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What you need to know beyond just “wear a mask, wash your hands, and keep 6ft apart”

Last major update: August 29, 2020

New section added: October 14, 2020

(Post #1 in my COVID-19 series; #2 is here on building a bubble/pod and navigating feelings, communication, and agreements; #3 is here on specific risk management strategies using objective tools)

What’s on this webpage:

Disclaimer about you

This webpage is aimed at people who are willing to trust sources like Harvard, Johns Hopkins, the National Institutes of Health, and the Centers for Disease Control.

If you believe that COVID-19 is a hoax, that masks are more dangerous than helpful, or that all of this is a conspiracy: I have empathy for you because I recognize how confusing everything feels right now; but, I don’t imagine this webpage will be helpful to you.

Instead, I encourage you to read this article. If you’re someone who prizes rational, critical thinking, I urge you to put your beliefs to the test: Please take a look at the sources I've listed at the bottom of this page, and if you believe it's all a conspiracy, I urge you to consider how vast and immense that conspiracy would have to be, and how many infectious disease experts would have to be in on it.

Disclaimer about me and this webpage

I have no medical background.

I’m simply someone who’s read a lot of articles and is skilled at summarizing and simplifying complex subjects.

So, please treat this document as imperfect, but also recognize that there’s quite a bit of research behind it.

The CDC, as a federal agency, has to be very careful and conservative with its guidance, whereas some of what I present here is from experts speaking more candidly in interviews about their personal beliefs (which allows this page to present more specific guidance versus the more general "wash your hands and keep 6ft apart" that you see on official government websites).

Wherever possible, I’ve tried to examine multiple sources to find a consensus.

Finally, I want to name my unearned privilege on display here. I'm very lucky to have enough wealth to afford high-quality masks, enough free time to thoroughly research all this, and the privilege of working from home. I very much recognize that many people—through no fault of their own—do not have those same privileges and have to go to work in less-safe environments. I see you, and I empathize with the frustration you must be feeling.

Quick October 14 Update

If you’re like me, at this point you’re sick of COVID conversations about what’s actually safe and what level of precaution makes sense.

Good news—I found an excellent tool that I'd like to share: https://www.microcovid.org/. It allows you to enter in an activity you're considering, and it will give you a specific risk score based on the most trusted scientific sources and continually-updated data for your specific area.

I've found it useful because our brains aren't designed to be able to easily do statistical analysis; so, we rely on our gut feelings, which can be quite biased (e.g., I like my friend a lot, therefore they're probably safe).

Here's a bit more advice since it can be super confusing to figure out what a reasonable level of risk is (e.g., are 1 in 1,000 odds of getting COVID high or low?)—it's impossible to know unless you can compare it to another common activity in your life.

So, this might help:

  • The chance of a drive in a car resulting in a crash is roughly 1 in 9,210, or 0.011%.
  • The chance of a drive in a car while intoxicated resulting in a crash is 1 in 625, or 0.16% (which is 14.5 times higher than the non-intoxicated number).
  • Then, as an example according to the microCOVID calculator, the chances of getting COVID while eating indoors in a restaurant today in Portland, OR for 90 minutes (with 15 other people in the restaurant) is 3,000 in 1,000,000, or 3 in 1,000, or 0.30%.

So, if you're wondering if 0.30% odds are high, consider this: We think of drunk driving as a highly dangerous activity even though it only has a 0.16% risk of resulting in a car crash. Therefore, by that standard, the 0.30% risk of getting COVID from that restaurant scenario is actually quite high.

Hope that helps!

Summary of the most important information

To reduce your risk of contracting COVID-19, here are the most important factors to be careful of:

  • Enclosed spaces with poor ventilation
  • Physical proximity to other people, especially if they’re not wearing masks (or not wearing them properly)
  • Number of people nearby
  • People around you who are breathing heavily (e.g., at a gym), yelling, coughing, sneezing, chanting, or singing, especially if they’re facing you
  • Amount of time you’re in a space with people nearby or where viral particles might be lingering in the air
  • (all of the above are probably more important than sanitizing the surfaces in your house)

Anyone can get COVID-19, and anyone can have it without realizing it

  • Young people and children are not immune
  • Nearly half of infections occurred via people who didn’t realize they were infected since they weren’t showing symptoms yet
  • The most viral particles are released from someone right before they start showing symptoms
  • Again, let those facts sink in: If someone is not in your bubble, you have to act as if they have COVID-19, because there's a very good chance they wouldn't even know they had it if they did—yet they could still give it to you

COVID-19 is still serious—things are not substantially safer, even if some people have become more lax

  • We’re not safe yet. The daily death rate in August is similar to that of heart disease, the #1 cause of death in this country. Living in a major city between March and May carried roughly an equivalent level of risk to skydiving every day (but, COVID-19 actually carries more risk because it can spread exponentially to others, whereas skydiving is only risky to yourself)
  • We still don’t know the long-term consequences of contracting COVID-19:
    • Articles in highly-reputable sources like Mayo Clinic and the journal Nature have explored the potential long-term effects of COVID-19, including damage to the brain, heart, and lungs. Many people who have recovered from COVID-19 have also gone on to develop long-term conditions like chronic fatigue syndrome
    • An August article in The Atlantic explored the tens of thousands of "COVID-19 Long-Haulers" who remained sick for months. These people had an average age of 44, and most were formerly fit and healthy
    • Even if you do recover quickly, Bill Plaschke described his COVID-19 experience like this: "It felt like my head was on fire. One night I sweated through five shirts. I shook so much from the chills I thought I chipped a tooth... I coughed so hard it felt like I broke a rib"
    • Bottom line: There's still so much we don't know, so please don't think of COVID-19 as not a big deal—this isn't just a mildly uncomfortable case of the flu for a couple of weeks followed by a quick recovery with a guarantee of no further consequences
      • (and, even though this is serious, that doesn't mean you need to hide alone inside all the time worrying about the world; it just means that it's reasonable to take some specific precautions that will greatly lower your risk while still allowing you to live your life—which this page will hopefully help with)
  • Use Brown University's tool to track the spread in your area, and consider different precautions depending on your color level (this webpage was written with a Yellow level in mind, since that's what it is where I live in Portland)
  • Men: Our culture gives us a lot of confusing messages about masculinity. But, please try not to see wearing a mask as a sign of weakness. Over 160,000 people in this country have already died of COVID-19. Your kids are looking to you for guidance. Is it more manly to step up to protect the people you love even if you might look silly, or is it manlier to prioritize looking tough and risk killing other people?

You’re significantly more likely to contract COVID-19 indoors than outdoors

  • Always wear a mask when indoors anywhere other than your home
  • Indoors, you might not be safe even if you stand over 6ft apart from someone
  • Even if you're alone but an infected person was recently in that room, viral particles can remain in the air (see the point below)

You’re significantly more likely to contract COVID-19 from particles in the air than from touching surfaces

  • Good ventilation is critical: open windows, air filters, and fans (you also need to be aware of which way the fan is blowing—point it toward a window to blow the room air out; don’t point it so it blows particles from one person to another)
  • Viral particles can stay in the air for hours, even after the infected person is gone. This is much less likely to happen outdoors though, and it’s more likely to happen from coughs, sneezes, singing, chanting, or yelling rather than just regular breathing
  • You’re also less likely to contract the virus if you’re in motion (e.g., walking, cycling, marching) rather than sitting or standing still with people

The good news is that you probably won’t contract COVID-19 based only on a quick exposure

  • A minimum number of viral particles must be transmitted, so that could be all at once via a cough or sneeze, or it could be a slower buildup over several minutes of talking
  • But, it's highly unlikely you'll get COVID by walking past people on the street

What about hand washing and hand sanitizer?

  • Most coronavirus transmission is through the air, but it's still important to wash your hands regularly and thoroughly (at least 20 seconds) if you touch things out in the world
  • Soap is most effective against the coronavirus, but if that's not easily available you can also use hand sanitizer:
  • The 20-second recommendation is because that's how long it should physically take to properly scrub all the different areas of your hands. Here's a video showing how to do it. If you're in less-ideal conditions like a poorly-stocked public restroom, even scrubbing with water for 10 seconds might be better than nothing, but still not truly safe (so avoid touching your face afterward). Finally, make sure you open the bathroom door with a paper towel

Masks and social distancing aren’t perfect

  • Studies show that coughs and sneezes can easily shoot out viral particles 8-12 feet or more. So, social distancing at 6 feet is a compromise to allow us to still live our lives out in the world, but it's not perfect
  • Even wearing a cotton mask, a cough or sneeze can shoot particles out at least a foot or more
  • The right type of mask can make a big difference (as high as 96% efficacy for a 3-layer quilted cotton mask versus 9% for a single-layer low-thread-count cotton mask). Here are the best types to look for:
    • N95 masks, but these are quite rare. If you do get one, don't use one with a valve (since that releases your particles to people around you)
    • 3-layer surgical masks (be careful because a lot of masks on Amazon look like surgical masks but then say "non-medical" in the description, which means they don't actually meet the specifications)
    • 3-layer cotton masks (including an absorbent inner cotton layer, a filtering middle layer ideally of polypropylene, and a non-absorbent cotton outer layer, with a high threads-per-inch count)
    • The worst type of "masks" are folded bandanas and neck fleeces ("neck gaiters")
  • For a mask to remain effective, if you wear it outside regularly you’ll need to wash it at least once a day (if it’s washable, or throw it out and replace it if not). If you don’t, any viral particles you’ve come into contact with will accumulate on it and could spread to you
  • Wearing a mask is more about protecting others from you. Unless you have an N95 (or, to a lesser degree, other filtering such as a polypropylene layer), your mask isn’t perfect at protecting you from others. So, even if you’re wearing a mask, if someone around you isn’t, you’re not well-protected

What specific mask should I get?

Get a flu shot—this year’s might be the most important in your lifetime

  • The CDC reports that the regular flu results in hundreds of thousands of hospitalizations annually. The flu and COVID-19 are both respiratory illnesses, so they'll be treated on similar medical equipment like ventilators, which are already in short supply
  • Luckily, we have a solution: get a flu shot. We've all been so excited about the promise of a vaccine for COVID-19, but we already have a vaccine for the flu. The problem is that only half of Americans get it each year
    • The CDC recommends everyone over 6 months old get the shot (other than very rare exceptions). There are a lot of misperceptions here—the truth is that the vaccine can't give you the flu, and it might just make the symptoms milder rather than preventing it outright. Most importantly, it's safe and you really should get it
  • Here's one more important reason: The symptoms of the flu look very similar to those of COVID-19. So, if you get the flu, you and anyone you come into contact with will likely worry that you actually have COVID-19. Get the flu shot so you won't have to go through that

Info for “bubbles,” “pods,” community houses, and other groups

I live in a community house with 6 other people. We've had hours of conversations about the pandemic, how we can best support each other, and what level of risk we're all comfortable taking on to balance feeling safe with living our lives.

Note: I decided to split off the rest of this section into a separate blog post.

Here is the spreadsheet that I made for my house. Please feel free to make a copy for your pod/bubble/house/group and make adjustments that work for all of you.

It's funny because I personally hate the idea of having to follow a list of rules; but, I also realized that there are so many nuances here and so many different personality types in my house that this approach made the most sense to ensure everyone had the same understanding and could feel safe.

I'm not a medical professional, but I've done many hours of reading. I also feel some vulnerability in sharing our spreadsheet because of the wide variety of opinions on COVID-19 precautions in the world. I know that some of you will look at it and think my house is crazy for being this strict, while others will look at it and imagine we're crazy for allowing so much. This is what we've agreed works for us, and I encourage you to find what works for your group 🙂

Detailed information about COVID-19, i.e., the FAQ

What happens if you get COVID-19?

  • 2/3 of people recover in 1-2 weeks, but 1/3 take at least 2-3 weeks
  • Even among younger people (age 18-34) with no underlying health conditions, nearly 1/5 took at least 2-3 weeks to recover
  • With severe cases, recovery can take over 6 weeks
  • Remember: A lot of the care we’re taking here is not for ourselves but for others who are older or who have weaker immune systems. But even for young and healthy people, we’re still not sure what the long-term effects of the virus are

      How dangerous is it to be living through this pandemic compared to other activities (i.e., is this really such a big deal)?

      • As of early August, the daily death rate from COVID in the United States is similar to that of heart disease, which is the #1 cause of death in this country
      • The risk of dying from COVID starts to become much more statistically significant after age 45, particularly for men
      • One way experts measure risk is through units of micromort, which indicates a one-in-a-million chance of dying
        • For example, going under general anesthesia in the United States has a score of 5 micromorts, skydiving has a score of 7 micromorts per jump, and giving birth in the United States is 210 micromorts
        • The average American endures an average of 1 total micromort of risk per day (e.g., from being in a car crash or being struck by lightning)
        • This is all based on averages and doesn’t take your unique circumstances into account, but: An individual living in New York between March 15 and May 9 of this year would have experienced an additional 50 micromorts of risk per day because of COVID. That’s double the level of risk of living on a military station in Afghanistan in 2010 or riding 44 miles a day on a motorcycle in California
        • Living in Maryland during that same time would have resulted in 7 micromorts per day (again, equivalent to doing one skydiving jump each day)
        • If you actually contract the virus, your score jumps to 10,000 micromorts, equivalent to the chances of dying on a climb in the Himalayas over 26,000 feet
      • Most importantly, remember that by not being careful, you’re not just putting yourself at risk as you would be with skydiving. You’re putting anyone you’ve come into contact at risk too

      Men: Please don’t be afraid of looking weak

      • Research shows that a lot of men are afraid that there’s something weak or feminine about wearing a mask
      • Our culture gives a lot of confusing messages to men, and we're held to standards of strength and confidence that can be hard to live up to. It’s easy to feel unsure of what to do when you want to project strength to your family, or if you see some of your role models not wearing masks
      • But, over 160,000 people in this country have already died of this disease. Your parents and grandparents are especially susceptible to dying from this. Your kids are looking to you for guidance
      • So ask yourself this: Is it more manly to step up to protect the people you love even if you might look silly, or is it manlier to prioritize looking tough and risk killing other people?
      •  

      You might not have the correct picture of how viral transmission works (I didn’t!)

      • It’s not “all or nothing”—it’s not that someone near you has COVID, they breath out near you, and you suddenly get it as soon as one tiny virus touches you
      • The truth is that the coronavirus is transmitted via particles, and there’s a minimum number of them that are necessary to infect you
        • Experts estimate that the minimum viral load (or “dose”) is around 1,000 particles (but again, that's only a rough estimate)
        • You could hypothetically get the virus via one big transmission (e.g., 1,000 particles at once via a sneeze) or many small ones (e.g., 100 particles each breath for 10 breaths)
      • If you’re exposed to a small number of particles at a time, a healthy immune system can deal with them. But, if you’re exposed to many at once or a certain number over a period of time short enough that your immune system can’t keep up, you’re likely to contract the virus
      • The viral load (number of particles you come into contact with) can influence both the likelihood that you’ll be infected as well as how severe your symptoms will be if you get sick. People with higher viral loads will also shed more of the virus, meaning they’re more contagious
      • Especially indoors, viral particles can remain in the air for several hours, so you can be at risk even if the infected person is no longer around

      Here’s the math and science of how transmission actually works

      • The bottom line is that infection risk = dose x time
      • The following facts are based on preliminary research, but they give at least a rough idea of transmission likelihood
        • Coughs can shoot around 3,000 droplets across a room at 50mph, and they can stay in the air for several hours. Sneezes can shoot 30,000 droplets even further at 200mph. Each droplet contains many viral particles
        • Coughs and sneezes can send out 200,000,000 viral particles that fill a room. Remember that the minimum necessary dose might be as low as 1,000. Even if you enter a room a few minutes after a sneeze or cough from an infected person, it’s possible that only a few breaths could be enough to give you the virus 
        • Here are some rough numbers:
          • Regular breaths release 50-5,000 droplets that fall to the ground quickly, especially with nose-only breathing. Regular breathing will likely release 20 viral particles per minute
          • Speaking increases the droplets 10 fold to 200 particles per minute
          • Singing is worst of all, so choir practices have been especially dangerous, even with social distancing
      • So, the good news is that it might require 5 minutes of speaking with someone for you to contract the virus from them (200 particles/min x 5 min = the minimum dose of 1,000 particles). In other words, it's extremely unlikely that you'll get it from passing someone on the street

      44% of infections have been from people without any symptoms

      • In other words, nearly half the transmission of the virus have been from people who thought they were fine but actually had the virus
      • This applies to any age. Yes, people over age 20 are more likely to send out viral particles, but it happens with children under age 10 as well. The number of viral particles also varies person by person and by stage of infection
      • People release the most viral particles right before they start exhibiting symptoms (i.e., while they still think they’re fine)

        Here are the biggest things to be careful of

        • Being indoors, especially with poor ventilation
        • People being physically close together, especially larger groups
          • Note that social distancing might not be effective indoors—in other words, if you’re in an enclosed space, keeping 6 feet apart might not be nearly enough. But again, remember the formula of infection = dose x time. A few minutes is fine, but an hour in a room with several people might not be
          • Also note that 6 feet is not a maximum distance the virus can travel but more of an average. Coughing or sneezing can easily shoot the virus out 12 feet or more
        • Talking, singing, yelling
        • In other words: In the United States, we’ve been focused on sanitizing surfaces, but it’s actually a lot more important to concentrate on airflow and direct transmission from person to person via particles in the air

        The worst outbreaks have occurred at

        • Meat packing plants (densely-packed workers who have to yell to be heard)
        • Weddings
        • Funerals
        • Birthday parties
        • Business networking and conferences
        • Sports arenas
        • Choirs

        Here are some common situations you might find yourself in

        • Restaurants and office buildings: It depends very much on the airflow of fans, air filters, and air conditioning, and on how close people are to each other. One study examined a single infected but asymptomatic person having dinner with 9 friends for a 1.5 hour dinner (i.e., someone who didn’t realize they had the virus). Just through their regular breathing, they released low levels of particles throughout the dinner and ended up infecting 50% of the people at their table and 75% of people at other tables downwind, plus a couple of other people upwind. Similarly, studies of offices have shown that transmission can easily spread to a whole section of the floor
          • You need to be aware of which way fans are blowing—if you’re setting one up at home or in the office, point it toward a window to blow the room air out. Don’t point it so it blows particles from one person to another
          • The more people in a room the faster the air needs to be replaced
          • It might be possible to estimate the viral load in the air in a space by measuring the CO2 level, but there’s been very little firm research about that
        • Shared or public bathrooms are likely fairly dangerous (there are a lot of high-touch surfaces such as handles, and toilet flushes shoot droplets up into the air—note that it's still uncertain if COVID can be transmitted via feces)
        • Grocery stores: The danger is much higher for employees than customers (remember: infection = dose x time). You should be fine if:
          • You wear a mask
          • Employees wear masks
          • The store limits the number of people in it at a time
          • You keep as much distance as possible from other shoppers
          • You don’t spend too long in the store
        • Walking, jogging, cycling, and having joggers, etc. move past you: These are all low risk. The heavy breathing might release more particles, but the movement disperses them more
        • Walking with a friend: Wearing a mask is always safer, especially if you’re closer than 6 ft and talking, which expels more particles, or if it’s a long walk, which will release more particles over time. It will be safer if you’re in motion, keeping your distance, looking straight ahead, and limiting your time together. Be more careful if you both look toward each other or if you stop walking
        • The protests do not seem to have substantially spread the virus because most protesters have worn masks, most have stayed outside, and most have kept in motion

        What about your specific city or county?

        • This webpage was largely written with a Yellow level of risk in mind (see Brown University's tool below). It might make sense to be even more careful in areas with an Orange or Red level of risk, or to be slightly more lenient in Green areas (but even then, be careful not to get too complacent—there’s still a global health crisis going on)
        • The virus is spreading a lot more quickly in some areas versus others. That can change quickly with a single “super spreader” event (e.g., if someone arrives in that area who has the virus but doesn’t realize it and they attend an event with a lot of people); so, please try not to get too comfortable even if your area currently has a low rate of transmission. That said, here are the two best resources I’ve found for checking how your specific area is doing:
          • https://globalepidemics.org/key-metrics-for-covid-suppression/Brown University's tool allows you to search at the county level, and it offers an easy color coding so you can see how bad things are in your area or in an area you’re planning to travel to
          • https://rt.live/ — made by the founders of Instagram, this site tracks the rate of transmission by state. If the number is, say, 1.5, it means that, in that area, every infected person will infect 1.5 other people. So, the virus would spread exponentially more quickly compared to if it were only 1.0 or less

        What about touch and hugging?

        • Remember the formula: infection = dose x time. The most dangerous part of physical contact is being physically close to them. So, hugging can actually be fairly safe if you do the following:
          • Hug outside
          • Wear masks
          • Don’t talk, cough, or sneeze
          • Hold your breath if you really want to be careful
          • Try to avoid touching their clothes or body with your face or mask
          • Don’t hug face-to-face—face opposite directions
          • Don’t linger: approach quickly, hug, then move far apart again
          • Don’t touch your faces (don’t wipe away tears)
          • Hugging someone from behind can also be even safer
        • Even with all that, you probably shouldn’t hug especially vulnerable people like those over 60
        • Remember too that it’s not just about breathing. With physical contact, it’s possible that the other person could have viral particles on their clothes, and touching you could transmit some of those to your clothes; then, you could touch your clothes afterward and then touch your eye, mouth, or nose. This scenario is certainly less likely than the direct breathing mode of transmission, but it’s still possible

            What about surfaces?

            • The only way you can get COVID is through the eyes, nose, or mouth. So, touching anything is fine as long as you thoroughly wash your hands afterward without touching your face. “Thoroughly washing” means washing with soap and water for 20 seconds or using hand sanitizer with at least 60% alcohol
            • After an infected person breathes, coughs, sneezes, speaks, etc., the particles from their mouth can land on a surface and remain there (though the number of active particles won’t remain as high). Then, if you touch that surface and touch your face, the virus can be transmitted
            • There are many factors at play, but here are some rough guidelines for how long the virus can survive on…
              • Glass: 5 days
              • Wood: 4 days
              • Metal: 5 days
              • Plastic and steel: 3 days
              • Cardboard and paper: 1 day
              • Copper: 4 hours

            What else about masks?

            • Make sure it covers all the way from above your nose to below your chin
            • Masks are more for protecting others from you in case you have COVID. So, even if you’re wearing a mask, if someone around you is not, you’re not well-protected
            • Mask efficacy can vary quite a bit depending on what materials it's made of and how you wear it
              • This can make a big difference—a single-layered cotton mask with 80 threads-per-inch has an efficacy rating of 9%, whereas a three-layered quilted cotton mask can get as high as 96%
            • Here's some info on specific mask types:
              • N95 masks are the most effective but hardest to get (if you do get one, don't use one with a valve because that releases air, which means other people around you won't be protected from you)
              • 3-layer surgical masks are next best (be careful because a lot of masks on Amazon look like surgical masks but then say "non-medical" in the description, which means they don't actually meet the specifications; the real thing to look for is standards and certifications, specifically things like ASTM F2100 or ASTM F2101, which very few available masks have)
              • Cotton masks work well, especially with 3 layers (ideally with an inner layer that’s absorbent, a middle layer that filters, and an outer layer that’s non-absorbent). Also, look for a high threads-per-inch count (at least 120 TPI and ideally 600+). If it has a polypropylene filter, that can trap some extra particles too with static electricity
              • Folded bandanas do not work well
              • Neck fleeces (or “neck gaiters”) used by runners and athletes actually do more harm than good since their material breaks down particles into even smaller ones
            • Here’s what another study found. With a cough or sneeze, particles could spread an average of…
              • 8 ft with no mask
              • 3 ft 7 in with a bandana
              • 1 ft 3 in with a folded cotton handkerchief 
              • 8 in with a CVS cone face mask
              • 2.5 in with a quilting cotton stitched mask
            • A recent study also found that coughing into a bare elbow does almost nothing to stop particles, though coughing into a sleeved elbow was substantially more effective, and that was better than coughing into cupped hands
            • Two other simple ways to get a general sense of the efficacy of a mask are:
              • To pull it tight, hold it up to the sky, and make sure you can't see daylight through it
              • To put it on, blow hard, and hold your hand on the other side to see if you can feel the air
            • If you really want to be safe, this article contains some specific things to look for to make sure your mask is properly certified and not counterfeit
            • The bottom line is that a mask helps a lot. It’s especially important to wear them inside. And, it’s important to remember that the types of masks available to buy right now (i.e., not N95s) are not foolproof at all. It’s not a perfect shield. Even when wearing a typical cotton mask, some cough or sneeze particles can still get through
            • If your mask isn’t washable, you should discard it after a day of use. And if it’s washable, you should wash it daily in the washing machine (or order a pack of several so you don’t have to wash as often). Remember that dose over time is important, and the particles will accumulate on and in your mask unless you wash it

            How does contagiousness work? What happens once you’ve recovered from COVID?

            • Symptoms typically appear 4-5 days after exposure, but the true range is 3-14 days
            • You’re most contagious in the first 2 days after exposure, before you exhibit any symptoms. That’s why we have to act as if anyone outside our bubble is contagious, even if they don’t think they have the virus
              • Most people remain contagious for 10 days after the symptoms resolve, but waiting 14 days is safest
            • The best way to tell if you’re no longer contagious is to have two nasal-throat tests or saliva tests 24 hours apart that both test negative
            • Regarding the question of whether or not you can get COVID again, see the final bullet on the testing question below

                    How does testing work? What about antibodies? Are you immune after you’ve had COVID?

                    • This webpage has talked a lot about the number of viral particles, and that applies to testing too. If you just contracted the virus, you probably won’t be able to tell for a few days, and a test won’t help either because you won’t have enough of the viral particles in your system yet
                    • So, if you just did something where there was a risk of being infected (e.g., going to the airport, going to a birthday party with lots of people, etc.), you should wait a few days before getting tested (and take precautions in the meantime as if you have the virus)
                    • At that point, a positive result is almost always trustworthy, whereas a negative result can be less definitive. If you took an antigen test (where results can come back in less than an hour), your doctor will likely suggest you take a more rigorous PCR test to confirm (which will likely take a few days to get you results). While you’re waiting, if you think there’s a chance you’ve been infected, you should wear a mask around people, keep 6 feet apart, wipe down surfaces you touch with diluted bleach or 60% alcohol, and generally act as if you have it, just in case
                    • An antibody (serologic) test will tell you if you’ve had COVID
                      • Research here is still inconclusive, but it’s likely that having the antibodies in your system will make it harder (or potentially impossible) for you to get it again
                      • However, research has also shown that those antibodies might start disappearing 2-3 months after infection
                      • Again, this piece is inconclusive, so please don’t act as if you’re now immune from COVID once you’ve had it and recovered. It’s still possible that you might get it again yourself; or, even if you don’t get the symptoms again (or as strongly), being exposed to someone else with the virus might still make you a carrier to transmit it to other people

                    Psychology, group dynamics, and caring for everyone in your bubble

                    • By this point in the pandemic, many people have decided to create pods or bubbles of people. The idea is that your bubble is made up of people you trust, and if everyone agrees to a set of agreements, you’re able to reduce your precautions around each other, e.g., regularly spend time together at less than 6 feet without masks, and potentially even engage in physical touch, etc. 
                      • Public health experts are divided on whether or not to recommend this practice 
                      • On one hand, loneliness, lack of touch, and depression and anxiety can all have major negative health consequences as well. So, even if you manage to avoid the virus by strictly remaining alone all the time, you might still suffer negative health outcomes from the mental health impacts
                      • On the other hand though, creating and maintaining a bubble requires very strong levels of trust and firm agreements. If even one person in the bubble breaks the agreements, the virus could spread to everyone
                      • Navigating conversations around this topic can be very challenging since everyone will have slightly (or largely) different levels of risk tolerance, and these discussions can bring up a variety of feelings and issues around self-worth, someone’s social standing in the group, setting healthy boundaries, etc. So, the remainder of this section will focus on those issues
                    • Each person needs to be clear about their boundaries as well as their personal dealbreakers to help them feel safe
                      • For some people, it might be very easy for them to tune into their values and name their clear boundaries
                      • For other people, they might not have boundaries pop into mind, so they might need to discover their boundaries by doing research on the science of COVID or by observing what boundaries other people are setting. Or, they might have trouble knowing what their boundary is until it’s threatened
                      • When someone states their boundary to the group, if it seems more conservative or challenging for some reason, here are a few things to consider:
                        • Be curious about where that boundary came from. Which articles have they read to reach that conclusion? Who have they spoken with? 
                          • It’s important to recognize here that feelings alone can be a legitimate reason for stating a boundary (e.g., if they feel so anxious about the pandemic that they don’t want to leave their house), even if their reasoning is not fully grounded in science. 
                          • But, it’s also reasonable for you and your group to adjust your behavior based on this person’s boundary or lack of boundaries (e.g., if they believe the Earth is flat so they refuse to get on a boat, you might not invite them out sailing with you)
                          • If you can’t come to a consensus that feels right to everyone, it might not make sense for you to be in a bubble together
                        • In any case, if someone sets a boundary and you care about them, you need to respect it if you want to remain in good relationship with them
                          • If that boundary doesn’t work for you, you could use that information to inform the actions that you take. Just like with an STI conversation, if someone says they don’t care about STIs, you might then choose to not have sex with them
                          • But, it would be less appropriate to shame them for their attitude or to try to emotionally manipulate them into changing their boundary. Rather, try to just focus on consequences: because of my boundary X, I’m unwilling to do Y; or, because you don’t have boundary X, I’m going to do Y or Z
                          • Ultimately, it’s best if everyone in your bubble is excited about keeping each other safe and adhering to the group’s agreements. If they feel like they’re being forced to do something, they’ll probably grow to resent the group and will be more likely to break the agreements
                    • There’s too much complexity here to just leave the rules up to everyone’s best judgment. Instead, your group needs to agree on specific boundaries and rules that work for everyone
                      • If you can’t agree, it’s reasonable for that to become a dealbreaker that might cause someone to leave the group (at least until the pandemic is over, and potentially permanently)
                      • A lot of this comes down to showing others you care about them. Try to start conversations by grounding in shared feelings and care rather than jumping straight to talking through a checklist of rules to follow
                      • Try to use nonviolent conversation: instead of saying “you’re bad because you did X thing,” try saying “when you did X thing, it made me feel Y, and what I need to feel safe is for you to do Z in the future”
                      • It’s also important to set the proper precedent with your group. Constantly making exceptions can be challenging, so try to only do so on rare occasions (e.g., a friend is visiting from far away who I haven’t seen in 10 years)
                      • Note that some people’s minds are naturally organized much more in terms of “these are the specific agreements we made” whereas others act more from a place of “what feels right in the moment.” It doesn’t mean that one type is a better person than another. But, it’s important to make sure everyone is on the same page about the rules your whole group is agreeing to and the consequences of breaking them
                      • Again, try to remind each other that your relationship is important, and that taking care of yourselves is important too. Someone can be a friend, and you might also not want them to do something that would put you in physical danger
                    • It might also be worth examining for yourself which consequence is most important to you if you get COVID. What's most important to you about slowing the spread of the coronavirus? What's your "why"? Depending on your values, one of these will likely resonate more with you:
                      • You don’t want to experience the physical unpleasantness of sickness
                      • You don’t want to risk the chance—however small—of needing to be hospitalized and potentially dying
                      • You want to follow the rules to keep society functioning in an orderly way
                      • You don’t want a virus to get into your body and despoil the purity of your health
                      • You want to feel safe in your home and in your bubble, and you want to know that others are caring about you and your health
                      • You want to care for frontline workers, people who work in the service industry, and groups that have faced systemic marginalization and are experiencing greater impacts from the pandemic
                      • You don't want to run the risk that COVID will have more serious long-term health consequences that aren't yet clear to us
                      • You don’t want to feel bad about accidentally passing it on to someone else and potentially making them quite sick or killing them
                      • Something else?
                    • Finally, it’s worth naming: Yes, all of this is hard. And, it’s important to remember that this is a once-in-a-lifetime global health crisis. Please treat it with that level of seriousness

                    Sources

                    6 Comments on “Research-Backed Coronavirus Precautions”

                    1. Fantastic article Michael. You dissected the most important parts of the research and made it simple and to the point.

                    2. Hi Michael, Awesome Research. I would like to ask if you have encountered a waterprooof mask. If you want to try it I can send you a sample. But I personally believe that waterproof breathable mask is another mask that can help prevent the spread of the virus as the virus is transmitted by water droplets. A lot of frontliners have already used our mask. I just wanted to share it with you as well.

                      Thank you,
                      Sirach

                      1. Thanks, Sirach. I haven’t personally seen much written on waterproof masks, but I appreciate that you’re doing work to support our frontline workers!

                    3. Thank you, Michael, for sharing your synthesis, spreadsheet and sources! It’s true, this is likely the only pandemic we’re going to experience in our lifetime and it’s very worth taking seriously – actually its an act of responsibility and loving kindness to take it seriously!
                      To Health,
                      Allegra

                      1. Thanks, Allegra—it’s definitely a strange thing to wrap our minds around since our brains are designed to support us with familiar everyday challenges rather than once-in-a-lifetime occurrences, which is probably one reason why that “don’t worry, it’s not a big deal” voice keeps popping up in my head and I have to remind it why this is in fact different than the usual.

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