Doctors rarely talk about the importance of bubbles. But now they're urging all Americans to hunker down in their bubbles through this disastrous Covid-19 surge.
Social distancing bubbles can help you stay safe and sane by seeing other human beings. But they only work if everyone follows the same strict rules.
Here's what a bubble is, what the ground rules should be, how to handle tricky conversations with friends and family, and what happens if someone violates (or bursts) the bubble:
What exactly is a bubble?
A Covid-19 bubble is the (select few) friends or family members you can socialize with and enjoy a meal with, mask-free. But the most important rule is no one can socialize in-person with anyone outside the bubble, especially without face masks.
It's critical to keep this bubble as small as possible, said Dr. Sadiya Khan, an epidemiologist and assistant professor of medicine at Northwestern University Feinberg School of Medicine.
'The fewer, the better,' she said. 'Your bubble consists of everybody that your entire bubble is in contact with. So even if you're only including one other person in your bubble, but that person has 10 people in their bubble, you've now got 11 people in your bubble.'
And 'if you bring 10 people together, there's a high likelihood one of them is going to have Covid-19,' said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
Why are bubbles so important now?
-- Health experts say the next few months will be the worst yet of this pandemic.
'I actually believe they're going to be the most difficult in the public health history of this nation, largely because of the stress that's going to be put on our health care system,' said Dr. Robert Redfield, director of the US Centers for Disease Control and Prevention.
-- Hospitalizations are soaring out of control -- affecting those without coronavirus, too. More hospitals are running out of ICU beds, meaning patients are getting sent out of state or not getting the emergency care they need.
-- Over the past week, the average daily death toll from Covid-19 has soared past 2,200, according to Johns Hopkins University.
-- Young and healthy people also need to bubble up. While they're generally less likely to die from coronavirus, many young adults are suffering long-term lung damage, fatigue and brain fog months after infection.
How do you make a social distancing bubble?
'Think about who you want to do your social distancing with ... and get ready to hunker down,' Hotez said.
Ideally, that should only be members of your own household or 'just a couple of friends' outside your household, he said.
Everyone in the bubble should follow the same ground rules:
Don't socialize with anyone outside the bubble -- especially not indoors. 'The virus is aerosolized, so it can last in the air potentially for up to several hours,' Khan said.
So someone who is asymptomatic can release the virus by just talking or breathing, 'potentially infecting someone else who's breathing that air,' she said.
Wearing a mask can help. But 'there is no zero-risk with people outside your bubble, especially (indoors),' Hotez said.
'That's why it's best to remain socially distant during this time of extreme virus transmission,' he said. 'Remember, it's not in perpetuity. Good vaccines are coming.'
Wear a mask around anyone outside your bubble if you're outdoors, Khan said. Even outdoor gatherings can turn into superspreader events.
Always wear a mask in public, Hotez said. 'Anytime you're out in public, whether you're outdoors or indoors, you have to have a mask on.'
Set rules on risky activities such as indoor restaurant dining or going to the gym, where not everyone might be wearing a mask. 'With dynamic changes in the infection rate, sometimes those rules may need to change,' Khan said.
'And unfortunately right now, given how high the rates are everywhere, I would really recommend restricting to only necessary activities outside the home.'
Who should be in my bubble?
'I think the safest is just the people you live with and need to interact with for ongoing care,' such as a babysitter, Khan said.
For those who live alone and must bubble with friends outside their household, 'the most important thing is to ensure that everybody is on the same page with the rules,' she said.
Elderly people and others at high risk of severe Covid-19 complications can be part of your bubble, too -- but the bubble must be 'pristine,' Hotez said.
Khan said it's important to balance Covid-19 safety with mental health.
'For many elderly folks who may not have a lot of physical or social interaction -- maybe they live alone or they live apart from other family members -- it's really important to be able to maintain contact, for emotional and mental health,' she said.
How do you safely include children's friends inside a bubble?
'In places where children could be outdoors and gather with masks, that would be preferred,' Khan said.
'If there is one other family that you want to extend that bubble with, and everybody's on the same page, I think that's another approach.'
What happens if someone breaks the bubble?
'It depends on the circumstance. But if this individual who has socialized without a mask outside the bubble, then that person needs to be in quarantine and get tested before you see them,' Hotez said.
He said the bubble violator should quarantine for seven days and then get tested.
And if others inside the bubble may have been exposed to the virus, they should get tested, too.
How do you decline invitations from people outside your bubble?
'You can take a few approaches,' said Elaine Paravati Harrigan, an assistant professor of psychology at Hamilton College.
'The simplest way is to let them know you will not be attending, without any justification. In other words, you can simply say, 'Thank you for the offer, but I won't be able to make it,'' she said.
'The second approach is to give them a bit more context,' she said.
For example: 'Thank you for the offer, but I am not comfortable going to an indoor gathering with those outside my immediate family yet.'
With either type of response, you could offer to meet up virtually instead. 'This allows you to acknowledge their importance in your life while not compromising your level of comfort,' Harrigan said.
Hotez said he understands how difficult this situation can be.
'It gets tough when there are certain people that you really have a craving to see,' he said.
'Right now I'm socially distancing with my wife and my special-needs adult daughter ... and not seeing my oldest daughter and her husband, (who) live in L.A,' he said. 'They wanted to come see us. We said no.'
What if people are offended that they're not part of your bubble?
'Try to convey your message in a spirit of caring, and underscore that it's not an easy decision to make (even if it's the right decision),' said Jayson Dibble, an associate professor of communication at Hope College and an expert on relational communication.
'If we're going to observe the concept of bubbles, then there have to be insiders and outsiders,' he said. 'Instead of focusing on who's inside or outside, suggest maintaining social contact through whatever means are safely available, e.g., Zoom or FaceTime.'
What if a friend or family member (outside your bubble) thinks you're overreacting?
Disagreements over safety measures were a thorny issue for some families over Thanksgiving, and they may cause tension again over Christmas and other upcoming holidays.
But you can ease that tension with open communication, Dibble said.
'Acknowledge their point of view and ask them for their understanding, if for no other reason than they care about you,' he said.
'Remind them that you wouldn't be taking these steps if you didn't think they were important. And if you have to agree to disagree, so be it. Don't let it get personal. Point out how much sweeter it will be when finally you can be together again, knowing you did what it took to care for each other this time around.'
Can I visit with someone outside the bubble if we both get tested first?
'Anybody you're seeing outside your bubble, they have to be tested,' Hotez said. 'And if it requires traveling a distance, then testing before and afterward.'
But even with testing, 'you're taking risk, because the testing is not foolproof,' he said.
For example, if you don't quarantine for a few days before your test, you could end up with a false negative result -- and a false sense of security.
Do we really need to stay in a bubble?
If you want to protect your loved ones and get life back to normal faster, then yes.
'Remember, it's this period that's the worst -- when people are indoors, the weather is cold, there's a lot of virus circulating,' Hotez said.
'This is not a time to let your guard down or be reckless. This is a time to focus on getting to the other side,' he said, when the majority of Americans could get vaccinated next year.
And with the accelerating rates of infections, hospitalizations and deaths, 'we have to do everything we can to be as cautious as possible and focus on reopening our schools as soon as it is safe and restarting our economy,' Khan said.
'And the best way to do that is to really hunker down now for the short term.'