Two emerging trends have developed since my last update, so very long ago, on July 10th 2020. First, there has been a growing recognition that the COVID-19 infectivity is frontloaded, occurring mostly in the first five days after infection. In fact, the CDC has now shortened the infection quarantine duration, from 14 days to 10 days, in recognition of the shorter duration of infectivity. Second, due to the surge in nationwide need for COVID-19 PCR testing, the turnaround time for tests is now regularly exceeding the five-day mark. Together, these trends lead to a contradictory situation in which many patients do not learn of their diagnosis until after most of their infectivity has already passed, creating a dire problem for infection control and further accelerating the epidemic.
Many of you have taken the precaution of getting tested prior to participating in social gatherings with friends or family members. Unfortunately, the recent surge in demand for COVID-19 PCR testing makes this approach untenable. First, the scarcity of the test has led to guidelines that seek to conserve tests for the most crucial cases, such as those in the hospital or about to undergo surgery.
More importantly, with testing turn-around times approaching the duration of infectivity, this approach no longer offers a benefit. Consider two possible scenarios: (1) you have the illness at the time of testing. By the time you receive your results after 5-7 days your infectivity would be waning, but you would have unknowingly infected others while waiting for your results. (2) you do not have the illness at the time of testing. However, because you had the test 5-7 days prior to a social gathering, you can acquire the infection while waiting for the results and be maximally infective at the time of the social gathering despite having received a negative test result.
What can you do in preparation for a social gathering? Test results or no test results, you need to carefully adhere to social distancing practices, relying on the principles we discussed in the last blog:
— Being around masked people safer than those not masked
— Outside much safer than inside
— Short exposure safer than long one
— Small groups safer than large groups
— Washing hands is important, wiping surfaces maybe less so
To achieve an extra margin of safety, you and others planning to attend a gathering should maximally adhere to social distancing rules for 7-10 days prior to an event. Any “cheating” during this time exposes not only you but everyone else at the gathering to increased risk.
Unfortunately, in most of the country, including California, the rate of COVID-19 infections has been rising, increasing the risks of social gatherings. Now may be an appropriate time to reassess the risks and benefits of planned activities, especially for those in higher risk groups.
I understand that the tone of this blog mirrors the current news cycle and is rather disheartening. However, we are making rapid progress in therapeutics such as medications and vaccines. Soon, I hope to write about positive developments.
Please contact me with any questions or concerns.
Barry Rotman, MD