Selecting your close-knit 'quaranteam'

At this point in the novel coronavirus pandemic, Americans have largely accepted that returning to life pre-2020 is not likely to happen any time soon. But that hasn't stopped many from trying to reestablish a sense of normalcy by maintaining social connections while still being mindful of the public health guidelines intended to slow the spread of the deadly virus.

One method that has gained popularity in recent months is forming a pandemic pod or bubble. Also known as a "quaranteam," the strategy has been adopted by a number of families - especially those with young children - and close-knit friend groups. It requires people in the pod to follow strict safety protocols, such as mask-wearing and social distancing, when they are in public or interacting with others outside the group. Ideally, pod members can then socialize together in person in settings where the rules can be relaxed, without increased risk of contracting or spreading the virus.

By managing risk while allowing social interaction, this approach is a way to "really support mental health and emotional health and the other aspects of human connection that are just really important right now," said Melissa Hawkins, an epidemiologist and director of the Public Health Scholars Program at American University.

And as the weather gets colder, making outdoor gatherings less feasible, experts say assembling a pod may be a way to ride out the pandemic winter without having to give up in-person interactions. Here are their tips for how to navigate the complex process of "podding up."

<h3 class="leadin">Thoroughly assess potential pod mates

Choosing people to form a pod with is "a little bit like dating," said Carolyn Cannuscio, director of research at the University of Pennsylvania's Center for Public Health Initiatives.

"We have to assess people's risk tolerance and their exposures," said Cannuscio, a social epidemiologist. "One thing the pandemic is making plain to me is that there is a wide range of behaviors that people consider safe."

It is critical to ask prospective pod mates a number of questions about their daily routines, ranging from their grocery shopping habits to whether they are frequenting bars and restaurants, Cannuscio said. But she noted that the simplest metric to base an assessment on is how many people the person has face-to-face contact with in a typical day or week. Then, she said, try to choose friends or family members who have similar numbers of these daily interactions that you do.

You should be prioritizing people you can trust, said John O'Horo, an infectious-disease specialist with the Mayo Clinic in Rochester, Minnesota.

"The most important thing in my mind is just trying to think about who are those individuals who I trust with my safety and they would trust me with theirs," O'Horo said. "Don't be afraid to be selfish when you're thinking about that. The people who you might consider your good friends aren't necessarily the people who you would trust in this situation."

Pod mates should not be "casual friends," Cannuscio said, adding, "These have to be people you can share very intimate conversations with."

Expect to talk regularly about the "minutia of daily life" and be willing to be open about your health and any potential exposures with the rest of the group, she said.

Cannuscio also emphasized the importance of making sure you actually like spending time with the people in your pod.

"Listen to your intuition about the relationships you have with all the members of the pod," she said. "If your intuition tells you that someone is going to rub you the wrong way, they will really rub you the wrong way as winter sets in and we're locked into these pods."

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Keep your pod small

There are no formal guidelines for the ideal number of people you should recruit for a pod, but experts say the smaller the group the better.

"Every additional person you're adding to your pod is increased risk for the whole group," said Michael Knight, an assistant professor of medicine at George Washington University. "For every additional person, there is a greater chance that someone may be exposed." He suggested trying to limit your pod to five to 10 members.

A good gauge of whether your pod has gotten too large is if you are unable to quickly determine who is and isn't in it, O'Horo said. "You should be very aware of who's in and they should be able to list you as well."

<h3 class="leadin">Agree on clear rules for members to follow

A pod or "quaranteam" should not be thought of as a "casual designation" for a group of people you occasionally enjoy spending time with, Hawkins said. "This is really a commitment to a long-term way of navigating in this unusual world and navigating it safely together."

This means a pod needs to establish rules and standards that all members agree to follow, which should guide their behavior both inside and outside the group.

Pods should at least require people to closely adhere to recommendations from the Centers for Disease Control and Prevention and their local public health authority when out in public or engaging with nonmembers, Knight said. That could include avoiding extended nonessential social interactions with anyone not in your pod, Cannuscio said.

"The pact that people are making when they form a pod is to forgo other pleasures and other invitations in order to protect the people they've made this alliance with," she said.

But Cannuscio noted that pods need to be ready to deal with members who can't adhere perfectly to the rules, which is likely given that most people must have outside social contact as they go about their daily lives.

"Rather than thinking of it as breaking the rules, I hope that it's just considered a normal life event that has to be discussed with all the other members of the pod," she said. "It's not like that person was bad."

It is also important for pods to have a plan in the event that a member tests positive for the coronavirus or has a concerning exposure. O'Horo added that pod members should not hesitate to cancel plans and self-isolate if they aren't feeling well.

Because there are so many scenarios a pod must be prepared to handle, some experts recommend creating a written document that details the rules and the group's responses to certain situations.

"Anytime you're verbalizing concepts or principles or rules, it's easy to agree upon them in a discussion, but then when circumstances arise that deviate from the stated rules or appear to deviate from the stated rules, that becomes really messy in working it out with the other pod mates," said Clarence Lam, director of the preventive medicine residency program at the Johns Hopkins Bloomberg School of Public Health.

"To avoid some of those sticky circumstances with pod mates that may have a different understanding of what those rules are, I think it would be wise to write those rules down," Lam added.

<h3 class="leadin">Be willing to change course

While planning is essential to the success of a pod, experts stressed the importance of adapting to the ever-changing environment created by the pandemic. Pods should constantly be communicating and updating its guidelines to best suit its members, Knight said.

"What we thought the normal was in May is not necessarily what the normal is today," he said. "As we continue to learn about the virus and experience this pandemic, recommendations may change … risk understanding may change, and so we have to be flexible."

Cannuscio suggested that pods set routine check-ins to assess whether the method is still working for a majority of members. For new pods, she recommended a group meeting after the first two weeks. "If it's not working, bail out and quarantine and start over with another pod," she said.

If a pod is no longer the right strategy for you, Cannuscio said, there are plenty of other ways to meet the need for social interaction. With creativity, she said, "people will find ways to connect. They may look very different from our usual ways of socializing, but they will surely sustain us."