As of June 16 2020, chances are that a large number of people saw the following “COVID-19 Risk Levels” chart somewhere on social media — purportedly ranking common activities (as well as some o”pontoon boat rides”) against one another in terms of relative likelihood a person would be exposed to or infected with SARS-CoV-2:
The “COVID-19 Risk Levels” chart was as pervasive as it was oddly specific, showing up on Imgur and across Facebook:
Readers and commenters typically were focused on the activities listed — “restaurants — takeout” and “tennis” at the lowest level of risk and “bars” or “sports stadiums” at the top on level nine — rather than the actual provenance of the chart. As in the Facebook post above, the chart was often shared between users as a helpful, if sourceless, guide to minimizing their risk of exposure to SARS-CoV-2:
It s good to know the levels of risks if you decide to go someplace. Please do practice social distancing and wear face covering to ensure extra protection.
A number of things weren’t immediately clear about the chart, such as:
- Who or what entity created it;
- On which data (if any) it was predicated;
- Why “pontoon boat rides” were one of the scant number of specific activities described;
- If at all accurate, for which particular country, state, or city the guidance was developed — such as, how far did the recommendations reach, and were the described risks identical in areas of dense population versus rural spaces?
Aside from the nine levels of “COVID-19 risk” described on the chart, there was very little notable indication of who put it together or who originally distributed it. A small, difficult-to-see footer on the image read:
Dr Matthew Sims, Dr Dennis Cunningham, Dr Mimi Emig, Dr Nasir Husain. Based on risk factors including inside/outside, nearness to others, compliance likelihood, and personal risk.
Again, none of those words made sense out of what might be their original context. The four names listed appeared to be doctors (although what sort of doctors was not clear), and the parameters seemed to be at least somewhat fluid — how was personal risk calculated, for instance?
One last small bit of text yielded the clue that provided a source for the actual chart, a URL: tinyurl.com/c19risk. It pointed not to a chart, but to a June 2 2020 MLive.com article titled “From hair salons to gyms, experts rank 36 activities by coronavirus risk level.”
That article began with background explaining the article itself, not the chart:
As governments continue to ease restrictions during the COVID-19 pandemic, the burden of managing risk is shifting to people.
Experts have advised people for months to wear masks, wash their hands and stay 6 feet apart. But now that some public places are reopening, individuals must decide for themselves which ones to continue to avoid and which ones pose little risk of spreading the virus.
MLive spoke to the following four public health experts in Michigan, asking them to assess the risk various activities pose to spreading coronavirus.
Dr. Matthew Sims, Beaumont Health director of infectious disease research
Dr. Dennis Cunningham, McLaren Health Care medical director for infection prevention
Dr. Mimi Emig, retired infectious disease specialist with Spectrum Health
Dr. Nasir Husain, Henry Ford Macomb medical director for infection prevention
From that short introduction, it seemed safe to say the risk levels in the chart were not necessarily strictly data-based. It appeared, rather, that four public health experts provided their individual opinions of risk level to MLive, which at some point resulted in the creation of the chart.
Subsequently, the article explained its “COVID-19 Risk Levels” methodology, before featuring a brief blurb on each of the activities from their “Level 9” to their “Level 1”:
The list, below, assigns a score for activities from 1 to 10, with a 10 being the riskiest and a 1 being the least risky. The score is an average of scores given by the health experts, rounded to the nearest whole number.
To clarify, it appeared each of the four individuals consulted for the article provided their own varying assignments of risk to activities — bowling, shopping at the mall, pontoon boat rides, and restaurants (dine-in and takeout). If one expert assigned a “9” score to “pontoon boating” and another gave it a “1,” the actual activity would be rated “5” as an average of those two numbers, which does not seem particularly scientific.
Also, there were some fairly large caveats:
For example, while the experts said going to a gym is very risky, attendees could be sneezing on each other and ignoring all precautions and still have zero risk if nobody has the virus. And vice versa, playing tennis is one of the least risky activities – but if your partner has the virus, the actual risk is high.
But because many people can have COVID-19 unknowingly without showing symptoms, it’s impossible to know who is and who is not infected at a given time.
The doctors emphasized that if everybody takes precautions, the risk level for each activity is dramatically reduced, they said.
As each risk level and activity was assessed, the four commonly differed on their individual risk assessment:
Risk level: 5
There were varying opinions on the safety of flying in an airplane during a pandemic – two experts called it medium risk, one said it’s low risk and the other side it’s high risk.
There’s a lot up in the air, regarding what precautions might become standard for airlines – from masking to eliminating the middle seat to wiping down surfaces.
“That’s actually pretty safe, the air is very well filtered on airplanes,” Cunningham said. “As long as someone’s not obviously sick, I’m going to give that a 3.”
Emig said the issue is most people don’t wear masks correctly. And plane trips can bunch lots of people together for long periods of time – which is why she believes airplanes are higher risk.
Risk level: 5
Beaches are complicated, the experts said, as there could be a wide range of risk depending on the situation.
A beach is low risk for spreading the virus if it’s not crowded and people maintain their distance.
“But therein lies the problem,” Emig said.
It’s difficult to limit numbers and enforce precautions at beaches, they said. Husain recommends going at an off-peak time, like at sunrise, to avoid risk.
Risk level: 4
Going to the dentist is another activity the experts disagreed about on its risk level of spreading COVID-19. Two experts called it low risk, one said it’s a medium risk and the other said it’s high risk.
Dentists already wear masks and will likely wear extra protective equipment like surgical masks and shields to keep themselves protected. Emig, however, was the one expert to say going to the dentist has a higher risk than getting a haircut.
“Dental cleaning aerosolizes what’s in your mouth,” Emig said. “If somebody unknowingly has the infection, that virus is going to get aerosolized.”
She recommends avoiding the dentist for now, unless there’s a specific issue that needs to be addressed.
“The difficulty is, if you’re a patient who’s coming into the room 20 minutes after a cleaning has been done on somebody who didn’t know that they carried the virus, you’re going to be walking into that room and breathing that virus,” Emig said.
In three random examples, the already small sample of just four opinions varied quite a lot. For instance, airplanes were ranked “5” because two experts called flying “medium risk,” while one each called it “low” or “high.” Similarly, going to the dentist ranked at “4,” with two votes for low risk, one for medium, and another for high.
Even in scenarios with little disagreement between the four experts, it was obvious that takeout’s ranking as the lowest risk on the chart still depended on a number of variables:
The experts have little concern about getting takeout from a restaurant – especially with all the new safety measures in place with curbside pickup and touchless payment at many restaurants. This is much less risk than eating at a restaurant, they said.
The “COVID-19 Risk Levels” chart definitely proved popular and was viewed over 100,000 times in a 24-hour period on Imgur, possibly an indication that people were desperate for any and all tangible guidance when it came to the COVID-19 pandemic. It’s not even clear where the chart itself came from, but it resonated way more than the actual article — which was not anywhere near as assertive as the chart. Although the article itself provided an interesting and possibly informative resource for understanding how public health experts assessed transmission risk, the chart by itself lacked the nuance supporting the entire piece. On its own, it really did not provide an incredibly trustworthy resource for planning summer activities while trying to avoid contracting COVID-19 during an ongoing pandemic.