It is challenging to keep up with evolving information on a day-to-day basis, perhaps even more so during a pandemic. The goal of this post is to provide you with a resource that can help you understand the risks associated with the environments you frequent. Erin Bromage, PhD, from the University of Massachusetts Dartmouth, has written a series of posts that put the science of the COVID-19 pandemic into lay language. Here is some content from his posts that I find the most useful in terms of understanding the risk associated with various situations.

Where do people become infected?

We know most people get infected in their own home. A household member contracts the virus in the community and brings it into the house where sustained contact between household members leads to infection.

Where do people get the virus in the community?

Indoor spaces, with limited air exchange or recycled air and lots of people, are concerning from a transmission standpoint.

How much exposure do you need to become infected?

In order to get infected you need to get exposed to an infectious dose of the virus…. it appears that only small doses may be needed for infection to take hold. Some experts estimate that as few as 1000 SARS-CoV2 infectious viral particles are all that will be needed. Please note, this still needs to be determined experimentally, but we can use that number to demonstrate how infection can occur. Infection could occur, through 1000 infectious viral particles you receive in one breath or from one eye-rub, or 100 viral particles inhaled with each breath over 10 breaths, or 10 viral particles with 100 breaths. Each of these situations can lead to an infection.

Social distancing rules are really to protect you with brief exposures or outdoor exposures. In these situations there is not enough time to achieve the infectious viral load when you are standing 6 feet apart or where wind and the infinite outdoor space for viral dilution reduces viral load. The effects of sunlight, heat, and humidity on viral survival, all serve to minimize the risk to everyone when outside.

Successful Infection = Exposure to Virus x Time

Where are the personal dangers from reopening?

It all relates to population density and air exchange within the space. IE the number of people, the size of the space, and the degree to which air can flow through the space.

When assessing the risk of infection (via respiration) at the grocery store or mall, you need to consider the volume of the air space (very large), the number of people (restricted), how long people are spending in the store (workers – all day; customers – an hour). Taken together, for a person shopping: the low density, high air volume of the store, along with the restricted time you spend in the store, means that the opportunity to receive an infectious dose is low. But, for the store worker, the extended time they spend in the store provides a greater opportunity to receive the infectious dose and therefore the job becomes more risky.

Basically, as the work closures are loosened, and we start to venture out more, possibly even resuming in-office activities, you need to look at your environment and make judgments. How many people are here, how much airflow is there around me, and how long will I be in this environment. If you are in an open floorplan office, you really need to critically assess the risk (volume, people, and airflow). If you are in a job that requires face-to-face talking or even worse, yelling, you need to assess the risk.

If you are sitting in a well ventilated space, with few people, the risk is low. If I am outside, and I walk past someone, remember it is “dose and time” needed for infection. You would have to be in their airstream for 5+ minutes for a chance of infection. While joggers may be releasing more virus due to deep breathing, remember the exposure time is also less due to their speed. Please do maintain physical distance, but the risk of infection in these scenarios are low.

Airline travel during this time seems worrying, and before going ahead you have to assess all factors into determining whether you fly or not. If you are in the high risk group for developing severe COVID-19 symptoms, then despite all the precautions you and the airline can take, it is unwise to get on a plane.

What is the role of asymptomatic people in spreading the virus?

Symptomatic people are not the only way the virus is shed. We know that at least 44% of all infections–and the majority of community-acquired transmissions–occur from people without any symptoms (asymptomatic or pre-symptomatic people). You can be shedding the virus into the environment for up to 5 days before symptoms begin.

Remember the Formula: Successful Infection = Exposure to Virus x Time

As we are allowed to move around our communities more freely and be in contact with more people in more places more regularly, the risks to ourselves and our family are significant. Even if you are gung-ho for reopening and resuming business as usual, do your part and wear a mask to reduce what you release into the environment. It will help everyone, including your own business.

Thank you to Erin Bromage, PhD, for sharing this information to the public.


The world is changing dramatically, and we must change along with it.  Medicine has changed in two very important ways that reflect the demands nature and society have placed on it. 


First, Telemedicine is no longer the wave of the future.  It is NOW.  Like social relationships that have transitioned to online meetings, so have medical services.  Dr. Larson holds telemedicine appointments using a HIPAA compliant connection through her Electronic Health Portal.  She was a pioneer in telemedicine, having used teleconference technology for several years over several platforms. 

Not all video connections were created equal.  They each have their pros and cons.  Variations in connection reliability, portability, and security make the choice of platform important.  When considering what kind of connection you want to have with your provider remember that unless it is compliant with the Health Information Portability and Accountability Act (HIPAA) the privacy of your health information may be compromised. 


COVID-19 has brought to our attention in a dramatic way that while we are all the same, we are also different.  Our vulnerability to infection and severity of disease varies with age, health status, and variables we have not yet discovered.  People are aware of their individuality and want medicine that delivers to their unique needs.  This pattern has been developing for some time but is now a driving force for change. 

Dr Larson’s Functional Medicine practice offers a path to personalized care through cutting edge testing and attention to the specific needs of individuals.   Those needs are uniquely expressed in an individual’s DNA.  The new science of Genomic Medicine expands the opportunities for individualization in medical decision making beyond what can be accomplished with even the cutting edge Functional Medicine tests.  To learn more about Personalized Medicine and Genomic Medicine contact Dr. Larson.

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