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Coronavirus: When will it be safe to work out at gyms or go on vacation?

Opinions differ widely on when it is safe to restart activities like working out at the gym, or going on vacation. Senior Health Correspondent Joyce Teo susses out what 15 experts and healthcare workers think.

Even as countries rush to ease lockdowns, places like Hong Kong and Melbourne have had to reimpose restrictions as coronavirus cases rise in the community.

When people gather in a big group, they can be exposed to all the people that others in the group have been exposed to. It is why public health measures such as physical distancing are going to be a way of life, possibly until a vaccine becomes widely available.

The Sunday Times asked 15 people, including infectious disease experts, doctors and nurses, when they plan to start doing 18 common activities such as eating out, going to a wedding function and shaking hands.

Although they are on the front lines of this war against Covid-19, their answers varied.

Two activities, though, are popular in this phase: 11 of the 15 seem happy to go get a haircut.

The same number also would not let the coronavirus get to the foodie in them. They are happy to eat out, be it at a hawker centre, foodcourt or restaurant, though one would do it only in phase three while three experts plan to do so only when a vaccine is available, which could be a year from now.

Singapore is now in phase two of a gradual reopening. People can now gather in groups of up to five and households can receive up to five visitors at any one time, among other rules.

Phase two started on June 19, nearly three weeks after the end of a two-month circuit breaker period.

Phase three, which will last until a vaccine is found, will start months from now, the Government said early this month. When it comes, social, cultural, religious and business gatherings or events would resume, although gathering sizes would still have to be limited in order to prevent large clusters from arising, for instance.

Seven out of the 15 indicated that they would work in an open office now, with physical distancing in place. For most, however, attending a wedding function, overseas recreational trips or watching a movie can wait.

Professor Teo Yik Ying, dean of the National University of Singapore's (NUS) Saw Swee Hock School of Public Health, would attend a wake now, but a wedding only in phase three as this is slightly riskier due to the typical socialising and rowdier interactions common at matrimonial bashes.

Dr Leong Hoe Nam, an infectious diseases expert at Mount Elizabeth Novena Hospital, said he is comfortable with eating out now, but you would not find him exercising in a gym or shaking hands until phase three.

Travelling for fun will have to wait

Infectious disease expert Paul Tambyah from NUS' Yong Loo Lin School of Medicine and a senior consultant at the National University Hospital would also eat out now, though he would do so only when there are fewer people around and avoid unhygienic or overcrowded environments.

In his view, hugs are not a good idea now. "I almost never hug anyone outside the family since I was a kid. If someone hugs me in phase three, I will not run away!" he said. That is also when he would consider travelling by airplane or not wearing a mask, which he finds uncomfortable, provided those are allowed.

For now, instead of flying to Boston in the United States for meetings at the headquarters of the International Society of Infectious Diseases, where he was appointed president-elect a few months ago, he will meet them online.

"I am one of those who think the virus may just disappear by the end of the year, or mutate to be less virulent," he said. "If the virus is controlled in the southern hemisphere (South America and Australasia) and the tropics, there is a chance that in October or November, we will not see the dreaded second wave similar to the 1918 influenza pandemic. That is a big 'if."

Some experts said they would be okay flying in phase three, although the demand might be affected by the number of destinations that are open.

Prof Teo said he believes there will be a strictly restricted list of destinations from Singapore for mass market tourism in phase three.

"Whether I will choose to travel for recreation before a vaccine is available, will really depend on the Covid-19 situation in the destination country," he added.

Singaporeans who love to take weekend trips will have to wait. Singapore and Malaysia said last week that they will start limited cross-border travel on Aug 10, but that is for long-term pass holders and those on essential or official business.

So much uncertainty There's so much we don't know about the virus... so for now I'll stick to the mask. It's minimal effort and I am less likely to catch coronavirus or other types of flu. Likewise, I am also less likely to infect others.

Dr Laureen Wang, an associate consultant with Alexandra Hospital's cardiology department, who plans to continue using a surgical mask in crowded places for some time.

When can i shake hands again?

Saying no to handshakes became trendy when Covid-19 cases rose earlier in the year, and the risk of being infected through touching someone's contaminated hands is enough for two experts to not want to do so until a vaccine is found.

A few would shake hands only in phase three, but some, like Associate Professor Hsu Li Yang, the programme leader of infectious diseases at the Saw Swee Hock School of Public Health, have no qualms doing it now.

"I just make sure I don't touch my face after that," said Prof Hsu, who has had a haircut and would eat at a hawker centre or a restaurant. However, he does not plan to stop wearing a mask until a vaccine is found.

Dr Piotr Chlebicki, an infectious diseases specialist at Mount Alvernia Hospital, who thinks that things will return to normal only after a vaccine is available, also plans to continue wearing a mask in enclosed spaces until such time.

Singapore is nearly six months into the Covid-19 outbreak and the yearning for a sense of normality is deepening.

Nurse manager Julianah Omar from the Urgent Care Centre at Alexandra Hospital (AH) wants to go to Johor Baru to shop for groceries, but is happy to have an excuse to not have to hug someone as a form of greeting.

Most of the respondents report that there is nothing they would stop doing for good, although Dr Laureen Wang, who used to go to the gym twice a week, may give that up after discovering the fun of following app-based workouts and YouTube fitness videos at home.

"I do not plan to exercise in a gym as I enjoy my newly found alternatives much more, and it's quite easy to have lapses in hygiene practices in the gym such as ensuring that the machines are well-sanitised before passing it on to the next person," said Dr Wang, an associate consultant with AH's cardiology department.

Others plan to take precautions when exercising in a gym, such as disinfecting surfaces.

When it comes to going to a pub or club, some are happy to do it in phase three and others, like Prof Teo, will do so only when a vaccine is available as the risk of being infected can be high, depending on the setting.

Drinking in an outdoor pub can be quite different from dancing shoulder-to-shoulder with other drunk people in an indoor location.

Prof Teo said in a recent episode of The Straits Times' talk show The Big Story that the high-risk settings are those where people come together to spend long hours socialising, singing and talking in close proximity.

These include clubs and discos, he said, pointing out that the new spike in Covid-19 cases in Tokyo was traced to a theatre show starring Japanese boy-band members. The authorities there have appealed for more than 800 theatregoers to get tested.

Ensuring mental wellness It is about finding ways to 'escape' from the pandemic in order to retain a sense of mental wellness; ways which don't rely on socialising with family, friends and colleagues, such as creative methods to exercise in whatever manner is allowed or immersing yourself in your favourite drama serials or books.

Professor Teo Yik Ying, dean of the National University of Singapore's Saw Swee Hock School of Public Health, on how to carry on with life.

Returning to pre-covid19 life

The main activity many expect to carry on doing until a vaccine is found is wearing a mask when out, with nine out of 15 people prepared to do so. Next comes not travelling by plane, with seven out of 15 comfortable to do so only after a vaccine comes. Seven out of 15 would also wait until then to hug someone as a form of greeting.

Some experts have said that it will be a year or more before a vaccine becomes readily available.

"Even when there's a vaccine, there may not be 100 per cent protection, and the protection won't be lifelong," said Prof Hsu.

He said a recent study done in China suggests that those with mild coronavirus disease might have lower levels of immunity against Covid-19 than those who become severely ill with the disease.

The study, published in Nature Medicine on June 18, highlighted the risks of using Covid-19 "immunity passports", as antibodies may last only two to three months, especially in asymptomatic people.

The uncertainty surrounding Covid-19 is why Dr Wang plans to continue using a surgical mask in crowded places: "There's so much we don't know about the virus. So for now I'll stick to the mask. It's minimal effort and I am less likely to catch coronavirus or other types of flu. Likewise, I am also less likely to infect others. I'm not saying it should remain mandatory, but I don't think there should be a stigma attached to it even after the pandemic ends."

Prof Teo thinks the world will slowly return to life before Covid-19 when a vaccine becomes available. He thinks Singapore may be able to get the vaccine in the second half of next year. "The existing measures and restrictions are not normal, and while people keep talking about the 'new normal', my sense is that the world (may) allow a temporary pause on normal pre-Covid life, but is unlikely to accept a permanent cessation or shift," he said.

"It was the same after the 1918 flu pandemic, and likely will be the same again. So, if there was an activity I was doing prior to Covid-19, I will likely return to it once the world has found a semi-or completely permanent solution for Covid-19."

Indeed, Professor Antonio Bertoletti from the emerging infectious diseases programme at Duke-NUS Medical School said: "Perhaps we should relook living in this state of suspended life since the infection in Singapore and South-east Asia has a mortality rate of lower than 0.1 per cent."

Life has to go on, and there will always be a slight risk of infections as we go about our daily activities, though in this pandemic, people should certainly remain careful when interacting with specific persons who are in the high-risk groups, such as the elderly and those with underlying illnesses, he said.

Prof Bertoletti said he would eat out now, or travel by plane if that is allowed, but he would not attend a wedding, watch a movie or go to a pub until phase three.

His greatest fears in this pandemic? "That I will never see my kids playing free in the park with their friends, and that the social and economic development of our world may be affected and millions of people may return to total poverty," he said.

Prof Teo's greatest fear is that the search for a comprehensively effective and safe vaccine may fail. "Then the world will truly need to accept the 'new normal'.

"Another fear... is that of the coronavirus mutating to become even more virulent and, yet, is just as transmissible. Then, that will truly be a nightmare scenario, with widespread infections and fatalities."

For now, as people carry on with life, it is also about finding ways to escape from it in order to retain a sense of mental wellness, he said.

These are ways other than relying on socialising with family, friends and colleagues, such as creative methods to exercise in whatever manner is allowed or immersing yourself in your favourite drama serials or books, he added.

Prof Teo climbed the stairs at the block where he lives during the circuit breaker when he could not go to the gym. He has yet to go back to the gym (he uses only the elliptical machine), as he finds stair-climbing a good enough substitute.

"Also, I enjoy the outdoors a lot and watching YouTube videos about trekking and camping has provided a form of mental escapism which surprisingly works," he added. "These are important for everyone because mental and physical wellness helps one maintain a degree of resilience and positive outlook during what is otherwise a straining time."


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