Home Health News There's no reopen template so the advice is: Follow the 4 C's – Minneapolis Star Tribune

There's no reopen template so the advice is: Follow the 4 C's – Minneapolis Star Tribune

7 min read


When the country was largely under lockdown, at least the rules were mostly clear. Essential workers ventured out; everyone else stayed home. Bars and restaurants were closed except for takeout; hair salons and spas were shuttered. Outings were limited to the supermarket or the drug store.

Now states are lifting restrictions, but detailed guidance about navigating the minutiae of everyday life is still hard to come by — and anyway, there’s never going to be a ready solution to every problematic circumstance you may encounter.

“Ramping down was easy by comparison, even though it felt hard at the time; we basically flipped a switch,” said Dr. Preeti Malani, an infectious disease expert who is chief health officer for the University of Michigan. “Reopening is much more complicated. There is no template, no playbook. We can’t just say, ‘Follow these 10 rules, and you’re good.’ ”

Even in the absence of detailed directives, however, there’s scientific consensus about a general approach that can reduce the spread of the virus. Try to follow three precautions: avoid contact, confinement and crowds. And make realistic choices.


You need to continue with social distancing precautions. That means wearing masks, washing hands well and often, and keeping a distance of at least 6 feet from one another. No hugs, at least not in the usual way. No handshakes.

Try to make sure that public spaces you frequent are maintaining mitigation measures: spreading out tables at a restaurant, limiting or spacing out patrons in shops and parks, and conducting frequent cleaning and disinfection.

The virus is spread most efficiently from person to person, but the CDC nonetheless recommends frequent cleaning of high-touch objects and surfaces like tables, doorknobs, light switches, countertops, handles, phones, keyboards, toilets and faucets, touch screens, ATMs and gas pump handles.

Any 15-minute face-to-face conversation between people who are within 6 feet of each other constitutes close contact, said Dr. Muge Cevik, an expert on infectious diseases and virology at the University of St. Andrews School of Medicine in Scotland.

The longer the conversation and the closer the physical proximity between the participants, the greater the risk of the virus spreading if one person is infected.

That explains why transmission is rampant within households.


Indoor activities in confined enclosed spaces, even large ones, are more conducive to spreading the virus than events held outside, especially if the air inside the building is being recirculated or the windows don’t open.

Many infections have been traced to public transportation vehicles like buses and vans. Some experts have raised questions about the safety of enclosed public spaces, like office buildings, indoor restaurants and nightclubs.

“When there’s stagnant air, the droplets could persist longer than you would expect, and there will be a lot of contamination on surfaces,” Cevik said. A flow of fresh air dilutes the virus, she said.


Large groups are risky no matter where they are gathered. Even outdoors, crowds mean more people, more contacts — and more potential sources of infection. And ultimately, preventing infection is a numbers game, where less is more.

“It’s a really different way of thinking that most people in the world aren’t used to,” said Dr. Barbara Taylor, infectious disease specialist at the University of Texas Health Science Center at San Antonio.

Many bars in Texas are outside, she noted, and are therefore relatively low risk. But the number of patrons in a space still matters.

“You can create a scenario where you have everybody 6 feet apart, but if that scenario involves 500 people, that is inherently more risky than if that same scenario involves 30 people,” Taylor said.

Another concern about drinking holes: As people become inebriated, they let their guard down and lose their inhibitions.


Every individual ultimately must make a personal decision about the level of risk he or she is comfortable with.

People at high risk for developing severe disease if they become infected with the coronavirus will want to take the greatest precautions.

That group includes those 65 and older; residents of nursing homes and long-term care facilities, and people with compromised immune systems, with chronic lung or kidney disease or heart conditions, or who are severely obese.

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