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I'm on a family vacation and I'm the only one who tested positive for COVID. How do I protect everyone else?
Yeah, it's exactly what you don't want to have happen. You're on a family vacation, maybe your first in a couple of years because of the pandemic. It could be just immediate family — or maybe grandparents, aunts, uncles, cousins and others have come along.
Then a couple days in, you get that scratchy throat feeling. Your COVID self-test delivers the bad news. Yup, you've got it. It happened to a colleague who was away with their partner and young kids. She felt like crying — and then wondered: Are my tears going to spread my COVID?
We talked to experts for advice on how to prepare ahead of time for a possible COVID infection while on vacation — and what to do if it does strike.
The big question of course: Will everyone get it?
"Part of me thinks: we're doomed!" says Linsey Marr, professor of civil and environmental engineering at Virginia Tech. "But the other part of me knows there are many things we can do to reduce the risk — and many, many cases where one person gets it [in a household] and not everyone else does. So it's not inevitable." Including her own family — her son had COVID and no one else got it.
Various studies estimate what's known as the "secondary attack rate in households" — other household members who catch COVID from an infected individual. "It does look like the secondary attack rate is over 50%," says Marr. "It is quite high but it is not 100%." Studies of earlier variants suggest that vaccination is a good way to keep down the infection rate in a household — and that if lots of people are packed into tight quarters, rates of infection are, as you'd expect, higher.
Tip 1: Preplan
Just like you pack suntan lotion and bug spray, you need to take a good supply of good quality masks (N95 or KN95), self-tests and maybe a few helpful medical tools, like a thermometer and pulse oximeter ... just in case. Also ask if folks in your vacation group are all vaccinated and boosted (if eligible for boosters). The shot might not keep you from becoming infected with the highly infectious and currently dominant omicron BA.5 variant, but it could lessen the severity of disease or shorten the span of your contagiousness.
Tip 2: Figure out the best way to isolate the person with the virus
"You need to remove them from the mix," says Dr. Preeti Malani, an infectious diseases physician and a professor of medicine at the University of Michigan. That's the ideal. But it may not be possible depending on your budget and your lodging options.
If you can book a separate hotel room or put the COVID vacationer in their own room in a rental property, that's ideal. If you're renting a house or staying with family or friends, see if you can assign the COVID case to their own room.
Tip 3: Mask up!
They've been politicized, people are tired of them, they're not exactly fun to wear in a heat wave. But masks are still the front line of protection. The patient should wear a mask when anyone is in proximity — and so should the rest of the vacation party if they're in the same space as the patient. I know we just said this a few paragraphs above, but our experts stress that you want N95s or KN95s for maximum protection and a mask that fits well. So it shouldn't slide down off your nose — and should also be comfortable. Some N95s have over-the-head straps that won't pinch the ears, notes Abraar Karan, an infectious disease physician at Stanford University.
Tip 4: Open windows
The overall goal is "harm reduction," says Malani. And opening windows is a helpful step for any space where the infected person might hang out or pass through. The airflow can help disperse pathogens exhaled by a sick person.
Hotel room windows cannot always be opened, so if your only option is to stay in the same room as the infected person, you might look for an alternative hotel with openable windows or balconies.
Tip 5: Fans are your friend
If the person with COVID will be sharing common space with others, fans are another harm reduction measure. See if you can get a box fan — hotels may have them or you may be able to buy one. Put the fan in the window, pointing outward to suck air (which could contain pathogens exhaled by the patient) out of the room. This is especially helpful if you can't find a separate bedroom for the contagious vacationer. See if you can push their bed near the window with the fan.
Tip 6: Distance makes the pathogen less risky
It's been drummed into the public mind that 6 feet of distance from a sick person is a way to reduce the risk of infection. That's true, but it's not an ironclad guarantee. Pathogen-packed aerosols exhaled by the sick person can travel beyond 6 feet — but "there's far less risk if the sick person is 6 feet away from others," says Karan, who adds, "the more feet the better."
Tip 7: Be bathroom-conscious.
Let's say the sick person is isolated in their own room but the vacationers are sharing a bathroom. If the patient takes off their mask for various bathroom activities, like showering or oral hygiene, they can exhale aerosols (containing viral pathogens), which will linger in the air. So someone who walks in immediately after the sick person is done is going to "walk into a big cloud" of SARS-CoV-2 pathogens, says Karan.
"Stay out of the bathroom for half an hour to an hour," suggests Marr.
Tip 7: Stay outdoors whenever possible
Outdoor airflow doesn't mean no chance of infection, but it does help disperse pathogens. So if you want to have a meal and include the patient — dine al fresco and keep some distance. If the patient is feeling well enough to take a walk and others want to go along, "the safest thing is to wear a mask," says Malani. And make sure that the other walkers are not downwind from the patient, especially if it's a breezy day. If the patient takes a solo walk and no one else is around, "you don't need to have a mask," says Malani. "It's cumbersome to wear a mask all the time."
Tip 8: Be honest with little kids
Our colleague with COVID said her greatest frustration was not being able to hug or share ice cream with her kids, ages 4 and 7.
So how do you explain it all to a kid?
"Young children are very smart, very conscious of wanting to make sure people stay healthy," says Dr. Jill Weatherhead, assistant professor of adult and pediatric infectious diseases at Baylor College of Medicine. "Be honest: Explain you don't want others getting sick and [the person with COVID needs to] stay separate for a few days to make sure nobody else gets sick."
Or you might ask them questions instead of telling them what's up, suggests Junlei Li, the co-chair of the human development and education program at the Harvard Graduate School of Education. That way, you won't just be lecturing, you'll be discovering how much they do (and don't) know and what their concerns are. Li says you might say:
Whatever you tell your children, says Li, the main message you want to convey is: "I want to keep you (and other people) safe too. You know a lot about what to do and what not to do. And we can still be together. We just need to find new ways."
Tip 9: Self-tests can only tell you so much
The great hope, of course, is that the person with COVID will get to a negative test fairly soon and be able to socialize without putting others at risk of infection. Many people ask if a faint "positive" line on a COVID test after a few days means there's a lower load of virus and less chance of transmitting it. In theory it might, our experts say, but it's not a sure thing. "There's no data to suggest that," says Weatherhead. A self-test "is not a quantitative test, it's qualitative. If there's a line, even if it's faint, it's positive."
Tip 10: Don't feel guilty
"Guilt is not helpful," says Malani. "Understand that you're doing your best and this wasn't your fault. This happens."
Tip 11: Don't fret about tears and COVID transmission.
"You don't need to worry about tears" being a major risk for spreading SARS-CoV-2, says Marr. Malani agrees: "There may be some virus in tears, but that's not really how this is spread. It's spread through respiration."
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