what is safe? What can I do? A guide to summer safe activities

In March, the Makah Tribe made a difficult decision to protect our community from the coronavirus outbreak by voting to create and enforce a shelter-in-place order. We are a community so deeply connected to each other and in a blink of an eye, we were asked to isolate from our closest friends and family. But, we united collectively to protect our people. A shelter-in-place order was implemented to prevent the virus from spreading in our community, prevent the collapse of our local health care system, and give scientists and public health officials time to research what is going on how COVID-19 affects people.

Preliminary research about virus spread and its effects has provided clues about which behaviors and activities matter most to limit coronavirus spread. Summer time is approaching and research on how the virus spread helps us have a clearer idea of what activities are safe and unsafe as states start to reopen and the Makah Tribe prepares to move into Phase 2 of the shelter-in-place order (for more information on the different phases, review the Makah COVID-19 Public Health Protocols) people are now in a position to take social responsibility to figure out their own application of risk assessment protocols in their daily lives. 

According to Tara Kirk Sell, a professor and risk-communication researcher at the Johns Hopkins Center for Health Security, we need, first and foremost, to be take basic precautions to protect the people around us: wearing masks in public, respecting other people’s space, and understanding that the people we encounter might be in far more danger from catching the disease than ourselves or our immediate family. 

A good rule of thumb, according to Dr. William Miller, an epidemiologist at Ohio State University: the more time you spend and the closer in space you are to any infected people, the higher your risk. Dr. Emily Landon, a hospital epidemiologist and infectious diseases specialist at University of Chicago Medicine says, “Always choose outdoors over indoors, always choose masking over not masking and always choose more space for fewer people over smaller space.” 

Here are a list of daily activities and an associated risk assessment:

1. Outdoor gathering with one other household: low to medium risk 
Bringing the family together in a small group outdoors is not too risky. Small gatherings could include a small BBQ in the backyard, family song and dance practice outside, and so forth. What makes this a low risk activity is gathering with one other household who have followed social distancing and have not left the reservation in the past 14 days. 

What increases the risk of transmission? Once we begin sharing food and touching the same utensils, the risk increases. Coronavirus is shown not to transmit through food but touching the same surfaces can be a risk. The gathering becomes riskier once people move indoors. 

2. Outdoor exercise such as hiking, jogging, walking, riding your bike: low risk
As long as the activity is non-contact, getting outside and exercising is a great way to maintain your health and wellness. Other sports like golfing and surfing are much safer than contact sports. Fortunately for us in Neah Bay, running and biking are low risk activities because paths are typically not crowded. 

What increases the risk of transmission? The activity becomes riskier if there are more people involved. It is possible to spread the virus if you are in close proximity to others. 

3. Going on a cruise around town on your own: low risk
Especially if you are in the car on your own, driving around town, looking at the sunset and listening to music is a low risk activity.

What increases the risk of transmission? What is a very low risk activity easily becomes a high risk if you have passengers who are not in the same household as you. The recirculation of air with asymptomatic passengers puts everyone in the car in danger. It also becomes a riskier activity if you are pulled over and chatting with others either outside or in their own car. Adding space between each other and wearing a mask can help air particles dissipate and not be transmitted when you are speaking. 

4. Going out to go fishing, gather firewood, camping with someone in your household: low to medium risk
Fishing, gathering wood and camping are all activities that are done in isolation and outdoors making it a low risk activity. If you are going out with people, be sure that you can trust them. Have they been social distancing and following the guidelines? If not, they could be asymptomatic and spread the virus. 

What increases the risk of transmission? Fishing, camping and gathering wood becomes riskier the more crowded the location becomes. A fishing vessel with very little space with individuals from more than one household can increase the risk for transmission.

5. An outdoor celebration such as a wedding, song and dance practice with 10 or more people: medium to high risk
Family and culturally-oriented celebrations are usually a summer tradition, but they come with a higher risk right now. Many weddings have been postponed, with good reason. Karan, a Harvard physician shares, “These types of events end up being large crowds where people are having extended face-to-face conversations.” The larger the guest list becomes, the greater likelihood one of the guests being positive for coronavirus. 

What increases the risk of transmission? If you are considering hosting a celebration, make it a small one with only local guests. Makahs who live off reservation are allowed to come home with the permission of the Tribal Council. Inviting people who are traveling on to the reservation from areas with positive cases creates a high risk scenario. 

It is our responsibility to protect our elders and members of vulnerable populations. Really think twice about inviting older family members or those with underlying conditions. Don not pressure people to attend an event, especially if it is hazardous to their health, even if you emphasize that you are going to try and make it a safe event. 

6. Attending a religious service or potlatch indoors: high risk
Worship services and potlatching involves people from different households coming together indoors for an extended time. All the pieces that promote the potential for people becoming infected in a short amount of time. An outbreak occurred at a rural Arkansas church where 35 of 92 people who attended services developed COVID-19. 

Singing - whether from your seat, the pews, or the choir or song leaders - is a high risk. A study done of a choir practice in Washington state found half of the attendees became infected. 

What decreases the risk of transmission? If people are appropriately socially distanced, wearing masks, and avoiding singing, it may reduce the risk. The risk declines if adjustments are made. As an example, one parish began having in-person services after establishing advance sign-ups with a limit of 25 people. Attendees were required to be healthy, wear a mask and sit 6 ft apart. 

7. Spending the day at a popular beach: low risk
As long as you can stay socially distanced, spending the day at the beach is a pretty safe activity according to experts. The water is not a risk since there is such a large volume, it causes the virus to dilute making it unlikely a source of transmission. 

What increases the risk of transmission? Once beach goers begin to come into close proximity to others, the risk inevitably increases. The biggest worry about beaches are kids. “There were a few times I went to the beach and my best friend’s children came running to hug me.” shares MichaeLynn Kanichy. It’s difficult to explain to children why it is unsafe to hug close friends, “but something I saw Isabell Ides do was build a ‘fort’ for her son out of driftwood which kept her son from running and hugging friends.” 

8. Getting a haircut, massage, or manicure: medium to high risk
Getting your haircut or going in for your massage involves close contact and breathing for an extended period of time. This is the primary mode of transmission and cloth masks are not perfect for this according to experts.

This is one of the highest-risk scenarios because there is no way to keep 6 feet from someone who is giving you a manicure. All it takes is one practitioner to be asymptomatic to put customers at high risk. 

What decreases the risk of transmission? Experts believe your risk is not terribly high if both your hairdresser and client wear masks and if COVID-19 is not very prevalent in your area. Be sure to do your research and make sure your salon enforces policies to protect its employees and clients. This includes wearing protective gear, hand washing and sanitizing equipment. 

9. Going shopping at the mall and grocery store: risk varies
The risk of shopping varies depending on how crowded the store is and how much time you spend there. Your risk increases if you find yourself in a crowded store according to experts. 

What decreases the risk of transmission? Outdoor malls are preferable and empty stores are better than crowded ones. It is important when you go shopping that you go with purpose and not leisure. It is best to get in and get out as quickly as you can to limit the amount of time to decrease your likelihood of exposure. 

When you go shopping, respect your space and those around you. Allow people time to a section to themselves before reaching for your groceries. Try to schedule shopping during off-peak hours. 

Resources:
Aubrey, Allison, et al. “From Camping To Dining Out: Here's How Experts Rate The Risks Of 14 Summer Activities.” NPR, NPR, 23 May 2020, www.npr.org/sections/health-shots/2020/05/23/861325631/from-camping-to-dining-out-heres-how-experts-rate-the-risks-of-14-summer-activit#camping.
Mull, Amanda. “So, What Can We Do Now?” The Atlantic, Atlantic Media Company, 30 May 2020, www.theatlantic.com/health/archive/2020/05/how-stay-safe-during-coronavirus-summer/612151/.

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