Question: What is the relative risk of going to a doctor or clinic for health care visits? A kid in our “pod” (two families that have merged our circles of isolation) recently went in to get routine immunizations, and we are wondering if we should un-merge from that family for a couple weeks. Likewise, my doctor asked me to come in and get blood work done, and I wonder (a) if doing that is worth the risk of contracting Covid, and (b) if I should isolate from my family and the other family in our “pod” afterwards. On the one hand, health care workers are highly trained and likely to be very diligent about masks, disinfection protocols, etc. But on the other, these interactions are indoors, typically in small confined rooms with limited air flow, in establishments where lots of people are coming and going, and without social distancing (you can’t socially distance from someone while examining them, giving them a shot, or drawing their blood). Arguably, health-care settings also attract more sick people than, say, bars or restaurants. We are in one of the areas of the country where cases are recently exploding. I’m not suggesting people avoid going in for preventative health care, but more wondering whether a period of self-isolation afterward is appropriate. On a scale from 1=”isolate at home” to 10=”attend a huge indoor rally”, how would you rate the risk of going to a clinic for routine health care?

Answer: We’re all grappling with this issue right now. Another friend wrote a similar question about going to the dentist and then there’s the Q&A from 7/9 about risk from being in a hospital waiting room. As with everything COVID-related, we’re still operating with incomplete information and our understanding of risk is limited as a result. When it comes to scaling risk of seeing the doctor or dentist, I suggest the following:

1. Read up on safety guidelines. CDC’s suggestions for infection control in dental offices are here and suggestions for pediatric healthcare providers is here. Additionally, the American Academy of Pediatrics offers practice management tips during COVID here.
2. Check whether your provider is following safety guidelines. After you’ve read up on infection control suggestions, reach out to your provider to understand what they are doing to protect themselves and their patients. Compare their practices with what you read. Do they align? Are they weaker/stronger? If they don’t meet the guidelines, consider finding another provider.
3. Check community transmission levels. You can find community transmission data from your local health department (e.g. Nashville’s is here). If the rate of transmission is greater than 1.0, then your community is seeing rapid spread. Other data points you could use are — 1) number of daily hospitalizations and currently hospitalized; 2) number of daily cases and percent of tests that are positive [note: increases in hospitalizations OR in cases + test positivity rate are both worrying signs.]

So, how would I then use this data? Three scenarios:

1. IF the provider is following safety guidelines and community transmission is declining, THEN your risk is quite low. On a scale of 1–10, I’d put it at a 3 (moderately low risk). I would go. And I wouldn’t be overly concerned if someone else in my pod had gone.
2. IF the provider is not following safety guidelines and community transmission is declining, THEN I would consider finding another provider. Even if community transmission were contained, I’d still want to know that my provider was doing their utmost to keep us all safe. And if my provider weren’t doing the needful, it would make me question their judgement pertaining to other elements of their healthcare practice/provision. I’m not sure how to rank this on a scale of 1–10; it really depends on how far your provider deviates from the safety guidelines.
3. IF the provider is following safety guidelines and community transmission is increasing, THEN I would: a) consider whether you can wait until community transmission is declining; b) if you decide that you need to go, then talk with your provider about how you can further mitigate risk, especially if you have underlying conditions/risk factors (perhaps you could be the first patient of the day, for example). On a scale of 1–10, I’d rank the risk at a 4 or 5 (moderate risk). And if I had a good experience with my visit (unlike our friend who had to go to the ER with a bunch of sick people the other day!), I’d probably keep hanging with my pod, but limit interactions to outdoor, socially distanced interactions only.

A few more things:

• When it comes to routine immunizations, I’m of the opinion that the risk of missing or delaying immunizations is far greater than the risk of COVID infection stemming from the visit. If your pediatrician recommends it, please do not delay!
• For a run-down of infection transmission in waiting room settings, see the Q&A from 7/9. And for a list of most common cluster transmission points, see the chart from yesterday’s Q&A.
• If you’re interested in seeing how other groups have ranked risk, the Texas Medical Association’s COVID-19 Task Force and Committee on Infectious Disease recently ranked a set of activities from low to high risk. Their list (Figure 1) largely aligns with another recent ranking from four Michigan doctors with a few exceptions — compared with the Michigan list, Texas list ranks movie theaters, airplanes and office buildings riskier while it ranks playgrounds as less risky. These lists are not the end-all-be-all, but since we still don’t have anything like it from our national public health authorities, it’s a start. That said, risk will be dependent on where you live in terms of what’s going on with community transmission, so please keep paying attention to your local situation to make informed decisions.

Figure 1. Activity Risk Ranking by Texas Medical Association