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November 25th, 2020

Hello,

Happy Thanksgiving ! We hope this email finds you well. In light of our holidays, this issue is devoted to frequently asked questions.

Sam


1. But my test was negative ?

Since the start of the pandemic, physicians and patients have been asking for more testing capacity. But we have learned that testing is not perfect. Why is it that someone with COVID might test negative? There are several reasons:

  • Test accuracy: We have discussed this in previous newsletters several time, but the accuracy of a test varies by type. Rapid tests were initially tested on symptomatic individuals. Subsequent tests have reported accuracy anywhere from 40%-85%, with worse numbers on asymptomatic people. PCR testing is more accurate.
  • Timing: The timing of testing can play a role in a test’s result as well. A person has to be shedding enough virus for the swab to pick up and the test to detect. Typically this is within the first few days of the illness, especially if there is fever present.
  • Sample Collection: The early tests required a deep nasal swab. Newer tests use “anterior” nasal swabs or swabs of the front of the nose. Some rely on saliva or cheek swabs. Knowing the type of specimen required for the specific test is important. An inadequate sample can be obtained and give a person a false negative result.

An ideal test then is one conducted on a symptomatic individual, in the first few days of symptoms, with an adequate sample, and run using a PCR process.

What if I have no symptoms? Many are relying on negative testing this season to determine if they are “ok” to be around family. This is not a wise practice. The White House continues to be the best example of over-reliance on testing in place of adequate safety precautions. Negative testing, especially rapid testing in an asymptomatic individual, is fraught with problems. It may play a role in the overall scheme, but it is only one piece in the puzzle of protection. The most important measure continues to be mask use.


2. I was exposed to someone with COVID, but I can just get tested, right?

No. Up to now, the CDC has continued to recommend a 14 day quarantine after exposure to someone with COVID. Although testing is recommended after being exposed, this is performed for contact tracing and to detect those who are asymptomatic but infected. Testing is not performed to end quarantine early, or to bypass quarantine. In addition, there have been recent reports in the media that the CDC is considering shortening the quarantine recommendation and adding an “exit” test at the end. Currently this is only a media report, nothing else has changed. The primary reason cited was non-compliance with the full 14 day quarantine on behalf of the general public. A testing approach of this kind is capable of screening exposed people but it does leave a small percentage of people who will become symptomatic after 7-10 days despite testing negative. So it is not perfect. But in the face of large numbers of non-compliant people, it may be a better strategy. More to come on this when official change is made.


3. Am I really expected to wear a mask indoors for thanksgiving?

Yes. Peer pressure is one of the most commonly cited reasons why people don’t want to wear their mask. It only takes on person to say “Come on, really? You’re wearing your mask? Don’t you trust us?” and suddenly you feel like the unreasonable one. Please know that this is not the case, mask use is necessary. There are numerous reports of large outbreaks and deaths among those who did not wear their masks during indoor gatherings. These are caused by people who are asymptomatic. Scientific evidence is on the side of mask use. So be that person at the gathering who says “Yup, I’m wearing my mask and you should too”. Once your other family members see you stand up to the peer pressure, they will join in as well. Mask use is the single most important strategy, especially indoors. It’s not just about protecting yourself, but your entire family.


4. But what about during mealtime?

During meals other strategies will be necessary. If there is an option for outdoor dinning (patio) at your home, take advantage of it. If seating is limited outdoors and it is comfortable outside, consider giving those seats to people at the highest risk like grandparents. Encourage family to stay away from grandparents during mealtime and have only one person serve them, with a mask on. Anyone on oxygen, with chronic diseases, elderly, or with immune problems falls into this same category as well. Keep them safe, away from others while they eat.  And everyone else? They can space 6 feet apart by family group. Those who live in the same household don’t need to be 6 feet apart. That allows for small groups of people to eat together in multiple areas of the home while keeping their distance from others. Once the meal is over, or even while getting up to get seconds, put a mask on. Make this thanksgiving about more than just meal-time.


5. I only have a runny nose. It’s not COVID.

Don’t take this chance, especially around family. If you are not well, stay away. Spend time in the hotel in isolation, stay home, consider using facetime or other video conferencing to be with family. Don’t risk the exposure. Even if you took some medication and you feel better, stay isolated.


6. The Car Analogy

Think of your COVID mitigation strategies like your car. When we drive cars we use seatbelts, we have airbags, there is stability control, there is an onboard computer with sensors and early warning systems like collision alerts. All of these systems help protect us from injury in case of an accident but the best single measure is an alert driver who is not distracted. For COVID, you must stay alert to symptoms and make wise choices about your health. You are the driver. There are masks, distancing, hand sanitizing, and other measures meant to protect you when you come in contact with someone who is infected, but it’s best not to need them. Just like airbags and seatbelts, we don’t want to rely on them but we don’t drive without them. Be safe.


We hope your holiday is restful and safe. As always, if this email was forwarded to you and you would like to receive our newsletter in your email inbox weekly, you may register for free here.

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