IRA FLATOW: This is Science Friday. I’m Ira Flatow. If you’re in a state that locked down at the beginning of the pandemic, maybe you can relate to our listener Brenda who called in from Washington state to our sci-fi VoxPop app.

SPEAKER 1: No, no one’s socializing yet. And it’s still pretty depressing, boring. We don’t get to see our friends, hug people. You get down a lot, but we’ll survive it.

IRA FLATOW: Yeah, it was a long socially distant spring, was it not? And as mask wearing becomes controversial, restaurants reopen to crowds. Some states are already seeing big spikes in coronavirus cases, for example, Texas, California, Florida, Arizona.

Maybe this is your cue to stay inside until there’s, what, a vaccine. But maybe you’re trying to find ways to live something like a life outside your home. And as guides to safe socially distant barbecues proliferate amid competing political messages about what we should do, we wanted to look to the science, how to make the best choices for ourselves regardless of where we are and who’s in charge.

So that’s what we’re going to be talking about. Let me introduce my guest, Dr. Oni Blackstock, assistant commissioner at the Bureau of HIV for New York City Health Department. Welcome, Dr. Blackstock.

ONI BLACKSTOCK: Thanks so much for having me.

IRA FLATOW: You’re Welcome. And Dr. Abraar Karan, a physician at Harvard Med School and Brigham and Women’s Hospital in Boston, Massachusetts. Welcome to Science Friday, Dr. Karan.

ABRAAR KARAN: Thanks so much, looking forward to it.

IRA FLATOW: Well, you heard one of our listeners talking about how depressing it is. I want to play another listener who sent us this story.

SPEAKER 2: I think I’ve gone out maybe three times since we’ve reopened. Every time I go out with friends or with family, we make sure that we are eating outside, not in a restaurant and that it’s not crowded. And so far, we’ve lucked out. It’s not crowded. Anytime an area has more than a few people who can’t keep a distance, then we don’t stay.

IRA FLATOW: Is there a right way and a wrong way to make choices like that about seeing friends, going to restaurants, and otherwise existing outside our homes, Oni?

ONI BLACKSTOCK: Yeah, I think that each person is probably going to make the best decision for themselves and their families and their community, but the reality is this is an infectious disease. And individual health and public health are tightly related. People need to really think about, not just their families, but their communities as well. So determining whether the place you’re going is going to be able to allow for social distancing, whether people will be wearing face coverings, whether it’s indoors versus outdoors, all of those factors are going to help you determine how risky that situation is.

IRA FLATOW: I know you’re in New York, and I can tell by the ubiquitous car horn that goes off, the car alarms on the streets of New York City. There are restaurants that are just now reopening for outdoor service. How do you with the health department go about crafting the guidelines it takes to keep people safe in these situations?

ONI BLACKSTOCK: Right. So as a health department, we develop guidance for the public, as well as health care providers. And the impetus often is coming from what we’re seeing and what we’re hearing from community members. And so I’m fortunate with the Bureau of HIV we have these very long relationships that we’ve had with HIV advocates and community members.

And for the guidance that we developed on social gatherings, this really actually came from a conversation I had with an HIV advocate on Twitter, as well as with Dr. Julia Marcus, who’s an epidemiologist. And we were looking at a posting on Twitter of an indoor party that was taking place during the height of the pandemics first wave. And people were shaming these individuals.

And so I realized that we needed to develop guidance so that the public knows what may be some lower risk versus higher risk social activities. And so that the public can make the most informed decisions for themselves, because the reality is that staying home is not sustainable. And we need to come up with other options that people have that may be more palatable or acceptable.

IRA FLATOW: We’re in the summer barbecue season. We just went through Memorial Day. We have the 4th of July coming up. Your neighbor is going to have a barbecue.

He says, hey, why don’t you come on over? Bring the family. And you’re saying, oh, how do I tell him no? What do I do? How can I go and still remain safe, Abraar.

ABRAAR KARAN: Yeah, you know, that’s a great question, a question that’s going to come up for a lot of people. And when I advise a patient of mine to do something, I think about their individual risk. Are they somebody who is younger?

Do they have comorbidities? What is the significance of the event that they want to do to their personal life? What does it matter to them in terms of their mental health?

And so I think for each person it’s going to it’s going to differ, but I think it’s OK to say this situation for me is not ideal right now. If you look at the nature of transmission dynamics, a situation that sort of lower risk can turn into a higher risk situation kind of within the same time course of an event. So you may be outdoors at a barbecue socially distancing.

People may be drinking and socializing and then before you know it you may had indoors to use the restroom. And there may be some crowding around there. And just all it takes is a few minutes indoors without masks, face-to-face for transmission to likely occur.

So I think keeping that in mind is a sort of important. And then the other point to Dr. Blackstock’s point is that you don’t want to sort of stigmatize or make your neighbor feel like that by you not coming you’re sort of judging the situation of why are you having a barbecue or something like that. And so I think it’s really important to have sort of clear communication and just let people know that if you don’t feel comfortable personally, it may be something related to the individual risk within your own household, but to make sure we don’t use stigmatizing language or be judgmental, because that’s not going to help. It’s probably going to drive people to do things in a more secluded way, but they will happen anyways.

IRA FLATOW: Oni, what about families? I know there’s this concept of communal bubbles we keep talking about. I know I am in one with my family, where we have decided we would see each other, but we would stay safe, take the precautions at the same time. Is that something as a policy decision that you would recommend?

ONI BLACKSTOCK: Yes. Yes, so in our social gathering guidance, we do encourage folks to consider social bubble. So having two or three families that you agree to socialize with, but with no one else. And then outside of the bubble, you follow a social distancing rules.

It’s really important to find a family that’s being as careful as you are, but you also pick a family that you can learn from and that will enrich your family that you can do fun things with, like your kids like each other, and you like the parents as well. And it may be an opportunity also to consider a family that may have maybe a different background from you. When we tend to socialize, we tend to socialize along race, ethnicity lines, as well as socioeconomic lines. So really thinking about, can you maybe engage with the family maybe who has a different cultural background from you so that you can learn from them and grow as well

IRA FLATOW: Abraar, but to us, in my social bubbles that I have, there’s a huge amount of trust involved that people have not violated the social deal that you have made. How do we manage the safety of those bubbles?

ABRAAR KARAN: Absolutely. I think you know you really hit the nail on the head here in terms of– in my opinion, trust is really the key to epidemic response in general. The Ebola epidemic actually was a great example of where the loss of trust between communities and sort of international health organizations meant we lost contact tracing and transmission chains, because we weren’t able to track cases.

Same thing here. You’re talking about trust in the context of families and interacting. It takes a lot of trust to join a social bubble, where in which you’re going to socialize and say, I trust you to not expose me. You trust me to not expose you. And so I think it’s critically important, as Dr. Blackstock mentioned, that it’s with families who you can really count on.

IRA FLATOW: And I notice that your department puts out guidelines, very interesting guidelines. And, of course, the one I could not resist looking at and that is the guideline for dating and having safer sex on dating.

ONI BLACKSTOCK: Yes. So that was probably one of our guidance that went the most viral. So as the Bureau of HIV we do many sexual health marketing campaigns. And we’re known for being very sex positive.

So we got a lot of questions early on about whether having sex during a pandemic was safe. We know sex is a normal part of life for so many people. And people will and should have sex during the pandemic. And so what we emphasize where harm reduction strategy is– so ways to enjoy pleasurable sexual activity while minimizing your risk.

IRA FLATOW: Dr. Karan, why is harm reduction better than completely eliminating risks of getting sick?

ABRAAR KARAN: Well, I think if you take a step back– so anytime I treat a patient clinically or even when I think of my own life, every decision that I make is not to optimize my health at the disregard of everything else. That matters to me as a human being. So I could avoid every single item of food that is deemed unhealthy or I could avoid ever having an alcoholic beverage or I could avoid doing anything that would cause me some kind of risk, but that’s not the way that we live as human beings in general.

And so when we think about it applied to this situation as well, we can only stay completely locked down for a certain period of time. Right after that all of these other effects sort of weigh in. And so I think we approach it both pragmatically and also think of it as avoiding stigma and judgment, which is completely harmful– and risk mitigation is what makes the most sense.

And as we understand more about transmission dynamics, we are able to use science to help guide what is safe and what is not safe. So I tell people a lot of the time, if you’re walking around outside by yourself, that’s a great time to get some fresh air without a mask on if there’s no one around you. And when you’re indoors, that’s where it’s most important to wear a mask.

Let’s say masking is an example where people may not mask the entire day. And so I think it’s important to remember it’s not just the advice we give. It’s what people are actually going to do with that advice that really matters.

IRA FLATOW: And I know because you work in HIV, a couple of weeks ago Dr. Fauci was on our show and said, he saw a lot of parallels between this pandemic and the HIV/AIDS epidemic. What do you see as lessons we can apply from HIV to this disease?

ONI BLACKSTOCK: So we were talking earlier about the harm reduction approach. That actually originated during the early stages of the HIV/AIDS epidemic. So Michael Callen and Richard Berkowitz, who were both gay men and both had been diagnosed with AIDS, they wrote this pamphlet. It was called on how to have sex during an epidemic.

And it really pioneered the strategy of harm reduction in the context of safer sex, because what they did is they recognized that many gay men are going to have sex. So let’s support them in making the most informed choices for themselves. And I think that whole harm reduction approach is something that we definitely need to implement and use as part of our response to the COVID pandemic.

IRA FLATOW: And, Abraar, you’ve worked on Ebola. Are there lessons there for us also?

ABRAAR KARAN: Absolutely. I think the most important lessons you’ve mentioned before was maintaining trust within the communities, because I really do think that as much as we’ve got a pandemic, we also have within that multiple local community level epidemics ongoing. And how communities interact is so different.

So if I go out in the street in Boston here without a mask on, people are going to look at me very, very strangely and may say something to me. Especially if I was indoors, they would undoubtedly say something to me. But if you’re in Arizona or in Florida, that might be very different.

And the way that people interact with their health care leaders or with what their government leaders in a community in Florida or in Arizona versus a community in Massachusetts may be very different. And so establishing trust with your community and leveraging that trust to promote scientifically backed public health guidance, like wearing masks, is so critical.

IRA FLATOW: Just a quick note that I’m Ira Flatow. And this is Science Friday from WNYC Studio. Dr. Blackstock, a lot of states are putting out a lot of messages. Some of them conflicting or confusing. If I live in a state with less clear messaging or want to do something and can’t find guidelines, if I want to think like an epidemiologist, how do we assess situations that I can’t find guidance for?

ONI BLACKSTOCK: Right. So the CDC actually has a really great website with lots of helpful information that can help with assessing your risk. So I think the first thing– the first question you want to answer is COVID-19 spreading in your community? And you can usually find this information on your state or local health department website.

And if you have trouble finding that, you can go to the CDC website. And what I would do is look at trends in the percentage of tests that are positive or trends in newly diagnosed cases, hospitalizations, and deaths. And if you see all of those increasing, that would suggest worsening community spread. And so it definitely would take greater precautions.

IRA FLATOW: And, Abraar, do you think that most people have accurate information about their personal level of risk?

ABRAAR KARAN: You know that is an interesting question. A number of patients that I have who are from very challenging socioeconomic backgrounds have lower access to health care services may not know if they have uncontrolled hypertension or if they’ve got poorly controlled diabetes to what extent that is.

And there’s a lot of overlap here, because a lot of my patients who are most vulnerable are also part of families where there is a lot of indoor crowding in the house where other family members might have been front line workers who are really carrying our society through some of the toughest times during the pandemic. And so that’s why I think we see a lot of the overlapping factors. And that plays into many complex social dynamics, including systemic racism and others, which I think make it hard for everybody to totally know their individual risk.

IRA FLATOW: And how do we– let’s say that this virus is a virus that we have now. Let’s say that it just keeps going on. I mean, how do we deal with it as a long-term issue?

It gets worse. It gets better. It gets worse again. And what if it never, never goes away, Abraar? How do we deal with that longtime?

ABRAAR KARAN: What I would say is this is where these first six months, year, we’re figuring out a lot of things, transmission dynamics. We’re figuring out therapeutics that may work. We’re figuring out how much children transmit.

We’re waiting to see what the long-term effects of this are going to be if there’s viral latency if this represents later. I think that we have to play it extremely conservatively initially as we figure all of these things out. And by next year, if we have a lot more understanding, our way of life may be very different than we may have adjusted to a new normal at that point, that maybe was better than our old way of life. So that’s my thoughts. I’m sure Dr. Blackstock has some thoughts too on that.

ONI BLACKSTOCK: Yeah, I think about sort of like a continuum of risks in terms of like, obviously, the lowest risk is staying indoors and sheltering in place. And then like the highest risk is you’re going outdoors, maybe by yourself, then outdoor gatherings, and then being indoors with other people you don’t live with. And I think we will kind of shift back and forth along that continuum in terms of depending on what the level of new cases is in our area, the level of spread. We may shift to the extreme end and everyone’s sheltering in place again. And then as things get better, moving along that continuum, but I anticipate we’ll be figuring out sort of what is a level of risk we’re most comfortable with and sort of shifting along that continuum and modifying our activities accordingly.

IRA FLATOW: Well, I hope everybody stays tune, because we will, we’ll be talking about this for months, years, who knows how long to come. I want to thank my guests, Dr. Oni Blackstock, assistant commissioner at the New York City Department of Health, and Dr. Abraar Karan, a physician at Harvard Med School and Brigham and Women’s Hospital in Boston. Thank you both for taking time to be with us today.

ABRAAR KARAN: Thanks so much, Ira.

ONI BLACKSTOCK: Thanks so much.

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