As Maryland slowly reopens, experts watching how public reacts to coronavirus risks

Now that Maryland is allowing more outdoor activities, some residents are eager to emerge from their stay-at-home cocoons. But public health experts are cautioning: Not so fast, social butterflies.

“It is not possible to say any of these activities is completely safe,” said Dr. Tom Inglesby, who directs the Johns Hopkins Center for Health Security.

“Most of the transmission that has occurred with COVID-19 has been inside,” he said. “It doesn’t mean that there is no risk outside, but it means the risks are lower than indoor settings.”

Inglesby is among the medical and business advisers Gov. Larry Hogan has turned to as he determines how to reopen the state. This week, Hogan allowed restaurants to offer outdoor dining, and camps, pools and some youth sports to resume operations — but only under limited circumstances.

Public health experts say outdoor activities generally will be safer than prolonged indoor contact. But they also say businesses and patrons still need to maintain the now familiar social distancing and sanitation practices of staying six feet apart, wearing masks and disinfecting shared surfaces.

Some are watching warily as the new measures take effect, having seen how dense crowds have formed quickly when the weather is nice or a beach like Ocean City reopens — often with few people wearing masks.

Public health officials have been offering advice on how to reopen in as safe a manner as possible.

“You have to work within the culture that exists,” said Crystal R. Watson, an assistant professor at the Johns Hopkins Bloomberg School of Public Health.

[ Stay up to date with the latest on coronavirus in Maryland ]

While other countries have imposed stricter quarantine measures — in Italy at one point, residents had to carry documentation for why they were allowed to leave their house — Watson said Americans don’t have the “appetite” for such strict enforcement.

And it may not be necessary, she said, because vast majorities support and have followed stay-at-home guidelines.

That’s important, because keeping safe distance often will involve self-policing. Area law enforcement agencies say they generally are opting for education and “voluntary compliance" over citing individuals or businesses for violations.

People are taking distancing guidelines seriously enough that thousands have called authorities to complain about what they perceive as unsafe behavior. In Baltimore County, for example, where spokesman Sean Naron said enforcement is “primarily complaint-driven,” officials have received 958 complaints. In nearly half, though, no violation was found.

Similarly, Anne Arundel County has responded to more than 900 complaints about pandemic-related emergency orders, police spokeswoman Sgt. Jacklyn Davis said. Police there have not arrested anyone solely for violating an emergency order, she said. Police will continue to respond and assess the situation, Davis said, and sometimes the county’s health department will follow up.

In Baltimore City, the task force that handles complaints about businesses has an updated list of outdoor dining permits “to perform proactive outreach and to follow up on complaints as they arise,” the health department said in a statement. The task force includes representatives of multiple city agencies including police, fire, health and housing departments and the liquor board.

City police have dispersed large crowds that have gathered, such as one in Fells Point earlier this month, by blaring their sirens and using a loudspeaker to remind people that the stay-at-home order was still in effect.

That incident occurred after Hogan announced the state was moving into a “safer-at-home” phase, although Baltimore Mayor Bernard C. “Jack” Young and some county executives maintained stricter measures.

Now, with even more restrictions eased both by state and local governments, public health officials are watching to see how the public responds.

[ What is allowed in outdoor dining and what have Maryland’s local officials said about reopening restaurants? ]

“Reopening means risk,” said Dr. David Marcozzi, a University of Maryland Medical System physician who previously served as a director of preparedness policy for the National Security Council.

Marcozzi, who also was among Hogan’s public health advisers, said the state has lifted restrictions in a measured way, pausing in between to gauge the effect and check data points before moving to the next phase.

There had been some recent troubling metrics, including an uptick in hospitalizations earlier this week and a positive test rate that remains above the 5 percent that the World Health Organization advises governments to meet or drop below before reopening. But general trends, averaged over the span of days or weeks, are going in the right direction, said Marcozzi, an assistant chief medical officer at the University of Maryland Medical Center.

Until a vaccine is developed, he said, the numbers will likely continue to rise and fall.

“We are entering a mountain range of peaks and valleys,” he said.

Inglesby agreed, noting that over a two week span, the number of COVID patients hospitalized in the state dropped by about 200, and there were 50 fewer people on ventilators.

“Things are slowly trending in the right direction in terms of those numbers,” he said.

Still, he said, hospitalizations and other metrics need to be monitored carefully to make sure what seem like blips or slight increases don’t turn out to be the start of an upward trend.

“That particularly will require difficult decisions about next steps,” Inglesby said.

Watson, the Hopkins professor who specializes in risk assessment, is among the researchers who developed the Center for Health Security’s “tool kit” for businesses to help them reopen. Businesses can walk through check lists that identify risks and how to modify them as they consider reopening.

Watson said testing and contact tracing need to ramp up further and “give us a better sense of where the virus is traveling.” That would allow officials to target areas for tighter or looser restrictions.

Until then, she advises caution, and that people try to keep their social circles as small as possible because you’re not just interacting with those individuals but also their networks.

“If we reopen now and we’re not careful," she said, “I think a surge of new cases is possible.”

With outdoor tables now beckoning and swimming pools soon, people face their own risk assessments.

Normally Diane Macklin, a public relations professional and dining-out enthusiast known as “Downtown Diane,” would be grabbing a table this weekend. She said she is thrilled restaurants have the opportunity to expand beyond takeout and delivery and hopes that will help them survive the pandemic and shutdown.

[ As Maryland breweries get the OK to open outdoor seating, here’s a look at how they’ve adapted amid coronavirus ]

But with her mother celebrating her 85th birthday Saturday, Macklin doesn’t want to risk contracting anything that she then might transmit.

She’ll be watching from afar, though, and hopes more spots join the first adopters of the new policy. Giving people more places to go, Macklin said, could help prevent restaurants from getting overcrowded.

Tara Reid, a single mother who lives in downtown Columbia, in part, because she enjoys being able to walk to trails, shops and restaurants, also is taking a wait-and-see approach even as she’s tempted to return to her favorite spots.

“It would be nice to have a meal out,” she said wistfully, after weeks of supporting restaurants by ordering takeout. “I was just having a conversation about this with my friends, and they’re very interested in going out and about but doing it safely.

“We were really missing social interactions, and that happens around food and drink,” she said.

But given that Reid is currently staying with someone who has elderly and medically vulnerable relatives, she doesn’t want to risk bringing home this, or any, virus. She laughs now, but remembers panicking when she was out recently and someone sneezed on her.

“I ran into the car," she said, “and baby-wiped myself down."

Baltimore Sun reporter Jessica Anderson contributed to this article.