Coronavirus Risk Doesn’t Stop at Your Front Door

In a pandemic, home is both a haven and a hot spot of transmission. The challenge will be to distance ourselves physically but not emotionally.

Arsh Raziuddin / The Atlantic

The jokes always start just after the crisis begins. Right now, Twitter is currently full of gallows humor about a global pandemic. Some of the jokes are funny, and many of them are not, but one common punch line is that self-quarantine will play out like a sitcom or a rom-com. This is the time to find out how strong your relationship to whomever you live with is, now that you’re going to be trapped in a small space together.

Not everyone lives with someone else, but, especially in cities where the population is densely packed and where it is economically burdensome to live alone, self-isolating often means increased proximity to other people—our kids, partners, or roommates. Bodies in close proximity—our families, chosen or biological—are our support systems, but proximity to other bodies is also how disease spreads, in particular COVID-19, the disease caused by the novel coronavirus. A disease that confines us to our homes is a crisis that happens on the level of our most intimate relationships.

Families—meaning households in which two or more people live together—have historically been among the most significant hot spots of infectious-disease transmission, and that seems to be true in this current pandemic as well. “If a person you live with contracts COVID-19, you’re much more likely to get it from them than from anyone else,” Ruthie Birger, a postdoctoral fellow in epidemiology at the Yale School of Public Health, told me. People are stuck inside with each other in order to limit their risk of infection, but at the same time this makes them among the greatest risks to those to whom they are closest. In a study from 2007, the rate of transmission of infectious diseases within households was shown to be so much greater than between individuals not living together that, Birger said, “the household becomes a larger transmission unit and kind of acts as its own person in society.”

Love is the opposite of hygiene. As a small example, I have two cats, and roughly every few months, one of them has some kind of horrible poop accident. Because I have chosen to have pets, this is unavoidable. I have chosen to love something, which is another way of saying I have chosen to clean up poop with my hands. Having a pet drives home how much caring for another living thing is incompatible with cleanliness; animals are disgusting. But people are disgusting, too. Romantic love and familial love are also about making a promise to clean up someone else’s poop, if it comes to that. Perhaps in less stressful times, it’s possible to fool yourself into believing that romance is not like cleaning a litter box, but in a moment when everyone is encouraged to be hypervigilant about personal hygiene, it is harder not to notice that love is intensely, physically disgusting. We are all far more porous than we can conceive of. Love means getting our hands dirty figuratively, but also literally, and we are in a moment when the most important thing for all of us to do is to keep our hands clean. It seems unavoidable that this will strain our relationships with the people in our space, especially if self-quarantine drags on for weeks or months.

Historically, epidemics, especially those involving quarantines, have placed huge burdens on intimate relationships, and the transmission of infectious disease within households has often been used to scapegoat the most vulnerable people. The 1860s and ’70s in New York saw multiple epidemics, including typhoid, typhus, and cholera. In these epidemics, poor and immigrant families were often blamed and seen as a threat, depicted as the carriers of disease, according to David Rosner, the co-director of the Center for the History and Ethics of Public Health at Columbia University. When quarantines were enforced, they were often applied punitively to these communities, putting intense strain on familial relationships.“This led to, within the family, both a fear of disease but also [people] beginning to hide disease in order to make sure that no one identified you or your loved ones as being sick,” Rosner said. “It plays into this very deep anxiety about what disease represents that lives in the social realm as much as in a medical or environmental realm.”

Comparisons to the still-ongoing HIV/AIDS crisis abound on Twitter and elsewhere at the moment. The impulse to map this epidemic onto our current situation is one worth resisting. For many reasons—first and foremost given the burden on and stigmatization of queer communities both historically and today—it is not necessarily instructive or fair to make a one-to-one comparison between COVID-19 and the pre-antiretroviral era of the AIDS crisis in the 1980s and ’90s. But stigmatization and racism are certainly present in this epidemic as well, in ways that echo, if not parallel, both the HIV/AIDS crisis and the epidemics of the 1860s and ’70s in New York. Steven Thrasher, a professor of journalism and scholar of HIV/AIDS at Northwestern University, talks about reactions within communities in the early 1980s. “In the community more broadly, gay people largely took care of each other,” he told me,  “but I think one of the dynamics that was similar to what we’re seeing today—except it’s global now—was that all gay people were afraid and all gay people were at risk, and so as more and more people got sick it became harder and harder for them to take care of each other.”

Sickness reminds us that we are all each other’s responsibility, but it can be painfully difficult to know how to enact those responsibilities when social distance is first and foremost among them. How do we help people when we need to limit physical contact with them? Thrasher cited the radical community-care work done within the grassroots organizaiton ACT UP, while also pointing out the difficulties in mapping that model onto the current crisis. “There’s something righteous and ethical in being willing to put oneself in danger to take care of someone else, but these vectors of transmission are very different this time, and we don’t want to be doing that in a way that’s going to put more people at risk,” he said. “If we take care of someone who’s sick, and we become a carrier, even if we don’t get sick, we could then still be putting more people at risk.” The juxtaposition of our responsibility to care physically for the people we love, and our larger responsibility to limit physical contact with others, places unique burdens on close relationships.

As hard as these calculations are for people living together, people who live alone will be especially burdened by this pandemic and the self-isolating measures advised to control it. It’s easy to make jokes about getting fed up with a spouse because we’re around them all day, and it’s a very real problem that families are being asked to operate as self-sustaining units without external resources. But loneliness is an equally real problem, one with physical as well as mental health consequences. People who live alone often create outside networks of support for themselves, but accessing those is much more difficult when you have to stay home and drastically limit social contact. The webs of habit and reliance that we take for granted are clearest when something disrupts or removes them.

I live in a small apartment with my husband, and I tend to think of our relationship as an escape from the social pressures and rules of the outside world. Even knowing that we will need to stay inside together during this health crisis, I wanted to believe that the rules of extra-cautious hygiene did not extend to our relationship in the privacy of our home. But those rules are not suspended just because we are in private. Birger advises that we should be particularly careful if we share a household with other people: “Wash your hands as soon as you get home, change your clothes as soon as you get home, have clothes that you just wear at home, don’t bring your street clothes in, don’t sit on the couch in your street clothes. If somebody is sick in your house, have them, ideally, use their own bathroom, and if that isn’t possible, you should try to use the bathroom and kitchen less, and scrub down the bathroom and kitchen after they use it. They should sleep in a different room if possible. And, given that we’re not supposed to touch our own faces, we should probably attempt to limit how much we touch each other.”

Until a week or two ago, many (if not most) of us had rarely (if ever) thought about how often we touch our faces, or whether we would be able to stop (a whole lot; absolutely not). Touching my face was an unnoticed and constant part of my day. Now I can’t stop noticing how much I do it. Newly present worries have made our invisible habits screamingly visible. Habits of physical touch exist not just between our own hands and our own faces, but with the people with whom we are in closest proximity. It is relatively easy to avoid large gatherings and not shake hands with or hug strangers; it is another thing entirely to not hug our families, pick up our children, kiss our spouse first thing in the morning. To notice and eliminate all the small and nearly invisible touches with the people with whom we are closest is as difficult as not touching one’s own face.

We cannot ever fully protect ourselves from each other. Bodies and their collisions are the fabric of our world, and there is no escaping that. The challenge of this crisis is to frame social distancing as an act of community, as something that brings us closer because it is practiced out of compassion, even as it physically asks us to keep apart. But another, smaller challenge will be to keep seeing our homes and families as a source of support rather than fear. Even if we have to avoid each other’s bodies, we can try not to let that avoidance seep into our emotional lives.

It will become easy to think of one another as a burden, especially when we are cooped up together or when isolation breeds feelings of abandonment. In a time of social distancing, our relationships have in fact never been more present, more of a challenge, or more of a necessity.