It’s summertime, and most businesses on Oahu have reopened following a flattening out of the curve in May, with numerous activities now allowed to resume, but the pandemic is not over yet.

The number of new COVID-19 cases is curving upward again this month, with double-digit increases and a spike to 42 on July 11.

What are the risks of having a backyard paina or a beach picnic? Dining in a restaurant or shopping at a mall?

Three physicians weighed in on the risks of 10 activities, rating them as low, medium and high. They were asked to list the risks, as well as what some of the mitigating factors would be.

Dr. Gerald S. Murphy is a longtime infectious disease and internal medicine physician with training in tropical medicine and public health both here and abroad. He has done field research in Southeast Asia and investigated outbreaks in New Guinea.

Dr. Darragh O’Carroll, an emergency room physician, appeared at news conferences with Honolulu Mayor Kirk Caldwell in April to explain how wearing nonmedical face masks helps prevent the spread of the coronavirus. Dr. Alan Wu (no relation to the reporter) is the CEO and medical director of Doctors of Waikiki.

For Murphy, the “low” rating means an activity you can enjoy with some common sense precautions. The “high” rating means asking for trouble, because of the risk to both yourself and others. High risk activities should be avoided, and alternatives should be chosen.

The “medium” rating is for risk levels in between, and where careful attention to mitigation can make activities safer, with care and good judgment.

Risk should also be assessed several ways, according to Murphy, taking into consideration one’s age and health condition, as well as exposure to others in high-risk groups.

“First is the risk of your getting or passing on the virus within the community, that is, the risk that you will be part of the problem of spreading the virus,” he said. “Second is the risk to your health or those near to us if you become infected. Both are considerations in assessing risk. We have a community obligation not to pass the virus around, and even if we are healthy, we don’t want to give it to someone who is likely to die from it.”

Generally, activities outdoors are safer than indoor, and the fewer people there are the better. Generally the more closely you interact with others, and the longer the interaction, the higher the risk, says the Centers for Disease Control and Prevention.

Wearing face masks helps reduce person-to-person spread, particularly from those that are asymptomatic, according to Murphy. Coronaviruses are primarily spread by small droplets of moisture as people exhale, cough or sneeze.

“Masks are a low tech way we can keep the economy and the society open,” Murphy wrote. “They are a way we show our kuleana to our community and kokua our kupuna. We wear them to help each other.”

The risks are rated specifically for Hawaii in early July, with travelers from out-of-state still required to quarantine for 14 days upon arrival in the state.

20200715 What's the Risk Doubletruck by Honolulu Star-Advertiser on Scribd

A backyard paina with up to 20 friends who have been living in Hawaii (haven’t traveled anywhere)

Murphy

LOW

Risk factors: Increased if any of the attendees are from high-risk groups. Mask-wearing is not really practical if the goal is to eat and drink together.

Mitigating factors: Discuss with potential attendees how well they have observed physical distancing. Consider decreasing the group number to 10 or fewer, especially if community spread is increasing. Could consider physical distancing, but that sort of defeats the purpose of the paina.

O’Carroll

LOW to MEDIUM

Risk factors: Twenty people is pushing the risk to medium, as the more people you have, the more chances they are not following physical distancing guidelines as carefully as you might be. The more households you gather, the higher your risk of unknowingly transferring or contracting the virus.

Mitigating factors: To lower risk, avoid sharing food, drinks, or utensils. Making it a BYO-everything party is a great idea. Limit alcohol consumption, as increased intake will cause attendees to be sloppy about social distancing, or use your bathroom/indoor facilities more frequently. Keeping masks on as much as possible and remaining outdoors will help.

Wu

MEDIUM

Risk factors: Asymptomatic carriers at the party.

Mitigating factors: Check everyone’s temperature, avoid sharing food, drinks or utensils. The food itself isn’t the risk but touching shared dishes or utensils could be. Designate a server with gloves, face mask and face shield to serve the food. Form a line with everyone remaining six feet apart. Offer each family a designated table while eating. A backyard lawn or open area recommended.

Shopping at an indoor-outdoor mall, and visiting multiple stores, with a stop for lunch

Murphy

MEDIUM

Risk factors: Crowding, so exposure to many people. Multiple stores. Other people not wearing masks, and you have no control over this. Touching things.

Mitigating factors: Wear your mask. Hand washing, especially before you touch your face or eat. Go at less crowded times. Outdoor venues are safer than indoors.

O’Carroll

LOW

Risk factors: The risk will remain low if you spend most of the time in the outdoor portion of the mall, when crowds remain small, and you wear a mask and practice good hand hygiene (bring portable hand sanitizer). Outdoor malls are much preferable to indoor ones.

Mitigating factors: Avoid the food court or anywhere people are mingling for an extended time. Avoid peak hours, and be cognizant when you touch highly shared surfaces like handrails or elevator buttons.

Wu

MEDIUM

Risk factors: Multiple patron exposure. Density and popularity of the mall. Higher density leads to higher risk. Open malls have less risk compare to indoor malls.

Mitigating factors: Don’t mingle in a single place for long. If too crowded, or you are feeling uncomfortable, you should not stay. Avoid prolonged window shopping. Know what you want and get it. Wear face covers and maintain social distancing.

Having a picnic at the beach with one other family (two families of four)

Murphy

LOW

Risk factors: Higher risk if beach is crowded. Engaging in contact sports. Children socializing with kids outside your circle.

Mitigating factors: Bring masks in your bag in case it becomes crowded. Minimize restroom and drinking fountain use.

O’Carroll

LOW

Risk factors: As long as you remain socially distanced from anybody outside of your immediate family unit, this is a very low-risk activity. Our tradewinds will keep most respiratory droplets from accumulating, and our tropical summer Hawaiian sun will help to destroy any virus if present. Avoid sharing food, drinks and utensils.

Mitigating factors: Make sure to wash hands or sanitize if using public bathrooms, maintain six feet of social distance from other parties.

Wu

LOW

Risk factors: Only if the family has not practiced social distancing and staying at home.

Mitigating factors: Ensure that no one has signs of illness — if they do, they need to stay home. Talk to the other family. Gather information. It should be another family you trust with long-term knowledge of their habits.

Swimming at a public pool shared with others, but limited to one person per lane

Murphy

LOW

Risk factors: Indoor pool. Poor ventilation.

Mitigating factors: Outdoor pool. Temperature screening at entrance to facility. Signs reminding users not to enter if they or anyone in their family is ill.

O’Carroll

LOW

Risk factors: Your biggest risk factor would be touching common areas or using the bathroom. Be mindful of crowding at entry points. The virus will be very unlikely if not unable to survive in chlorinated water.

Mitigating factors: Avoid common bathroom areas; post-exercise shower should be done at home.

Wu

LOW

Risk factors: Only if you don’t practice social distancing from nonfamily members.

Mitigating factors: The pool water itself is not a risk. The chlorinated pool water and volume of water will degrade and dilute out the virus, making the water a highly unlikely source of infection. One person per lane and at least six feet between lanes, or every other lane to avoid running into each other when getting out of the pool.

Having multiple drinks sitting at a bar

Murphy

HIGH

Risk factors: Crowding. Decreased judgment due to alcohol. Close proximity. Conversation. Poor hygiene with washing, garnishes, swizzles, etc.

Mitigating factors: Outdoors. Physical spacing. Contact lists. Cap on number of customers at one time. Thorough cleaning of glasses. Bartenders wear masks. Keep drinks to two or fewer.

O’Carroll

HIGH

Risk factors: Alcohol will always cloud your judgment and increase your chances of forgetting about hand hygiene and physical distancing guidelines, and the congregation of people sitting close to one another at a bar exponentially raises your risk. Combined with the fact most are indoors with poor ventilation, bars pose one of the highest risks.

Mitigating factors: Maintain six feet of distance, keep your hand sanitizer out, and ensure everyone in the bar is wearing a mask while not seated.

Wu

MEDIUM to HIGH

Risk factors: Crowds, close contact, and inhibition-loosening alcohol are risk factors. When drinking, people become less compliant with rules even without being intoxicated.

Mitigating factors: Stay six feet away from the next person. But what’s the fun in that? You might as well drink at home without the worries.

Going for a group hike with 12 friends

Murphy

MEDIUM

Risk factors: A more rigorous hike causing people to breathe harder might increase risk a bit. Trail crowding would increase risk a bit. Hikers would generally not wear masks.

Mitigating factors: Non-strenuous hike would be low risk, especially if physical spacing is observed. If strenuous, one could increase physical spacing to 24 feet.

O’Carroll

LOW

Risk factors: If any of your friends has been less conscious of following physical distancing guidelines and public health measures, your risk of being around them outdoors will remain as low as possible. However, some hikes are getting very crowded. It’s best to avoid those hikes, especially mingling in rest or break areas.

Mitigating factors: Maintain six feet of distance and be careful using common bathroom facilities.

Wu

MEDIUM to HIGH

Risk factors: Asymptomatic spreaders of COVID-19 among friends.

Mitigating factors: Know where your friends have been, determine if they practice good social distancing on a regular basis. They should stay home if sick. Avoid cluster trail hikes. Form a line that is six feet apart. Avoid sharing drinks. Bring hand sanitizers.

Getting your hair colored and cut at a hair salon

Murphy

MEDIUM

Risk factors: Crowding. No masks. Poor cleaning of instruments. Barber talking to customers while working.

Mitigating factors: Physical spacing inside shop. Barber wears mask and customer does too, to extent practical. Good hygiene with cleaning of tools between customers. Maintain a contact list. Temperature check for workers and customers. Minimize speaking when in close proximity.

O’Carroll

LOW to HIGH

Risk factors: Haircuts involve close contact and sharing the same “respiratory space” for sometimes more than an hour. If both parties are not wearing masks, this is one of the highest risk activities, as a barber or stylist is coming into contact with many persons throughout the day.

Mitigating factors: This activity is low-risk as long as proper guidelines are maintained, as was shown by two Missouri hairstylists who unknowingly had coronavirus, but none of their 140 clients became infected. Look for a salon or barbershop that enforces polices to protect their staff and patrons, like wearing masks, sanitizing tools and hands, and keeping chairs at least six feet apart, preferably more.

Wu

MEDIUM to HIGH

Risk factors: Hair dresser contact in between clients.

Mitigating factors: Both stylist and client have personal protection equipment on at all times during the process. Sanitize workstation area in between clients. Allow time interval between clients for appropriate cleaning.

Attending a protest with hundreds of others, while wearing a face mask

Murphy

HIGH

Risk factors: Large numbers of people with super-spreader risk. Physical exertion and yelling or chanting with 24-foot infection zone. Lack of inhibition due to mass hysteria of mobs. Causes first responders to become exposed. No contact lists to facilitate contact tracing.

Mitigating factors: Mask wearing. 24-foot front to back spacing. Avoid yelling, chanting, or singing. Avoid violence and crime requiring intervention of first responders into crowd.

O’Carroll

LOW to MEDIUM

Risk factors: At this time, the amount of virus in Hawaii remains low. As long as the protest remains peaceful, and six feet of distancing is maintained, risk of being outdoors with a mask is low. However, once crowding, yelling, and a paucity of masks are introduced, the risk will automatically jump.

Wu

HIGH

Risk factors: How good is your mask and others’ protective equipment? Sweating, yelling, screaming and breathing on each other is the basis of spread.

Mitigating factors: Cloth masks only protect others from you, while FDA- and National Institute for Occupational Safety and Health-­approved respirators reduce that risk of the individual from getting infected. Avoid the protest if possible. If you go, do so with proper protective equipment, which should include a respirator, face shield, coveralls and built-in hydration system.

Using a public restroom

Murphy

MEDIUM

Risk factors: High use. Not routinely cleaned. Some viruses known to spread this way, such as Norovirus.

Mitigating factors: Frequent cleaning. Good air ventilation. Get in and out quickly. Use paper barriers. Use paper towels to turn off faucet and open door. Wear mask if practical.

O’Carroll

LOW to MEDIUM

Risk factors: Currently low, but will rise depending on if cases rise. Public bathrooms have multiple high-touch surfaces, and we do know that viral genetic material and virus can be detected in feces. Unknown if flushing toilets translates into aerosolized viral particles. At this time, it’s unclear whether the virus found in feces may be capable of causing COVID-19.

Mitigating factors: Avoid small, indoor, busy and poorly ventilated restrooms, such as small gas-station restrooms. Avoid bathrooms that have long lines. Avoid high-touch surfaces, and use your own hand sanitizer after leaving.

Wu

LOW to MEDIUM

Risk factors: Poorly ventilated and dirty restrooms. Enclosed restroom with poor aeration and ventilation are to be avoided.

Mitigating factors: Choose a bathroom that has good ventilation, looks clean and is well stocked with paper towels, soap and toilet paper. Avoid a line to use the toilet or staying there long. Maintain six feet from others. Wash your hands in the restroom, and use hand sanitizer after you leave.

Going to eat at a restaurant serving appetizers, a main dish, drinks and dessert, seated indoors

Murphy

MEDIUM

Risk factors: Crowding. Raw or cold food. Unclean menus. Long time at table. Multiple dishes. Alcohol decreases judgment. Buffets and self-serve drink bars can be contaminated. Ice machines contaminated. Poor air circulation.

Mitigating factors: Physical spacing. Cooks wearing masks (waiters to a lesser degree). Order piping hot food. Cleaned or disposable menus. Good hygiene with dishes, utensils, and in the kitchen. Contact list. Outdoor dining.

O’Carroll

MEDIUM to HIGH

Risk factors: Indoor dining is risky as people tend to sit for long periods and enjoy their food, negating if proper six-foot distancing is established. Sitting for long periods indoors with members outside of your household is a riskier affair.

Mitigating factors: Choose a restaurant that has followed all local guidelines and especially one that has adequate spacing. Dining only with members of your household. Sitting outside.

Wu

MEDIUM to HIGH

Risk factors: Poorly ventilated and crowded establishments. Congested seating arrangements. Servers/workers without face masks, or masks not covering their nasal cavities.

Mitigating factors: Choose restaurants that require servers to wear masks, have spaced-out seating and hand sanitizer or hand-washing stations. Recommend single-use utensils and condiments. Avoid soda fountains, buffet tables, paper menus. Choose outdoor seating. Keep an eye on entire staff to make sure they are using masks.