No one is coming to save us

At this point in the pandemic, nearly everyone in my circle has had at least one family member or friend get sick or die from COVID-19. As cases rise, it’ll likely affect (or has already affected) you and your circles too.

Unfortunately, no one is coming to save us. The sooner that we realize this, shake our denial, and take action — the better. We are not living our normal lives, and we’ve got to evolve our response to adapt to the situation. Sure, we may have a better federal response soon, but that’s thousands of preventable illnesses and deaths away from now.

I’m not willing to wait that long.

This article isn’t advising you to “cancel the holidays” or “avoid everyone all of the time.” Yes, both of those sacrifices will lower your risk, and consequently, the risk to everyone else. But not everyone has those options. Instead, I hope it will help you choose safe(r) activities to avoid COVID and respond if/when COVID comes knocking.

I wrote this because I’ve heard too many people say that their workplaces, their schools, and their places of worship are woefully unprepared. We need to take care of ourselves, our families, and our communities. Though the people who govern us are supposed to be supporting us in these dark times, there isn’t sufficient time in a day, public health employees, or funding for them to dig us out of this deep, deep hole we are in.

We need to take matters into our own hands. I repeat: It’s up to us.

These are guidelines for what you can do to:

• Reduce your risk of getting COVID-19,
• React if you or someone near you has been exposed to COVID-19,
• React if you get sick with COVID-19, and
• Persuade the people around you to take action.

You may not need this today — and I hope that you don’t ever need it — but please, bookmark it. And then come back if you do.

If you’re gonna close this article now, do it after you read these three things: (1) People with COVID are infectious for the three days before they have symptoms and a minimum of ten days after their symptoms start, (2) About one in five folks won’t have symptoms, especially kids, and they can still spread it, and (3) We will only end this madness with a vaccine (especially one that prevents asymptomatic transmission)OR if everyone who’s been exposed to COVID quarantines for 14 days as soon as they realize they’ve been exposed and while they feel entirely well.

You know those dystopic novels/movies where one very normal person finds that they are the “Chosen One” and have to save the world? That’s you. We’re all Neo in the Matrix. Right now.

But the world is on fire. How can I change anything?

Get educated and be a leader for the people around you. Specifically, I want you to learn how to do “contact tracing” — community-based contact tracing.

Contact tracing just means knowing what to do if you’re around someone who is sick from COVID or you get sick with COVID yourself. Then, once you know what to do in those situations, community-based contract tracing is trying to help others going through those same situations.

Early in the pandemic, I was part of the Johns Hopkins Bloomberg School of Public Health team that created a free course on COVID-19 Contact Tracing. The course has been used worldwide to establish legions of contact tracers who can help us slow/stop the spread of COVID-19. It has enrolled more than one million people to date. While I encourage you to take the full Coursera course if you have 5–6 hours of free time (lol). Most of us don’t though, so I wrote this article.

The article won’t cover everything and isn’t scientifically annotated. It’s not totally in depth, but it should get you started.

Two life-changing stories have emerged from this course.

First, a woman from India reached out and said that all of the aunties in their apartment building decided to educate themselves by taking our course as a group. Around that time, there was a case in their building. Because they were prepared, the aunties conducted their own contact tracing and were able to stop the virus from spreading further. Hell yeah aunties!

Second, a friend in L.A. reached out to say that community based organizations (CBOs) there wanted to build their own capacity to contact trace instead of relying on the city. They were concerned that people weren’t going to pick up, take, or trust a call from public health officials. In comparison, the CBOs knew where people lived, how to connect with them, etc. The CBOs trained up, and now, as cities grow overwhelmed with cases, I expect that this corps of lay civilians means their community will be more resilient than others.

My own experience

I recently had multiple family members test positive. (They’ve recovered with no complications, thankfully.) When this happens, immediate action is needed. I let my family know that people with COVID-19 are infectious up to three days prior to when their symptoms start. During this time, they felt 100% well but could have passed it onto others. My family immediately texted any friends they’d seen in that window and asked if it was OK that I called them too.

I ended up talking with and quarantining a handful of households. People were hesitant. They felt healthy and needed to go to work. I said, “You were exposed. You could become sick. If you were infected, you could pass the virus to others for DAYS before you even start to feel ill. And one in five people with COVID won’t ever feel ill — especially kids. That’s why it’s important to stay home and get tested.” Eventually, many agreed.

Unfortunately, one household ended up also testing positive. BUT thankfully, the household was at home while they were infectious (despite feeling healthy) — so, no one else got sick! Imagine if they had continued going to work or to school. That is the power of contact tracing.

It’s been a month since that happened and neither the city, county, nor state has called to check in on the people with COVID-19 yet.

If you’re more of a visual person, here’s how contact tracing works:

Top scenario, do nothing and spread happens.

Middle scenario, wait until someone becomes symptomatic and then they isolate (black box). By then it’s too late. It’s the same thing as doing nothing.

Last scenario, anyone exposed to a case quarantines themselves — while they still feel fine. By doing this, we stop others from being infected.

My point is this: Contact tracers are facing HUGE barriers to reaching, building trust with, and persuading potentially infectious people to stay home. In some areas, contact tracers aren’t even able to keep up.

Community-based contact tracing doesn’t face the same barriers. If we conduct our own contact tracing, then we can move faster, reach more people, and be more persuasive for action. We often know our neighbors, engage with far-flung friends on Facebook, and have more trust with people in our circles.

Doing your own contact tracing means calling people up if you get sick, knowing what to do if you are exposed, and offering to help out when you see others who are sick. If your job gets a COVID case and everyone seems unfazed, I want you to intervene. If there’s a case at your kid’s school and no one gets quarantined, I want you to say something. If you get a flyer from school that says siblings of sick kids just need to stay home for 10 days, I want you to know enough to recognize that’s wrong and to challenge it.

I think that my family is extraordinary (bit biased though ¯\_(ツ)_/¯). They were immediately transparent about their test results with others, and they had me to help call their contacts. That’s not a #HumbleBrag. My point here is that my knowledge is not special.

YOU can have, and should have, those skills too. If you want the full training, go here. Otherwise, let’s suit you up with some good ol’ education and protect your people.

Here’s what you need to know TODAY*

The following is not meant to cause fear or panic. Instead, I want you and your community to be prepared and have a plan for how to:

1. Prevent infection
2. React if you become ill with COVID-19
3. React if you are exposed to COVID-19
4. Persuade others to take action

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Before we jump in, a lot of folks have been asking me about what to do for the holidays and whether their college students should come home to visit them. Obviously not everyone has access to testing, but do what you can. In collaboration with several colleagues, our hot take’s below. If you want more general holiday guidance, the COVID-19 Response Corps is a great resource. If you plan to travel or gather, I trust everything written about how to reduce your risks in this article too.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License

Alright, let’s jump in:

1. How to prevent infection

More interventions = more effective. Even if every intervention is imperfect, each one adds up! I want a seatbelt AND an airbag — not just one. See left side of this Swiss cheese:

Every time you leave your home:

• Wear a mask
• Be outdoors
• Stay six feet from people outside of your household

If you can do all of these things, awesome! But the world’s messy — so, aim for at least 2/3rds of those bullets. For example, if you can’t wear a mask, then be outdoors and at least six feet from people outside your household. For my crew, we’ve been doing a lot of distanced picnics. This will obviously be harder in the cold winter months, but I mean...

Above all, wear a mask.** If you are packed indoors like sardines at your job because you must be, keep that mask on. If I were still waitressing at R.Bar right now, I’d insist on also wearing a face shield. The virus is spread both by droplets and by hanging out in the air. If you share air with other people, wear a mask. That means if you have your own cubicle in an open plan office, wear a mask regardless if people are two or fifteen feet from you.

More on wearing masks from Dr. Theresa Chapple:

1. Wear masks, even when speaking, over mouth and nose
2. Don’t remove mask to sneeze/ cough
3. Wash hands before putting mask on & taking it off
4. Wash cloth mask after daily use
5. Set it and forget it

And lastly, if someone is ever too close for comfort, just cough really loud. It really works :)

People have also been asking me about how to reduce spread while traveling by air. If you absolutely MUST travel by air, then I recommend double masks (one paper KN95 or surgical) with a cloth mask over to keep the paper mask close to your face. Mask brackets are cool and makes things more comfortable. But it’s key to seal the edges against your face as much as possible. Again, I also recommend a face shield. They look wonky but they prevent droplets from landing in your eyes. Some folks are even using goggles. Do whatever steampunk thing works for you.

There aren’t really clinical guidelines on vitamins and their role yet, but if they make you feel good, then by all means, take them. Specifically, zinc and vitamin C are being looked at for prevention, but there aren’t any strong conclusions on those yet. Just don’t overdo it.

2. How to react if you become ill with COVID-19

First, a caveat: I am not a medical doctor. Instead, what I’m about to tell you is what I told my own family. Aren’t sure that you have COVID? If you’ve lost your sense of smell and/or taste, it’s probably COVID. If you have fever, cough, feel fatigued, then it’s could also COVID but maybe it’s the flu.

Even in the face of uncertainty, you can choose to act quickly and decisively. If you feel lousy, cancel that dentist appointment. Don’t visit your friend who plans to see their grandparents soon.

I’m going to focus on what to do if you definitely have COVID-19 though:

• First, take action to protect the people in your household. Isolate yourself from your housemates. Ideally, you would have your own room and bathroom. Basically, avoid sharing air with others. If someone typically shares a bed with you, put them (or you!) on the couch or floor in another room. If you have to be in the same room as someone else (e.g., kitchen to grab some water), have everyone wear masks inside, stay distanced, and try to open a window — even a crack helps. If you share a bathroom: flush with the toilet seat down and then, wipe down the toilet seat handle, the faucet, and the door knob as you’re leaving.
• Second, take action to protect others you may have accidentally exposed. If you got symptoms on Monday, then you were infectious in the three days prior: Friday, Saturday, and Sunday. Infectiousness isn’t a binary though — you were most infectious on Sunday and Monday. Did you see anyone on those days? Tell them. For me personally, I’d recommend telling everyone I saw on those three days for transparency’s sake, but you especially want to get in touch with any of your “close contacts” and tell them to quarantine (keep reading for what this means). Close contacts include: (a) being face-to-face (masked or not) within 6 feet of someone for 15+ minutes cumulatively or (b) being in a closed environment (masked or not) such as a classroom or meeting room for 15+ minutes cumulatively. Note that there is no distance specified for being indoors with someone because COVID is airborne. This is where a “contact journal” can come in handy. This is another community-driven effort where everyone keeps tabs on who they’re hanging around. Why is this step important? Your illness will not just impact the people in your “bubble” but also their bubble. And their bubble’s bubble. And so on, which is why it’s important to not just have a small bubble but also know the risks that people in your bubble are taking too:

I got this image from a friend whoooooo… got it from a friend whooooo… got it from the wonderful @thoughtsofaphd

• Third, quarantine your household. This is where things get complicated. Household members (e.g., kids, partners, spouses) who were with you during your infectious period should stay away from people outside the household. They should continue to stay at home for these 14 days while they wait to see if they come down with COVID-19 symptoms too. This 14 day clock begins on the their last day of exposure to you. The issue is that anyone in your house could become sick and cause a chain of dominoes that pushes the quarantine clock back-and-back. For example, imagine that I live with three housemates:

But quarantine can drag on if this happens:

The thing is… people in the same household should be quarantined away from one another if possible. Why? Because in a nightmare scenario, this could happen:

In the real world, I recommend that the infected person stay in their own room. If there are any high-risk folks in that same household, try to keep them in their own room too. The remainder of the house quarantines together. This protects the high risk folks and prevents the positive person from spreading further. If you have kids in school, one sick kid means at least 10 days of all their siblings staying home while the first is infectious plus 14 more days after that to see if the siblings develop symptoms.

• Get people in your household tested: While testing is not perfect, it can at least increase your confidence that you’re negative and help catch positive people without symptoms. Getting tested 6–8 days after exposure to someone with COVID-19 helps increase accuracy. It’s the Goldilocks of testing—not too soon and not too late. If you have to choose, doing it later will likely be more accurate than doing it too soon.
• Track any and all symptoms. COVID has some weird ones, so just track anything that you think may be related. Everyone in the house should do this.
• Take temperatures twice daily (and record them). A fever is 100.4 F or higher. Everyone in the house should do this. Be sure to sanitize your thermometer before sharing!
• Get or borrow a pulse oximeter. I sent two to my family — one for them and another for neighbors. This is another place where a community-based response can be leveraged. If you have an oximeter, let folks in your neighborhood/church/school know so that in their time of need, they can borrow yours. Take your oximeter reading twice daily (and record them). You want your hand warm and measuring on a finger without nail polish. The reading will vary over time, but in general, a person with healthy lung function is looking for mid to high 90's. If it dips lower than 92 and another person in your house with healthy lungs is still measuring above 92, see next bullet:
• While many people with COVID will be OK, have a low threshold for seeking care: Get care right away if your oximeter drops below 90, you have any signs of stroke (which can be different for women), or you have any of the following: difficulty breathing, shortness of breath, blueness in face/lips, chest pain that keeps on, or feelings of confusion. Survival rates for COVID patients are increasing and are best when treatment starts fast. Talk with your doctor and make a plan for what to do in these scenarios.
• Again, RE: vitamins for reducing severity of symptoms. There isn’t much research out there, but there’s research interest in Vitamin D for those who are deficient (most of us) and glutathione. Don’t overdo it though.
• Expect ups and downs. You might have some initial symptoms, feel better, and then get hit hard before recovering again. The strange thing about COVID-19 is that it causes all sorts of seemingly unrelated symptoms from loss of taste/smell, COVID toes, and dementia-like forgetfulness. There’s also long COVID, which has been a months long affliction for both young and old with no way of telling how long it will last…
• Stay isolated for at least ten days. If you have a fever, it must have been gone for 24-hours without medications before you leave isolation.

3. How to react if you were exposed to COVID-19

So…

Someone at work or school was positive. Or, maybe, you were within 6 feet of a COVID case for 15+ minutes. Or you are a COVID positive person preparing to call relatives that you may have unwittingly exposed. Maybe you took the Coursera and want to help your COVID-positive neighbor reach out to people they’ve been around.

Why do we quarantine people? Quarantine is the act of keeping a person, who isn’t sick yet but MAY become sick, away from other people. You have to quarantine people who feel perfectly healthy. Why? Because people with COVID spread it to others for 2–3 days prior to coming down with symptoms. And a chunk of people will still spread it without EVER having symptoms. Have I repeated this enough yet? (Sorry! But also, not sorry!)

Who should get quarantined? This is a bit of a repeat, but anyone who might be considered a “close contact” of the case. This includes:

• Face-to-face contact (masked or not) within 6 feet of the case for 15 or more minutes
• Being in an enclosed environment (e.g., a classroom or meeting room) with a case for 15+ minutes. Note that there is no distance specified for because COVID is airborne. Risk is a spectrum though — so being closer to a case, people not wearing masks, and being in a less ventilated space are all more risky.

What should people in quarantine do? Assume that you have COVID and take whatever actions you can to protect people around you.

• Get a test about 6–8 days after your exposure.
• Take temperatures twice daily (and record them). A fever is 100.4 F or higher. Everyone in the house should do this. Be sure to sanitize your thermometer before sharing it with others.
• Track any and all symptoms.
• Stay isolated for at least fourteen days since your last exposure to someone who was infectious. See black and yellow lined diagrams above for more info on this.
• If you develop symptoms, you’ll need to quarantine anyone with whom you’ve had close contact in the three days before your symptoms or if no symptoms, three days before you tested positive.

What if I was exposed? Does that mean my housemates were exposed too? By the time you find out you’ve been exposed, yes, it’s likely that you could have exposed your housemates too. But not necessarily. Consider these examples:

• I am exposed to a COVID case on Day 0. Then, I hang out with my roommates on Days 2 and 3 and 4. I get sick on Day 5 so I was infectious on Days 2, 3, and 4. Roommates should quarantine.
• I am exposed to a COVID case on Day 0. Then, I hang out with my roommates on Days 2 and 3 and 4. I find out that I was exposed on Day 5. I immediately hang out in my room with my own bathroom EVEN THOUGH I FEEL HEALTHY. Since my roommates have been with me, and it’s unclear of whether I am infectious, my roommates begin quarantine on Day 5 too.On Day 6, I seal my mouth and nose off with a mask (to avoid expelling infected air into the apartment and elsewhere) and take my private car to get tested on Day 6. I come home and continue to isolate on Days 6, 7 8, 9, and 10. On Day 10, I get back a positive test and also start getting symptoms. So, I was infectious on Days 7, 8, and 9. Since my roommates last saw me on Day 4, then they were not exposed and can technically end quarantine on Day 10 (when I got my negative results).

4. How to persuade people to take action

Finally, I wanted to include this because everyone overlooks it, and I think it’s the most important. Now that you know what you know, I’m asking you to apply it and get in other people’s business. Simple as that.

If your job gets a COVID case and everyone seems unfazed, I want you to intervene. If there’s a case at your kid’s school and no one gets quarantined, I want you to say something. If you get a flyer from school that says siblings of sick kids just need to stay home for 10 days, I want you to challenge it.

But people aren’t gonna budge if you just shove data and science in their faces. Per Teddy Roosevelt (probably) and my friend Waggles:

“People don’t care about how much you know, until they know how much you care.”

I think this is the most attractive aspect of community-driven contact tracing. We are rarely convinced by rando people. Instead, we tend to be most open and trusting with the people around us. When I called family friends to talk about quarantining, they knew that I was looking out for them, their families, their schools, their jobs, and beyond.

“Among driving sentiments behind the current waves of vaccine [or health!] questioning and dissent are a sense of lost dignity and distrust … Listening to rumors and the stories behind them can help us understand the reasons. [Those stories hold the] cues to building new and more trusting relationships.”
– Dr. Heid Larson (Author of Stuck)

However illogical people seem, actions and beliefs typically stem in a way that is rational to them.

“Dr. Larson spoke with a group of Nigerian mothers who were upset that they were being called ‘ignorant’ on the radio for not simply taking the vaccine. They told her, ‘We wouldn’t be asking questions if we were ignorant.’ She became convinced that more had to be done to engage people with doubts, and not merely dismiss them. ‘I saw how much of the communication strategies were very much driven by what the public health community and immunization people thought the public needed to know,’ Dr. Larson said. ‘But they weren’t responding to what people’s concerns were, or issues, or questions.’”

– NYT article about Heidi Larson

We dedicated an entire section of the Coursera course to the “HOW” of connecting with people. For example, when you say, “I totally understand,” have you really walked in their shoes or do you just hear what they’re saying? If the latter, then just say “I hear you.” In my opinion, the phrase is more powerful.

Consider avoiding “why” questions. They’re just … not nice! “Why didn’t you pick up the groceries?” “Why are you acting weird?” “Why do you think masks don’t work?” It feels accusatory.

Instead, try questions like, “What have you heard about masks? What have you heard about contact tracing? What have you heard about what to do if you’ve been exposed?” Instead of forcing people into a corner about “what they know”, you can talk to them about what they’ve heard. That way, you’re not combatting their belief system but instead just stuff they’ve maybe seen but not yet evaluated. It opens a door for you to help them walk through the logic while balancing the emotional response.

What about if they get defensive or angry? “I know what’s best for my family.” “We’re not going to cancel Thanksgiving.” “COVID is completely made up, and I’m not going to turn my life upside down.”

Try taking some cues from the world of nonviolent communication and translate their words into what they’re needing:

• They say: “I know what’s best. We’re not cancelling Thanksgiving” →
  You say: “You’re needing to connect with your family members because you care for them and you want to spend time with them.”
• They say: “I’m not turning my life upside down” →
  You say: “You’re needing to keep paying your bills, educating your kids, and staying sane. Radical change would totally upend all of that.”

From there, just listen. See what happens. If they say, “The virus is a hoax.” Then reframe it, “You don’t believe the virus is real.” Keep repeating what they’re telling you until a lull. Then, you know that they’ve felt heard.

Once they feel heard, then proceed to affirm your care for them and deliver information: “You care about your family. I hear that. I care about you and your family too, which is why I‘m needing to let you know that you can lower your risk by avoiding your elderly parents for the next X days. Extra caution to protect them might be good. Healthy people who’ve been exposed to COVID can still pass on the virus.”

Lastly, you know the person so deliver the information however you think will get across. Use humor. Connect things back to old experiences that you’ve had together. Try to draw a picture for them or deliver it in text message or a phone call or while playing Among Us. Make a rhyme up!

In the end, you are only in control of yourself.

Again, please bookmark this page and keep it around. I hope you won’t need it, but with cases increasing exponentially, better to be prepared.

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*Michael Barbaro. Looking at you.

**Personally, I wear a paper KN95 with a cloth mask over it to keep the paper mask secure against my face