Let’s venture out on a limb: Can we go for a walk?
A lot of today's realities would have been hard to imagine two months ago. As a journalist, I certainly never expected to be hounding senior health officials with the question: can we go for a walk?
In this disorienting new pandemic universe, the answer is not necessarily obvious. The public has been firmly instructed, sometimes even scolded, to remain inside for all but essential outings to slow the spread of COVID-19. We know physical distancing saves lives. So is going for a walk an "essential outing," or a reckless luxury?
While the messaging has been occasionally muddled from different levels of government, Toronto's top public health officers have been consistent: you can go for a walk. You actually should go for a walk. Staying cooped up inside can have mental and physical health consequences too, and they don't want residents suffering those ill effects, either.
"Going for a walk can be necessary if you have a pet. It's also an important public health intervention to keep physically active, to build muscle and to improve mental health and well-being," said Dr. Vinita Dubey, Toronto Public Health associate medical officer of health.
There are critically important exceptions to that advice. If you have COVID-19 or are otherwise ill, if you had close contact with someone who has COVID-19, or if you recently returned from international travel, you should not - and now in Toronto legally cannot, in most of those cases - go for a walk.
If you don't fall into one of those groups, and you do go for a walk, you should maintain two metres of physical distancing from other people at all times - and granted, in dense urban environments, that's not always easy or even possible.
This advice could change in the rapidly evolving outbreak. But while simply ordering everyone to stay home with no exceptions might be easier to communicate, isolation has risks too, experts say.
"The ramifications of enforcing confinement are huge. They're huge, and they could be very detrimental to a certain segment of the population," says Myriam Mongrain, a clinical psychologist and professor at York University.
Before addressing the health consequences of staying inside, let's tackle the safety of going outside.
While we have only known of this virus's existence for about 90 days, Canada's public health authorities and infectious disease experts express confidence that people who stay two metres apart from others, and who don't touch any surfaces, are very unlikely to catch COVID-19.
The disease is primarily acquired by coming into contact with droplets expelled out of the respiratory tracts of contagious people through coughing, sneezing or talking, or by touching surfaces where those droplets have been deposited and then touching your mouth, nose or eyes.
Again, while COVID-19 is very new, the current evidence suggests that the virus can only linger in the air under highly specific circumstances, such as when a hospitalized patient is intubated, an invasive procedure that causes extreme coughing.
"COVID-19 is spread through respiratory droplets from coughing, sneezing or talking in close contact with someone who is contagious. Going for a walk outdoors while keeping six feet physical distance from others has very low risk to spread COVID-19," Toronto Public Health's Dubey said.
Authorities scolded residents of Toronto for congregating in parks and other spaces last weekend. In a city like Toronto, it can be hard, however, to find a place and time to get outside where it's easy to stay a hockey-stick-length away from other people.
"With dense urban settings, there's more of a challenge there " where do you go?" said Dr. David Williams, Ontario's chief medical officer of health, on Wednesday. "We're trying to leave some green spaces open so you can go there."
Williams suggested planning walks and other outdoor exercise for off-peak times - though again, if an entire city of millions is choosing off-peak times, the concept of off-peak becomes kind of meaningless. Just use common sense.
"Go at times when it's not busy, and plan your exercise, your jog for when it's still safe."
The health consequences of having large parts of North America isolated inside and inactive for weeks and likely months is possible to guess in general terms - it's bad - but the exact outcomes are harder to predict. Experts in physical and mental health the Star spoke to struggled to find comparable scenarios for which there is good scientific evidence.
Mongrain, the York University clinical psychologist, worried about the toll of isolation on people, especially children, in unsafe households.
"There's a huge segment of the population that doesn't have really good space within the four walls of their household," she said.
"Is this space healthy, or is it a space with toxic or dysfunctional relationships? Let's think about children in households where there's domestic violence or a greater likelihood of abuse. These are kids who are vulnerable."
Enforcing a mandatory stay-at-home order for everyone could have terrible consequences for children and adults in this situation, Mongrain said. Those people, more than most, need to be able to leave their houses for a walk.
On the physical health side, David Hood, a professor and tier one Canada research chair in kinesiology and health science at York University, says he worries about formerly active young people. The negative changes of inactivity on the body are rapid, Hood said.
"I'm more worried about younger people who are normally very active and now suddenly finding themselves without anything to do. They're sitting in front of screens much more than they normally would. Young people aren't immune to the changes in muscle strength and size and the cardiovascular decay and the metabolic problems that are going to come up by becoming inactive."
Mongrain had an exception to the recommendation for going outside.
"How do you feel going out for a walk? Is your level of anxiety going up " are you able to put those thoughts of contamination out of your head? If not, stay home."
Kate Allen is a Toronto-based reporter covering science and technology. Follow her on Twitter: @katecallen