Multiple people in the circles I speak to in Pleasanton, California and across the United States reflected the notion this week that they have hit a wall.  We’ve been sheltering in place for what feels like forever.  We recognize that this is going to be a long haul.  Life has changed.  It will never be the same again and we are struggling to envision the future.  Dreams for summer have been put away.  Even the Fall looks chaotic with some schools planning to reopen and others committed to distance learning. 

Are the wheels in your mind going around and round trying to make heads or tails out of the situation?  If so, don’t despair.  You aren’t alone.  We are in the middle of a crisis.  The way out is to go forward, not backward.  There is a new normal somewhere in the distance.  It just hasn’t taken shape yet.


Social distancing is getting harder, but we have to keep at it.  Because it feels safer to venture into stores or other public places many people are taking baby steps back into circulation.  If you do that please use the following strategy to stay safe:

  • Wear a mask when you are in “exposure” zones (mainly places with other people).  
  • Treat your home, car, and yard as safe places (no mask or gloves).  
  • Be on high alert on what you are doing with your hands when you are in “danger zones.” This is when you must not touch your face.  
  • Consider wearing gloves (even winter gloves or work gloves can be helpful) but only for short periods of time and only when in “touch exposure” danger zones.
  • Remove your gloves (and mask) when you return to your safe place.  
  • Wash your hands every single time you take off your gloves or mask or move from a danger zone back to a safe zone.  
  • When you are at home and after washing up, you can relax, scratch your nose, rub your eyes and floss your teeth…without worry.  


  • If you need to reuse your mask these are recommendations for handling and reusing it:
  • Wash your hands with soap and water before handling your mask.
  • Avoid touching the inside of the mask.
  • Discard any mask that becomes contaminated with respiratory or nasal secretions.
  • Wash a homemade mask regularly.  Consider buying or making a second one that you can rotate through the wash after public outings.
  • Store your mask in a paper bag or hang it on a hook to keep it from brushing against potentially contaminated surfaces.
  • Don’t share your mask with anyone else, including close family members.
  • Discard any mask you are wearing if you are exposed to a person sick with COVID.


If you become sick in a way that would normally prompt you to seek medical attention go ahead and behave normally.  Call your doctor or go to an emergency room.  Avoidance of proper attention to medical conditions may result in a worse outcome than the potential of exposure to Sars-cov-2.  


  1.  Tippett MD, PhD, Peter.  Saving your health, One mask at a Time
Plans to reopen US economy
Plans to reopen US economy

On Thursday evening, April 16, 2020, a summary of the Federal government’s plan to reopen the U. S. Economy was shown on the San Francisco NBC evening news. While I watched I took screenshots of my TV.

There are 3 categories of Gating Criteria proposed to be met before proceeding to Phase I Opening.

State or Regional Gating Criteria

These criteria require not just a flattening of the curve. They propose to see a downward trend in reported symptoms and case reports. Hospitals need to be able to handle all non-crisis care and they should have in place a robust testing program for at risk healthcare workers, including new antibody testing.

These criteria make sure that our healthcare system is no longer overwhelmed with COVID illnesses. It’s good to see the call for a robust testing program for Healthcare Workers. How about adequate PPE?

The Phases to Reopen The Economy

Governors have discretion in when they feel their state is ready for Phase One.

Phase One

This is a huge step. It means many people back to work, many people going to public places, and an INCREASED need for each individual to protect themselves and others against exposure. It means: Keep wearing a mask and gloves. Keep social distancing in place. There is a lot of awareness required. MORE than is required now when so many people are out of circulation. If we don’t do well enough at this step the curve will turn upward again.

Returning to work in the age of Covid-19

What are the recommended health requirements for return to work? Temperature measurement is a poor screening measure. It will only capture those with active illness who have ignored the mandate to stay at home when sick.

It won’t capture those with lingering ability to spread the virus or who are in the incubation period after exposure but not yet sick. We need better guidelines here. Social distancing is completely appropriate but it can’t make up for screening errors. There are too many occasions where social distance is either ignored or not possible in the workplace.

Does this step allow for gyms and theaters to open? It appears so but Phase 3 mentions opening restaurants and theaters.

The bullet points are brief and consequently cannot include measures to ensure appropriate sanitation in public places. There also aren’t any guidelines for testing of the larger population, a measure clearly recommended by public health officials.

Phase Two
Phase Two

It’s hard to predict when this phase can be implemented. Already many schools are closed for the rest of this school year. Summer programs and vacations have been cancelled. State by state it will happen.

Phase Three
Phase Three

It’s time to consider how you will change your behavior as we move to more freedom to circulate. If you are a business owner forced to close during the shelter in place period how will you adapt your business practices when allowed to open?

We are all in this together. Please use caution and STAY WELL! Susie Larson, MD