April 19, 2021: What is a safe distance in COVID?

We are all aware of the health and safe protocols we must follow to help protect our loved ones, those around us and of course ourselves from the coronavirus: wear a mask, wash hands frequently and maintain a distance of 6 feet from other people.  A 6-foot separation from others was the recommendation of the CDC at the start of the pandemic.  This figure was not based on any specific study for the coronavirus but extrapolated from other studies related to the distance droplets and aerosols traveled when expired from our respiratory track.  The WHO (World Health Organization), on the other hand, has promoted a distance of 1 meter (approximately 39 inches).  Who is right?  The answer is somewhat complicated as the distance the expired particles travel varies by size.  Larger ones may fall the to ground very quickly and the small ones tend to stay airborne and travel further.  In addition, the environment plays a big role as well. Air filtration and improved ventilation (open a window, use a window fan, etc.), significantly decrease viral transmission.

Recent studies of transmission of coronavirus in school children determined that a distance of 3 feet was adequate separation for children in a classroom. To confuse the situation even further, this guidance was not applied to their teachers.  How does this apply to adults in group situations?  The most obvious analogies might be gyms.  Many states have reopened gyms with the recommendation that the gyms reduce the size of classes to maintain separation, increase ventilation, and mandate mask wearing. These may not be enough. As people work out and start to sweat and breathe faster, their masks get damper and damper. Not only are they potentially expiring more viruses and pushing the droplets out with more force, but a damp mask is not as efficient in filtering viruses as a dry one.

One recent report described a potentially interesting way to monitor the situation in a gym.  When we breath we are exchanging oxygen (O2) for carbon dioxide (CO2).  During a workout, the increase in the respiratory rate naturally also leads to an increase in the amount of C02 we are expiring. Measuring the amount of C02 in the air might be one indirect way to determine the adequacy of the ventilation in a room.  If the CO2 is going up, then ventilation might be inadequate and the occupants of the room at a higher risk of exposure to an airborne agent. We use CO2 monitors every day in the OR. This technology is, thus, available now and the devices are relatively inexpensive.

It likely that one of the indirect health hazards of the pandemic is the weight people have gained after gyms closed and home quarantine was begun. We have heard quips about the “pandemic 15” (or even 20!). A recent study published in the JAMA open network by Dr. Gregory Marcus and his colleagues gives credence to this weight gain. They reported that in a group of 269 adults closely monitored during the last year, the average weight gain was 0.6 pounds every 10 days or about 2 pounds a month.  Anecdotally, this is consistent with the demographics of consults experienced in my own practice. We have seen an increase in the numbers of patients coming in for consultations for liposuction or body contouring.  In addition to liposuction, SmartLipo and Power Assisted Liposuction, we now offer Physiq. Physiq is the newest non-invasive device for fat reduction and muscle toning.  In the interim, if your gym as not open or, perhaps, you do not feel comfortable going there yet, as the weather improves, please get outside, exercise and, of course, remember to wear your mask!!