Comprehensive Covid-19 Testing Policy

As promised, we have updated our company testing policy, below. It’s also a one-page pdf attachment here. (For related testing information, see the Feb. 2, 2022 post.)

Knowing when to do PCR testing vs. antigen testing is critical, as it turns out that with Omicron, the antigen tests are pretty much worthless for early detection because they have such a high percentage of false negatives. See for example The Atlantic article "Get Ready for a Wave of Missed Infections.” TheAtlantic.com 3/23/2022

And there’s one more critical thing, since there are many diseases spreading now—and more easily, because most people aren’t wearing masks. Because many of these colds and flu have symptoms that overlap those of covid-19, if you want to avoid possibly spreading covid-19 to those around you, you need to isolate—stay home from work or school, and social engagements—at the first blush of symptoms, until you get negative PCR test results.

Here is our updated policy …

Covid-19 Testing Policy

Before or During Covid-19

If you have no symptoms, but think you might have been exposed and want to check…
==> wait three days after possible contact, and get a PCR test (only—NOT an antigen test)

If you have any kind of symptoms (see list below) and want to check for covid-19…
==> right away, get a PCR test (only—NOT an antigen test)

If you have been sick for a week, and didn’t think it was covid-19 and didn’t test, but now want to check…
==> you can take either a PCR test or an antigen test—remember, for antigen tests: “The first test should not be taken before the fifth day after symptoms have started” because it usually takes a while for virus levels to rise to a detectable level.

Repeat Testing
For all of the above tests, a positive result can be counted on. Negative test results from a single test are not reliable, and additional testing is needed.

A negative PCR result will be wrong at least one time out of six. To get a more reliable answer, follow up a negative test with a second one 24 hours later.

A negative antigen result will be wrong at least TWO times out of six. To get a more reliable answer, follow up a negative test with a second one 24 hours later and then a THIRD one 24 hours after that. Pubmed.ncbi.nlm.nih.gov - 3/2022

After Covid-19
If you get covid-19, and want to know when you are no longer contagious before returning to work and social life…
==> take ONLY antigen tests (NOT PCR tests), two or three negative tests 24 hours apart
==> wait at least till Day 6 for your first test

What Are Symptoms?
“Symptoms can be almost imperceptible. … The key is to determine any differences between how you feel on your best days and right now. … Symptoms of [Omicron] Covid-19 include fever, shortness of breath, cough, loss of taste or smell, fatigue, body aches, headaches, sore throat, congestion, nausea, vomiting, diarrhea, a scratchy or sore throat, nasal congestion, dry cough, muscle pain including low back pain, … runny nose and/or headache.” Vox.com - 1/18/2022

Specificity vs. Sensitivity
By the way, if you are looking at research reports on testing, you will encounter these terms:

Specificity means how often the result is positive when it should be—true positives divided by total tests. The higher the number, the fewer false positives.

Sensitivity means how often the result is negative when it should be—true negatives divided by total tests. The higher the number, the fewer false negatives.

You can remember which is which because sPecificity has a P for positive, and seNsitivity has an N for negative.

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Keeping Your Balance in the New Normal

Everyone wants the pandemic to be over. Here’s a quote from someone in a bar enjoying March Madness: “Do you know how good it feels to be in a loud place? … At this point, this gives us hope we’re going back to normal. I know they just came out with a new variant in Europe. We’re kind of standing on a piece of thread. Let’s just enjoy the balance.”

Washingtonpost.com 3/17/2022

Here are some tips for keeping your balance. Also see our March 10th post, Three Simple Steps for the New Normal.

- Cases, hospitalizations, and deaths are declining nationally, although locally some numbers are rising. National deaths are below 750 per day for the first time since last August, but still three times higher than last summer’s low point. Remember how you felt and how careful you were last summer, and consider acting the same way now.

- If you have had covid, you had some natural immunity, but now it’s probably wearing off. I haven’t seen a lot of studies on this, but the NFL figured it would last three months (January 27th post).

- It’s a similar situation for vaccination shots and boosters. I got my original shots a year ago—now I figure they are completely ineffective. The booster shot from a few months ago should still be having some effect, but it’s also losing its punch.

Washingtonpost.com 2/11/2022

- So with immunity of all kinds wearing out, cutting your risk in half (very approximately) by wearing a good mask is still important for many people. Remember how the virus is spread:

"The most common way COVID-19 is transmitted from one person to another is through tiny airborne particles of the virus hanging in indoor air for minutes or hours after an infected person has been there." Dr. Alondra Nelson, head of the White House Office of Science and Technology Policy and Deputy Assistant to the President (March 23, 2022)

"The virus can also spread in poorly ventilated and/or crowded indoor settings, where people tend to spend longer periods of time. This is because aerosols can remain suspended in the air or travel farther than conversational distance (this is often called long-range aerosol or long-range airborne transmission)." World Health Organization (December 2021)

Straight.com 3/26/2022

- And of course, fresh air ventilation is always important.

- "In fact, research shows changing the air in a room multiple times an hour with filtered or clean outdoor air—using a window fan, by using higher MERV filters in a Heating, Ventilation, and Air Conditioning (HVAC) system, using portable air cleaning devices, and even just opening a window—can reduce the risk of COVID-19 transmission—with studies showing five air changes an hour reduce transmission risk by 50 percent." Dr. Alondra Nelson, head of the White House Office of Science and Technology Policy and Deputy Assistant to the President (March 23, 2022)

Straight.com 3/26/2022

- Symptoms remain the best early warning sign of a possible infection. The trick is that "symptoms can be almost imperceptible."

Vox.com 1/18/2022

- Finally, testing is still critical to avoid spreading covid-19 to others. As a friend reminded me, Omicron progresses extremely quickly, so testing at the first symptom—not waiting even till the next day—does the best job in protecting others. PCR testing is now readily available with quick turn-arounds—as quick as six hours in Keene. But remember: both antigen test and PCR tests can have false negatives, about one time out of six. So if you want “all OK” results you can really count on, you need TWO tests, 24 hours apart, then your chance of a false negative is only 3%.

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"The 60-Year-Old Scientific Screwup That Helped Covid Kill"

"All pandemic long, scientists brawled over how the virus spreads. Droplets! No, aerosols! At the heart of the fight was a teensy error with huge consequences."

This is a long, entertaining, and perhaps chilling story behind the stubborn reluctance of the medical establishment to admit that the covid-19 virus is spread through the air. Even though it’s from May of 2021, I discovered it just recently.

The punch line for me is near the end, where one scientist says: “… acknowledging this history—and how it hindered an effective global response to Covid-19—will allow good ventilation to emerge as a central pillar of public health policy, a development that would not just hasten the end of this pandemic but beat back future ones."

Wired.com 5/13/2021

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Three Simple Steps for the New Normal

Masks are mostly gone. The six million worldwide deaths (one million in the U.S.)—if not forgotten, then are something we don’t really like thinking about. Almost half of us in the U.S. have now had the disease, and lived through it. Case rates and (a more important indicator) hospitalizations are way down, now in New Hampshire just four times higher than the lows of last summer. Here is what I suggest:

1. Watch the community spread rates and wear a mask for your own peace of mind or safety. With most people not wearing masks, it won’t make much difference to other people whether you are wearing a mask or not. But study after study shows they make a difference—see recent example below. In this CDC study of schools, mandatory masking cut covid-19 cases by a quarter.

Rockdalenewtoncitizen.com 3/8/2022

And, of course, as I have explained before, my preference is that if you’re going to wear a mask, you may as well do it right and make it really effective, as explained below.

https://www.kohlerandlewis.com/covid-19blog/2022/1/4/mechanicalengineeringrecommendations

One of the best numbers to follow for community spread is the count for hospitalizations—here is the source I use for New Hampshire:

Covidactnow.org - NH

2. Get on board with the new, magical solution: Fresh Air Ventilation! Yes, of course, I have been beating this drum for a couple of years, and now there is a growing chorus. "The White House’s roadmap for the next phase of the pandemic covers all the usual suspects, including Covid-19 surveillance, testing, vaccination and treatment. But there’s also a happy surprise tucked in there: a series of proposals to help improve indoor air quality. This marks an essential shift toward acknowledging that cleaning the air can help mitigate the spread of Covid.”

Bloomberg.com 3/8/2022

All the tools you need for this are in past blog posts, including the one about meters, shown below.

https://www.kohlerandlewis.com/covid-19blog/2022/1/20/mechanicalengineeringrecommendations

3. Keep an eagle eye out for symptoms. This is important whether or not you have had the disease. If you have had it, be aware that some long-haul symptoms can begin months after the infection. Here are a couple of examples.

KSL.com 3/8/2022
NBC11news.com 3/7/2022

If you haven’t had it, be aware that a wide range of symptoms could indicate covid-19. Now that testing (either home antigen tests or lab PCR tests are easily available), if you get tested at the first onset of symptoms, you can take advantage of the improved treatments now available, and also spread the disease to fewer people. Check the various blog posts for more information and suggestions.

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One. Million. Deaths.

I have been pondering this all week.

There are several ways to count the covid-19 deaths. One is the official count, where people can legitimately argue about whether a death was “by covid” or “with covid”. That count in the U.S. is at 943,000.

A better way is “excess deaths” which the health authorities (Centers for Disease Control in the U.S.) have been routinely counting, long before covid-19. Historically, the number of deaths follows a consistent pattern—not level throughout a year, but pretty consistent from one year to the next. Against this baseline, it is straightforward to find the excess deaths—and one can argue that these are ALL, directly or indirectly, due to the pandemic. Last week, the U.S. excess deaths topped one million. The Keene Sentinel had an excellent story (from the Washington Post) observing this tragic event: Sentinelsource.com 2/19/2022

They included this picture of a man near his brother’s gravesite in Arizona. It gave me goosebumps—what a perfect way to encapsulate the one million deaths tragedy.

As far as I can tell, today is exactly two years since the Sentinel’s first mention of the “novel coronavirus”. On March 2nd, I wrote in my diary “corona virus hysteria is building …” Then, of course, things happened fast: the local schools closed on the 16th, Vermont began stay-at-home on the 25th and New Hampshire on the 28th, the same day I emailed a friend and speculated that this would lead to one million U.S. deaths.

But even though I expected it, now that it has come to pass, the whole pandemic is astounding to me—the most important historical event since World War II. While case rates and hospitalizations have plummeted in the U.S., the disease continues to kill about 10,000 people a day throughout the world, now totaling at least six million deaths.

We have become numb to these kinds of numbers. But we must never become numb to these kinds of numbers.

The pandemic is not over. We now have greatly improved tools and understanding for moving forward. Fresh air ventilation. Meters for measuring it. Masks that work. Methods for calculating the overall safety of multiple measures.

Let us remember the ongoing human costs—the dead, the injured, and the survivors. Let us appreciate and use the gifts we have, and work together to create the new normal.

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Beware of Clear Masks

The purpose of a mask is to filter the incoming and outgoing air, and capture at least 95% of any virus particles in the air.

But—there is a lot of junk out there. Masks like the one shown below don’t actually do any filtration—the air just leaks in and out along the sides.

Then there are some that look like they partially work, and may meet surgical mask standards, but this tells us nothing because surgical masks are for big droplets and they don’t filter the air effectively because they leak around the edges.

The only clear one I know of so far that maybe does it OK is this one--at least it has 99% rated filter material behind the opaque pieces. I’m testing one of these now, and I’ll let you know!

For a full discussion of masks, go to the blog for Jan. 4th. The only mask I wear for more than ten minutes is the BROAD AirPro Mask, the one with the external fan and HEPA filter.

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