Say you’re walking down the street to get some fresh air while you’re practicing social distance. You’re attempting to stay six feet away from those around you, as public health experts advise. You pass someone on your right. You want to give them a smile and a greeting, but you avoid eye contact for fear of some accidental spray of droplets, however asymptomatic you appear to be. Then you see as they walk by that they’ve dropped their hat. You bend to pick it up — but wait. The germs! Your normal impulses are totally thrown into disarray.
For many, the long-developed norms about how to be a good neighbor and urban citizen have been entirely upended by the rules of coronavirus. When we develop habits, the simple gestures we’re accustomed to happen without effort, and redirecting them requires a conscious recalibration. The very term “social distance” suggests that you not engage in normal interactions with other people. And yet the strains of a global pandemic demand that we give our best selves to other people if we can.
Whether you’re performing essential work; volunteering; taking necessary trips to grocery stores; caring for relatives; or just stretching your legs, venturing out into the world introduces new ethical and social dilemmas. If I get really sick, how do I responsibly get myself to the hospital? Should I pick up furniture from the side of the road? Can I just sit on my curb?
To get solid advice on how to navigate a few common etiquette questions of the social distancing age, CityLab spoke with four public health professionals; two from the University of Berkeley, one from the University of Washington, and another who runs a digital health platform. Remember: Depending on one’s occupation, location, and personal needs, the rules for day-to-day living might vary.
Should I go outside at all?
For those who have the choice to stay inside, it’s not an easy call whether simply leaving your home puts others at greater risk.
Getting fresh air is not only allowed, it’s encouraged to boost mental health and strengthen immune systems — but only if walking, running or hiking can feasibly happen without impeding on someone else’s six-foot zone. And on many dense streets, crowded parks, or narrow hiking trails, that can prove challenging.
“It’s very unlikely that even if someone comes within six feet of you if they’re running right by you, that you’re going to get much of a viral exposure,” said John Swartzberg, a clinical professor emeritus at UC Berkeley’s School of Public Health — but you could get some.
Some states have stricter edicts than others on what outdoor space is accessible, mostly brought on after too many residents congregated outside. In Washington state, for example, the government closed state parks and national parks; some city parks, where kids gathered to play basketball; and some beaches, where people sat together in the sand. Yosemite, the Grand Canyon, and Joshua Tree are all closed. So is Muir Woods.
“I’d recommend that people walk around or run around their neighborhoods,” said Marilyn Roberts, a professor of Environmental and Occupational Health Sciences and an adjunct professor of Global Health at the University of Washington. “But they need to make sure they give people six feet.” If you don’t know how wide six feet is, imagine a person is laying down across the sidewalk. Do not step on them.
Using this metric, make a calculation based on your surroundings about whether it’s safe and appropriate to go outside: In my San Francisco neighborhood, I may want to go outside at 6 p.m. after work, but I shouldn’t, because that’s when everyone does; in the most populated cities, you’d benefit from choosing a less-trafficked time, like late at night or early in the morning. Same goes for hiking: Is the parking lot full? You should probably turn around. Is it less-traveled, and accessible without encountering crowds of people on the way there? Enjoy it, but stay vigilant.
What’s the best practice for walking and running when other people are around?
Be compassionate! That goes both for the exercisers and the ones who judge them.
There are a few tactics you can practice to keep six feet apart from your fellow travelers. This one should be a given: If you’re traveling in a group of two or three people you live with, switch to single file when passing others.
Perhaps less intuitive, though: You may have to do more than sidle over slightly as you pass someone by. On many sidewalks, walking past another person or group of people on opposite ends of the pavement won’t allow for enough distance. In places like New York City, this is partly a geometry problem: In a small survey of New Yorkers, Motherboard’s Aaron Gordon found that the majority of their neighborhood sidewalks had fewer than six feet of truly walkable space. Mayor Bill de Blasio has resisted calls to shut down more streets to cars, which would allow folks to spread out more safely.
Absent sweeping urban pedestrianization projects, consider your options: Scoot to the farthest edge of the pavement you can, or walk on the grass or dirt. (The grass “is not hot lava,” noted Eleanor Barkhorn, an editor at the New York Times, on Twitter). Also consider walking into the street (if cars aren’t coming), or onto the opposite sidewalk, if it’s safe to cross. Or, at your own risk, onto someone’s front yard. And give special deference to people in wheelchairs or walkers, or with strollers. They won’t have the same options to get out of your way.
Another good suggestion comes from Linsey Marr, an engineering professor at Virginia Tech who specializes in airborne disease transmission and told The Atlantic’s Ed Yong: “When I go out now, I imagine that everyone is smoking, and I pick my path to get the least exposure to that smoke.”
Runners bear extra responsibility. Because people may not be able to avoid you as you speed into view, it is even more incumbent on you to anticipate and avoid them. That will in many cases mean hopping off the sidewalk for a moment as you pass, or just stopping for a second so pedestrians aren’t taken by surprise.
“I don’t want to discourage people from running,” said Swartzberg. “I just want to discourage people from being close to each other while they’re doing it.”
When I see other people, can I greet them?
All this would seem pretty rude and awkward in another era. Literally turning heel and getting the hell away from your neighbors is the opposite of whatever community mindfulness we’ve been told to practice, especially at a time when everyone needs the support. Sometimes, you’ll dodge left and the other person will dodge right, introducing a new awkward shuffle to daytime walks. But Swartzberg reminds us that there is “no data to suggest that opening the mouth to say ‘Hi’ is going to expose you,” if you’re the requisite six-plus feet away, despite the fear that it could lead to an accidental exchange of fluids. And eye contact — even a crinkle of a smile above a masked nose and mouth — is entirely non-threatening.
In fact, pairing an awkward escape off the sidewalk with a greeting, a smile, or a wave may smooth things over. “People need to keep people’s spirits up,” said Roberts: Stand on your porch and sing, or put stuffed animals in your window. Chat with friends six feet apart, and bring out your dog so it can wag at people. “Those kinds of activities should be stressed,” she said. “It maintains social distancing but allows some people to look forward to something other than eating.”
Much like passing someone on the sidewalk, though, standing six feet apart from someone while in conversation doesn’t place you inside an invisible force field; and there are plenty of situations where face-to-face contact gets you even closer. The Los Angeles Times’ Julia Wick gives the example of stopping to thank a grocery clerk for their essential work. The impulse is excellent — but the proximity between the register and customer is inherently too small.
The thing about wearing a mask
Here’s another thing you can do, particularly for your local grocery and other front-line workers: Wear a mask.
There’s been a lot of mixed messaging on masks. But so long as you’re not hoarding the ones that are in short supply for medical workers (and you should donate those to your nearest hospital), wearing even homemade face coverings on trips outside can have multiple benefits: If worn correctly, covering your mouth and nose can prevent you from contracting the virus, spreading it, and touching your face. Even the CDC has since revised its skepticism, issuing a national recommendation on April 3 for everyone in the U.S. to start wearing them in public.
Especially for those who are interested in being good urban citizens, it’s worth noting that homemade masks are more beneficial for protecting other people than protecting yourself. People who may be more susceptible to a fatal case of the virus than you. People like front-line workers who may be getting far higher amounts of potential exposure, which could make a difference in the severity of their case.
To understand the role a mask plays, Roberts points to the example of a choir in Washington state. Sixty members of the group rehearsed on March 6, and not one felt or appeared sick. By the end of the month, the L.A. Times reported, “45 have been diagnosed with Covid-19 or are ill with the symptoms, at least three have been hospitalized, and two are dead.” They hadn’t hugged or touched, and they hand sanitized upon entrance. But they sang. “That allows for more spray,” Roberts said.
And here’s another thing. You know all these protocols we’ve been covering about staying six feet apart? Well, some experts say droplets from strong coughs and sneezes can travel 20 feet. So if you just distance and you don’t wear a mask, well, you do the math.
The important thing, experts stress, is that wearing a mask cannot act as a replacement for other social distancing and personal hygiene practices.
Here are a few helpful guides on how to sew your own mask, how to fashion one out of T-shirts or bandanas, and how to (and how not) to wear one. (Pulling up a scarf or hood around your face is another makeshift solution.) “Soon,” writes Joseph G. Allen, an assistant professor of exposure and assessment science, in the Washington Post, “not wearing a mask will seem selfish … The true badge of honor is someone wearing a homemade mask.”
Picking things up
Back to the hat example. What if someone drops something on the street, and you want to pick it up? Wearing latex gloves can help protect you from the virus, and works well if you’re picking up litter or something else you’ll immediately discard. But the outsides of the gloves can still transmit and carry the virus, meaning touching something that you’re going to hand to someone else could be unwise. In some cases, you’d be better off calling out to them so they can retrieve it themselves.
“Every now and then you see an old lady, she dropped her stuff and you have to help her. You can’t just say, oh well, coronavirus,” said Khang T. Vuong, a Master of Public Health Administration out of the GW Milken Insitute School of Public Health, and the founder and CEO of Mira, a digital health platform that helps the uninsured. That said, every situation is different. “Use your judgment,” he said. “We’ve got to help people.”
Or what if, like me, you find a beautiful chair on the street that you want to bring home and sit in, because now you’re spending all your time in your bedroom trying to type upright. “We know the virus can live on inanimate objects,” said Swartzberg. “Given that, if you want to pick up something on the street, make sure before you touch your mouth, eyes or nose, you wash your hands.” The virus probably doesn’t live longer than three days on most anything, he says; on more porous objects, like cardboard, it lives about 24 hours at the most.
Mail, for example, is very unlikely to be contaminated, says Roberts. “I’ve brought mail [in] and put it in other people’s mail boxes because sometimes you get different people’s mail,” she said.
“The only way the virus can replicate is getting inside of a cell. If there are no live cells on that object, then the virus is going to die in three days or less,” said Swartzberg. “What you can do is you could pick up something and not touch it for three days, and then you can feel very comfortable that the virus is dead.”
Telling people you have coronavirus
If you start experiencing symptoms of coronavirus, and suspect you have it — even if you’re unable to get a test — there’s the inevitable fear that you’ve infected someone who crossed your path recently. Should you inform people? How? Who?
First, you should call your local health department, says Roberts, so they can determine whether you need a test or not. If they suspect you have the virus, they may conduct contact tracing, and where relevant, alert local restaurants or stores that you’ve entered. Contact tracing means figuring out who you came into “close contact” with — that’s defined best as more than 10-15 minutes of face-to-face proximity — and alerting those people to your symptoms. In some countries like Singapore and South Korea, this has been done through extensive monitoring and technology. In the U.S., official use of the tactic is much spottier, and so far, lower tech.
“The problem is that many of the health departments are so overwhelmed, and doing contact tracing can be difficult,” said Roberts. Where it’s possible, it’s important to do your own makeshift contact tracing, by reaching out to people in your own network who you’ve been in close contact with over the last 14 days: This might include activities like having lunch with someone, seeing them at work, or going on a long walk — even one that’s socially distanced. Tell them with a (sensitive) text or a personal call.
“There has not been any research on this, but it’s been our hypothesis that one of the biggest underlying catalysts for the spread is the stigma,” said Vuong. “People not telling others, but feeling a little sick and feeling ashamed.” He suggests making a list of people to tell, and writing a script. “You don’t have to tell them every single detail,” he said. “Say, I have been having symptoms; I don’t know if it’s coronavirus or not, but I’m in the process of getting tested.” Give them space to process, and update them with test results if they become available.
But stop short of contacting every store you’ve entered to report your case, Vuong advises. Given the other potential adverse consequences of disrupting its operations unnecessarily, leave that to the health professionals, and above all, STAY HOME.
If you live in an apartment building, you don’t have to put a sign on your door explaining your symptoms, because the odds of transmission in, say, the stairwell are not high enough. “Keep to yourself and don’t even leave your house. Take precautions,” said Vuong. The purpose of telling people you’ve been more intimate with is not to scare them — it’s to remind them to be more careful themselves.
“People can have symptoms and not realize that they’ve been exposed,” says Roberts. “If they have been exposed, they should really be self-quarantining for 14 days, which means not going to the grocery store, not going out, and if you live with other people separating from those people if at all possible.”
What’s the ethical way to get to the hospital if symptoms gets worse?
You’re home alone and you’ve been having symptoms of the virus. You think it’s time to get to the hospital, but you don’t have a car. How do you get there?
This was a hard one for the experts. Calling a Lyft or an Uber will put the driver at risk for transmission; hopping on public transit will, too; and if it gets to the point that you need a doctor, Roberts says you likely won’t be able to walk. But ambulances can cost upwards of $1,000 a ride, and most people would prefer not to take one unless their emergency is acute enough. While Cigna and Humana announced they would waive coronavirus-related fees like ambulance costs, and even the uninsured will likely get some financial help with hospital bills from the federal government, relying on that coverage may still be a roll of the dice. As Vuong points out, what happens to that protection if you take an ambulance and it turns out you do not test positive for coronavirus?
All the public health experts stressed that going to the hospital was the worst-case scenario: If you can isolate at home, you should do so. If you have quarantined for a while only to have your symptoms get markedly worse, the first thing you should do is call your care provider — or an urgent care clinic, if you do not have one — and talk through your symptoms, then ask what steps to take.
“If you have really, really severe symptoms — which means you can’t breathe, you’re having pneumonia symptoms — call 911,” said Vuong. “They’ll be at your doorstep right away.”
If you do call an ambulance or a paramedic, Roberts says to make sure you tell them that you think you have Covid-19 so they come prepared with the right personal protective equipment.
“It really freaking sucks,” said Vuong of the lack of good, affordable options for transportation.
Keeping others accountable
What do you do if you see someone acting in a way that’s, in your mind, selfish or reckless? Hesitate before passing judgment. Understand that we’re all experiencing different realities right now.
The people at the fish market that you think are clustering too close together could be gathered to use their new allotment of food stamps right at the time of the month when the funds become available. African Americans who aren’t wearing masks may fear that racial profiling can be more dangerous than the disease. That group running close together could all live in the same group house, swapping germs all day. The people crammed on the subway are contending with commutes made harder by limited service. You or your fellow traveler may be operating under wrong assumptions gleaned from non-peer-reviewed science circulating on Medium. Guidance changes quickly, and access to information varies.
That’s not to say give everyone a free pass, but it’s a reason to start not with blame or shame, but with compassion. Don’t take pictures of people in the park and tweet them. Read up on how to spot coronavirus misinformation. Agree on rules with your roommates. If the situation demands it, speak up. Lead by example.
Roberts said she’s seen younger people shop during seniors-only hours at the grocery store, for example, and struggled over whether to confront them. “The problem is, these people are often in high stress and one never knows if they’re going to blow up,” she said. “If it’s somebody you know, it’s one thing. If it’s someone you don’t know, you may be playing Russian Roulette, because people are really stressed.” She says unless you’re the manager of a grocery store, with the authority to ask someone to come back later, it might not be worth it to start a confrontation.
Behave as if you’re sick
It should be clear that if you’re experiencing symptoms of coronavirus, many of these rules fly out the window, and quarantining begins. But research shows that people can have Covid-19 and remain completely asymptomatic.
In the Los Angeles Times, Julia Wick writes about her experience with the disease — she suspects she contracted it a full week before she started losing her sense of taste and feeling increasingly ill. She endlessly replays the days leading up to the presumptive diagnosis, thinking about all the ways her attempts to help may have hurt. The cycles of fear may be familiar to many: What if, when I dropped groceries at a friend’s mother’s house around the corner, I also left the virus? What if, when I volunteered to package meals for seniors, I was boxing up a disease that would lead to their death? What is the right balance between nothing and something?
Wick’s advice should act as a lodestar for anyone wondering how to move through the world right now as a benevolent force: “[Act] at all times as if you already have the virus. Because you very well might.”