As the various levels of government start relaxing the lockdown regulations the citizen has been given back the responsibility for his/her own welfare. It is a big job. It was not easy for the elected authorities and their army of advisors and now we get the job.
Well we are the ones who could get sick so we better do the job properly.
There are two groups of citizens who will be exiting the lockdown. The ones who suffered a Covid infection and the ones who did not. Their issues are slightly different. Let us take the easier one first.
So, you were unlucky enough to get a Covid infection but you were lucky enough to survive. You don't have to be afraid that you will get the infection from someone else. Most authorities believe that infection with this virus like almost all other viruses does convey immunity to immediate reinfection. But you are a responsible citizen and you don't want to feel responsible for the rest of your life that you killed a friend, a neighbor, a spouse or a grandparent. Your real concern is how dangerous am I? Do I still carry live virus? As I write this article, we do not have a reliable test to answer the question. The technical problem is the issue of the false negative. In plain English it means what it says. When the test is negative it frequently lies. To be clear many people with negative tests can still infect people they meet.
So, what to do? There are two solutions. Originally I recommended something drastic. Assume that the infected patient remains potentially infectious for between 3-4 weeks after all the symptoms and temperature have completely ceased. Since most people have symptoms that last three to four weeks that implies avoiding vulnerable persons for a total of six to seven weeks after the infection started. It is often much easier to pick a date when the illness started than when it ended because it grinds to a halt in such a meandering fashion. So, I recommended timing from the beginning of the infection. We now have new guidance from the CDC. They suggest that 10 days after the onset of the infection a patient who feels well is no longer infectious. This is based on a reproted observation that by 10 days the antibody response has eliminated live virus even if the nasal swabs are positive; the nasal swabs apparently are reporting dead virus when they are positive. This was adopted by my local health director in New York. If this recomendation survivies scrutiny it will greatly simplify the process of getting Covid survivors back into circulation.
The second part of the solution for the caring responsible recovered Covid patient is to recognize the hierarchy of his/her new contacts. For contacts that are high on the frailty/ risk index extra caution and distance is warranted. So the recovering patient would be more reluctant to visit a grandparent or a friend with serious medical condition. I personally have great difficulty finding people that I am not worried about. But there is one class of contacts that are safe-- other recovered Covid patients. Contact with them should be safe.
We have spilled a lot of ink and toner on the easier of the two groups. Now what can we say to the person who never had Covid who emerges from lockdown. Frankly this person must realize that he/she is entering a dangerous world. We do not know how many carriers are out there. We do not know if the carriers know that they are carriers because many patients have asymptomatic disease. We do not know how seriously the carriers take their responsibility for their fellow citizens. I don't know, you don't know and neither does anyone else.
In this foggy world one has to be guided by his/her own feeling of self-worth, his/her own dread of getting sick and his/her own willingness to take risk. I have no magical answers, and conceitedly I don't think anyone else has either. But I will venture this. Because nobody can predict what the infectious risk is to the uninfected person rejoining society why not just wait another two weeks? If there is a true second wave of infection it will take at least two weeks -- to spread the infection to the uninitiated, and for them to get symptoms and for the health authorities to notice and for the news media to report it. Yes, this is very painful for people who need work and a livelihood. It is painful for people who have real duties to the elderly or to children returning to school. But for those for whom an extra two weeks of quarantine is tolerable suffering and an affordable luxury it is the best way to mitigate risk. Wait and see what happens to everyone else. It is perfectly ethical. You didn't infect them you just waited to see what would happen if they took the government's advice.
My formulation has been pessimistic, and frightened but I am worried. Because I have taken an unappetizing position, I want to recommend a wonderful, slightly theoretical but beautifully written analytical explanation of how some of us will get Covid if we are not careful. For an enjoyable informative, humble but cunning read please see Professor Erin Bromage's article at https://www.erinbromage.com/post/the-risks-know-them-avoid-them
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