As government continue to ease restrictions during the COVID-19 pandemic, the burden of managing risk is shifting to people.
Experts have advised people for months to wear masks, wash their hands and stay 6 feet apart. But now that some public places are reopening, individuals must decide for themselves which ones to continue to avoid and which ones pose little risk of spreading the virus.
MLive spoke to the following four public health experts in Michigan, asking them to assess the risk various activities pose to spreading coronavirus.
Dr. Matthew Sims, Beaumont Health director of infectious disease research
Dr. Dennis Cunningham, McLaren Health Care medical director for infection prevention
Dr. Mimi Emig, retired infectious disease specialist with Spectrum Health
Dr. Nasir Husain, Henry Ford Macomb medical director for infection prevention
The doctors pointed to five factors, when considering how risky a given activity might be: Whether it’s inside or outside; proximity to others; exposure time; likelihood of compliance; and personal risk level.
Outdoor activities are generally safer, they said, because the virus becomes less concentrated outside and doesn’t get recirculated around like it could indoors.
Activities that prevent social distancing – like playing basketball or packing in at a music concert – are also riskier.
The experts also point to exposure time as a factor. Walking by a person on a trail is less likely to spread the virus, compared to sitting in an enclosed space with somebody for hours.
Some environments are tougher than others, when it comes to enforcing precautions. So places where compliance is most likely are a lower risk than places where people don’t have to follow the guidelines.
People must also consider their own personal risk level, such as if they have health risks that make them more susceptible to COVID-19.
"Until we have a vaccine, we are going to have to move forward with risk reduction strategies," Sims said. "Because you can't keep the economy on hold forever, you can't keep peoples' lives on hold forever."
The list, below, assigns a score for activities from 1 to 10, with a 10 being the riskiest and a 1 being the least risky. The score is an average of scores given by the health experts, rounded to the nearest whole number.
Naturally, there are caveats. For example, while the experts said going to a gym is very risky, attendees could be sneezing on each other and ignoring all precautions and still have zero risk if nobody has the virus. And vice versa, playing tennis is one of the least risky activities – but if your partner has the virus, the actual risk is high.
But because many people can have COVID-19 unknowingly without showing symptoms, it's impossible to know who is and who is not infected at a given time.
The doctors emphasized that if everybody takes precautions, the risk level for each activity is dramatically reduced, they said.
"Anything where there's a crowd of people, without risk reduction strategies, it's a 10," Sims said.
Here's the ranking of 36 activities, starting with the most hazardous.
Bars
Risk level: 9
Experts agree – bars are very risky.
"After a couple of drinks, they're starting to feel a little more invincible," Husain said. "And that's when the trouble starts."
People let their guard down when drunk, so expect fewer precautions to be followed at bars. Also, people can't wear masks when drinking, people pack in tightly and there's more mingling – making bars riskier than restaurants.
Being inside also raises the potential for the virus to spread in bars.
"I'd probably give bars a 10," Sims said. "I'm really worried about bars."
Large music concerts
Risk level: 9
Even if a concert is outside instead of in a stadium, large gatherings like this can be a hotbed for virus spreading, experts warned.
Like bars, people are packed in and drinking alcohol. But another issue is the singing.
"Singing is a really effective way of spreading the virus," Emig said.
When people talk loud or sing, it potentially emits more of the virus into the environment, further increasing the risk level, here.
Sports stadiums
Risk level: 8
Just like concerts, sports stadiums have crowding and alcohol. People are also likely to cheer, yell and sing, among other noises, which also makes the spread easier.
Gyms
Risk level: 8
Similar to singing, people emit more respiratory secretions when working out and breathing heavily, Husain said.
It's also tough to work out while wearing a mask and can be difficult to distance, the experts said.
Once gyms are open, Emig suggests using the individual equipment – and wiping it down – instead of doing indoor group activities like spin and dance classes.
Amusement parks
Risk level: 8
Lots of precautions will be needed to keep amusement parks from being coronavirus spreading zones, experts said.
Parks need to limit the number of people, enforce distancing, wipe down rides after each use and more.
"Even with risk reduction strategies, I think it's going to be difficult," Sims said. "It's about the riskiest you can get."
Churches
Risk level: 8
Some of the early coronavirus spread has been tied to churches, Sims said, and there's a good reason.
The risk can be reduced if seats are arranged the right way, everybody wears a mask and other precautions.
"If they add singing, then it's on a par with bars," Emig said. "People are going to hate that, but it's the truth."
Buffets
Risk level: 8
Buffets are more hazardous than regular restaurants, but not as bad as bars, the experts concluded.
People congregate at a buffet and share serving utensils. If a buffet is redesigned to limit the flow and other risks, Sims said the risk level can be lower.
Basketball
Risk level: 7
The experts agreed that most outdoor recreational activities are low risk, but contact sports like basketball are the exception.
"You're banging into each other," Sims said. "There's a chance for masks to be ripped off. People may not want to use masks, because as you start breathing harder, the masks become more and more uncomfortable."
If you're playing by yourself or against others from your household, the risk is much lower, Husain said.
Public pools
Risk level: 7
Swimming in your own pool with people from your household is fine. Swimming in a public pool is a different story, the doctors said.
"There's no way to make it safe," Emig said. "How are you going to wear your mask in the pool?"
Because masks aren't waterproof, the experts said it's highly unlikely to see swimmers wearing masks – heightening the risk. Crowds are also likely in public swimming areas.
"We don't have good data to show how the virus would behave in a pool," Husain said. "Pool water does have chlorine in it, but I don't think it's high enough to be very effective in completely reducing risk to zero."
Schools
Risk level: 7
Schools have a bunch of complicated factors, when it comes to risks for spreading COVID-19. Students are often within 6 feet of each other and for hours at a time.
That's on top of the added challenge of getting children to follow precautions like staying separated, wearing a mask and washing hands well.
Casinos
Risk level: 6
Casinos check many of the concerning boxes – like crowds, alcohol and loud talking. Casinos with more of an open floor plan and other precautions in place will be less risky, the experts said.
Restaurants, indoor seating
Risk level: 6
Eating inside at a restaurant is riskier than eating outdoors because of the air exchange, the experts said. Because the same air is recirculated through a building and people aren't wearing masks, it's easy to spread the virus to people even more than 6 feet away.
If you’re going to do it, Sims recommends asking for a table that’s not in a high traffic area such as near the entrance or bathrooms.
Playgrounds
Risk level: 6
Similar to schools, experts are worried about playgrounds because it's difficult to enforce health precautions on children.
"Kids tend to touch their mouth or cough or sneeze on surfaces. You can't make little kids separate by 6 feet – it's just not the way they work," Cunningham said. "I'm not a big fan of playgrounds right now."
Supervised playgrounds with small numbers of children have a much lower risk, Sims said. Even though kids rarely get symptoms of COVID-19, they can easily be vectors for the virus, Emig said.
Hair salons, barbershops
Risk level: 6
The nature of haircuts and hairstyling make social distancing impossible.
"That's high risk, no matter how you look at it," Husain said. "They're right in your face."
To make hair places less risky, masks should be required for all customers and staff and the waiting area should be closed to make people wait outside or in their vehicles.
Emig also recommends going to a place that doesn't use hairdryers, as that could potentially circulate the virus inside. Older people and others at a higher risk for COVID-19 should get a first-in-the-morning appointment, which is when the salon or barbershop should be the most virus-free.
Pontoon boat rides
Risk level: 6
Going for a boat ride with people you’re living with isn’t risky, but it can be if you’re doing it with a big group of people from other homes.
It's a slightly higher risk than some other gatherings, because there's a better chance of drinking and loud talking on boat rides, Emig said.
Movie theaters
Risk level: 6
Movie theaters aren’t designed with pandemics in mind. They’ll need to look differently if they want to reopen with low risk, with precautions like spacing out seating, making people wear masks and limiting when people can get up and walk by others who are seated.
"The movie theater of old is going to be tough," Sims said.
Outdoor theaters would be better, due to better air circulation, experts said.
Dinner parties at a house
Risk level: 5
Indoor social gatherings bring more risk than outdoor ones, the experts said. Having a dinner inside a house might limit the amount of people to a gathering – but it's harder to space people out.
Airplanes
Risk level: 5
There were varying opinions on the safety of flying in an airplane during a pandemic – two experts called it medium risk, one said it's low risk and the other side it's high risk.
There's a lot up in the air, regarding what precautions might become standard for airlines – from masking to eliminating the middle seat to wiping down surfaces.
"That's actually pretty safe, the air is very well filtered on airplanes," Cunningham said. "As long as someone's not obviously sick, I'm going to give that a 3."
Emig said the issue is most people don’t wear masks correctly. And plane trips can bunch lots of people together for long periods of time – which is why she believes airplanes are higher risk.
Backyard barbecues
Risk level: 5
Outdoor gatherings make it easier for people to stay 6 feet apart. If people are masked and keep their distance, experts said this becomes a low-risk activity.
Malls
Risk level: 5
Without precautions like limiting the number of people in stores and requiring masks, malls can be high risk, Sims said. If everybody is following all the rules, it can be as low as a 2 out of 10 on the risk scale, he said.
Beaches
Risk level: 5
Beaches are complicated, the experts said, as there could be a wide range of risk depending on the situation.
A beach is low risk for spreading the virus if it's not crowded and people maintain their distance.
"But therein lies the problem," Emig said.
It's difficult to limit numbers and enforce precautions at beaches, they said. Husain recommends going at an off-peak time, like at sunrise, to avoid risk.
Bowling
Risk level: 5
Bowling balls, tables, consoles and other equipment need to be cleaned thoroughly, people need to wear masks and every other lane needs to be left open to reduce risk at bowling alleys, Sims said.
The fact that it's indoors and people are near each other for hours at a time doesn't help.
"Bowling alleys are not known for their high levels of air filtration and circulation," Emig said.
Dentist's offices
Risk level: 4
Going to the dentist is another activity the experts disagreed about on its risk level of spreading COVID-19. Two experts called it low risk, one said it’s a medium risk and the other said it’s high risk.
Dentists already wear masks and will likely wear extra protective equipment like surgical masks and shields to keep themselves protected. Emig, however, was the one expert to say going to the dentist has a higher risk than getting a haircut.
"Dental cleaning aerosolizes what's in your mouth," Emig said. "If somebody unknowingly has the infection, that virus is going to get aerosolized."
She recommends avoiding the dentist for now, unless there's a specific issue that needs to be addressed.
“The difficulty is, if you’re a patient who’s coming into the room 20 minutes after a cleaning has been done on somebody who didn’t know that they carried the virus, you’re going to be walking into that room and breathing that virus,” Emig said.
Walking in a busy downtown
Risk level: 4
Walking around downtown carries a lower risk because it's outside and you don't have to be exposed to any given person for very long – and can steer clear of non-masked people.
But if it's particularly crowded, it could still be a problem.
"Anything with crowds is bad. Try to avoid crowds," Sims said. "We're going to need to learn to thin out the crowds."
Offices
Risk level: 4
Unlike shops and restaurants, offices are lower risk because employers can better enforce the rules of distancing and masking.
The experts say it's still safer to work from home, though, since being around people for eight or 10 hours increases risk.
Doctor's office waiting rooms
Risk level: 4
Many hospitals and doctor's offices are changing protocols in response to the pandemic, spacing out chairs or having people check in with their phones curbside and waiting in their vehicles.
These precautions all help lower the risk, but waiting rooms could be risky if places are ignoring precautions.
Eating outside at a restaurant
Risk level: 4
The four experts interviewed unanimously agree: Eating outdoors at a restaurant is safer than eating inside.
The better air circulation reduces the concentration of the virus in the air, therefore reducing the risk people might inhale it.
Getting groceries
Risk level: 3
Grocery stores are adding lots of new precautions to keep from becoming a virus-spreading zone. But they're another place where masking is key.
If many people aren't wearing masks, the risk is much higher, Sims said.
Camping
Risk level: 3
If this is a family unit going camping by themselves, it's riskier than staying at home. But big camping events or overnight camps for children pose higher risks, Sims said.
Hotels
Risk level: 3
The biggest risks at hotels are at check-in time and any other time people might congregate – like breakfast. Try to find a hotel that has contactless check-in, Emig said, to lower your risk.
Don't worry as much about how well your room was cleaned or who stayed in the room before you, that's not the most likely way the virus would be spread in a hotel environment, Emig said.
Golfing
Risk level: 3
Golfing has a low risk, among the recreational activities, because it's outdoors, is a non-contact sport and has small groups of people.
It starts to become an issue when people start mingling, sharing golf carts and getting within 6 feet of each other.
"Just play golf, say hi and bye, and go on your merry way," Husain said. "Don't come close to each other."
Libraries and museums
Risk level: 3
These aren't typically super crowded areas and often have larger spaces and higher ceilings, which helps lower the risk.
These places are also in a position to enforce masks and distancing better than many other spaces, Emig said.
Going for a walk, run or bike ride with others
Risk level: 2
Walking, running and biking on trails poses a low risk, because you don't come into contact with many people and aren't near them for long. The risk increases if you're with a larger group of people who are close together and not wearing masks.
It's not a bad idea to give extra space to unmasked people running past you in the other direction, Husain said. When you're working out and breathing harder, you're spewing more of those respiratory secretions and potentially the virus into the air, he said.
Getting fuel
Risk level: 2
Gassing up your car is low risk, experts said. It's outdoors, you're not close to anybody and you're not there for long.
While in theory, the virus can stay on the handle of the gas pump from the previous customer, the virus is mainly spread through the air via close contact with people, the experts said.
Still, using hand sanitizer after refueling doesn't hurt.
Getting takeout from a restaurant
Risk level: 1
The experts have little concern about getting takeout from a restaurant – especially with all the new safety measures in place with curbside pickup and touchless payment at many restaurants. This is much less risk than eating at a restaurant, they said.
Playing tennis
Risk level: 1
There’s also little concern with playing tennis, the experts said. Spacing is part of the game, it’s typically outdoors and there’s only two to four people on a court. While some sports activities cause concern for the health experts, tennis is not one of them.
COVID-19 PREVENTION TIPS
In addition to washing hands regularly and not touching your face, officials recommend practicing social distancing, assuming anyone may be carrying the virus.
Health officials say you should be staying at least 6 feet away from others and working from home, if possible.
Use disinfecting wipes or disinfecting spray cleaners on frequently-touched surfaces in your home (door handles, faucets, countertops) and carry hand sanitizer with you when you go into places like stores.
Michigan Gov. Gretchen Whitmer has also issued an executive order requiring people to wear face coverings over their mouth and nose while inside enclosed, public spaces.
Additional information is available at Michigan.gov/Coronavirus and CDC.gov/Coronavirus.