Epidemiologists weigh in on whether it’s safe to see a “closed circle” of friends during the pandemic.
The coronavirus pandemic has made one thing painfully clear for many single people and people who live alone: The most precious commodity these days is human contact.
Under social distancing, the “haves” are those lucky humans who’ve got kids, partners, or roommates. Yes, they may be loud and exhausting and downright crazy-making at times. But a warm body is a warm body. To the “have-nots” who are isolated in their homes for days or weeks on end, this can seem like an incredible luxury. A Skype call just isn’t the same as in-person company.
So over the past couple weeks, I’ve heard some of these have-nots asking: What if I create a “closed circle” of friends who are all healthy, and we only hang out with each other? Say I decide to see only one friend, and I know that she’s only seeing one other friend, who’s only seeing her. Then we have a loop of three people who can still have dinner together sometimes, so we’re not maddeningly lonely. Is that okay?
It’s an important question, because even before the coronavirus came along, loneliness was a silent epidemic, afflicting millions around the world. A meta-review of 70 studies found that loneliness increases your risk of premature mortality by 26 percent. Some experts say it’s as bad for your longevity as smoking. We know that it actually hurts our white blood cells.
Isolation can also be very harmful to people’s mental health, triggering or exacerbating conditions like anxiety, depression, and suicidal ideation. So while we absolutely need to follow social distancing rules as laid out by public health authorities and local governments, we should also ask what we can do to mitigate the “social recession” they’re causing.
With this in mind, I called a few epidemiologists to ask: For people who are really struggling with isolation, is forming a “closed circle” of friends a safe and acceptable strategy? The experts explained why, unfortunately, it’s not as good an idea as you might think. Their answers, edited for length and clarity, are below.
Krutika Kuppalli, infectious diseases physician, Johns Hopkins University Center for Health Security
Look, I’m single, and I get how hard it is. I went through a 21-day quarantine back in 2014 when I came back from West Africa after treating Ebola. It’s extremely hard.
But I personally wouldn’t feel comfortable doing something like this because I don’t know where my friends have been. You have to think about the other people, what potential risk factors they have, and how much you trust them.
I’m an infectious diseases doctor, so by nature I don’t think people tell me the truth. I never fully believe people. My background was in HIV, and I can’t tell you how many times my patients would come in and their test would come back positive and they’d say, “I don’t know how it got there, it just got there!” Or any of my other patients, I’d ask them about their sexual histories, and then I’d test them and they have gonorrhea or chlamydia and again they say, “I don’t know how it got there!”
This is a human behavior. You have to gauge how comfortable you feel with that, because there’s going to be a risk. You might trust your friend, but how much do you know the friend they’re seeing? Can you trust them? You’re putting your life in their hands at that point.
And the problem is, the data shows that there can be presymptomatic or asymptomatic transmission. I don’t want to be exposed to someone who may not be having symptoms but can get me sick.
I understand it’s hard to comply with these measures, but at the same, we’re talking about life and death here. I’ve seen what happens when people don’t adhere. I’ve seen people die.
So I would say it’s not okay. When someone says, “Stay at home,” I’m like, yeah, just do it. Myself and my colleagues are busting our butts on the front lines to take care of patients right now. And all I’m asking you to do is stay at home and not go out. I don’t think that’s too much to ask.
Carolyn Cannuscio, social epidemiologist, University of Pennsylvania
This is the kind of idea that sounds better in theory than it works out to be in reality. All of us as human beings are flawed. We set out with great intentions but … it’s complex for human beings to actually follow through on those kinds of promises.
Entering into these relationships is complicated and it’s opening up the potential for risk of transmission. So I’m not going to make a blanket statement that this is a safe thing to do. I would prefer that people not socialize outside their household.
I feel like people are looking for the magic loophole that will allow them to live as normal a life as possible. It’s very difficult to grant that absolution because any social interaction outside your household unit, even if it’s as simple as going to the grocery store once a week, does involve a non-zero risk.
But recognizing that this could go on for a long time, I worry about suicidality and extreme forms of mental illness. I struggle with this because I know of people who are extremely lonely right now and really suffering. That’s important, too. We all have to go through this calculus of balancing risks and benefits. … Our drive is to dramatically reduce our social interactions, and I’m positive that for most people, if they interact with only one other human, that will be a dramatic reduction in their social interactions.
But [if you’re going to interact with one other person], be very explicit about what the agreement is, and try to choose someone who’s got [a similar level of risk]. If you’re a writer and can work from home, ideally your friend would also be somebody who’s able to work from home, not an emergency medicine physician.
Let me give you an example of something else a student of mine decided to do. She lives alone in Philadelphia and her best friend also lives alone in Philadelphia. They each isolated themselves for two weeks and then moved in together for the duration [of the pandemic].
I like that plan so much more than the other plans I’ve heard of, because then you’re in constant communication with the other person and you’re aware of anything they need to do to break the protective bond. It’s easier to have an ongoing conversation about preventative strategies when you’re living with the person. If people are living separately, one person might forget to update the other.
Saskia Popescu, senior infection prevention epidemiologist, Honor Health hospital system in Arizona
If you interact with vulnerable people — elderly, immunocompromised — I would discourage you from doing this. Just stick to FaceTime and Skype.
That being said, at its crux, social distancing doesn’t mean you need to stay home by yourself in a dark room. Really it’s about keeping to small, small groups of people. So if you have dinner with a friend, that makes sense as long as it’s just you and them.
For people who are going to have those one-on-one friend hangout sessions, it shouldn’t be, “I’m going to have five one-on-one sessions with five different people” — that defeats the purpose. Really limit it to just one friend.
Also, really limit that exposure. That means, try to FaceTime as much as possible and then make [seeing each other in person] a very special thing for when you’re both really needing it. If you’re doing it two or three times a week, you’re increasing the risk of exposure for both of you.
If you want to be an awesome coronavirus epidemiology buddy, do it every 14 days, because that’s the incubation period. You’d want to do that from the last known date of exposure. That includes going to the grocery store, because theoretically anytime you go into an environment with a lot of people, there’s more potential for exposure to the disease. Then you want to ask each other, “Have you been symptom-free for 14 days? Have I? Yes? Okay.”
Harm reduction is a really big piece of this. All the infection control measures [like staying at least six feet apart] are really important during these interactions. They should wipe down their surfaces before you come over and also clean after you leave. Try to be somewhere open [in the outside air, like a backyard]. Don’t share eating utensils. Don’t touch your face. Wash your hands. And if you start to get sick within a couple weeks of seeing them, you need to notify them. That transparency is really big.
So, what’s the bottom line here?
This is not the news anybody wants to hear, but the idea that you can safely form an airtight circle of healthy friends is unsound, for three main reasons.
First, you and your friends will each have some baseline risk of exposure from going to get necessary items like groceries, or even from traveling across the city to visit one another. And it’s possible that one of you will get sick but show no symptoms. So the notion that any of us can proclaim ourselves healthy with certainty is, unfortunately, a fiction.
Second, not everyone in your circle will necessarily have the same fidelity as you, so the risk is probably higher than you think. Many STD studies show that the idea of safe circles is a fallacy because human beings sometimes cheat on their social contracts and lie about it, or they forget to make certain key disclosures.
Third, forming these circles would be unsustainable on a population level. Even if each circle has only a small risk of transmission, that risk increases exponentially if lots of us are forming these circles. The best way to lower both your individual risk and the population-level risk is to simply stay home.
That said, all the experts I spoke to acknowledged that total self-isolation can also have very harmful effects, and we each need to weigh those harms against the benefits. If your friend who suffers from depression is having a mental health emergency, it may well make sense to visit them. But if you simply miss your friend and feel a bit lonely? Maybe just play a game like Codenames over Zoom. Or use an app like Netflix party to arrange a virtual group hangout where you can watch great movies and TV shows with your friends. Don’t convince yourself that an in-person interaction is necessary when it’s not.
Remember that although a couple of experts cracked the door open to seeing a friend when it’s truly needed, it is just that — a crack — and the overwhelming takeaway is that the risk is still too great.
Going for a walk with a friend is fine, all the experts agreed, as long as you stay 6 feet apart. It’s probably better to interact outdoors than indoors, because more air ventilation means less of a chance that you’ll breathe in virus-carrying droplets.
If, after reading this, you’re still set on having human interaction that extends beyond a stroll, you’d do well to limit yourself to just one coronavirus buddy for the duration of the pandemic and commit to observing all of the precautions outlined above.
And if all this feels too difficult, bleak, and unrewarding, keep reminding yourself that the better we do at social distancing now, the sooner we can get back to normal life — with extra hugs and elaborate dinners and dance parties galore. “This is a temporary measure,” Popescu said, “and if we can just be super vigilant right now, then we’ll be able to move past social distancing.”
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