You are listening to a press conference from the Harvard T.H. Chan School of Public Health with Joseph Allen, assistant professor of exposure assessment science. This call was recorded at 11:30 a.m. Eastern Time on Tuesday, May 19.
Previous press conferences are linked at the bottom of this transcript.
JOSEPH ALLEN: Thanks to everyone for joining. I’m happy to spend the next hour with you answering questions and try to be a resource for you. Appreciate your interest in seeking out Harvard and our school as a resource as you write up these stories. So I just want to share some quick background on some of the newer work I’ve been doing to set the stage here. So, I direct the Healthy Buildings Program at the School of Public Health. I’m also the deputy director of our NIOSH, National Institute of Occupational Safety and Health, Education and Research Center on Worker Health and Safety. I’m a certified industrial hygienist. Industrial hygiene is a field where we anticipate, recognize, assess and control hazards in the workplace.
I mention that because it’s relevant to the conversations that are happening right now in terms of our return to office strategies that companies across every sector of the economy are working for at this point and thinking about, well, what’s next as they develop these plans. Prior to joining Harvard and still today, I was in consulting where I conducted many hundreds of sick building investigations. Everything from radiological hazards, biological hazards, chemical hazards. I’ve done infectious disease outbreaks, specifically Legionnaires disease in hospitals. I mention that because while this feels like it’s new and different for all of us, the pandemic, a lot of it feels very familiar to me in terms of taking the science and applying it to reduce risk in any indoor environment.
So my focus is the healthy buildings. I had a book come out two weeks ago from Harvard University Press called Healthy Buildings. But the strategies in that book and in my own research apply broadly to any, really any into our environment, including airplanes, which was a new piece I wrote yesterday in The Washington Post that had the title You Don’t Get Sick When You Fly, Really. And so, my background on healthy buildings and extended to airplanes for 10 years, I did research on air quality in airplanes and I was the one of the lead authors and experts on a 2013 National Academies report titled Infectious Disease Mitigation in Airports and on Airplanes. So, with that, I’ll open it up and I’m happy to answer any questions.
MODERATOR: Alright. Looks like we’ve got some questions already. First question.
Q: Hi. I’m wondering if you can tell us about the national parks. As you know, they’re opening up sort of partially and everyone’s dying to get outside. But the question is whether it’s safe to do it. Some of the former park rangers talk about how crowded those parks are under normal circumstances. And some of the early reports like the Great Smoky Mountains show that when they’ve gotten reopened, they’ve also been really crowded. What do you think about that?
JOSEPH ALLEN: So, you know, I wrote a piece a couple weeks ago with two other professors at Harvard. One is Marc Lipsitch from our Harvard Center for Communicable Disease Dynamics. The other is Ned Friedman, who’s the director of Harvard’s Arnold Arboretum, where we argue and make the case that parks should be kept open. Part of that is because there are a lot of benefits to being outdoors and access to open space. Mental health benefits, physical health benefits.
And the other part of that is that if managed properly, the risks can be can be significantly reduced and also manageable. So I do understand that, you know, this concern that if we open up parks, that it can create conditions of overcrowding. So what we’ve been arguing for and I also advised The Boston Globe on their internal board on their position on this recently, including around beaches and parks, is that we should pursue this in a phased approach where we should limit the numbers of people that can access this in the beginning until we show that we can manage the crowding and people heading to the parks and beaches and can manage risk acceptably. Importantly, the burden is not just on the parks and park rangers, but it’s also on people. And to get through this, it’s going to take a great deal social trust. That means people are going to have to act responsibly and abide by the rules, including universal mask wearing staying six feet from others, staying home when sick.
And if people do that, then I know we can manage this effectively and start to scale up. What we’ve seen in some cases is that people have failed to act responsibly and follow the rules in that regard. And my view of this is that we should view going to parks and other activities that are starting to be reopened as a privilege. We should view this as a privilege and one that can be revoked quickly. If we demonstrate we’re unable to abide by these rules that are designed to prevent – one, to help people with their own, limit their personal risk, but also help with population and dynamic standpoint, so we don’t have mass outbreak conditions from overcrowding.
Q: I mean, I’m just wondering, it’s, you know, it seems like you’re putting a lot of responsibility on the individuals and they just show up, people show up at these parks. It’s – how are they supposed to gage the crowd levels? It seems to be that, you know, what the park people should be doing.
JOSEPH ALLEN: Yeah, so definitely I’m not going to back down on on my assertion that there is a huge individual responsibility here. You know, we’re not going to get by here if people just say, well, it’s you. It’s the responsibility of a building owner or park manager to keep me safe or a grocery store manager. We all have to do our part of this. It’s the only way to get through this successfully. But to your other question about what can be done? Yes, this is going to have to be managed. It’s different. Park rangers haven’t had to do this before. Grocery store managers haven’t had to do this and manage crowds and choreograph this this well. They’re going to have to work on their plans for how to manage crowd control, limiting parking lots, limiting number of entrances and exits.
I know some parks around Boston are doing that and doing it quite effectively. Coming up with plans for enforcing rules for people who are not following the guidance on what they’re doing when they’re in the park. So, you know, there’s a way to do this. It has to be managed. It’s going to require personal responsibility.
But also people who have not so far have not had to worry about these things, now it’s their responsibility. It’s all of our responsibility. And it’s not just, it’s not very much different than other sectors of the economy which are having to deal with this, these questions for the first time. How do we do densify a building? How do you handle crowd control in an elevator?
So in a lot of ways, there are a lot of parallels that people haven’t thought much about infectious disease mitigation in all aspects of society now have to think about that, how we choreograph and manage people.
Q: OK, great. And then I’ll just one more question that will lead to the next subject, I’m sure. Just you mentioned masks and so on. What advice do you give specifically to people when they’re outdoors, whether they’re in parks or wherever they are?
JOSEPH ALLEN: Right. Masks, you know, just like you don’t leave the home without your phone and wallet these days, you shouldn’t leave the home without a mask and some hand sanitizer. Universal mask wearing should happen. It’s supported by the scientific evidence. I wrote an article in Washington Post maybe four, maybe six weeks ago outlining for the evidence, the four-fold evidence on why they provide a benefit. So we need to be doing this. Certainly, when we head into indoor spaces where we can encounter people. If you’re at a park, though, and separated from others, it’s OK to pull your mask down. If you’re near other people or if you’re passing people on the sidewalk or certainly if you’re at a store, you should be wearing a mask.
Q: Great. Thank you so much.
JOSEPH ALLEN: Thank you.
MODERATOR: Next question.
Q: In fact, that was a nice segue, Dr. Allen, into the workplace. You mentioned crowd control. I would like to know what your strategies are for employers as they consider reopening both for the buildings as well as the employees.
JOSEPH ALLEN: Yeah. Nice question. I’ve been thinking a lot about this and doing a lot of work in this space, advising every different groups from hospitals and health care to universities to commercial real estate, media companies, theaters. We have a new partnership with Harvard’s American Repertory Theater, developing roadmaps for recovery and resiliency. And the approach I’ve been using, I’ll start with the framework. And I think it’s really helpful. And it’s grounded in decades of worker health and safety strategy. It’s called the hierarchy of controls. And what I’ve done and what I’ve written about and I wrote about this in Harvard Business Review two weeks ago with the coauthor of my book, John Mack from Harvard Business School. And we wrote about this hierarchy of controls as applied to COVID-19. It has five parts, which makes it a nice framework. And it gives everything a home when you’re thinking about strategies.
So here they are – it is a layered defense approach. The first one is eliminate the hazards. So in the hierarchy of controls, the first step is elimination. Can you eliminate the hazard? In the context of this pandemic limiting the hazard means staying home. And we should still prioritize work from home, but that’s not the path towards reopening the economy. And for some businesses and workers, that’s not possible.
Second step in the hierarchy of controls is substitution. So in the context of COVID-19, we’ve been talking about that in terms of businesses identifying the bare minimum number of people that have to be physically present in their buildings to keep their business operational. Third in a hierarchy of controls is what we call engineering controls. The easy way to think about this is healthy buildings controls. So you think about higher ventilation rates, enhanced filtration, maybe new air cleaning technologies, but it’s the physical function of building, healthy building controls. Fourth is administrative controls. And here we put this under the umbrella of de-densification of our buildings. So very much like we’re talking about with the parks a minute ago. How do you de-densify your space? How do you manage flows of people in buildings? How are you going to handle queuing at the security desk? Are you going to do temperature screening at the front door? What do you do about elevators? What about open floor plans? All of that falls under administrative control. The last in the hierarchy is PPE, personal protective equipment. And this is where masks fall in.
So it’s a nice hierarchy because one of the real challenges here is that there’s such a flow of information, it’s hard to find the signal through the noise. And there’s so many things to be concerned about while cleaning, disinfection and elevators. And this gives everything a home and it prioritizes it too. The hierarchy I listed in that order goes from most effective to least effective, most effective being stay at home and least effective is PPE.
Another way to think about this is I like talking about it as a layered defense strategy. There’s no such thing as zero risk in anything we do, certainly not during a pandemic. But if you layer enough of these control strategies on top of each other, you can significantly reduce risk. And it’s very much like how we approach physical security or cybersecurity and other aspects of business that are not zero risk and you can’t put in perfect controls. So what do you do as you layer enough defenses and you make it really difficult, and in this case, difficult for the virus to be transmitted. So that’s the approach we’ve been talking about and using. I think it’s helpful. And the best part about it is not you know, we didn’t just invent this overnight. We’ve been using it in the field of worker health and safety for a long time.
Q: Can you talk a little bit about the idea of working in shifts and how meetings could be managed?
JOSEPH ALLEN: Yeah, I think, for me this falls of the administrative controls. I think companies need to extend the workday. That provides a couple of benefits and it allows you to work in shifts. So automatically that’s a de-densification strategy. So let’s say you can start the work day at six, the first shift comes in six to one. You know, you have an hour for cleaning. Next shift comes in two to eight or nine. And so that’s de-densifies by half immediately.
The other benefit that comes with that kind of approach is that it helps your workers avoid rush hour. So particularly workers in cities who may have to take public transportation or busing or, you know, subways so that that helps avoid that 8:45 a.m. rush and the 5:01 rush at the end of the day. That also helps de-densify the building and make sure that those same rushes are happening at the security desk and the elevator. So it’s a nice strategy to extend that workday. Another idea is to alternate workdays and go to A/B days where one team is Monday, Wednesday, Friday. The second team is Tuesday, Thursday, Saturday. So that’s another strategy that immediately de-densifies.
If you combine an extended workday with shifts and alternate days, already you can reduce occupancy by 25 percent. Now, granted, some businesses can’t function like that, you need the overlap of workers. But these are some of the considerations or the things that companies should be thinking about in terms of strategies for how do they get back to being physically present in an office, but also maintaining the physical distancing that we need.
Q: And what about meetings?
JOSEPH ALLEN: Yes, right now the guidance is we shouldn’t be having large meetings. I would recommend not using your conference rooms and closing amenity spaces early on, like kitchen areas and workout rooms. And the way I think about this – I think companies should be thinking about this way too – is in phases where, you know, early on in our first returned to office approach, we should be, we should air on the side of caution, follow the precautionary principle, and if anything, be overly restrictive in our approach.
If we demonstrate after some period of time that these controls are effective, meaning no one in the building is getting sick, and regionally the disease dynamics are in control, then and only then shall we go to that next phase and start to pull back some of these restrictions. If we do it the other way and we move too fast without enough restrictions, it’s hard to put that genie back in the bottle. Somebody gets sick in your building, you may end up closing your company, your building, could be another couple of weeks of self-isolation, self-quarantine. There are brand risks to that, too, in addition to real individual risk.
So, it makes sense to follow that precautionary principle. Show you can manage these risks effectively and then move on to the next phase where you can start to pull back restrictions, including having meetings with not large numbers of people, but larger numbers of people or opening up some of these amenity areas.
Q: Thank you.
JOSEPH ALLEN: Thank you.
MODERATOR: Next question.
Q: Hi. Thanks for doing the call. What’s the latest you’ve heard on seasonality? Have you seen any data regarding ideal temperatures? Ideal humidity for transmission? And what does that mean for the summer, especially as people get tempted to crowd into cookouts, public pools, beaches, et cetera? What are you tracking in that regard?
JOSEPH ALLEN: Yeah, I mean, so when you’re outdoors, you get a couple of benefits here in terms of unlimited dilution. So indoors, I’m a proponent of and have been on record since early February that we need to deploy these healthy building strategies like increasing the amount of fresh outdoor air that comes inside. Open your windows, bring in more fresh outdoor air. In your car, roll down your window. When you’re outside, we get that benefit already. There’s some evidence, we know that the virus doesn’t survive long on surfaces in the presence of natural light. So you get some benefits from being outdoors. In terms of humidity and including indoors, you know, what we know about this virus is limited as changing fast.
But what we know from other viruses is that typically viruses survive better at lower humidities. And so, you know, when we think about influenza, the ideal indoor humidity is 40 to 60 percent relative humidity, but also provides a benefit to your own respiratory system. We don’t know the specifics yet for this virus, if it’s going to behave like all other or other viruses. In terms of seasonality and seasonal forcing and things like this, I would leave that to my colleagues in the Center for Communicable Disease Dynamics to talk about the SCIR models and seasonal dynamics.
Q: Thank you.
MODERATOR: Next question.
Q: Hi, Joe. Thanks for doing this. Next weekend is Memorial Day, the kickoff of the summer. I wonder if you could talk generally about how normal a summer season people can anticipate. I suspect that hopes are high, given that many places are reopening across the country. And then I wonder if you could specifically address a couple of other things, locations and situations that are specific to summertime, such as summer camps for kids and summer cottage rentals and things like that.
JOSEPH ALLEN: That’s a really good question. You know, I share the view I think of many of my colleagues that we’re in the early stages of this pandemic. And this is not the time to let our guard down, even though, you know, we’ve all reached this point now a couple of months we’re ready for change. I’m sure we’re all ready to get out of this. But we don’t yet have the systems in place to manage this effectively.
So, we should expect that things will be very different this summer. I don’t think this is going to be anything like past summers in terms of, of course, there won’t be nearly as much, if any, travel. I think resort. I mean, I think vacation areas will be less visited. I know some vacation areas rely on an influx of workers and that they’re having trouble there for many reasons. So that will be different. Restaurants are already struggling. They may not be able to – well, depending on the guidance regionally and how this goes, there could be a limited capacity so that everything is going to be very different. There’s no question. How that differs, I mean, what that looks like will vary by region and state and also the type of activity, right. There may be some camps where if it’s mostly activities outdoors and they keep everybody separated, they have activities for that that can happen.
But other activities where you can’t really do that, or other camps that those aren’t going to be, you know, the risk will be higher there. And it wouldn’t be advisable to go. So in terms of what’s different, yeah, this is going to be a very different summer. I was reflecting earlier in the week on reading The Great Influenza, John Barry’s terrific book about the 1918 pandemic. And I remember reading it many years ago right around the time the H5N1, the avian flu, and wondering and thinking, right, when you look back and you see how deadly the second and third waves were, how people could get so complacent after the first wave.
And here we are right in that spot. And now it’s not so hard to see why people got complacent. It’s frustrating to be locked down like this. I think people are tired of it. Many people have lost their jobs. Many more businesses are at risk. So there’s this great urge to get back to the way things were, despite what we know about this virus, that it’s easily transmissible. And it’s not like other disasters that, let’s say, hit like a hurricane, and you pick up the pieces and march on step by step. This hurricane is sitting just offshore of every city waiting for us to let our guard down, and then it will strike. And we see that from every model that this can exist. So I went out a little bit off tangent there, but really it was answering your first question about, you know, will this be a normal summer? I think definitely not. And it also shouldn’t be.
Q: And just to follow up on the implications of what you’re you, you said, would that be for people to look at this summer, you know, yes, get outside, but in a way, kind of maintain a sort of family unit exposure. You know, don’t go to a concert. There may not be any. But, you know, look for activities you can do maybe with your household that you’ve been quarantining with already. You know, that kind of thing, you know, plan activities for the group that you’re already exposed to, kind of saying rather than, you know, exposing yourself to a lot of new contacts.
JOSEPH ALLEN: Absolutely. We’ve been we’ve been using the term physical distancing for a while now and sort of social distancing. You have your network of people. You know, what I’m going to do in a couple of weekends, we’re going to meet up with my brothers at one of my brother’s house. He’s got a nice big deck, fortunately. And we’re all just going to stake out a corner of the deck, right.
So we’ll keep our distance. But it’s you know, you do want to see people. And so that kind of activity is absolutely fine, right. It’s low risk, but it’s not the time to say, you know, next Monday or this Memorial Day, we’re just going to let loose and let our guard down. The prudent course of action for individual risk, but also population risk, is to maintain these sensible controls. Doesn’t have to be totally restricted where you can’t get enjoyment out of going to park, going for a run, seeing people but at a little bit of a distance. That can and should all happen. And I hope it does. But we still want to limit the direct contact we have, limit it to essential trips. And you know, like, for example, go to the grocery store, the pharmacy. You limit your activities to those that are really essential. And if you wear your mask, wash your hands, do all these great, important public health 101 measures, it’s a way to stay safe and keep your family safe through all this.
Q: Great. Thank you.
MODERATOR: Next question.
Q: Thank you so much. Dr. Allen. Going off what you just said about the summer, I’m wondering what you think about the sort of cognitive dissonance people might experience when they’re told by their state and federal leaders that it’s it’s time to go back to work. And yet thousands of people are going to be getting calls from contact tracers saying you may have been exposed and you need to stay home. Wondering about that, given that those orders depend on people voluntarily sort of going along with recommendations from their public health department.
JOSEPH ALLEN: Yeah, I mean, the reality is, you know, governments, federal government, local government, mayors, governors can declare their state or city open for business all they want. But ultimately the consumer decides and the consumers, that is also the people who have to go work in some of these buildings, acknowledging fully that some people have to go to work and don’t have that option or choice. But for those who do, they’re going to make the decision based on their read of the news and the science and their personal risk. So, you know, in some states might declare open for business. But if you look at the consumer sentiment polls, people are not ready.
And so there is this there’s certainly a tension there. And if you look at point you to a project put together with several other faculty in the Center for Communicable Disease Dynamics, we call it COVID Path Forward, covidpathforward.com. It’s 14 priority areas to save lives and the economy. This planet has existed for a long time. We know the steps that governments have to take to get us to a place where we would feel comfortable reopening. And currently, we don’t have the systems in place like wide-scale testing, contact tracing, self-quarantine, self-isolation to show that we can effectively identify an uptick in cases and quickly stamp it out before it becomes a forest fire in that city. So, you know, we’ve known this for a long time and I think the public is aware of this. If you go to the sentiment polls, the public is aware of that and it’s different from the messaging on reopening.
Q: Following up on that. Are you concerned about compliance when it comes to contact tracing given reports that a lot of people aren’t answering the phones at all and there’s nothing to force people to stay home if a contact tracer asks them to because they’ve potentially been exposed?
JOSEPH ALLEN: Yes, I’m very concerned, and I think I said maybe in my answer to the first question, that the only way through this is a great deal of social trust. If you think about all these actions we have to take, it’s all about social trust. If I stay home when I’m sick, that’s social trust. Covering your cough, social trust. Wearing your mask, social trust. Staying six feet away from others, social trust. And so self-quarantining is social trust. If we don’t do those things now, this is going to get a lot worse and we know it will. So, we all have our part to play. So, yeah. You know, actually, we talk about it in COVID Path Forward. One of our priority areas is personal behavior change. This has to be part of this. If we don’t do it, we’re going to pay the consequences. That said, you know, there’s never 100 percent compliance on anything. So, if enough people do it, that can have dramatic benefits to the population at large, right, if enough people. The problem if you don’t test the contact traces, that one person can affect many others and they can go on and spread. But if you can stop that, even by getting 90 percent compliance or ninety five percent compliance and most people stop and abide by the rules, that can also help slow down this spread. So that we’ll never have 100 percent compliance is deeply concerning and troubling. But you know, if we get a really – I shouldn’t even pick out a number here. But the more compliance you have, the better off we’ll be.
And that goes for all of these social trust measures here. Yeah. I mean, this is where really, we benefit from strong leadership because this message has to come. I think, you know, Americans have shown to have great resolve and be quite resilient in the face of threats over history. And I think we can all rally around causes if there’s strong leadership and we know that there’s a path forward and a plan. The uncertainty, the mixed messages, not following protocols, leaders not following the protocols that the CDC is giving sends a mixed message and the public is confusing. I’m fully confident that if that if that message said, you know, if everybody abides by these things and does their best for the next coming months, we will ramp up our scientific endeavors here. We will ramp up vaccine. The whole country will mobilize and we will get through this together.
Everyone has their part to play. I think if that kind of uniform messaging came out, it would be easier for people to rally behind this and say, yes, there’s a plan in place, it will work. We all have a role to play and we’ll get through this. Without that kind of leadership and the current mixed message that’s going out, you already see it. People are confused. Do I have to wear a mask or do I not? I see leaders not wearing it. I see leaders not social distancing, physical distancing. So, it’s not a surprise, then, that the population is confused. And the danger is that it puts all of us at risk. Because if that mixed message or uncertainty is there and people aren’t following these protocols, it increases the likelihood that this virus will spread uncontrollably.
Q: Thank you so much.
JOSEPH ALLEN: Thank you.
MODERATOR: Next question.
Q: Hi. Thank you for taking my call. I have a question about if you have any specific recommendations for people from high risk areas. We’re wondering about travel this summer. I’m wondering specifically for New York City residents. What would you tell New Yorkers who are wondering if they can go rent a car, rent a house, get out of the city this summer?
JOSEPH ALLEN: Yeah. So, you know, one of the things that, I mentioned this article on airplanes, is that while the risks are low on the airplane, the travel experience presents other risks. For example, in the airport and elsewhere and maybe most importantly and to your point is that airplanes and, you know, cars are good vectors for disease. So, if someone is sick, asymptomatic and doesn’t know it and they get on a plane and travel to a new area or drive to a new area, they could be introducing if they’re sick, that virus – I shouldn’t say sick, they’re a carrier, even if they’re asymptomatic – into a new area. So, I agree with some of the signs I’ve seen in and around even Massachusetts, where we are, urging people who are traveling from other areas of the country to self-quarantine. And again, you know, it gets these questions of it’s not policed. People have to abide by these rules themselves. The social trust moment. But I think that’s the right approach. So, again, if people act responsibly and can do it, then it would be okay, because you’re not introducing that. You’re being mindful that you might be a carrier carrying that virus and maybe spread it into an area that hasn’t had a large outbreak yet.
MODERATOR: OK. Next question.
Q: Thanks so much. So, some states have as part of their reopening efforts in the first round of reopening barbershops and hair salons and other high touch sort of personal services have been in that first round. You’ve talked about efforts to make workplaces a little bit more safe by following some of these guidelines. Does the science support including barbershops and hair salons in this sort of first round of reopening? And how can that be done safely?
JOSEPH ALLEN: Yeah, so I think it’s a good question. I mean, I think it’s hard to pick which businesses open and do not IPO. But I do – I’m fully on the side that we we we have to act in a way that protects people, saves lives while also being fully cognizant of the economic impacts here. I think even in these kind of shops that that controls, if stringent controls are put in place, we can minimize risk. So that includes thinking about ventilation, recirculating filtered air, maintaining as much physical distance as is possible, which is not always the case, but even know mask wearing and limiting how much direct face to face. There are things you can do to reduce that risk.
You know, any way you cut this, if we’re going to start reopening – if we just keep it shut down until a vaccine, there’s not going to be much of anything left in the economy by that point. So we are going to have to figure out how to slowly open different aspects and different types of shops and businesses. And so, I think it can be managed effectively if it’s slow and steady and the extra controls are in place.
The bigger problem for me is that we don’t have the population level controls in place to effectively catch and determine any rise or rapid outbreak, which requires that we have our testing apparatus fully functional, contact tracing fully functional. And so we’re not quite there yet. But I do think with precautions, you know, there’s again, there’s no zero risk. But I feel confident that businesses can take appropriate steps to reduce risk in their whatever business or whatever building they have.
Q: It seems, you know, one thing that I guess I keep struggling with is that so barbershops and salons and other high touch services, we’ve talked about people maintaining six feet of distance where possible. But these are services that require you to be within a foot or a foot and a half of people’s faces for 20, 30 minutes on end. So I wonder how much of that is is actually an acceptable risk. And on top of that, I wonder how much these decisions have to be on considerations of human behavior. By that, I mean, at some point people are really going to want a haircut and they’re going to try to find one perhaps on the black market or perhaps in addition to that, the people suffer mental health consequences by not being able to take care of themselves in the way they were before the pandemic. I wonder how much that’s a concern.
JOSEPH ALLEN: Yeah, so, I have to fully disclose. I don’t know if you’ve seen my picture, but I’m not necessarily sympathetic to barber shops and hair salons. I’m bald and so I don’t think about this much. It wasn’t first top of mind but I get that it’s top of mind to a lot of people. I’m joking there. Yeah. So. So, one of the things, if you think about the loosening of restriction from a population dynamic standpoint, these are not places where you’re going to have mass spread events, right? It’s not like a sporting event or something like this. So as a part of a slow and steady restart, it seems reasonable to me that some sectors of the economy like this – I don’t know why these were chosen over others but – could start to be restarted knowing that we would tamper it down if it gets out of control.
The second thing specific, right, these are environments where, as you mentioned, it is really difficult to avoid close contact. But if you think about that hierarchy of controls, you know, this is where PPE comes in, that, you know, when all of the controls are exhausted, the last one is PPE. So if you put in injury controls, that’s great. You put in some of these administrative controls, that’s good. Maybe you limit just how often you’re next to somebody or you’re not breathing right face to face. And the customer wears a mask, too. And you don’t have people in the waiting room. There’s a queue outside or only by appointment. Right.
And so through those mechanisms, you’re limiting the number of opportunities both for the guest, for the client customer, but also for the worker in that space. And then if you’re adding PPE, that’s the last line. So what people will have to weigh in all of these decisions is even if it’s open, you have to make an assessment about personal risk. So is this necessary? Well, okay, yeah, going to a barber shop is not necessary for me, but for some of the people, it might be for their mental health, their well-being, maybe even that, just a little bit of social interaction. And so they need to assess, is it necessary for me? Do they have personal risk factors or are they in a high-risk category where it would it make it unacceptable for them? And ultimately, what’s their personal risk tolerance? Is this something they’re okay with?
And so if you put, you know, – those have to be part of that matrix, right, individual decision and individual risk tolerance. And then you put in these controls and you can try to minimize risk as much as you can. And from a population standpoint, if one shop didn’t get everything right and one or two people got infected, it shouldn’t set off a super spreader event like the Biogen conference or the cruise ships, right. So from a population risk standpoint, I think it’s reasonable that we start to figure out ways to restart the economy in these slow and steady starts. And I don’t know if that factors into their decision making in terms of why barbershops versus other types of businesses. But that’s the way I think about population risk and individual risk.
MODERATOR: Great. Thank you. Next question.
Q: I really enjoyed your article on airplanes, and I was wondering if you can kind of elaborate on how some airlines are talking about blocking middle seats, taking other precautions. And I’ve spoken to passengers who still feel like they’re too close for comfort on planes. And I was wondering if you can speak to whether there are other measures that can be taken on airplanes or airports in general for people to feel safer.
JOSEPH ALLEN: Yeah, so it’s really good comment and, right, even with all the best controls in place, I understand that people may feel anxious and don’t want to go. I also think we have to put in that same kind of analysis that I just did for barbershop. Is it necessary? Is this essential travel or non-essential? What’s your personal risk factors? What’s your personal risk tolerance? The point of that article was to say that, you know, while you’re in your seat on an airplane, the air quality, the air exchange rate is very high. All the research that air go through HEPA filters, which captured 99.97 percent of airborne particles. The airflow is designed to minimize the entire cabin from being a well-mixed space. So that’s the – what I’m trying to say there is that the air only moves within your row and maybe a row or two beyond.
So it’s not, even though there are a lot of people in a tight space, the airflow dynamics prevent widespread transmission even if someone is sick. If you add on masks, one study showed that it reduced risk by another factor of 10. Then if you start to do other strategies like not using middle seat preventing or discontinuing meal and drink service during the flight, in other words, you grab a water and snack when you board and that’s it, you also limit the amount of transfer that’s happening or you know, the amount of people that are passing by. What I wrote in the article, though, so those are good strategies. And people should also, you know, bring a wipe and clean up their tables and the armrest for extra feeling of feeling secure, although the airline should also be cleaning and disinfecting surfaces between each flight. The bigger concern for me is that, you know, what I wrote the article that you don’t get sick on airplanes, but everyone thinks they do is that you can never disentangle that from the travel experience.
Every time you fly, you wait in long queues in security, you’re at the jetway, you’re in their waiting area, maybe in a restaurant at the airport, you maybe took a bus or the subway. Maybe you didn’t get a full night’s sleep. You’re changing time zones. You’re staying in a hotel when you land, another subway or bus or taxi. And so there’s all these other opportunities. And so people do get sick when they travel, but I think what we’ve seen based on the airplane dynamics is that it’s not the time in the airplane that’s driving risk. And so I was an author of that national, one of the lead authors of the National Academies report where we outlined steps that airplanes, airlines, and people should be taking. And so, I think airports are going to have to do more in that regard in terms of keeping people spread out, managing queues differently, providing more opportunity for hand-washing and hand sanitizer.
And then for the airplane, there is one area that might surprise you. We’ve done measurements of air quality in airplanes for a long time. And it turns out that while you’re boarding that the airplanes aren’t always using gate-based ventilation. So if you’re ever on airplane and it feels kind of stuffy or hot when you’re first on there, it’s because the airplane’s APUs, auxiliary power units, may not be on. You’re not pulling an air through the engines yet like when you’re flying or during takeoff, and they should be relying on gate-based ventilation. But oftentimes they’re not. And so that’s a problem. If you think about with everybody boarding or – that’s not a problem – that can be a problem or it’s an area that needs attention where everyone’s boarding and you don’t have the ventilation system on.
So airlines and airplanes should be coordinated. That is a better choreographing the time in the jetway, the boarding. It will take longer. It will be frustrating, more frustrating. And they need to be sure the ventilation system is running before the first person steps foot on the airplane.
MODERATOR: Next question.
Q: Yes, hi. So we are on the Cape and we focus on the Cape and Islands area. And with that, I wanted to ask you a little bit more specifically about beaches, because we have a significant increase in summer population. When travel is shut down because of the summer, the second homeowners and so on the beaches. I’ve heard proposals everywhere from six feet to 12 feet between parties on, you know, groups of people on the beach. I’m wondering what you think is safe on beaches.
JOSEPH ALLEN: Yeah, I think we should follow these guidelines for six feet. I think that’s based on science. We know outdoors you have greater dilution; the wind can dilute any airborne contaminants as well. I think the challenge for beaches is going to be like we talked about with parks is that they’ve never had to manage flows of people in this way. Sure, they manage the number of people, the number of cars in the parking lot. But pretty much when you get on the beach, everyone just finds a spot and people naturally distance as best they can a little bit, right.
But if you think about how it goes, it’s very haphazard where kind of people are walking past each other, through each other. And so it can be done in a more choreographed manner where you may even have, you know, what’s the right way to say it? Maybe like lanes or roads, right. Not roads, lanes that are cordoned off where people can walk one way this way, one way back, you find your spot. And so you’re not kind of walking through everybody trying to find that, you know, your little corner or area that that’s distance from other people. But I think if we do that and if we stay within groups, you know, the group you travel with, or the group you’re normally quite self-quarantined with, then we can we can do it safely.
And so the way to manage that, too, is to manage the inflow of people who can arrive at these beaches, right. The number of parking spaces that are available. If you limit that, you will limit the density on the beach. Some beaches already have to do that, right. Because there’s just not enough space, so they limit the amount of parking, they limit it and turn people away all the time. This isn’t totally new for everybody. It’ll be new for some people who expect maybe their favorite beach that they’ve gone to forever, maybe they won’t be able to access it on a certain day if there are too many people there. And that’s just the unfortunate reality of this pandemic.
Q: Do you have any thoughts on the difficulty of enforcement of that?
JOSEPH ALLEN: I think this is really tricky. You know, it’s not my area, security or homeland security or policing. But, you know, we’re going to have to have plans in place for how to deal with that. I’m not sure – it’s really outside of my area of expertise other than to know that there will be some compliance issues. You can already see tensions flaring up between people if someone near them isn’t complying or not wearing a mask or people flout the parking roles. So, yeah.
Q: Yeah, that’s okay. And just one more. What about masks? I mean, people are outdoors, it’s windy. Should they be wearing masks on the beach?
JOSEPH ALLEN: With wearing masks, they get there, they walk to their space, they pass other people. But if they’re maintaining social physical distancing and they’re just with their group, then, you know, kind of like if you’re out of the park, then it’s okay. But if you’re out and about walking around, passing by people, walking to the shared bathroom, walking across, you know, I don’t know, a narrow pathway or a bridge or a dock, whatever it is, then it makes sense to have it on. So, you should definitely bring it with you. Yeah.
MODERATOR: Next question.
Q: Hi. Nice talk to you again. I had a question about the risks from water. I mean, is there any risk or evidence that the virus can be transmitted by swimming in a pool or a lake or the ocean and is one sort of type of water better than another?
JOSEPH ALLEN: You know, it’s interesting, Right off the bat, I say the risks are through transmission or it’s not an issue at all. And then. But I also realize I haven’t really looked into it. So I can get back to this if you’re interested. But yeah, I think the risks are negligible through water. And the risk there, I guess, is that still you should maintain physical distance thing. You know, it releases through emissions from people coughing or sneezing still. If they’re adjacent to you, right, you could still inhale that.
Q: We don’t know if the virus lives in water?
JOSEPH ALLEN: I mean, I’m quite confident that that risk is not something to worry about. But at the same time, I hadn’t really thought about it much for that reason.
MODERATOR: Okay. Next question.
Q: Hi. Thanks. So I wanted to get back to this this idea of out-of-state travel and, you know, visiting, you know, visiting family. You know, a lot of people are maybe not necessarily going to be looking to travel so soon, Memorial Day weekend, but then the next big holiday, you’ve got July 4th coming, a big time for people to go to the beaches, get out of town, that sort of thing. Do you do you feel like it might be safe for people to go and visit family, out-of-state people that they haven’t been able to see in a long time? That sort of thing?
JOSEPH ALLEN: You mean just following all these other precautions, is that what you mean?
Q: I mean, or like, you know, if you, to go and visit an out-of-state family, I mean, would it be okay to stay in a hotel or would you say, you know, it’s okay to stay with family?
JOSEPH ALLEN: Yeah, I mean, look, the this starts getting to individual risk and what you find acceptable or not. I mean, the goal here is to minimize the number of social contacts people have. I am thinking and then moving in this direction to that, as we start to figure out what we can do that gets back to some semblance of normal, one way might make would be to do this is to limit the number of contacts you have. And if you know they’ve have been social distanced and self-quarantined for two weeks and you have too and you’re not having any other exposure, then I think people could make a reasonable decision based on their own personal risk profile that this would be a low enough risk to spend time with others.
Where it gets tricky or problematic is if everybody starts doing that and assuming that, and you start to have your social network starts widening and widening, well, then it quickly gets back to the potential for a larger spread or a breakdown in that transmission. But in terms of personal risk, it would be would be relatively low.
Q: Right, okay. And then this just sort of goes as well to, you know, whether you’re in a hot spot state or so-called hot spot state or not. I guess it’s sort of just all, you know, the advice would be whatever your individual risk factor would be?
JOSEPH ALLEN: Yeah, I mean, we have to take these decisions in the context of what’s happening individually, your own personal risk factors you might have, but also what’s happening in the context of the regional disease dynamics. Your decisions right now in Montana can be very different than, you know, going to visit someone right in New York City right now and that will change over time. So, it’s hard to give that generalized guidance, but you have to take it in the context of what else is happening around you.
Q: Great, thanks.
MODERATOR: To kind of follow up on that question. Do you have any sense of when large gatherings like weddings might occur again and what adjustments may need to be made in order to host weddings, limiting crowds, masks, distancing? Any ideas on that?
JOSEPH ALLEN: Yeah, that’s a really good question. And I guess I approach this kind of like all of this where I feel confident that any environment controls can be put in place to minimize risk sufficiently. But it will look a lot different from a typical wedding, right. So yeah, if that means people wear a mask. People being spread out. I wouldn’t – you say large wedding and that’s a relative term, but you know, you know, if you have 300 people crammed into a dance hall, that’s going to be very different from 50 close friends spread out in an outdoor location, right. So, I think there are ways you can do it.
But, you know, again, I think one of the things I’m hesitant to give kind of this generalized guidance. And again, it’s also could depend on the context of what’s happening with disease and our ability to control it. But definitely we should be mindful and be wary of large gatherings of people in any context where we can have these events where many people get sick and then go on to infect many others. So that’s we’re trying to guard against. You see that some of the controls. Particularly in Massachusetts, as we start to reopen slowly, these decisions to limit large events and the super spreading events, to be sure we can manage these kind of lower risk environments first.
MODERATOR: We have two more questions. Would it be okay if we keep going, Dr. Allen?
JOSEPH ALLEN: Yeah, I can do two more. But I also want to address about this earlier question because, you know, the more I think about it, yes. I haven’t been thinking about it because the risks are – there isn’t a risk through the water. Particularly, it you think about a swimming pool or otherwise, and you have chlorine and bromine or bromine in the water that’s alginated to disinfect water. That hasn’t been a risk. We know this through drinking water. So the risk around pools or oceans or beaches, if any, would be the usual transmission routes, which is if you’re near somebody and close contact through breathing. Yeah. So, sorry. I’ve been reflecting on that one and I hedged my earlier answer because I realized I hadn’t really thought about it or even looked into it.
MODERATOR: Sure thing. Next question.
Q: Hi, how you doing? Thanks for taking questions. What would your advice be to houses of worship and to people considering going to the houses of worship in the coming days?
JOSEPH ALLEN: Well, it’s the same as I just mentioned for weddings. I put this in the same category as these lot of the locations, or not quite businesses but organizations that we have the potential for congregating a large number of people, we should we should avoid. One, from the individual standpoint, right, it’s the frequency and duration of exposure. It’s you’re more likely to run into somebody who has it in a larger group. It’s hard to maintain physical distancing in those situations. You know, there may be singing. And so we know we emit more aerosols when we’re singing.
So, you know, it’s an environment again, but it comes down to, you know, personal risk. And I totally understand that some people that this is one of the most important things in your life, and you want to get back to that. That’s understandable. And so, the question is, what kind of controls are in place and how well are they managing, including the same things we’re talking about for buildings? Did they have the right administrative controls to keep density down? Are they limiting the number of people in there? Are they spacing them out? Have they thought about choreographing entry and exit so people aren’t passing by each other or congregating outside? Is your place of worship big enough that you can space people out in there? Can you cut back on activities or parts of the service that may bring people together or, you know, no handshaking and no touching common objects and things like that?
So, I think it can be done safely again. But if it’s managed right. And also back to the healthy building strategies, you know, I’m not sure a lot of places of worship probably think too much about their ventilation strategy or their filtration of the recirculated air. And, you know, of course, where that one high profile outbreak in a choir. So, you have to think about the space where we have people, how close they are together and what controls are in place. It’s interesting, the hierarchy of controls and all that logic follows straight through places of worship, health care, theaters, barbershops and, you know, and businesses, going back to office buildings.
Q: Thanks very much.
JOSEPH ALLEN: Thank you.
MODERATOR: Next question.
Q: All right, yeah. So I’ll make this quick. This was basically just a narrow follow up sort of advice on travel and going outside, heading into these sort of summer vacation weekends. And I just guess, again, just to make it a little bit more narrow, given where we are in Massachusetts with the case load and a lot of restrictions on that or places easing on Memorial Day specifically next week. I was kind of curious if you had any specific recommendations for residents here kind of headed into this weekend. Again, typically a lot of people are looking to go outside, do barbecues and stuff like that.
JOSEPH ALLEN: Yeah, so I think the recommendations I’ve been saying hold, right. It’s the same things. It’s to limit nonessential travel and activities. If you’re with other people, maintain the distancing. Definitely wear your mask. Be vigilant about hand-washing. You know, get outside, absolutely. Get outside. Meet with friends outside at distance. That’s great. Go for a walk, but separate out when you’re talking. Meet in someone’s backyard, but separate out, you know.
Look, it’s one of the things that it’s different at first and feels uncomfortable. But I think about the early conversations I have, you know, with one of my neighbors in March and the first time we had a conversation on the street, but we kept, you know, eight feet away from each other, it felt funny. And now it feels totally normal. It’s actually nice to see them and have that conversation. So it may feel funny or awkward at first, you know, like a physical distanced barbecue. But, you know, there’s nothing like seeing friends face to face and hopefully share a couple laughs in this really stressful time.
Q: Alright. It seemed that that kind of also the 10-person limit on gathering still is, you’d say to follow that.
JOSEPH ALLEN: It makes sense too, right, because, well, you know, maybe some people have places where they can fit more than 10 people physically distant, but most don’t, right. And so, that’s largely where that’s coming from, right? Sure. So if you have some giant property, okay. You know, it’s really about de-densification. But for most of us, most everybody, right, we don’t have that much room. So you could keep it small to handle people. Makes things easier to control, makes it easier to manage the bathroom usage. It makes it easier to keep people separated, right. Everyone can be comfortable without people being on top of each other. Those are smart rules.
Q: Great. Thank you.
JOSEPH ALLEN: Thank you.
MODERATOR: Thank you, Dr. Allen Do you have any last comments before we end the call?
JOSEPH ALLEN: No, you know, we covered a lot. Normally I save something for a last comment, but I think we hit everything. I guess I would just iterate my last thought. I did say it earlier for sure, but on this social trust thing, and how people should view these reopening and the loosening of restrictions around parks, beaches, offices, barbershops, you name it, places of worship, is that we should definitely view this as a privilege and one that can be and actually will have to be revoked swiftly if crowds do not act appropriately. So, it’s incumbent upon us to do our part in this. Otherwise, we’ll be back where we were for the past couple of months.
This concludes the May 19 press conference.
Michael Mina, assistant professor of epidemiology (May 18, 2020)
Michael Mina, assistant professor of epidemiology (May 15, 2020)