Vicki:

Good. Yeah. Thank you for defining that. And also, thanks for pointing out that people should be mindful and pay attention to their health because as you said, being in the situation of being obese can bring on other health problems, which makes us more at risk. So for people Dr. Valerian, that are not in that, underlying health condition, more vulnerable position, what should they do when they are socializing or start socializing, and going places in public?

Chris:

Sure. So according to the CDC, and by the way, for most of my reference point would be CDC guidance on this or WHO World Health Organization, either of those two references are good reference points for people, but basically the recommendation in public or social settings is really to maximize your physical distance. And we’ve all heard the six foot number, stay six feet away from people. And so that is still applicable even in public spaces, whether it’s parks or beaches or, whatnot. And many of those places are identifying that distance for you. I’ve seen signs on beaches saying, this is what six feet looks like. And then for other establishments that are indoors, it’s still social distancing is still the recommendation and different indoor establishments, I’ve seen have been doing that creatively, whether it’s reducing the number of tables available at a restaurant, for example, or something like that, or having demarcating lines that, stand this far apart or something like that. And then of course, in addition to the social distancing, there is still the advisory to be wearing a cloth mask over your face when in public settings.

Vicki:

Yep. Those are all really good recommendations to follow. And I also noticed in our own community, some of the things that you pointed out in terms of demarcating distances and things like that are helpful. I also noticed that some of the establishments are also changing their restroom situation where they’re trying to do touch less soap, touch less hand drying, those types of things. So, hopefully we’ll see more of that and people will feel safer. So another thing I was thinking about because I had to cancel a wedding trip, which was the right thing to do is where are we with travel now? You know, what about travel?

Chris:

Sure. So it depends on where you are in the country as to what the recommendations are. Some places have started to ease non-essential travel. And by the way, so essential travel has always kind of been okay, whether that means you’re a healthcare worker or essential worker traveling on a plane or public transportation or whatnot into a work location, or to another facility. So that’s always sort of been in the works, but non-essential travel is what has started to ease up in different parts of the country, including airlines. So for example, on air travel, airlines are starting to get back into a bit of a routine where they sell every other seat, every other row requiring face masks on the plane or in the airport, or should say and in the airport, public transportation has limited settings. If you’re taking a train somewhere or a bus somewhere where people are spread out a little bit more.

Chris:

So that’s the sort of logistics of travel. I think the general concept of should I go on a trip or should I take a vacation? I think, especially with summer upon us, I think it’s more of an individual decision. I think you should evaluate what the risks are. So are you in one of the high risk categories or do you live with someone who’s in the high risk category? Even if the location you’re going to is open and available and you could find a flight there, is it worth it for you to do that? So again, I think non-essential travel is certainly getting eased up and allowed to happen in different parts of the country, but we should still be thinking about what are we risking when we do that?

Vicki:

Yeah, thank you. That’s really, that’s such good advice for people to be mindful about. The other thing I wanted to talk to you about, and I know a lot of folks are facing this. I have a daughter and a son-in-law who have a three-year-old and the daycare’s and the camps, and, the schools and organized youth activities that are currently closed. Some of them may reopen some of them may not. The ones that we are going to be seeing reopened. What should people be looking for to feel safe about having their kids return to these places once they open?

Chris:

Sure. And this is the big question, right? And, everybody knows that kids bring everything home, I have four myself. So I understand, I understand. And again, very variable depending on part of the country that you’re in as to what is allowed to be open and, what the restrictions are with those openings. I think if you start one on the spectrum of sort of the organized sports activities and youth sports and things like that, I think those are probably a little bit easier because most of them are outside and you can social distance a lot easier. And especially in the non-contact sports, it’s a lot easier to manage those situations. So I think just vigilance is the key there, and making sure you wash your hands, your kids wash your hands a lot, wearing this when not participating in the activity, et cetera are sort of the guidelines there.

Chris:

I think when it gets to daycares and, schools reopening, it gets a little bit trickier and it’s going to really come down to the individual locality and what their recommendations are. I think it’s safe to say in general, though, the concepts of frequent hand washing, and we’re using hand sanitizer in, school or daycare settings, social distancing whenever possible. And I’ve seen a variety of suggestions on how different schools are managing, getting back into a brick and mortar schools, whether it’s alternating days and dividing the student body into, like an A and a B kind of thing, or whether it’s split days, morning, and afternoon sessions, or, hybrid of tele- learning with, with in-person learning. So again, I think that’s highly variable, but when you are in a confined space, I.E A school building or daycare setting. I think thinking about, covering your face, first of all, don’t go if you’re sick, right? So if your kid is sick, keep them home. That’s going to be the mainstay.

Chris:

If they do go to school or daycare, again, frequent hand washing, educating, and depending on the age of the child, educating on math, glaring and social distancing are really the best we can do.

Vicki:

Yep. Does all make sense. And I am seeing in our area, some things are reopening and they’re putting the measures in place that you just talked about. So, that gives us confidence. The other thing is, I was thinking about a situation that I had personally, but a lot of other people have as well is about visits to senior living facilities, hospitals, or elderly relatives, which you’ve had to keep a distance from. So I’m just wondering, how do you see that now that we’re starting to reopen gradually, how will that impact our ability, maybe, reconnect with these folks on a basis that feels a little bit more normal.

Chris:

Sure. Yeah. And that’s really important. I think, especially the senior living facilities and having them isolated is probably more detrimental than you and I being isolated or quarantined. So I think you’ll find that most of these facilities that are reopening or are allowing outside visitors in are doing so with new guidelines, generally, it’s one visitor at a time it’s requiring, mask and gloves, depending on the level of contact and, the facility itself. Obviously the amount of time that they’re allowed to spend with visiting with the individual is limited as well. So again, I think there is an absolute need to have in-person contact with loved ones in whether it’s a hospital long-term care facility, et cetera, but we just need to be mindful about the precautions of how we do that and limiting who does that and how many people at a time, and then again, washing hands wearing appropriate PPE when we do it.

Vicki:

Great. Thank you. Because I am going to start trying to visit my mother-in-law and my own mother. And I had been thinking about it a lot. So hearing you say that makes me feel much better. So another thing people have been asking us about is what about larger venue things such as, a sit down dining, movie theaters, maybe a sporting venue, or even places of worship, but what do you think about that?

Chris:

Yep.

Chris:

So, those are starting to open to even in the Northeast where I’m located, those things are starting to happen more and more so there’s, I think again, with summer upon us, I think a lot of the restaurants are focusing more on outside dining whenever possible. I’ve seen, every deli and every little store has a quote, outside the dining area now, which is basically a pop-up table on the sidewalk kind of thing, to try and help with the social distancing piece. And then even inside again, capacities are cut so that there are less people on top of each other at any given time. I think, movie theaters and other areas, other venues like that, even before the shutdown, they were doing some creative things, which I thought was great, which, again, selling limited capacity is the first issue, but quarantining off sections of the theater.

Chris:

So, you have to sit four seats away from the next person next to you, for example, or two rows in front or back of people. So I think there’s a lot of creative ways that those larger venues are going to start reopening. Sporting venues and public, sorry, professional sports and stuff. I think that’s going to be a little bit further down the line since it’s not really a need to have. It’s a like to have kind of thing. I think, as professional sports starts back up, they’re going to be fan less at the beginning. And I think gradually you’ll start to see fans will be allowed in and with a lot of restrictions in place, so that I would not count on in the near future. Places of worship has been another area that has started to reopen.

Chris:

And they’ve been doing creative things in our area with like drive by or drive in masses and drive in communions and things like that. So I think that’s ongoing, but even physical, physically going inside places of worship, sitting every other row and distancing from other people and wearing masks, there’s hand sanitizers in all of the churches around in my area as well on the way in, and the way out, removing things like public fountains and areas where people would normally have congregated before. So I think those areas are safe to use as long as you follow those guidances.

Vicki:

Yep. That makes sense. And, I also heard someone say to me that if you attend one of those places and you’d like to try to go back as they’re reopening, if you’re not sure what they have in place, or you have concerns, just ask, and that will make you feel more comfortable. So another thing I wanted to ask about this affects me personally. So I’m using your being a subject matter expert today to help me with some of my personal decisions. What about elective surgeries? I was supposed to have a surgery, which is not life-threatening to have, but I was supposed to have in April. And now I’m trying to decide when I’m going to do that. And I had heard from my provider that they are going to start doing that next month and they just wanted to see, what do you think about that? Do you feel like it’s safe for people to do that?

Chris:

Yeah, so I would say having elective surgery is obviously it’s a personal decision, but it certainly is safe to consider going back at this point. You know, the reason that elective surgeries were suspended in most parts of the country that did suspend them was really because at the hospital level was really not so much that the surgery itself would be an issue. But what happens if there was a complication and you had to go to the ICU and the ICU didn’t have available resources, whether there was no beds or no PPE or something like that, or what happens if you had to get admitted and stay overnight and they didn’t have the staff or the resources to support you. So it wasn’t really an issue of the surgery itself was not going to be safe like the, O.R wouldn’t be clean or sterile.

Chris:

It was more around what happens if there’s an issue and you have to use a valuable resource that could have been used for somebody that had COVID and needed, the intensive resource. So now that several months have passed, PPE supply for at least for healthcare facilities is less of an issue. Hospital capacity is less of an issue. Outpatient facilities are again, they have all of the required PPE and other issues, things in place to help manage the processes so that we’ve, we’ve come a long way in two months is what I would say. So I think if you were putting off an elective surgery, I think it’s fine to start considering where you do it. A lot of people are considering an ambulatory surgery center, outpatient setting. If they have an option, instead of going to the hospital directly, for a variety of reasons, that certainly makes sense and outpatient ambulatory surgery centers.

Chris:

At least in most of the states that I’m familiar with in the Northeast, they have very strict guidelines and rules about how they manage the patients coming in as well with mandatory testing, screening, questionnaires, temperature screenings, visitation, having one person with you only that comes in the back, maybe waiting in the car instead of the waiting room.

Chris:

So there’s a lot of different restrictions that are in place for your safety. So long answer to your question I think it’s fine to consider an elective surgery, and then you can consider what location you’d like to have it at.

Vicki:

Well, thank you for minimizing some of my fears, and I guess I better call my provider back [00:17:12]. But the other thing too is thinking about, because I have some neighbors that were big. They, would go to the gym every day and they are really wanting to get back to the gym. And I just wanted to see what you thought about that. I know some, where I live in Connecticut or reopening.

Chris:

Yep. And so gyms are another one of those nice to have, but don’t need to have as self by the regulators, I think, but I’ll tell you I’m, I’m one of those. I’m missing the gym myself. In fact, I went up right up until the morning that they closed the gyms in New Jersey. I was in that morning. I was there knowing what the issues were. So I think you’ll find as gyms start to reopen that they’re again, limited capacity. So maybe, half of the machine, the way that the machines are lined up are going to be different to allow for distancing. You’re going to find that classes, class size, if you take a spin class or a yoga class or whatever, probably going to be limited so that there’s physical distancing. Wipe down and sanitizing procedures are going to be a lot heavier than they were before. So I think, again, going to the gym is a personal decision.

Chris:

I don’t think it’s necessarily putting you at any more tremendous risk than any of these other activities. We’ve talked about, assuming that you follow the appropriate guidelines, wipe equipment down, hand wash before and after, and just adhere to what the restrictions are.

Vicki:

Okay. Yeah, that definitely makes sense. So another thing I wanted to ask you about is what about bars?

Chris:

Liquor stores have been [crosstalk 00:18:57] in an essential business. Yeah, of course. So liquor stores have been essential from day one. I’m not sure how that ended up that way, but bars a different story. So I think it’s going to be awhile the CDC right now is recommending bars stay closed. I think really it’s more of just a social gathering location, not the actual activity of are you buying alcohol? Which you can do at a liquor store. So I think anything like bars where, or concerts, things like that, where you’re encouraging outdoor gatherings, or I should say close gatherings, not outdoor gatherings, but close gathering are going to be later down the road. Some of the reopening plans, again, depending on where you are in the country, have them in later phases, bars opening in later phases of the plans with restrictions.

Chris:

So it’s going to be mostly capacity, limited outdoors, outdoor walkup service whenever possible, depending on what part of the country you’re in and what the weather allows. So for the time being, I think you’re going to find that it’s going to be hard to find a bar to go pull up a stool too, but I think you’ll start to see them start to reopen with restrictions later on in the next few months, certainly ones that have outdoor capacity will be a lot easier and a lot, you’ll see a lot of other bars sort of having, I think, outdoor seating capacity. Because it just makes it easier.

Vicki:

Yeah. That makes sense. And seems like it would be a lot safer. So, before we close today, if there’s one thing that you could say to everyone that you think is the most important thing, what would that be?

Chris:

Yeah, I think, the pandemic is, can be a seasonal thing. Just like, the flu is a seasonal virus, COVID can turn into a seasonal virus. We just don’t know yet. It doesn’t mean we have to shut the world down every time that the season comes upon us. I think, during the common sense, things of social distancing, wearing a mask, washing your hands, everything you’ve been hearing and everything you’ve probably been doing for the last several months, you should continue doing those, I think, and the re-entry back into the world and sort of getting everything sort of started again, I think is the right thing to do. I think we just need to do it in a prudent common sense kind of way.

Vicki:

That makes sense. So I really wanted to thank you for being here today.