Risk for getting extremely sick or dying from the novel coronavirus isn’t an all-or-nothing situation, but instead exists on a scale. It grows if an activity involves crowds, closed indoor spaces or prolonged contact with other people.
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The risk is different by what community you are in, with some Ohio counties experiencing much more volatile situations with higher levels of spread. It also depends on you and your personal health, with people who are older or with certain underlying health conditions having a higher likelihood of severe disease.
Dr. Michael Dohn, Public Health - Dayton & Montgomery County, pointed to a question that Gov. Mike DeWine recently fielded at a press conference, where he was asked about if it is safe to go to the beach. The answer is that the level of risk depends, said Dohn. If you fly, that’s higher risk than if you drive down in your personal car. If you hang out in a crowd at the beach, that’s higher risk than if your household just sticks together with each other.
“It depends on how we behave and how the people around us are comporting themselves,” Dohn said.
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Risk of the activity
In general, the more closely you interact with others and the longer that interaction, the higher the risk of COVID-19 spread, according to the Centers for Disease Control and Prevention.
Indoor spaces with less ventilation where it might be harder to keep people apart are more risky than outdoor spaces. If you and those around you aren’t wearing cloth face coverings, that also increases your risk.
Activities are safer if you can maintain at least 6 feet of space between you and others, because COVID-19 spreads easier between people who are within 6 feet of each other.
Following the new mask mandates for high alert counties like Montgomery County, several local residents talked to the Dayton Daily News about how they think about the rules and managing their risk.
Alex Beltran, 27, who moved to Miamisburg from Connecticut in January, said he thinks the mandate is going to keep people safe because people are not going to do it on their own. He said he wears masks inside places or around people he doesn’t know, even on the street, and wears masks less outside than inside.
Beltran said he thinks going to bars and crowded restaurants are a risk, and that he’s trying to stay isolated, away from people he loves and cares about that are at risk.
If you decide to engage in public activities, continue to protect yourself by practicing everyday preventive actions. Keep these items on hand when venturing out: a cloth face covering, tissues, and a hand sanitizer with at least 60% alcohol, if possible.
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The CDC states it can’t give advice on every scenario and asks people to think about:
- How many people will you interact with? Interacting with more people raises your risk. Being in a group with people who aren't social distancing or wearing cloth face coverings increases your risk. Engaging with new people (e.g., those who don't live with you) also raises your risk. Some people have the virus and don't have any symptoms, and it is not yet known how often people without symptoms can transmit the virus to others. Steps like organizing and reducing errand trips and only having one member of the household running an errand can help reduce interactions.
- Can you keep 6 feet of space between you and others? Will you be outdoors or indoors? The closer you are to other people who may be infected, the greater your risk of getting sick. Keeping distance from other people is especially important for people who have an increased risk for severe illness. Indoor spaces are more risky than outdoor spaces where it might be harder to keep people apart and there's less ventilation. Things like eating outside at a restaurant at a spaced out table has less risk than eating inside with a crowd at the restaurant.
- What's the length of time that you will be interacting with people? Spending more time with people who may be infected increases your risk of becoming infected. Spending more time with people increases their risk of becoming infected if there is any chance that you may already be infected. Running in and out of a grocery store as a customer is lower risk than working a long shift in a higher exposure job.
With the chart rating activities on a 1-10 scale, Dohn said that the risk of the specific activity can change based on the specific situation, such as if everyone is wearing a mask or whether the people doing the activity have health conditions.
“If you’re an older couple and you’ve been keeping to yourself and there’s another older couple and they’ve been keeping to themselves … then you go over to their house and you eat and come back, there’s some risk to that but it’s not terrible,” Dohn said. “On the other hand if you go eat at somebody else’s house and there’s seven people there or a bunch of other couples and they are socially active … then suddenly the pool is much greater.”
Risk of the community
The risk of activities increases in communities with higher levels of virus spreading in the community. Ohio has a system with four levels of alert for how high risk a county is based on seven indicators of how widespread the virus is. The county-level alerts are updated each Thursday afternoon at coronavirus.ohio.gov.
Dohn said with the virus in the community, it’s like a version of a game of tag where everyone who gets tagged remains it. When we all have a lot of contact with each other, it’s like having a bunch of ‘its’ chasing everyone else and it gets harder not to get tagged, Dohn explained.
“The levels that the government has, that’s telling us how many people in our area are ‘it’” Dohn said.
Dr. Sara Paton, epidemiologist with Wright State University, said it takes multiple indicators to understand how widespread the novel coronavirus is in a community.
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One indicator might increase because of an anomaly, but the state’s system of using seven indicators means multiple layers help prevent an anomaly from painting a misleading picture of the level of risk. One indicator alone isn’t necessarily enough evidence to trigger any kind of alert, she said.
“It takes out the chance … that this is just something randomly happening in the community or a small outbreak in one area,” Paton said.
One indicator is whether a community has more than 50% of positive tests stemming from congregate settings. If the majority of cases are coming from a few congregated settings like nursing homes or prisons, that can be a sign of spread contained to specific locations and that broad community measures like social distancing aren’t needed.
“If you’re going to have a community wide alert, you want this to be because it’s throughout your community,” Paton said.
In Montgomery County, public health officials reported as of July 7 more than 63% of cases are not in congregate settings, signaling transmission in the broader community.
Recent community outbreaks in the county have occurred in workplaces, restaurants and nursing homes, Ohio Department of Health reports. The state is still working on adding standardized contact tracing data for each county that would give more tailored data on spread.
The level of alert takes in a number of health care service indicators including ICU bed occupancy, whether there’s a sustained increase in new COVID-19 hospital admissions for at least five days, a sustained increase in outpatient visits for at least five days, and whether there’s a sustained increase in emergency room visits for at least five days.
Personal health risk
Death rates are 12 times higher for coronavirus patients with chronic illnesses than for others who become infected, according to a CDC report released mid-June, which highlights the dangers posed by heart disease, diabetes and lung ailments. These are the top three health problems found in COVID-19 patients, the report suggests.
Gayle Kers, who lives in Miamisburg, said she has a pacemaker and COPD so is careful about masks and wears one in crowds and businesses but not on the street. “I’m for it. I don’t think it’s over with. I think there’s going to be a lot more people getting sick,” Kers said.
The Associated Press said the report was based on 1.3 million laboratory-confirmed coronavirus cases reported to the agency from January 22 through the end of May.
Information on health conditions was available for just 22% of the patients. It shows that 32% had heart-related disease, 30% had diabetes and 18% had chronic lung disease, which includes asthma and emphysema.
Among patients with a chronic illness, about 20% died compared with almost 2% of those who were otherwise healthy. Virus patients with a chronic condition were also six times more likely to be hospitalized — 46% versus almost 8%.
People with chronic disease “are much more likely to suffer severe effects of COVID-19, but we can’t lose sight of the fact that previously healthy people can also become very ill and even die as well,” Dr. Leana Wen, an emergency physician and public health specialist at George Washington University, said in a statement.
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