I am an epidemiologist. Open the playgrounds.
A global pandemic of a lethal respiratory virus is among the most frightening and economically devastating threats to public health humanity could face. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) presents additional and novel complications, like pre-symptomatic virus transmission with peak infectivity the day before you fall ill. In the U.S., a failure of leadership in managing the epidemic has cost hundreds of thousands of lives with no plan in site. We don’t yet know when a safe and effective vaccine will be widely available, and when it is, 30–50% of the population might refuse to take it. In other words, get comfortable with your mask and hand sanitizer.
Talking to an epidemiologist about risk might surprise you. The concept of harm reduction is commonly accepted among health professionals. Examples of this include offering clean syringes to injection drug users to slow transmission of HIV and hepatitis C. The thinking is, changing human behavior is nearly impossible, but offering safer alternatives, and influencing social mores can reduce the burden of disease. So, solving drug use is hard, but asking drug users to use clean syringes is less hard, and has extensive population level health benefits.
In the case of COVID-19, early data about fomite transmission (viral transmission from touching an object or surface) had all of us scrambling for clorox wipes and hoarding purell. However, from contact tracing studies of how people actually got sick, there has not yet been a documented transmission event directly linked to fomite transmission outside of healthcare settings. COVID-19 is transmitted through close personal contact with an infected person, which is far more likely to occur in an enclosed space, such as a bus, or during choir practice, but is most often found to have happened where people live.
Where I live, in Menlo Park, California, the playgrounds have been closed for the past six-months due to a concern about the risk of fomite COVID-19 transmission or crowding. If you have seen a playground in my area pre-COVID, you will know that it is somewhat unusual for a large group of strangers to congregate within droplet transmission distance and start up a lively conversation. When I try to make eye contact with my fellow parents, they are often sneaking a few minutes to immerse themselves in their phones, or intensely focused on their own child. Children on playgrounds also don’t spend a lot of time in face to face conversations over a long period of time. Moreover, we know now that being outdoors lowers the risk of transmission by 20-fold, with the majority of transmission events happening with larger group gatherings, and where there are face-to-face unmasked conversations over some duration of time. For these reasons, in the grand scheme of things, playgrounds present a very minor COVID-19 transmission risk.
However, the impact of closing the playgrounds has removed one of the only outdoor activities for parents who have spent the past eight-months stuck inside with limited to no childcare and zoom school. Screen time among children has increased dramatically, parents are suffering untold stress and mental health repercussions, and child abuse is on the rise. These impacts are more severe for parents without ready access to green space, yards, common spaces, or safe places to let their children play outside. With playdates canceled and most kid friendly activities closed, the only thing we can do is take kids outside.
In the spirit of harm reduction, let’s adopt strategies to protect ourselves from COVID-19 that matter. While we may need to have another year of zoom birthdays, open the playgrounds and give parents the tiny mental health break they need right now.
