I'm High Risk for Coronavirus, So How Do I Proceed Once the Country Opens?

Erin Blute's doctors defined her school-age daughters as the biggest threats to her health being a blood cancer patient. An expat who resides in London, she left her husband working, fled her apartment, and flew to Arizona with the girls when the pandemic hit. She sent them to live with her mother-in-law and self-isolated in a house next door so they could enjoy more summer freedom than she could provide.

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Three months later, Blute is reconsidering the arrangement, but the U.K.'s national health care system—the National Health Service (NHS)—sends her text reminders she's still vulnerable and should stay shielded. Blute misses hugging her children. "It's one thing to hunker down, but I can't stay away from my kids forever. But I don't know if I can be with them indoors." As Blute watches restrictions loosen, she pours over literature from organizations such as the Centers for Disease Control and Prevention (CDC) and the Leukemia and Lymphoma Society, realizing that information for the vulnerable population is limited. "Nothing tells you how to maintain a normal family life apart from isolating."

The CDC estimates 45.4 percent of U.S. adults might be at increased risks for complications from COVID-19 because of existing chronic conditions such as cardiovascular disease, diabetes, respiratory disease, hypertension, or cancer. And then there are pregnant women and newborns.

Eleni Leonaki, a full-time working mother, gave birth to her third child on May 14 in Manhattan. Leonaki considers herself lucky. After delivering at a hospital in the COVID-19 epicenter, she tested negative and immediately took her newborn home. "Initial data suggests that infants up to 12 months may be at higher risk for severe illness from COVID-19 and if a mother tests positive, the newborn may go to the NICU and be released into someone else's care," says Elizabeth Cipolla, M.D., MPH a pediatrician at New England Pediatrics, in Stamford, Connecticut. Leonaki hasn't had anyone in her apartment and has only ventured outside with her baby at off-peak times with the stroller's rain cover on, but she wonders if anything else is safe.

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As countries fast-track reopening after the coronavirus pandemic, weakened individuals desperately want to coexist with their healthy families. But for now, Leonaki and her family will maintain their quarantine bubble, which means no summer camp for her older kids and together time away from the city. "We aren't willing to take a risk with our newborn." She worries about the fall, though, because if school reopens, then the siblings could be exposed.

As for Blute, she's still frustrated by the lack of advice available for the vulnerable population. "These people didn't choose to have preexisting conditions," she says. She'll stay on top of recommendations and will consult with her physician about reuniting with her family soon. For now, she's waiting for more research that provides a better understanding of COVID-19, and she still receives the NHS warning texts. "But it's round two for me. I've been separated from my family due to a major health care crisis before. I feel like because I'm a mom, I have to re-emerge."

If you're one of the many parents confused about heeding advice to reduce your risk of severe infection yet have kids that can't stay locked away indefinitely, experts offer these tips and advice to help navigate the coming months.

Stay Home If You're Pregnant, Says the CDC

According to the March of Dimes, "We still don't know if pregnant women have a higher chance of getting COVID-19 compared to the rest of the general population or if they are more likely to get seriously ill. Based on limited reports, adverse outcomes like preterm birth have been reported among babies born to moms with COVID-19, but it's not clear if that's related to maternal infection."

The CDC says, "stay home and avoid close contact, especially if you are at higher risk for severe illness." Jessica Fiorelli, M.D., assistant obstetrics and gynecologic professor at Columbia University Medical Center, provides some good news: "Although pregnant women are immunocompromised, so far they seem to be doing no worse than usual."

Put Service and State Regulations First

"You can try to put yourself in a safer situation but you can never be safe," says Michael Bernstein, M.D., a pulmonologist in Stamford, Connecticut. Since this disease is so new, the best parents can do is make informed choices while kids venture out. Bernstein thinks the CDC guidelines have been good with giving public recommendations that address containing outbreaks but unclear with personal advice such as how to conduct an outdoor playdate. That's because the nuanced situation presents us with a spectrum of risk, and nobody has perfect answers.

"Parents must decide on the practical reality of how much someone needs the service," says Dr. Cipolla about allowing kids to attend outdoor summer camps. "If the personal benefit outweighs the risk, they should trust the institution enough to follow state regulations." Fiorelli supports schools reopening this fall, although she urges susceptible parents to consider if preschool is a necessary exposure unless they're working.

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Prioritize Your Family, Not Others

Ted Lipman, M.D., a psychiatrist who specializes in child and adolescent psychiatry in Livingston, New Jersey, has seen a rise in families' mental health needs since the quarantine began. He said, "the pandemic shatters our illusions of control." Re-emergence anxiety is real, and he suggests employing therapy, religion, or anything that helps someone "accept that truth instead of consuming the wrong things, like too much news."

And some families, especially ones with teenagers, feel left behind as they see other clans drop some social distancing measures. Dr. Lipman says, "Every family has a different perspective on what is safe to do or not," and he advises vulnerable parents to not worry about others.

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Address Your Mental Health as Well as Physical

"I'm really a 'gynochiatrist,'" jokes Joyce Rubin, M.D., a gynecologist in Smithtown, New York. Since resources are limited, she thinks capitalizing on established relationships with medical professionals to gain sound advice is vital. "Sometimes my patients are so happy to talk to someone who will listen." She provides support in many ways, from expressing concern to touting the benefits of physical fitness.

Dr. Fiorelli says new mothers usually have an in-person six-week postpartum appointment with their obstetricians. During the pandemic, her practice has instituted a successful, one-week video check-in to address her patient's many concerns. Virtual doula care and informational telemedicine appointments are also excellent tools for high-risk parents-to-be to limit exposure.

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Continue to Minimize Your Family's Exposure

"By the fall, we'll have acquired more knowledge about COVID-19. For now, it comes down to space," says Dr. Bernstein. High-risk households could limit family together time and meals to outdoor areas and refrain from using shared sections of the home. He hopes when schools reopen, robust testing will enable communities to act quickly amid spikes and allow schools to move to virtual learning when outbreaks occur. But if local hotspots emerge and children are in school, high-risk people should ideally move out to isolate.

Dr. Cipolla says, "Apply hand sanitizer whenever kids leave public places." For extra safety upon re-entry to the house, in addition to hand-washing, kids could remove shoes, bag clothes, and shower immediately. She has also seen evidence that HEPA filtration systems might reduce some small particle transmission.

In addition to maintaining a 6-foot personal radius inside, wearing masks, and disinfecting commonly used surfaces, high-risk individuals or newborns with caretakers could spend most of the day in a separate, sanitary, well-ventilated "safe" room even if nobody else is home. Even better, seal it off with plastic and provide a dedicated bathroom.

Commercial electrostatic spray services that deep clean public spaces such as schools are costly and don't provide long-lasting protection to make sense in shared personal spaces. Although professional sanitizing could work when initially cleaning the "safe" room.