In the midst of the COVID-19 pandemic, people around the world have been asked—and at times directed by government officials—to practice social distancing. This public health term calls for avoidance of mass gatherings and maintaining a distance of six feet from other people. How can these fairly simple steps limit the spread of the virus? Waleed Javaid, MD, Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, explains social distancing and how the practice aids in the fight against COVID-19.

How does social distancing help limit the spread of COVID-19?

If we are standing close together or talking close together in any setting, it’s possible that our respiratory droplets can be transmitted to the person standing or sitting next to us. Since it appears that respiratory droplets are a primary transmission vehicle of COVID-19, that in itself is a risk.

The other phrase we often hear in relation to ‘social distancing’ is ‘flatten the curve.’ What does that mean?

For coronavirus, the curve is going upward. We have doubling of infections every two to four days, which means there is uncontrolled spread in the community. Through effective use of social distancing, we hope to decrease the overall number of people who get the infection, or flatten that upward curve.

To achieve this, it is important that everyone does their part. So, if I am having a party at home, that will not help this situation. Decreasing the number of transmissions will benefit our community and reduce the stress on the health care system.

If you have an essential job and need to use mass transit to get to work, how can you protect yourself?

I have been using mass transit for several days and, right now, it is easy to maintain social distancing because everything is pretty empty. Since policies have been put in place to reduce staff, crowding has been decreased substantially. However, if you have to get into a more crowded bus or subway, make sure to keep your distance, more than two arms distance apart. If you can’t, try turning around to move your face away from crowded situations

Can I take a walk in the park or a bike ride in an uncrowded area?

It’s really great exercise, but as we are all challenged to sacrifice, if it is not vital for our survival, we should stay home and exercise.  We really cannot participate in any activity that increases community risk. We need to think of this from a different angle, not from personal but from the community we live in, which includes the elderly and those who may have a much higher risk of bad outcomes if they get infected.

Are any outdoor activities acceptable while practicing social distancing?

Minimizing all outdoor activities is ideal. Try to do only what is absolutely necessary. This outbreak is like nothing that has been seen before. So, let’s just pause some of our activities. We need to minimize our exposure and think things through. An individual action could have a grave effect on a community.

Health care providers have to come to work because a lot of lives are affected. We have to be in a social situation. We have to do that for everyone’s health. So think, is your activity more important than the community spread of this virus?

As COVID-19 continues to have a dramatic impact around the globe, and front-line doctors, nurses, and health care staff are managing a growing number of cases, there is understandable anxiety.

Waleed Javaid, MD, Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, and Director of Infection Prevention and Control at Mount Sinai Downtown, offers a perspective on how health care providers can help keep their families safe.

“Health care workers, like everyone in the community, should remember hand hygiene, be mindful of social distancing on the home front by avoiding large family gatherings, and in times of a pandemic, they need to have a plan for their families,” Dr. Javaid says.

In this Q&A, he provides additional advice to reassure health care providers how they can help keep their families safe.

What kind of issues do I need to discuss with my family?

Health care workers, like everyone in the community, should discuss all aspects of the pandemic with their families. Everyone should have a plan in place for their home should anyone in the family get ill—and most importantly, planning does not mean panic. It’s a simple thing: should somebody become ill, have you identified a place in the home, an extra bedroom, or separated area, for example, where they can remain separated? The vast majority of people who become ill can get better on their own, and with proper social distancing and precautions, family members can remain protected.

What kind of precautions do I need to take as I leave my shift?

Outside of the hospital environment—where you do not have protective equipment—it is important to reinforce that you should use the same precautions as everyone else: hand hygiene and maintain social distancing.,

First, wash your hands before you leave. Then, take a moment to gather your thoughts. Make sure that if you had any exposure, or any concerns of exposure, that you address it with your supervisor so the issue can be followed up immediately. Check your symptoms—How are you feeling? Also, take an additional moment—because in this crisis you have played a very important role. Wipe your work surface with hospital wipe, and remember to clean the surfaces again when you return.

Should I remove my work clothes before I walk into my house?

Before the COVID-19 pandemic, there was the general recommendation from infection prevention that health care workers in procedural areas like the operating room should change into street clothes before leaving the hospital. The recommendation is still true today. Health care workers who are involved in procedures that may lead to contamination of their scrubs with blood and body fluids should change into street clothes before leaving the hospital. For everyone else who does not work in procedural areas, donning and doffing PPE throughout the day may cause you to sweat more. Respiratory viruses, including coronaviruses, are not transmitted through articles of clothing. But it is not unreasonable to change when you get home if that would make you more comfortable.

Should I avoid my family members when I am at home?

If you are feeling well, there is no reason to avoid your family members. Frequent hand hygiene with soap and water or alcohol-based hand sanitizer is recommended. Everyone should make sure that they cover their nose and mouth when they cough or sneeze, but otherwise you may act normally with your family members.

Should I avoid interacting with my pets?

If you are feeling well, there is no reason to avoid your pets. Similar to contact with humans, you need to make sure that you cover your nose and mouth when you cough or sneeze.

Are there any additional precautions I can take at home—for example, wash my clothes separately?

There is no recommendation about separate clothing screening. But, washed clothes should be dried in a dryer because that helps reduce any contamination on the clothing. You should think about wiping the phone and other products with a compatible cleaner, preferably one that has antimicrobial rating. Wash your hands afterwards, and you should be good.

As the outbreak of COVID-19 widens, transplant patients have some special concerns. Meenakshi M. Rana, MD, the Director of Transplant Infectious Disease, Mount Sinai Health System, shares her perspectives on what transplant patients need to know about the virus.

Should transplant patients be concerned about COVID-19?

We’re just learning how this virus could potentially affect transplant patients. We do know that this virus is similar to other common respiratory viruses, and that the symptoms have a lot in common with the flu. Many of the patients affected by COVID-19 have mild symptoms, typically fever and cough. Many of them are fine at home, though some patients may have more severe complications such as pneumonia and may require hospitalization.

What is the special concern for these patients?

We are very concerned about our transplant patients because they have compromised immune systems, and they’re more at risk of having severe complications. It’s really important that our transplant patients take precautionary measures such as hand hygiene. We know the virus is spread by direct contact. However, it is easily killed simply by washing your hands with soap and water for 20 seconds, or using an alcohol-based hand sanitizer. So washing your hands is the most effective thing you can do to prevent transmission of this virus.

What other precautions should transplant patients take?

First of all, if you’re sick, please stay home. If you need to cough, don’t cough into your hands, cough into your elbow. Throughout your home, use a disinfectant to wipe off surfaces that are commonly used such as door handles, bathroom fixtures, and countertops.

As a practical precaution, make sure that you have an adequate supply of your medications at home. Call your physician and ask for a three-month supply of your transplant medications so you don’t run out.

And if you do go out, be very conscientious about hand hygiene and disinfecting surface like your phone. If you know someone is sick, this is not the time to visit with them. And in general, avoid large crowds.

What about masks?

We have been getting a lot of questions about whether protective masks are effective. We don’t think wearing a mask in public is an effective way of protecting yourself. Washing your hands and disinfecting surfaces is a much better way to prevent transmission of this virus.

What should transplant patients do if they have symptoms of COVID-19?

If you have symptoms such as fever, coughing, or shortness of breath, call your transplant provider. We want to know if our patients aren’t feeling well. We will ask about your symptoms. If you’re having mild symptoms, such as a cough, sore throat, or runny nose, we may advise you just to stay at home. We’ll follow up in a day or so to see how you’re doing. If your condition has worsened, and you have a high fever and shortness of breath, we may bring you into the hospital and evaluate you further. If you do decide to come in, we ask that you call ahead so that we know how to triage you, and so that we can determine the best location to receive you.

Meenakshi M. Rana, MD, is the Director of Transplant Infectious Disease for the Mount Sinai Health System. She is also Associate Professor of Medicine of Infectious Diseases at the Icahn School of Medicine at Mount Sinai.