• In the midst of the COVID-19 pandemic, some regions have found success with “double bubbling” — the concept that two households can safely spend time together.
• Social isolation has negative effects on mental health. Double bubbling could help alleviate this by allowing people to see each other.
• Experts interviewed by Healthline endorsed the concept but caution that it must be carried out responsibly.
• It’s important to be mindful of public health recommendations and any family members who might be at higher risk.

Are “bubbles” the next phase as the United States begins to reopen businesses and public facilities in the wake of the COVID-19 pandemic?

Alameda County, which includes Oakland and Berkeley in the San Francisco Bay Area, issued new guidelines on Friday that allow for “social bubbles.” These are groups of 12 or fewer people from different households who can gather together outdoors.

Face masks and physical distancing are still recommended. County officials also state that a person can’t belong to more than one bubble at a time.

Canada has been following what’s been dubbed the “double bubble” strategy, one originally enacted with success in New Zealand.

It’s a modification of the sweeping shelter-in-place orders seen in March as the pandemic accelerated.

Rather than restricting social interactions to members of the same household, the new strategy takes the same philosophy but doubles it — allowing two households to link up and socialize.

It isn’t in place across the entire country.

Canada’s largest city, Toronto, is still a hotbed of COVID-19 cases. But in areas that have put the policy in place, the early results seem promising.

Is double bubbling safe? What are the risks versus the rewards?

According to two experts interviewed by Healthline, there’s merit to the idea — if it’s done responsibly.

Mental health a major concern

Experts say physical distancing (aka social distancing) and disruption of daily routines can impact mental health.

Dr. Sean Paul, a psychiatrist and founder of NowPsych, told Healthline that social isolation commonly causes symptoms of depression and anxiety.

“Grieving is something that’s harder to do alone and I feel like people have truly been grieving the loss of their ‘normalcy’ in the purest sense,” he explained.

“The other thing I have seen happening is socially isolated people spending more time trying to connect using social media and this tends to backfire,” Paul added. “People end up getting in heated debates on social media they otherwise wouldn’t in person, or feel more isolated if they see others doing things or spending time with people when they can’t.”

Paul said that, as a psychiatrist, he sees double bubbling as a valid option that will benefit mental health.

“Being alone as a family can be isolating and stressful for children and parents,” he said. “As long as the families agree to follow agreed upon guidelines, then adding a few people to their bubble should be relatively safe.”

Who do you choose?

While the concept of double bubbling is simple, carrying it out is another matter.

For starters, the concept itself limits itself to two bubbles.

For people from large families, or couples trying to decide which set of in-laws to spend their time with, the decision could be difficult.

From a mental health standpoint, Paul recommends careful assessment.

“It’s important to choose the people who add the most value and quality to your life,” he said. “That can be social value, value from their assistance with things like childcare or sharing meals, value you gain from physically being with them, or people you share interests and hobbies with.”

Paul also cautions that choosing one household effectively means rejecting other family members. He recommends being prepared to feel some guilt and potentially having to explain your reasoning.

Dr. Reuben Elovitz, an internal medicine specialist at Private Health Dallas in Texas, told Healthline that another crucial factor is the health of family members.

“The first thing to think about if you’re expanding outside your environment is who in your family is at risk, or if you’re at risk,” he said. “Whether it’s an uncle, aunt, child, or grandparent, or someone else in the home, it’s important to be aware of whatever their medical conditions may be.”

Risk vs. reward

Elovitz said that even responsible double bubbling carries a certain level of risk.

“You’re obviously increasing your risk of exposure,” he said. “Depending on someone’s age and medical conditions, then this becomes potentially more important and more significant if they’re especially vulnerable.”

Elovitz also points out that not everybody has been following physical distancing guidelines throughout the pandemic.

“I would say there’s definitely segments of our patient population that already are kind of [double bubbling],” he explained. “Theoretically, if both households have been strict about social distancing, it should minimize the risk. The downside is when you have one or two kids or adults in the households that really haven’t been strict, it kind of defeats the purpose.”

While caution is important, Elovitz said double bubbling makes sense, as long as it’s done responsibly.

“Not everyone is following strict rules. If people have vulnerable family members, especially when they’re elderly, obviously it becomes more of a concern,” he said. “But from a theoretical standpoint, double bubbling sounds like something that would make a lot of sense.”

Paul added that it’s always best to follow the advice of public health officials.

“As with any public health recommendations, there should be pretty clear guidelines, such as how many people can be in a bubble, what types of occupations should preclude people from doing this, and what leeway, if any, there should be in terms of leaving the bubble,” he explained.

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