COVID-19 risk levels: winter edition

Published November 18, 2020


Way back in June, we shared Coronavirus Risk Levels by Activity to explain that some activities are at a higher risk to spread COVID-19. Now, winter is upon us. We've also learned from contact tracing where people commonly contract COVID-19.

We've asked infectious diseases expert Nicolás Cortés-Penfield, MD, to update our assessment. Here, Dr. Cortés-Penfield shares how risky these activities are with what we know now. 

"Loathe as I am to make myself the posterchild for doctors who don't want you to have nice things, Nebraskans need to understand that our hospital systems have already reached their breaking point," says Dr. Cortés-Penfield. "The increase in COVID-19 diagnoses we're seeing now has already ‘baked in' an increase in hospitalizations that will come in the following weeks as many of those people get sicker, and this spike in demand is going to exceed our supply of beds, caregivers or both."
 COVID-19 Risk Levels By Activity - Winter Edition

Note: These imperfect rankings are based on assumptions. Every situation is different. People can change a safe activity into a risky one by not wearing masks, staying indoors, not social distancing, interacting longer than 15 minutes and other unsafe behaviors. Talk to your primary care provider for medical advice for your specific health condition. Adapted from graphic with info from MLive, by David Foster/Yahoo Finance.

Spending the holidays safely

"Our COVID-19 situation is already out of control. Having hundreds of thousands of Nebraskans all expose themselves to COVID-19 at once when they gather for Thanksgiving or Christmas is going to make it so much more dire," says Dr. Cortés-Penfield. "This would be the exact opposite of flattening the curve – we'll have thousands of people all needing hospital care at once, way beyond the number of people Nebraska's hospitals will be ready to serve. In this version of the holiday season, we'll see a lot of fellow Nebraskans who might have otherwise lived die."

"For what it's worth, I'm saying this as a new dad, with an infant daughter that three out of four grandparents have never met, and my wife and I told our folks to stay home this year," he says. "So I know it's a hard thing to ask. But, if you actually care about your neighbors and your extended family, I think the right thing to do is have the in-person holiday dinner with just the people you live with, and maybe you prop up your phone at the table where your folks would usually sit and have them join by Zoom. The goal this year ought to be making sure everybody is still at the table next Thanksgiving."

The high risk of indoor dining

Indoor dining spreads COVID-19. "Restaurants are the major source of Nebraskans' prolonged, close-proximity exposure to multiple people outside the household right now and almost certainly a primary driver of our pandemic," says Dr. Cortés-Penfield. "Most people aren't wearing masks most of the time because they're eating. The folks who are trying to wear their masks are taking them on and off again to eat, repeatedly touching their masks and faces and risking exposure that way." The takeaway is to stop dining in and get takeout instead. 

Airplanes (risk level six) are also still riskier than driving in your vehicle (risk level three). Dr. Cortés-Penfield explains, "I bumped the risk of air travel up because there have been a couple of large clusters associated with air travel. It is still rated lower than indoor dining because restaurants are a more prevalent means of transmission."

Winter fun: ice skating, sledding and Christmas caroling

For common winter activities, consider spacing whether you're indoors or outdoors. If you keep away from people you don't live with and wear a mask, it's less risky. "A busy indoor ice rink probably carries substantial risk, whereas skating outdoors with just a few other people probably does not," says Dr. Cortés-Penfield. "Similarly, if your sledding doesn't include prolonged physical proximity to other people, it would be a fairly low-risk activity."

"Finally, Christmas caroling is going to be a relatively high-risk exposure because it usually involves groups and always involves singing, which has clearly been implicated as a high-risk activity. There have been several superspreader events associated with church choirs. From a safety perspective, the two things Christmas caroling has going for it is that it's outdoors and can be done at a distance." Note that churches are riskier than Christmas caroling because the singing happens in an enclosed space indoors.

Gyms and theaters

Indoor gyms may be a specific transmission risk because: 

  • A lot of people congregate in a small space
  • People breathing heavily puts more virus into the air
  • Heavy breathing or sweating can dampen your mask, making it less effective

What about going to the movies? "Movie theaters seem an obviously high risk to me," says Dr. Cortés-Penfield. "Even a half-full theater (50 to 100 people) would be nearly guaranteed to have someone with COVID-19 right now. And, you'll be spending two to three hours in a poorly ventilated room with them. Given the increasing evidence for airborne or small particle transmission of COVID-19 in this setting, merely sitting 6 feet away from your fellow movie-goers would not be adequate." Theaters could partially mitigate this risk by holding screenings hours apart and limiting capacity so that moviegoers can space themselves more than 10 feet from people outside their household, but these are imperfect solutions. "You could stay home and watch the Mandalorian instead," he says.