This is exactly the type of scenario you want to avoid right now. Bret Redman

Public Health

A Guide to Social Distancing in Dallas as Coronavirus Cases Ramp Up

We know to avoid large crowds like in the photo above, but what about dinner with a friend? How are we to live, and what are we allowed to do?

The novel coronavirus is now being transmitted in our community. On Thursday night, Dallas County Judge Clay Jenkins blocked gatherings of more than 500 people after revealing that an individual with no travel history had contracted COVID-19. That is evidence of a “community spread,” meaning it has bounced around to people who wouldn’t have had any of the social risk factors that previously determined who was tested and who wasn’t.

On Friday, the city followed suit, filing an emergency declaration. But the city isn’t shut down. If the space is functionally separated—think about offices, schools, multiplex theaters, anywhere that allows you to avoid others—it’s not going to be forced to close. Which makes the act of social distancing so important.

But where do we draw the line? Do we go out to eat? Have a drink at a bar? Work in a coffee shop? Buy some jeans at NorthPark? Stop dating?

“Can you go to a restaurant tonight or tomorrow night? Yeah, that’s probably fine,” says Dr. Mark Casanova, the president of the Dallas County Medical Society. “I think we are going to see that a lot of those public places—restaurants, parks, whatever the case may be—are likely going to be quieter in the coming days and weeks, inherently. I think in terms of: Do you just need to stay behind closed doors and not exit your residence? I don’t think we’re there yet. Well, let me rephrase that. We are not there yet. I’m sure we will get there.”

Casanova started our conversation on Thursday evening with a caveat: “My response to just about anything you’re going to ask me will be an acknowledgement of what we know right now.” Which is an important thing to remember about this outbreak. The virus is not totally understood, so it is important to heed the basics. The best chance at not getting the coronavirus is avoiding it, and that means staying away from people and practicing proper hygiene. Wash your hands for 20 seconds. Avoid touching public surfaces. Don’t shake hands. Don’t sit shoulder-to-shoulder with anyone. Stay six feet from others. Will the place where you’re going tonight make it difficult to do those things? You should probably stay home.

Casanova referred to it as “situational awareness.”

“I don’t mean to just sound diminutive or flippant, but let’s use some common sense,” he says. “Let’s not go to a new movie premiere tonight, which is going to be a crowded theater, but maybe we go see the matinee of something that’s been out for a month.”

The thing compounding all this? We don’t know how bad this is yet. Jenkins noted last night that testing capacity is lacking in Dallas County, just as it’s lacking elsewhere. He was straightforward about it: “We have not positively tested everyone who has the virus,” he said.

Tucked into the city’s disaster declaration is a mandate that all labs—commercial and otherwise—submit the total tests they provided to patients each day. Tristan Hallman, a spokesman for Mayor Eric Johnson, said the city attorney was drafting the specific order Friday morning and expected it to be in place later today. This afternoon, Gov. Greg Abbott revealed that just 220 Texans had been tested for the virus through the CDC and another 75 were waiting on results. Drive-through testing zones are coming to San Antonio.

If you’ve started to self-diagnose, the first thing to think about is difficulty breathing, keeping in mind “one’s self knowledge that they’re not a healthy individual.” From there, you’re looking at a cough and a fever. Generally, the mild symptoms are actually mild, Casanova says.

But it’s those high risk folks who are of greatest concern. That’s chronic medical conditions like COPD, cancer, diabetes, or another underlying health condition. If you’ve traveled out of the country or to a hot spot like Washington state, there’s another concern.

From there, call your healthcare provider. Don’t just show up in an ER. You’ll be referred to the Dallas County Health Department, which has a hotline set up for this very thing. (Scroll up for that number.) If you don’t have a physician, call that line first. They’ll dictate your next steps. This is particularly important for those without insurance: Dallas County has the highest uninsured rate in the nation, which makes public health officials fear a run on hospitals like Parkland.

“The young and healthy do fine, many do fine. And then you have this other population of underlying medical conditions, which again, is that a surprise? No,” he says. “That’s exactly what we would expect from a new novel virus or really any insult to a community at large.”

There are already many comparisons to the 1918 influenza pandemic, which killed millions worldwide. (The total amount, believe it or not, is likely unknown.) But Casanova cautions against that comparison. Comparing the two implies we understand COVID-19, and we don’t. We don’t know all the ways it is transmitted. (“I’d say partake in some Netflix workout videos right now,” he says, as opposed to your gym.) From the CDC: “COVID-19 is a new disease and we are still learning how it spreads, the severity of illness it causes, and to what extent it may spread in the United States.”

With the 1918 flu, social distancing saved lives. And the decision to push forward with big events in tight spaces wound up killing people. To that end, Casanova says he is “heartened” by the public response. Just in the last week, offices have started to thin out. Emergency declarations have been ordered. People seem more vigilant about protecting themselves, Casanova says.

“I think it’s responsible. I think it’s wise. It’s safe. It’s measured,” he said. “I am heartened in what I sense and I feel, and when I talk to my patients, I’m heartened by, generally speaking, the community having a sense of, yeah we need to go ahead and help each other out here, and do what we need to do.”

But with that hope comes reality. Considering the population of this planet, are events like these going to be more common, not unlike the hurricanes and weather events driven by global warming? Casanova didn’t let me finish the question.

“Absolutely,” he said. “We should have plans in place.”

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