By Marlene Cimons | July 3, 2020
As Americans learn to live with the coronavirus, many are struggling with decisions about which practices are safe or risky for them. The Washington Post asked six public health/infectious diseases specialists about their own behavior choices.
Questions & answers
Q: When and where do you wear a mask?
Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases: It dominates everything I do. The only time I don’t wear one is when I am alone, when I am home with my wife, or when I am speaking in public — provided there is 6 feet between me and the people to whom I am speaking, as was the case when I answered questions at the recent Congressional hearings.
Elizabeth Connick, chief of the infectious diseases division and professor of medicine and immunobiology at the University of Arizona: I walk in the morning and never wear a mask walking around in my neighborhood. Even if you see somebody, you can keep your distance. But I do wear it otherwise. I don’t wear one inside my own office, but I do wear one in the general office area. I wasn’t wearing one before, but now everyone is masking because we have more covid spread [in Arizona]. Paul A. Volberding, professor of medicine and emeritus professor of epidemiology and biostatistics at the University of California at San Francisco: I wear a mask most of the time, although not inside the house or sitting outside on my second-floor deck. I think people are crazy not to be wearing masks. The evidence that they are effective is pretty strong. I’ve noticed in recent weeks that the number of people wearing them seems to be decreasing, which concerns me. There is no shame in wearing a mask.
Linda Bell, South Carolina’s state epidemiologist: I wear one in public whenever possible, in stores, office settings, if I encounter groups of people that I can’t distance myself from and during press conferences when I’m not speaking. Barry Bloom, Jacobson research professor and former dean of the Harvard T.H. Chan School of Public Health: Every time I leave the house, inside and outside, and certainly when I shop. David Satcher, former U.S. surgeon general, former director of the Centers for Disease Control and Prevention, and, most recently, founder of the Satcher Health Leadership Institute at the Morehouse School of Medicine: All the time. Even when I’m in the office, I keep it on, since people are always coming in and out. The only time I don’t is when I am home.
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Q: Besides family, do you allow anyone else inside your home, such as cleaners or service people for repairs? Fauci: The only person who comes into the house besides (my wife) Christine and me is the woman who cleans the house once every two weeks. She wears a mask and gloves at all times while in the house. Connick: I pay someone to clean house. She was very afraid at first, and didn’t come for six weeks, but I paid her anyway. Then she decided she was comfortable and came back. I’m not here when she cleans, and she’s gone when I come home. So I am not breathing her air. I do have a pest control guy come. He’s quick, and I stay far away from him. Volberding: We have cleaners who come once a week. They text me when they are nearly here, and (my wife) Molly and I close ourselves into a room on the top floor study and don’t interact with them at all. They text when they are leaving. They are good about disinfecting. As for the room we stay in, it’s my chore to keep it clean. Bell: I allow repair workers in the home and don’t make them wear a mask while they’re working, but I do when I have contact with them, and I keep my distance. Bloom: Yes, but only people I know, and we keep our distance and often wear masks. Satcher: Yes, probably more than I should. My daughter is upset at the number of people I let in who don’t wear masks, although I wear one. Q: Do you shop in grocery stores, or order online? Do you wash the items off or disinfect the outside of packages once you get home? Fauci: I do physically go to the grocery store, but I wear a mask and keep my distance. I usually go at odd times. I spend half the day alone in my office, and I’m part-time at the White House. In the late afternoon or evening, when I’m finished with the White House, I go shopping for groceries, or to drugstores. I don’t disinfect the bags. In general, I will take the materials out of the bags, then wash my hands with soap and water, and then use Purell, and let everything sit for a day. Connick: I wear a mask when I shop, and stay away from people while in the store. I try to minimize my trips. As infections become more widespread, I think I will be more conscientious about making only one visit a week. I don’t wash the packages. I did that for about a week, then decided there would be more cases if the virus was transmitted that way. I don’t think there is a lot of virus hanging around on those packages. But I do wash my hands. Volberding: We have wonderful stores in our neighborhood that really enforce everything. They don’t let you get close to anyone else and everyone wears a mask. I don’t disinfect or wash anything. I don’t think the evidence for surface contamination is real. I don’t wear gloves in the store, but I wash my hands before I go and when I come back. Bell: I shop in grocery stores and order online. I don’t disinfect packages that I bring into my home. Bloom: I shop at grocery stores, and also have them shipped. I don’t wash them, but usually let them sit for a day before I use them. The bug dies pretty quickly. Satcher: I shop in grocery stores and I wear a mask. I do the handwashing thing. I’m compulsive about that. I don’t wash or disinfect the packages, but I do wash my hands after touching them. Q: Would you dine inside a restaurant? Outside? Do you get takeout? Fauci: We don’t do anything inside. I don’t eat in restaurants. We do get takeout. Connick: No, no restaurants. I avoid any closed space with a lot of people, particularly when it’s people whose risk I don’t know. I think the biggest risk is being in a closed space and breathing the same air that other people are breathing, and also not wearing masks. I wouldn’t go even if they were wearing masks. I might consider dining outside, although I would rather not. I think being outside is much safer. Takeout, yes. I would die if I didn’t do takeout. Volberding: I wouldn’t feel comfortable yet with indoor seating, but I’d feel comfortable outside, with distances between the tables. We haven’t gone yet. We’ve gotten takeout a couple of times. We are cooking a ton, and love it. Bell: I would not dine in a restaurant, but I would dine outside if the restaurant had a safe set up. I do get takeout. Bloom: I would not dine inside now. I would dine outside. I’m a big believer in outside, that it’s safer outside. Satcher: I have not dined inside a restaurant in a long time, and I used to do it a lot. I have not dined outside, but I would if I could be six feet away from other people. I do sometimes get takeout. Q: Do you take any precautions with your mail or packages? Fauci: I used to, but now I just bring the mail in, wash my hands, then let it lie around for a day or two before I open it. Connick: I’m just not that interested in my mail. It’s in a locked box across the street from my driveway, and I only pick it up once a week. If there is any virus on those letters, it gets cooked off. I don’t think a virus is living on my mail, and I’m really not worried about it. I don’t worry about packages. I open them. Volberding: I don’t take any precautions with my mail. As for packages, there is no contact with the delivery person. I don’t leave them outside — they’d be stolen if I did. Bell: No. Bloom: I let them sit for a day. That’s probably irrational, but I do it that way. Satcher: I’m so compulsive about mail that I’m reading it before I get it into my house. But I do wash my hands afterwards. Q: Do you go to friends' homes for dinner, or have friends to your house, or see them in other ways? Fauci: On the rare occasion when we have people over, we have them out on the deck, six feet apart, and we never have more than two people, and they are people who themselves are locked in. We wear masks, unless we are eating. We don’t share anything. There are no common bowls. Each person has his or her own receptacle. Some people even bring their own glasses. We always do takeout and I tell the takeout people that I want the food in four separate plastic containers, so no one has to touch anyone else’s food. Everyone’s food is self-contained. Also, we always stay outside. We don’t do anything inside. If it’s too hot, or rainy, we cancel it. Connick: There are a few friends I see for dinner. In Tucson, you can sit outside to eat. I’ve had a few people over to dinner and we eat outside. I don’t have many people over. The people I have over have been quarantining. We don’t wear masks. We sit outside at a good distance. I think if you are outside at a good distance the risk is very small. I invite over people who are very circumspect in their behavior. No one comes over to my house who goes to restaurants or bars. Volberding: Except for seeing immediate family, the only thing we have done was to go to a birthday celebration for a friend in Golden Gate Park. Everything was widely spread out, and everyone was wearing masks. Everyone brought their own blanket and food. We haven’t been in anyone else’s house, and no one has been in ours, except our kids, and only once in a while. Bell: I don’t go to friends’ homes for dinner at this time. I do see friends by practicing physical distancing and using masks if we have to be closer than six feet for longer than a few minutes. I allow friends in the home whose practices I’m confident in. Bloom: I have only seen friends once, to dine outside, which was very nice. I am very keen on the outside and dispersion of aerosols sitting in the open air, but concerned about them in closed settings. Satcher: I have not been to anybody’s house for dinner since this started. My son and his family came over for the day, and my daughter was over once to help me with a Zoom presentation. Q: Are you getting your hair cut? Fauci: I usually get it cut every five weeks, but I didn’t go for a long while. By the 11th week, it was looking really bad. So I asked the woman who cuts my hair if I could come in really early in the morning, at 7 a.m., and we arranged to do that. No one else was there. She wore a mask and I wore a mask. Connick: I do not go to the hair salon. I pay my hairdresser to come to my house. The first time he did it, he said: “It’s on me, thanks for being a health-care worker.” The second time, I insisted. He did it outside the first time, the second time, inside. He comes once a month. No mask for my hairdresser or me in the past. However, now that salons are open, I will have to ask him how much time he has spent at the salon. If he is spending a lot of time, I may ask him to mask. We will definitely do hair outside next time. The pandemic is unfortunately ramping up in Arizona, and everyone’s risk is greater now than it was two months ago when he first cut my hair. Volberding: [laughs] I am quite bald. I have a little hair on the sides and I buzz that off myself. I know Molly would love to get to the hair salon. She took some kitchen shears a couple of weeks ago and whacked off her hair. I understand the urge to get back to some of those personal services, but I haven’t been inclined at all. Bell: I have not, but I would go if the business only allowed one client at a time in the general area, there was no waiting with other clients and the use of masks by all employees was required. Bloom: Nope, I haven’t in three months, but that’s because the barbers were closed down. Now you have to make an appointment, and I haven’t had the time. Everybody wears a mask, so it would be fine. Satcher: I haven’t been to the barber since this started. I cut my own hair now, just like I did when I was in college. Q: Are you willing to fly? What about bus, train, subway? Fauci: I’m 79 years old. I am not getting on a plane. I have been on flights where I’ve been seated near people who were sneezing and coughing, and then three days later, I’ve got it. So, no chance. No Metro, no public transportation. I’m in a high risk group, and I don’t want to play around. Connick: I would only fly if I had to, for an emergency. I would not fly now for pleasure or work. I have a family reunion that happens every year, and I’m not going. But if I had to fly, I would wear an N95 mask. Volberding: I haven’t flown, and I’m not eager to. I don’t like the idea of being in an enclosed space, especially when the airplanes are full. I’ve only ridden BART (Bay Area Rapid Transit) once because we were in the East Bay to see our new granddaughter, and a Black Lives Matter protest took over the Bay Bridge. There was no way to get back except by BART. Normally, I wouldn’t have done it, but it wasn’t very crowded. Bell: No. With the current disease activity in the country, I don’t know when I’ll fly again while airlines don’t require physical distancing and masks required for all. No [buses or trains], but public transport isn’t widely used in my community. Bloom: No, none of them, not until the numbers of cases are down to much lower levels than they are at the moment. Satcher: I am willing, but I haven’t flown recently. If someone invites me to speak, and I can speak by Zoom, I do it. If someone said they really needed me somewhere, I would go, but I would wear a mask all the way. I have not been on the subway since this started, but Atlanta isn’t as big on subways as New York or other places. I just usually drive my car. Q: Would you visit your kids/grandkids? Fauci: My middle daughter, who teaches school in New Orleans, drove up here after they closed the schools. She could teach online from here, so she thought: Why not come home and see her parents? When she got here she went straight through the back entrance into the basement. She stayed in our basement, which has a room with a bed, a shower, electricity, and she did not come upstairs for 14 days. My wife brought food down to her on paper dishes. She lives in a very high risk city, and she wouldn’t let us near her. I wanted to hug her when she arrived, but she said: “No way, dad.” She came upstairs after 14 days, and then stayed with us for several months. Connick: I’m not going to go visit him [a son, 22, who lives in New York City] because of the flying. Besides, who wants to go to New York when you can’t go anywhere? Also, I wouldn’t take the bus or subway there. Those are enclosed spaces where you share air, and I avoid them. Volberding: Not very often. At first, we didn’t at all. We have family cocktail hour Zooms twice a week. We talk a lot about covid, and everyone is being super safe. I held my granddaughter — I couldn’t help that — but I don’t hug my kids or their partners. Bloom: I have a brand new grandson, 2 months old, who lives in Los Angeles. He’s the cutest kid in the world. I would love to fly there and see him, but I won’t. Satcher: I’ve visited my son and daughter-in-law once or twice. They needed me to sign some papers, so I went over. We were social distancing in the garage area and wearing masks, and my grandkids were wearing masks. We also do family Zoom meetings every other week on Sundays which include my two brothers and sister and their children. Q: What would you tell your kids or grandkids who wanted to join a protest march or go to a political rally? Fauci: My daughters feel very strongly about social injustice, but would not likely want to do that. They are very careful with their health. They stay away from crowds. Connick: I’d be so proud of him. I would tell him to wear a mask. He’s young and doesn’t have any health conditions. Nothing is risk free. If that’s what he wanted to do, I’d ask him to wear a mask. Volberding: We are a pretty political family, and believe in these protests. But I haven’t been to a rally. I’m old enough that it’s probably more serious for me. They are young enough that it’s probably less serious for them. But I would tell them to stay to the side and wear masks all the time, and that being in the mosh pit of a crowd is a pretty bad idea. Bell: I would advise them that the risk for exposure is high, and that they should wear a mask at all times, and make every attempt to distance themselves from people without masks. Bloom: The answer would be yes, but wear a mask and try to stay [six to eight] feet away from everybody. I wouldn’t do it because I am at high risk. Satcher: I was quite active in the civil rights movement when I was a student at Morehouse. I went to jail at least five times. What bothers me about today’s protests is that they aren’t as organized as we were. You don’t know who you are marching with. You don’t want to find out when you get there that someone is going to throw a rock or start a fire. Q: Would you go work out at a gym? Swim in a pool? Run? Walk? Fauci: I wouldn’t go to a gym. I need to be so careful. I don’t want to take a chance. I have a pool at home, so I swim in that. I do power-walking with Chris. I was running until about a year ago, but every time I went running, my back would tighten up the next morning. So now I walk the same distance. It just takes longer. We go every day with few exceptions, 3.5 miles per day during the week, four miles over the weekend. Prior to covid-19, I did it at lunch alone in the parks near NIH. Now, I do it in the evening with Chris around the neighborhood. On the weekends, Chris and I do it together on the C&O canal. Connick: I wouldn’t go to a gym. I’d go to an outdoor pool, which is much safer than an indoor pool, since everything dissipates in the air, although I wouldn’t go to a crowded outdoor pool. Volberding: I had a gym built in my house before this and it has everything, so I have no need to go to a gym. But I wouldn’t go eagerly. They can’t disinfect everything all of the time. As for pools, if anything, outdoors yes, indoors no. The swimmers would need to be far enough apart. There is a lot of heavy breathing, so even if they are in the next lane, I don’t think it’s fully safe. I try to get out and walk most days. Bell: Of these I would only run, walk or hike where there were few other people, making it easy to avoid close contact. Bloom: I’m on the treadmill every other day at my house. I belong to a gym, but don’t believe gyms are the safest place to be until the numbers go down. Swimming outside itself is pretty safe — but stay out of the locker rooms. Satcher: I’m not a gym person, even when there is no pandemic. I have to be outside. Being outside is good for you. I still run and walk, although I walk more than I run. I go about three or four miles most mornings. I would swim, since there is no evidence it is spread in water. I would only swim outside, since I am not an indoor swimmer. Q: Are you making routine trips to the doctor or dentist? Fauci: No, not yet, although I might check in within the next few weeks with my physician to get some soothing meds for my throat since I have a hoarse voice from so many briefings and interviews. He will probably take a look and say: “Just stop talking so much.” Connick: Fortunately, I had my doctor checkup just before the shutdown, but I probably would not. As for the dentist, I probably wouldn’t go unless I had an emergency. I wouldn’t go for a routine cleaning. Volberding: Nope. I had one doctor’s appointment done by video. I haven’t been to the dentist, although the problem with dentists is not my health, but theirs. I feel sorry for them. Bell: No. Bloom: No. I’m still nervous about infection control. If I had a major dental or medical emergency, I would go. The medical people take good precautions, but I am concerned with other patients going in and out. Satcher: I haven’t seen a dentist since this started, but probably will go in soon. I’ve seen a physician once or twice for routine appointments, and I was comfortable with the way they handled the visits. Q: What about mammograms? Would you get a routine mammogram/advise your wife/daughter to get one? Fauci: If routine, I’d probably tell her to wait. Connick: I am going to do it because I am a year overdue for mine, and want to get it done, otherwise I probably wouldn’t. Volberding: Not yet. Bell: Yes. Bloom: Probably not. Satcher: There is breast cancer history in the family, so yes. Q: What kinds of questions would you ask a doctor's office before going for a routine appointment — and what are "acceptable risk" answers? Connick: I would ask if they practice universal masking and whether they are seeing sick patients in their office. Volberding: I would ask about disinfection, masks and face shields, and — for the dentist — whether they are using tools that generate a lot of aerosols. Bell: I would ask if they separate sick patients from others, whether they keep a physical distance between patients, whether they require the use of masks for all employees and patients in common areas, do they screen health-care providers for symptoms, and exclude those who are ill. Satcher: I have not interrogated the doctors, because I trust them, and I haven’t been disappointed. Q: Are you working in your office? What precautions do you take? Fauci: I don’t wear a mask when I’m alone in my office, but I slap one on if I walk out into the hall and could pass someone, like my assistant, who also wears one. Connick: In our infectious diseases clinic, if anyone is sick, they are sent home. They are screened outside and talked to on phone, and asked if they are sick. We see people for HIV or other chronic infectious diseases and they are asked not to come if they have a fever or upper respiratory tract symptoms. Also, everyone must wear a surgical mask or we won’t see them. I wear an N95 mask if I am seeing covid patients, as well as goggles and a shield. Volberding: I still have AIDS patients I do by phone. I went into clinic once a few weeks ago, but stayed only a brief period of time. I’m still not too eager to get back to the clinic. I do most work from home. Bell: I primarily telework, but I wear a mask in group meetings when I’m in the office. Bloom: Until recently, school has been closed and locked. I have permission to go in, but no particular reason to do so. I live by Zoom, and it’s fantastic. Satcher: I go in about twice a week and wear a mask all the time, which is the rule. Also, everyone gets temperature checked. Q: Will you ever shake hands again? Hug/kiss someone? Fauci: I think it’s going to be a while. The infection rate will have to be extremely low or nonexistent, or we have to have a vaccine. Right now, I don’t even think about doing it. Connick: I don’t know if people will ever shake hands again. Not until this thing is gone. Not until this is over. If my son came to visit, I’d hug him, but I’m generally not hugging people. Volberding: It’s been a long time since I have shaken a hand. Maybe I will again once there is a vaccine. I grew up in Minnesota where hugging is not common, but since I’ve been out here, I’ve wanted to hug people, and love it. Once there is a vaccine, I want to get back to hugging. It just feels normal. Bell: Yes [to shaking hands], followed by practicing good hand hygiene. Yes [to hugging and kissing.] Bloom: I’d try to avoid it. I think it’s a bad idea. But I would rub elbows. Satcher: I forget upon occasion and reach out my hand. I’m supposed to set an example, but I don’t always remember. Handshakes have always been a big thing at Morehouse, a firm handshake was one of the things they recommended when I was a student. I do the elbow bump thing, and I’m now a stickler for social distance. I don’t hug or kiss anyone. Q: If you had young kids, would you send them back to school in the fall? Fauci: It really depends on where you live. Connick: I think that’s a very difficult question. I’m very glad I don’t have to make that decision. If they got sick, they may be fine but they could give it to me. As a doctor, I feel obligated to not get sick. It would be very difficult [to] have children who were in the school system. Volberding: Oh boy, that’s a hard question. It’s such a challenge. The data I’ve heard about suggest that the really young kids are not much of an infection reservoir, so I think it might be okay for preschool, day care and elementary school. The question gets to be harder in high school and college. I think the schools probably will have shifts, morning and afternoon, and limited hours. They might consider teaching in cohorts — small groups of students, so if one get infected, they can quarantine that one group to keep it from spreading. I don’t think you can replace direct interaction with Zoom. Bell: Yes. Bloom: Yes. I believe that the process of socialization is really important, and that long-term deprivation of that is probably going to do more harm than the occasional child becoming infected. We also need to liberate parents and get them back to work, but as carefully as we can. I think kids need schooling and socialization. Satcher: It would depend on what arrangements the school made to protect their health. Q: Have you been tested for the coronavirus? Fauci: Yes, every time I go to the White House. Connick: I have not been tested. I’ve had no symptoms, so I see no reason to get tested. Volberding: No. I am asymptomatic. I take my temperature every day and I have a spray bottle of fragrance that I spray into the air every day to make sure I haven’t lost my sense of smell. I’m in my house almost all the time except for walks in the neighborhood and trips to grocery stores. Bell: No. Bloom: No. But I have no symptoms. Satcher: Yes, Morehouse requires it before we can come back. I actually took two different tests, the nasal swab and an antibody test because I was curious. I didn’t have any symptoms. Both were negative. Q: What is your best guess about when a vaccine will be available? Fauci: We have multiple candidates, and my hope is that we will have more than one, probably by the end of this year or the beginning of 2021. Connick: Hopefully in six months. That would be a dream. Volberding: The challenge isn’t making a vaccine, it’s in testing it for efficacy in large numbers of people. It’s got to be placebo controlled to know it’s working, and done on enough people with exposure risk. If everyone is staying at home, you won’t know. It also depends on how the epidemic goes. If, unfortunately, it is blasting along, you’ll be able to test it. It will take longer if there is a pandemic lull. I’m not expecting anything for at least a year from now. Bell: Based on previous vaccine development, and the expectation that safety and efficacy were well tested, a complete guess would be late 2021. Bloom: It’s unlikely we will have one that is 100 percent effective. But it would be terrific to have one that’s 50 percent effective, which is in the ballpark for flu. You need about 30,000 people to test and I don’t think 30,000 people are going to volunteer for each trial. So how many to know it’s safe and effective? My guess, though, is that we could have something by the first quarter of 2021. Satcher: I wish I could say we will have one by the end of this year, but I can’t. We may have one in 2021, but I think it’s a long shot. 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Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. Barry Bloom, Jacobson research professor and former dean of the Harvard T.H. Chan School of Public Health. Paul A. Volberding, professor of medicine and emeritus professor of epidemiology and biostatistics at the University of California at San Francisco. Elizabeth Connick, chief of the infectious diseases division and professor of medicine and immunobiology at the University of Arizona. Linda Bell, South Carolina’s state epidemiologist. David Satcher, former U.S. surgeon general, former director of the Centers for Disease Control and Prevention and most recently founder of the Satcher Health Leadership Institute at the Morehouse School of Medicine.