Galileo’s Guide to a Safe and Healthy Post-Covid Reopening
As states start to open up for business and public life, a whole new set of practices for staying safe and protecting others from Covid-19 is coming into play. At Galileo, we've followed the research closely and our physicians have kept abreast of what's known and how to translate that into supporting a safe return to work and community life. Here, we've answered some common questions about how to minimize risk for ourselves and those we come into contact with.
What should I be thinking about when I go out into public?
Covid-19 remains as high a risk as ever for vulnerable populations (which include older individuals and those with compromised immune systems and chronic disease), so always keep in mind that your precautions are to protect others, as well as yourself. Your risk of contracting Covid is dependent on the number of people you’re in frequent contact with (and their contacts), the inherent risks of your activities (which vary considerably), and your ability to distance (easier, say, in a park than public transportation).
This may seem obvious, but it deserves mention: if you do feel sick, continue to isolate at home. Covid manifests with a variety of symptoms, including but not limited to fever, body aches, cough, fatigue, gastrointestinal upset, and loss of taste.
What actions should I be taking in public spaces?
If you’re feeling well, hygiene measures, physical distancing, and masks are three of our best allies in reducing transmission of this virus.
Aim to wash or sanitize your hands when going in and out of group settings.
Try to stay 6 -10 feet apart from others. Spending less time (fewer than 15 minutes) with a person decreases likelihood of transmission, and loud talking or singing spreads droplets further than quiet talking. Coughing, sneezing, and blowing your nose around others are obvious modes of airborne transmission.
Wear a mask when possible, especially in indoor public spaces. We know that 2-layer masks perform better than 1-layer masks; cloth is appropriate for popular use (virus particles do not survive long on cloth); and breathability and proper fit increase adherence to mask use. Though mask styles vary, they all should cover both the nose and mouth and should be washed frequently.
How does a Covid infection typically progress?
Timelines provide a useful framework for understanding risk reduction. Below are time periods that can help determine need for isolation, distancing, and expected recovery.
Virus Incubation period: about 5 days. Testing for active infection less than 5 days after known exposure may produce a false negative result, since viral burden can be low in the first days of infection.
Contagiousness: viral shedding (which is when you become contagious) starts around 2 days before symptoms do, peaks at the time of symptom onset, and declines substantially by 7 days after symptom onset. Viral load drops to nearly undetectable levels by about 21 days.
Isolation duration if symptoms present: remain isolated for at least three days after the resolution of symptoms (and at least ten days after symptoms started).
Peak severity of infection and risk for hospitalization: 7-10 days after symptom onset.
Active infection test accuracy: highest 2 days before to 7 days after symptom onset.
Past infection (antibody) test window accuracy: highest 10-20+ days after infection.
What are my testing options?
There are two main categories of tests available: active infection testing and past infection testing (antibody testing).
Active infection testing is used to diagnose if a person currently has Covid, whether or not they have symptoms. If you’ve had Covid and recovered, you will not test positive. You also won’t test positive if you’ve been exposed to Covid and the virus is still in the early incubation stage (up to 5 days). Importantly, while you won’t test positive during this stage, you can pass the infection on to others. If you’re testing because you’re preparing to spend time with someone who is more vulnerable to the disease, wait a few more days before visiting and continue to be careful about exposure.
Active infection testing is performed by collecting nasal secretions (via swab) or saliva. These types of tests are available either in-person or by mail order, for a cash price of about $100, and can be performed by a provider or by oneself. Testing for virus particles, through lab processes that amplify viral genetic material, is highly accurate during infection.
An emerging active infection test type called antigen testing will be increasingly available in coming months. It may miss more cases even though it returns results more quickly than most of the amplified virus genetic tests.
The waiting period for active infection results in most settings currently is 1-5 days, depending not on the lab process itself, but on other logistics including location and lab capability.
Antibody testing evaluates for the presence of antibodies created by past infection by the virus, either symptomatic or asymptomatic. Antibody tests are most accurate 20 or more days after symptom onset and are considered unreliable for the first 10 days after symptoms begin or about 15 days after suspected exposure (since incubation period is about 5 days).
The FDA is evaluating the accuracy of the many different antibody tests available. The best ones provide reliable results more than 90% of the time if timed properly. It still isn’t clear how long immunity might last if someone does have antibodies against Covid. Antibody tests rely on blood testing. Currently, this is mostly drawn by lab personnel, but skin prick antibody tests will be increasingly available in the future. The cost is similar to active infection test costs, mostly close to $100.
It’s important to note that both virus and antibody diagnoses are moving targets, and a single test of either type may not provide enough information to make clear decisions. The timelines above are meant to help with proper timing of test types and to put test results into context. Repeat testing may be necessary to increase certainty and safety. Test availability, cost, and methods are evolving.
As we have more answers and a better understanding of how the virus works, there will be clearer approaches delineated for social reintegration. In the meantime, common sense is an ally—and so is the healthcare community! Don’t hesitate to reach out to Galileo with your questions and concerns.