After nearly two years of this, I think we all need to realize that altering our personal behaviors helps to mitigate the spread of COVID19.

We flattened the curve at the beginning, remember? We can do it again!

A large part of the early flattening was shutting down schools and workplaces. We stayed home to avoid others. Most of us don’t want to return to those extremes, but we have learned so much about how COVID19 spreads in the past 2 years that now we have better options.

Much like looking at the weather report to choose our clothes, we should look at local infection rates to choose our prevention strategy.

Find your local rates by using one of the following resources:

• CDC COVID Tracker

• COVID Act Now

• Johns Hopkins COVID Dashboard (worldwide data)

• CDC Flu Tracker (because precautions help against flu too!)

Disclaimer:

The following are my current personal recommendations. They will change as new information is learned.

I’m a general pediatrician who has followed COVID closely since this started. I read and listen to experts, but I do not have any sources of information that are not publicly available.

My recommendations are based on CDC guidelines, local school and health department guidelines, and information I’ve learned from experts in their fields but are not official recommendations. Talk to your personal physician for their advice.

All of the various organization guidelines don’t align, which makes it hard for anyone to know the “right” answer. It’s a moving target because we keep learning new things. Sometimes research indicates new guidelines are needed, but it takes time to go through channels to approve them.

Local conditions are important. Unfortunately, local guidelines are often not based on science. Everything has become political. I don’t want to be political. I respond to the information at hand. I want to help people understand risks and mitigations - it shouldn’t be an all or none thing. I will share information about the strategies and then my proposal to alter your precautions based on risks.

High standards!

Remember that you can (and often should) have higher standards than the minimum requirements.

As I always tell kids, just because you don’t have to wear a bike helmet by state law doesn’t mean you shouldn’t. To be safe, wear a helmet.

Every time a COVID19 infection is shared, it gives the virus a chance to mutate into something worse, so by preventing spread, we’re preventing the next variant.

Each new variant has the potential to evade the training your immune system has had. This is why it’s VERY IMPORANT that we each do our part to stop spread.

The good news is we know how to limit spread:

• masks

• ventilation

• air filtration

• vaccines

• staying home when sick

• testing as indicated

• adjusting precautions based on current rates

Mask up!

It’s time to ditch the cloth masks and upgrade to better quality face coverings with the rapidly rising rates we’re seeing currently.

Cloth masks were important initially to help stop spread. Early in the pandemic we were still learning how COVID spread and there were shortages of medical masks. We now know that COVID19 can spread in the air in smaller droplets for a longer time than originally thought. The highest risk is when you're in close proximity to others, but some have been infected from an area when not immediately with an infected person.The great news is medical grade masks and respirators are usually easier to breathe in than cloth masks and offer better protection for the wearer, not just for others. They are easier to get now than before.

Wash or sanitize hands before & after touching any mask/respirator.

Teach kids that the mask is a germ catcher: their germs should stay on the inside, other germs on the outside. Either way there are germs so hand washing is important if the mask is touched. If kids cannot wear it properly safely remove it & try again later. Let them practice at home for small amounts of time even if they're not going anywhere yet - they will one day benefit from the practice!

The mask/respirator should cover your nose and mouth.

Do not pull it down to talk. This defeats its purpose.

Moving it up to your forehead or down below your nose increases the risk of spreading germs, so don’t move it.

If you need to remove it to eat or drink, fully remove it from your face and put it in a paper bag, in an open plastic container, or on a paper towel.

Find protective masks and respirators for adults and children:

• Clean Air Crew has kid's disposable and reusable options available. More general mask advice is found on their Masks page.

• ProjectN95 is a nonprofit that offers protective equipment and test kits from vetted suppliers. I did several random cost comparisons and they were the least expensive option for all the products I compared.

• MaskLab has a great selection of KF94s.

• Brookwood Medical has many kids KF94s - super cute!

• Hardware stores are often stocked with N95s. Look for the 3M Aura Respirator 9205+. It fits most adults.

• Airgami makes reusable N95s. They have a unique design and instructions for how to clean them on their site.

• Kid's Mask List from Aaron Collins (AKA the Mask Nerd) has all his data and on the far right, links to purchase. Learn about how to find the best mask for kids on this video from Mask Nerd. He has many other helpful videos for adult masks and general mask information too!

For more on masks, see Masks4All.

The air around you… COVID is Airborne!

There are now many studies showing that SARS-CoV2 (the virus that causes COVID19) can spread through the air at distances greater than the often cited 6 feet. Some people have entered an area previously occupied by an infectious person and gotten infected, even though the infected person left the area prior to their arrival.

Physical distancing is still helpful stop spread of germs, since the highest concentration is near the person who is infected. Try to stay 6 feet from others as much as possible.

Imagine that others are smoking and you want to avoid their plume of smoke, so walk around it. That’s the highest risk area - though with COVID19, you won’t know which people are infected, since we can share the virus before symptoms develop.

As for the virus hanging out in the air, remember the times you’ve walked into an empty elevator and you could still smell the odors left behind by previous occupants? That’s how the virus can linger…

Outdoors is safer than indoors, but remember that even in large outdoor crowds you should still wear a mask if community rates are high.

Ventilate rooms.

Even a slightly cracked window can help circulate the air.

Turn your home heating/cooling system fan to “on” rather than “auto” so the fan runs all the time.

If you frequent public areas with questionable ventilation, consider getting a portable CO2 sensor. Look for levels less than 800 ppm - if they’re higher, more ventilation is needed.

For more tips, see Clean Air Crew.

Use a HEPA filter.

I made the Corsi-Rosenthal box below for my family. Despite not being crafty, I found it very easy. It was going to be a 2 filter box, but my husband talked me into a 4 filter box after the first 2 filters were taped together, so the edges are a bit off but it still does the job. Again, I’m not known for being crafty.

Learn how to make a Corsi-Rosenthal box here.

Get vaccinated if eligible.

Vaccines help prevent serious infections really well when given per current recommendations.

If you haven’t gotten your J&J+ booster or 3 doses of mRNA (over 16 years) or 2 doses mRNA (5-16 years): get vaccinated now! With the current levels rising, it’s not time to wait and see any longer!

I wish younger children were able to get vaccinated, but the more precautions are followed by everyone, the safer these kids will be! When they get approval, I will strongly recommend they get vaccinated too.

Are vaccines safe?

No matter what safety concern you’re looking at, it’s always safer to get the vaccine versus the infection.

Infections have greater acute illness risks, including hospitalization and death, as well as long term complications.

Vaccines have very few adverse events, and most of those are brief and can be managed at home.

If you’re pregnant, see this article before deciding to wait for your vaccine.

Vaccines work.

When there are breakthrough infections, it is not a sign vaccines don’t work. In fact, the fact that most fully vaccinated people have less significant illness compared to under-vaccinated and unvaccinated people shows just how well the vaccines do work!

Vaccines teach the immune system to respond quickly when your body is infected with a virus, but they don’t put a bubble around you. If you’re exposed, you can become infected. The good news is you won’t get as sick if you’ve successfully been vaccinated.

There is evidence that vaccinated people spread infections less than unvaccinated people, helping to stop the spread.

Most hospital beds are filled with unvaccinated people.

Most deaths from COVID have been in unvaccinated people.

I’ll add vaccine information at the bottom of this newsletter.

Use a risk based prevention strategy.

Base your precautions on local levels, your overall health status, and known exposures.

Are you sick or well? What’s the community rate? Do you know of an exposure?

All of those questions should be considered.

If you feel sick:

Get tested. Testing is getting easier. Hopefully we will soon have a mechanism to report all home test results to help guide others based on community levels.

Don’t forget influenza! If influenza rates are high in your community, get tested for COVID + flu. Early identification of flu can allow for antiviral treatment.

Stay home and isolate if the test is positive. Notify people you’ve been around.

Stay home and isolate if the test is negative but you’ve been exposed. False negatives are possible, so exposure increases risk. Consider serial repeat testing until symptoms resolve or it’s been more than 10 days since your last exposure.

If community rates are high, stay home and quarantine (or isolate) even if you test negative and don’t know of an exposure. Again, serial testing can be helpful.

If community rates are low and you don’t know of any exposure, you don’t need to quarantine if you have a negative test. Wear your mask out of your home to prevent spread of whatever infection you have - that’s just being kind to others. Keep testing until symptoms resolve or you have a positive test. If you test positive, stay home and isolate.

Wear a mask if you go out of your home to stop the spread of whatever infection you have. Remember that even non-COVID infections shouldn’t be shared. You can get someone else sick, which starts a cascade of people needing testing - increasing healthcare costs and putting others at risk of quarantine, lost work and school absences.

In your home use precautions to keep others from getting sick, regardless of the type of infection. These include:

• frequent hand and surface cleaning

• everyone old enough should wear a mask, but try to stay in your own space as much as possible

• open the windows (even a crack helps)

• use a HEPA filter (learn how to make a Corsi-Rosenthal box here)

• turn your home heating/cooling system fan to “on” rather than “auto” so the fan runs all the time

If you’re exposed:

If you feel sick, see the previous section.

You will need to test and isolate.

If you still feel well but have no prior immunity from infection or vaccination:

Stay home to quarantine.

Get tested. PCR testing is currently recommended if there are no symptoms. If negative, retest at least once 5 days from last exposure. Consider serial tests. Ask your physician for the most current recommendations. These may change as variants emerge.

If you feel well but have been fully vaccinated:

Get tested. PCR is preferred if you have no symptoms.

If positive, isolate based on current recommendations. For now, this is 10 days from the date of your positive test or 10 days from first symptoms. This may change as new information is learned.

If your test is negative and you’re fully vaccinated, wear a quality mask if you go to public areas.

Retest at least 5 days from your last exposure. (For household contacts, this may be many more than 5 days if you cannot isolate from the person with the infection.

Low community rates, no exposures and feeling well?

Great! This is where we want to be. (We’re not here now and shouldn’t act like we are, but we can get back if we use proper mitigations.)

Go outdoors unmasked.

Hang out with fully vaccinated friends (which includes boosters as recommended) indoors unmasked.

If you’re low risk, go to public indoor areas unmasked if you’re comfortable unmasked. (It’s never wrong to wear a mask.)

If you’re high risk (or live with someone who is high risk) wear a mask to lower your risk of exposure, but with low community rates, this is the time to go out!

Increasing rates, no exposures and feeling well?

Resume wearing your mask whenever in public buildings.

If you or someone you love is high risk, upgrade to an N95 or KF94.

Limit activities in high risk areas, such as indoor sports, movies, indoor dining, especially for those who are not vaccinated or who have had a recent infection.

Test before indoor gatherings, if you feel unwell, and if you’re exposed.

High rates, no known exposure and feeling well?

Remember your immunity from previous infection and/or immunization will only help prevent a serious infection, not the infection itself - and immunity is not perfect.

If community rates are high, be very cautious - potentially inside your home and out.

If your household members are low risk (they wear well fitted quality masks, don’t frequent large indoor gatherings, and are feeling well) you can loosen precautions in the home.

If you have a household member who is higher risk, you may need more precautions even at home. Higher risk may be due to medical conditions that put their health at risk if they get infected or the risks they take outside the home. These risks may include being around someone known to be infected, feeling sick, or if they aren’t reliable to wear a mask in public areas.

Upgrade your mask to an N95 or KF94 to prevent infection when community risk is high. Learn more about how to choose masks and where to find them here.

Limit your activities based on your household risk level and risk aversion. This might mean you remove kids from sports, work from home, and continue to avoid indoor public areas when possible. You might need to turn down party invitations or change travel plans, depending on your risk tolerance.

Test before and after indoor gatherings. This can help identify people who should not attend the gathering or alert others if you have a positive test soon after the gathering.

Optimize air quality in your home with the precautions above. This helps in case someone you live with becomes infected but you haven’t recognized it yet. It can help stop spread to others in your home.

You might not recognize the risk until it’s too late, so step up your game when the community level of infection is high.