We are nearing a slow release of social isolation measures.  When these measures were enacted by states in early March, there was never a concrete time limit or end-date announced when a sudden abrupt change in our routine occurred.  The exit strategy is slowly materializing and will likely take the form of successive steps to ease back into our new normal – one that is still a moving target.  At a time that more than 33 million people in the US have filed for unemployment over the last seven weeks, economic uncertainty will likely persist after these measures have lifted.  It is a mixed blessing to still have a job, because many jobs have switched to work-at-home arrangements or reduced hours (which may even pay less than unemployment).  People may be on thin ice, with higher rents in big cities.  For this and other reasons, a person may find themselves in a difficult living situation during the COVID.

Say you have a friend who needs a place to stay – and you happen to have an unoccupied Airbnb rental house or condo, since all the guests canceled – thanks to the COVID pandemic.  Maybe your friend is a healthcare worker, and worked out something with his/her family to keep the family safe.  Or, for whatever reason, their shelter arrangement has become either unstable, financially unsustainable, or unsafe for them.  You want to be a good friend and offer them your space, but are well aware that you may be “breaking your bubble of safety from COVID” to allow him or her to stay in your house.

Maybe you have a good friend and you both live alone – maybe you can become roommates for the time being to reduce loneliness.  Zoom conferencing or facetime is getting old.  Would this work?  Or you have a love interest – you have been dating for several months already, and then the social isolation measures were placed?  Maybe this is the right time to move in sooner than planned?

The question becomes how can you safely share or lend a living space to someone else during this time of shelter in place?

1. What is the sharing arrangement? Are you lending them an extra space that you own that you don’t regularly or need to visit?  Are you sharing the same space?
2. What is the epidemiologic situation in your city?
3. What is the risk of each individual based on their work, volunteer situation, and exposure risk?
4. If the person having any symptoms prior to staying?

Sharing a space with another person during the COVID-19 pandemic factors has another extra layer of complexity.  We are asked to avoid any congregation of any size, but is there a point when one’s risk bubble can safely intersect with another’s?  We can address this in a number of angle, but ultimately there will be some risk.  It is a risk that you have to agree on up front.

Entering another’s shelter bubble

All viral infections have an asymptomatic or presymptomatic period, in which a person is capable of transmitting disease without even knowing it.  Scientists are aware of this from studies symptomatic residents of nursing facilities who tested positive after an exposure.  Of the 76 residents who participated, 48 tested positive;  27 (56%) of these residents had no symptoms at that time of testing but developed symptoms 3 or 4 days later.

Reasons why we are using social isolation measures:  As a virus cannot effectively survive in the environment for longer than a few days, it requires humans to be a force of its transmission.  By limiting contact with others, the virus is not capable of propagating and we flatten the epidemiologic curve.  Social distancing, social isolation and quarantine need better clarification.  Social distancing is the practice by which one person who is not infected distances himself/herself from the general population, without knowledge of other people’s infection status.  It is a generic application of a preventive strategy.  In this case, it means staying 6 feet from other people, no gathering in groups or avoiding more crowded areas of group meetings. Social isolation is related to the statewide practices to reduce the spread of infection through closure of restaurants, bars and meeting places, including the cancellation of concerts, events, and other shows.  The family becomes a unit and does not leave the house, except for essential reasons, such as shopping, pharmaceutical pick-ups, and going to work deemed essential.  Quarantine is a term applied to a period of surveillance in someone that has been exposed to an infection.  They assess themselves daily for symptoms.  If symptoms develop, they are tested for the disease, COVID in this case.  The usual duration of quarantine for COVID is 14 days from the exposure, since there is an incubation period, ranging from 2 to 14 days that usually is needed before a person develops symptoms if they are infected.

It is unlikely that people can actually practice social distancing while sharing the same household.  The common areas, such as the kitchen and bathroom, as well as living spaces, can increase the risk of acquiring the infection from Fomite or contact with contaminated surfaces.  Fomites are objects that can get contaminated by respiratory secretions.  But a person has to be infected to be able to transmit.

The number of people that live in one household increases the risk of all of the members of the house becoming infected.  People who live in shared housing settings, where multiple members are working essential jobs are at a higher risk.  The CDC provides measures can be taken to reduce the risk of infected the entire household.

Some questions to ask prior to breaking each other shelter bubble:

1. Have either of you had contact with anyone that you know was sick with viral symptoms, cough, or fever?
2. Have either of you developed a cough, fever, nasal symptoms, loss of smell and/or headache in the last few days?
3. Would either party be at a high risk for severe disease, if the other member had the disease and was pre-symptomatic now or their work required them to leave the house and put themselves at risk?

Entering into cohabitation

There are many reasons why friends or partners would consider moving in with each other during the COVID-19 social isolation measures.  One question to ask yourself, whether it is a friend of lover, is whether you were already considering this change before the covid pandemic.  If this is a new relationship, where you haven’t had any significant disagreements to understand each other’s communication style and challenges, you would be in for quite an abrupt realization.

Moving in with someone during this shelter-in-place period differs from regular times.  First of all, there aren’t as many buffers to relationship strain or external means of entertainment to nurture a relationship.  You can’t just get in your car and drive to see a movie or attend a social activity, with all nonessential businesses closed – unless you can make a group trip to Wall-mart or Target entertaining.

There is also a greater deal of stress associated with the current times.  There may be financial strain, when a person has been let go from their work or the hours have been significantly curtailed.  To the brain, the dramatic change constitutes an adjustment reaction akin to death or divorce.  This change and the isolation that results from it, may exacerbate mental health conditions such as anxiety, depression and drugs and alcohol abuse.  A study comparing post-traumatic stress disorder (PTSD) symptoms in quarantine (see definitions) showed that criteria for PTSD was met in 30% of isolated or quarantined children and 25% of parents.  Though, a healthy, shared living experience could certainly buffer each person from developing any stress states.

Photo by Andrea Piacquadio on Pexels.com

Some questions and recommendations to ask yourself and your partner before deciding to cohabitate:

1. What is each other’s current living situation now? Saving money is probably not a sound reason in itself.
2. Is the pace appropriate or too soon, regardless of COVID?
3. If you lived together, what would be the living plan AFTER COVID?
4. Is there enough space to allow this cohabitation but provide enough free space when someone requires some quiet/personal space?
5. What is the financial arrangement? Will the person moving in provide a rental payment?
6. If there were disagreements, can each of you effectively communicate to ensure that each of your needs are met?
7. Decide upon relationship boundaries to set. If your partner is moving in, do you need to sleep in different rooms and stay on a slower trajectory?  Or can you share a room together?

If you are not as close friends but your friend needs an emergency shelter (e.g. domestic violence), an ideal situation might be a partitioned house where all of the basic needs of a living setting are available for your friend.  Examples would be a Mother-in-law suite or an independent of self-contained addition on your house.  It also might be reasonable to consider co-habitating in the same household, if each of you have followed social distancing practices, were at otherwise low risk of contact with COVID-19, and are at low risk for disease severity.  Perhaps, allowing three to five days in the separate spaces might also be another safety measure.  Co-habitating with a friend or partner in an otherwise isolating time may be fulfilling and protective for each other’s mental and physical health.

Lending an extra home or apartment to a friend or guest

The principal method of transmission of COVID-19 is via respiratory droplets from one person to another, if the owner of the space is not symptomatic (whether infected or not), it isn’t expected that there should be any risk of airborne particles remaining in the living space.  The greatest risk of airborne spread is from someone with cough, who is using an apparatus, for example a breathing treatment nebulizer that scatters the particles in the air and allow them to remain suspended for two to three hours.

If the space is otherwise unoccupied, there are minimal risks to the guest. The owner should consider preparing the house by wiping off all common contact surfaces with disinfectant.  The keys should be cleaned with a disinfectant wipe, while wearing gloves and placed in a container or envelope.  An exchange can be made in person, with appropriate measures.  Otherwise, the guest is at little risk as they occupy the space.  A guest can assess their symptoms while sheltering in place.  If they develop cold symptoms, this may be a sign of COVID-19.  Once the guest is ready to leave, care should be taken to clean off any common contact surfaces, including tables, chairs, doorknobs and keys.  The owner could decide to wait a period of 48 hours before returning to the home.

What is the typical duration of viable virus on surfaces?  When surfaces are contaminated by respiratory droplets from an infected person, the virus may still remain infectious even two to three days.  On porous surfaces such as clothing or cardboard, they are unlikely to remain infectious for a significant time (cardboard up to 24 hours).  Fortunately, the virus is easily killed after contact with a disinfectant spray or wipe.

For more information on disinfecting surfaces and which disinfectants are recommended, refer to the CDC website for more details.  Some examples include:

• Soap and water
• Sodium hypochlorite, or bleach
• Ethanol spirits at least greater than 60% concentration
• Surface wipes, usually containing benzalkonium chloride
• Hand sanitizers (Ethanol containing)

Keep an eye on the Local COVID-19 Cases

A useful tool is to look at the status of the outbreak in your city and county.  These resources are available online, such as worldometer, the CDC website, or your local public health authority.  Although this does not guarantee that you are free from risk of infection, areas with lower caseloads have a reduced risk for those who need to work outside of home.

Benefits of Cohabitation during COVID Social Isolation:

• Companionship to discuss concerns, questions, and plans
• Teamwork for food preparation, cleaning, shopping and other errands
• Shared experience in arts/crafts, entertainment (Netflix binges, etc), and nature hikes
• Social interaction and Stress Processing
• Financial Collaboration

Summary 

The pandemic has placed a lot of strain on our usual routines.  Along with health and financial concerns, living spaces may become threatened to some or a way another person could provide assistance to a friend or associate.  Careful planning can make this experience a beneficial growth experience for both parties.

For more information as to any specific questions, refer to the CDC website and Your Health Forum hyperlinked topic section.