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Safely expanding your COVID-19 bubble

Adding people to your trusted circle has benefits, but do it carefully, experts say

As the pandemic rages on, some people are beginning to break out of their COVID-19 safety bubbles, beyond the people they live with. There are mental health benefits to increased socializing, but it’s important to do it carefully to reduce your risk, say Northwestern Medicine experts.

Experts also stress opening your circle is for those living in places where the prevalence of the virus is decreasing.

“The period of social isolation this spring was difficult for multiple reasons, and a central one has been the loss of connections with others,” said Mercedes Carnethon, vice chair of preventive medicine and an epidemiologist at Northwestern University Feinberg School of Medicine. “Those face-to-face social interactions are critical for mental wellness and can certainly promote physical health.”

But Carnethon warns, “As we have opportunities to interact again, it is important to carefully consider your personal risks—and the risks to those who are already within your personal ‘circle’ as you expand to include more people in that circle.”

Here is advice about how to do it safely from Carnethon, Dr. Sadiya Khan, Dr. Michael Angarone and Dr. Robert Murphy. To speak to any of these experts, contact marla-paul@northwestern.edu.

Mercedes Carnethon is vice chair of preventive medicine and and epidemiologist at Northwestern University Feinberg School of Medicine.

“A question you should ask yourself is whether expanding your circle places others you rely on or interact with regularly at higher risk. I live on a block where I am sharing childcare with another family. I need to make responsible decisions about expanding my bubble because my choices affect the other family and the people they have in their extended network.  

“There is no single number of people that define a ‘safe’ or ‘low-risk’ exposure other than to say that fewer is better. But even more important is to gain clarity about what those individual’s behaviors have been leading up to your interactions with them.”

Dr. Sadiya Khan is an assistant professor in preventive medicine and an epidemiologist at Northwestern University Feinberg School of Medicine. She also is a cardiologist and Northwestern Medicine physician.

“A good way to expand the bubble safely is to meet outdoors especially in the summer and maintain 6-feet distance. Socially distanced outdoor events may allow some small (less than 10 people) summer activities to proceed and provide much needed mental and emotional support. 

“The main thing is to keep it small and if anyone is to get sick in the bubble, all individuals must self-isolate for 14 days from the last contact.

“The most important thing is to ensure that everyone is following the same safety precautions, in particular, wearing face coverings or masks in public at all times and avoiding large gatherings. People within your bubble can interact with each other without masks but should still use social distancing and masks with everyone else. Hand washing frequently is still advised.

“It is important to realize that the more people in your bubble, the greater the chance of being exposed to COVID. Since many people (estimates range from 20% to 40%) may be asymptomatic, you may be exposed and not even know it. Therefore, temperature and symptom screening are not a reliable way of preventing transmission and should not promote a false sense of reassurance.

“There are clear mental health benefits to expanding the people that you see without face coverings. Children learn predominantly through facial expressions during their formative years and being able to interact and engage with other children and adults is really important and needs to be weighed against the potential risks for each household.” 

Dr. Michael Angarone is an assistant professor in infectious diseases at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician.

“I think expanding (or letting more people into your COVID bubble) is safe to do at this time. The best way to do this is to discuss with those individuals that you will be ‘letting into your bubble’ and try and identify what their risk for SARS-CoV2 may be and what they have been doing to protect themselves. 

“After these discussions, ground rules should be established; no hugging or handshakes, staying outside (hikes, BBQ), try to distance yourselves and when appropriate wear masks. Groups of six or less may be safest. Avoid indoor restaurants or large settings. When it comes to kids, make sure there is no rough play and that the kids are OK with masks.”

Dr. Robert Murphy is executive director of the Institute for Global Health Research at Northwestern University Feinberg School of Medicine. 

“We have to expand our networks at some point. Do it in moderation and gradually with people you know and trust, but you have to realize there is somewhat of a risk. It’s a small one, though, if you are cautious.

“The best way to vet people is to have everyone in the group get tested. Then you have to act like you are part of a family and trust the other people are practicing social distancing and wearing a mask everyplace else, just like your own family is doing. The ground rules have to be clear and agreed on.”