Creating 'Social Bubbles' With Clear Rules Can Help People Socialize

John Whyte, MD, MPH; William Schaffner, MD

Disclosures

June 30, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

  • A social bubble is when two families or a small group of people agree to take similar COVID-19 precautions so that they can meet up socially.

  • Forming social bubbles can allow people to socialize while reducing their risk for COVID-19 as states begin to ease restrictions.

  • Social bubbles should follow current guidelines of gathering in groups of fewer than 10 people.

  • Manage your social bubble with clear and honest conversations so that everyone can agree to the same rules.

  • Younger people who don't follow the guidelines can spread COVID-19 to others.

This transcript has been edited for clarity.

John Whyte, MD, MPH: You're watching Coronavirus in Context. I'm Dr John Whyte, chief medical officer at WebMD. We're starting to see an increase in the number of cases in some states. So, what do we do to protect ourselves and others?

Joining me today is one of the foremost authorities on COVID, an expert in infectious disease, Dr William Schaffner from Vanderbilt University School of Medicine in Nashville, Tennessee. Dr Schaffner, thanks for joining us again.

William Schaffner, MD: It's always a pleasure.

Whyte: Let's start off with this concept of a COVID bubble as a strategy to keep yourself and your family members and friends safe while slowly expanding the number of people that you can interact with. What do we mean by a bubble, and do you recommend it?

Schaffner: It's actually a very clever idea. People are trying to take the national guidelines and adjust them to their own personal lives. Now we're opening up, but you want to open up carefully, right? You would like to get out with your family and interact with friends. The question is, how do you do that safely? And that's the notion of the bubble.

Let's say we have a family with two children that wants to get together with another family with two children. The trick would be to have a conversation with that family to make sure that they're on the same careful wavelength that you are. If both families have been careful, then you can get together. The children can play with each other, the grown-ups can have dinner, and so on.

You can be assured that everyone inside that bubble is on the same wavelength as far as wearing masks, social distancing, and being careful. So, it considerably reduces the risk of having the COVID virus be part of your bubble.

Whyte: You've established ground rules. Is that right — based on your appetite, in a sense, for risk? Everyone's at a different place for how they assess risk. Would that be a good characterization of it?

Schaffner: Yes, it would. I don't like to use four-letter words like "safe" because we can't ensure complete safety. The moment we walk out the front door, we assume a little bit of risk, and we want to control that risk. By having a conversation with that other couple, making sure that you're on the same wavelength, then you reduce the risk that either you will introduce COVID or they will introduce COVID to your bubble. And you can get together and interact rather safely.

Whyte: How big can the bubble be?

Schaffner: The larger it gets, the more chance for risk. So the conversations really have to be pretty clear. At least in our neck of the woods, the recommendation continues to be that we not gather together in groups larger than 10. And so there is admonishment: Don't gather in large groups. If you gather in small groups (eg, a few people getting together for a poker party), that's fine as long as you can be reasonably assured that you're all together.

Whyte: You have to have those specific discussions about whether folks want to go to the gym, whether they're going to choose to go in the morning (or when there's not a lot of people), or you're only going to associate with people who won't go to the gym or will only eat al fresco. Is that accurate as well? You really want to discuss with the other people in your bubble what you all agree to and then be honest when folks don't adhere to those guidelines that you're all establishing.

Schaffner: As my mother told me, conversations are very important — having clear and honest conversations, saying, "Frank or Susie, we're all trying to be on the same page. So let's go through some of these details and make a list of those things: When do you go to the supermarket? Are you going to the gym? Are you going to work?" Make sure that you are both comfortable with how things are going to work out.

Whyte: Our mothers always do give us good advice. I wanted to ask you about a couple of things that are in the news. We're seeing in some states an increase in the number of COVID cases in young people. That's not surprising. They're probably not physical distancing and wearing masks as much as we would like. Does that concern you, either for the young people themselves or the fact that they may infect people who are at greater risk?

Schaffner: Well, actually both, because young people — although they're profoundly less affected by COVID than older persons — are not totally without risk. There are hospitalizations and deaths among young people who are perfectly healthy. This can be a very nasty virus. Although their infection is very mild or they may have no symptoms at all, they can be contagious and infect people who are at greater risk for severe disease. That concerns me a lot.

Whyte: What's your latest take on the data regarding antibodies and recent research that indicates that they're probably not protective because they don't last long? There are challenges with what type of antibodies have been measured and how they are tested. What's your current thinking on the role of antibodies and their presence in terms of protecting someone from reinfection?

Schaffner: I think our thinking is still in its infancy. We're learning a lot more about this. If we take lessons from the human coronaviruses (eg, the ones that produce common colds), we do get protection after we've had an infection with one of those human strains. However, the protection and the antibodies start to wane after about a year, and you can become resusceptible and can get reinfected. The very early data regarding COVID are beginning to resemble those data, so we need to wait and see. This has implications for vaccines because they may only be able to provide protection for a relatively short period of time. In the future, if everything goes well, we may be rolling up both of our sleeves every fall: flu vaccine in one arm, COVID vaccine in the other.

Whyte: Isn't that a little unusual, other than the influenza example? Most vaccines that we have developed have conferred a longer time of immunity. If not lifelong immunity, certainly many years.

Schaffner: For sure. Now remember, we're supposed to get reimmunized against tetanus (and now combined with diphtheria and pertussis in one vaccine) every 10 years. So we have some precedent. We've developed the vaccines that are so good and were the easy ones to develop. Now we're into the advanced course, we might say. Things are going to get a little bit more nuanced.

Whyte: Dr Schaffner, I want to thank you for taking time to provide insight into how we can stay safe and keep our family members, friends, and our community safe. Thanks for all that you're doing to help protect us.

Schaffner: My pleasure. And stay safe yourself, John.

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