The Omicron variant of SARS-CoV-2 is rewriting the rules for living with COVID-19, like the Delta variant did before it. The biggest difference is that it is much more transmissible than previous variants. Along with that, current vaccines are less effective at preventing infection. Fortunately, it appears to cause less-serious illness on average, especially among vaccinated individuals. But it is still killing thousands of people every day around the world.
After two years of living with COVID-19, and nearly a year of tasting relief in the form of better treatments and vaccines, no one wants to lock down again. However, Omicron has made it harder to know how to socialize safely. In this article we’ll offer some of the best tools and tips we’ve found.
Whether or not to get vaccinated is obviously a hot button issue, but there is ample evidence that a gathering of those who have been vaccinated (and ideally also had a booster) is safer than one where some people are unvaccinated. Unfortunately, with Omicron in particular, those who are vaccinated can still both contract and spread COVID-19, so only socializing with other vaccinated individuals is no longer a guarantee of safety.
Gather Outdoors when Possible
One continued bright spot is that gathering outdoors, especially if you can keep some distance between people, is much safter than being indoors. Many restaurants and other venues have now had a year to beef up their outside dining options — an alternative that wasn’t available during the initial lockdowns.
If being outdoors isn’t an option, then the less time you have a group in any one place, the better. This is another area where the scientific studies unfortunately don’t provide much in the way of specific help, but the probability of transmission increases with time spent in close proximity with others.
Rapid (Antigen) Tests
Rapid tests were often promoted as some type of Holy Grail for those wanting to gather safely. The truth is, they’ve never been that. Sports teams, businesses, and even the White House, have suffered from inaccurate rapid test results during the nearly two years they have been using them. Now that they are available to the general public, they have the added burden of uncertainty in how well they can detect the Omicron variant — since all the effectiveness studies were done pre-Omicron.
About the best you can do with rapid tests at this point is have everyone take one a day or two before the event, and another at the last minute. Unfortunately, the roughly $10/test cost and limited availability have made that a problem. The good news is that tests should now be either free or reimbursed, assuming you can find them. Also, the US government recently rolled out a new website that allows each American household to order four tests at no cost.
At-home rapid tests are most accurate when used by people who have already had symptoms for at least a day. At that point the test’s ability to detect whether someone is infected (sensitivity) can be above 90% — depending on the age of the person and the specific brand of test. However, the numbers were generated pre-Omicron, and may be lower now. When asymptomatic individuals are tested, or even those just developing symptoms, sensitivity is lower — potentially a lot lower. That is a big part of the explanation of all the people who contracted COVID-19 at Holiday parties where everyone had tested negative. In many countries, including finally the US, the government is providing some of these tests for free, so they can be an easy and inexpensive way to get a little more confidence, but certainly aren’t enough by themselves to be a solution
In general, PCR tests are considered the “gold standard” of COVID-19 tests. However, unless you’re fortunate enough to be an employee of one of the companies that sent out $700 at-home PCR test devices made by Cue Health, you’ll almost certainly need to have one done at a facility that administers tests, or get a sample kit and send it in.
The downside is that test results can take from a day to a week to come back, unless you pay to expedite them. During holidays and surges, lead times get longer. I take one every week because I teach at Stanford, and results have come back in as little as a day, and as long as six days.
Evaluating your Test Results
There is a lot of confusion over how to interpret the results from a COVID-19 test — starting with the general use of the term “accuracy.” In fact, accuracy includes both sensitivity (chance of successfully detecting a positive sample) and sensitivity (chance of a correctly identifying a negative sample). A test’s predictive value depends on the result, sensitivity, specificity, and the estimated prevalence of the virus in the population.
If you’re up for plugging in a few numbers, we’ve put together a Virus and Antibody Test Results Calculator for you to use. It does require a little homework to get the accuracy numbers for the test you’ve taken.
I haven’t met anyone who actually likes wearing a mask, especially when socializing. But there is plenty of data showing that wearing a good mask — ideally one that meets the N95 standard or international equivalent — helps reduce the spread of COVID-19 for both the person wearing one and whomever they are with. In my case, I’d rather only go to social gatherings where I think I’m safe enough to not need a mask than spend a lot of time socializing while wearing one. It is difficult enough to teach with everyone wearing one.
Air and Environment Quality
We’ve written about air quality quite a bit over the last few years. First in terms of fire smoke, and now, COVID-19. It turns out that measuring air quality related to fires is much simpler than figuring out possible exposure to SARS-CoV-2. Plenty of AQI meters can measure the number of particles in the air, but it is almost impossible to directly measure the prevalence of Coronavirus outside of a specialized lab environment. So, even though many of the filters we’ve written about have HEPA or MERV ratings that are very impressive, the way they are tested doesn’t directly measure virus concentration in the air.
So for the last two years I’ve been working on finding a company that tackles the issue head on. Finally I think I’ve found one. Aura has gone the extra mile, and then even further, to create a system that can help impede the transmission of SARS-CoV-2 — and for that matter improve your air quality in general. In particular, they had a lab perform a test in a controlled environment with live SARS-CoV-2 virus in a sealed 8′ x 8′ x 10′ chamber:
The lab then put live SARS-CoV-2 in the chamber and measured the concentration of live virus over the next hour. They performed the same experiment with a wall-mounted $500 Aura unit operating:
The results are certainly dramatic enough that they make the case that proper air filtration and ventilation matter.
For businesses and organizations, Aura provides an additional layer of protection in the form of allowing customers to specify sets of rules for their air quality systems. For example, according to research published in the American Journal of Microbiology, a number of air-quality variables effect how well viruses can transmit.
The research suggests keeping CO2 below 800 (which is a good sign that fresh air is being brought in at a rate that is keeping up with the number of people), that PM2.5 (the 2.5 micron number that contributes to the overall AQI) be below 15, and relative humidity between 40%-60%. All of these can be measured with sensors built into devices like those from Aura, or with relatively inexpensive hand-held tools. In Aura’s case, an organization can put these rules into their system, so that air-handling devices can react if there is an issue with one of them.
Personally, I like the sleek design and wall-mount of the Aura units for permanent installations. Our Coway units are more conspicuous but have the advantage that we can move them around as needed. The unit in the photo at the top of the article is a battery-powered version suitable for travel.
Unfortunately, we’re at a point where any form of socializing indoors carries some risk of transmission. Case numbers have been through the roof even among those who have been vaccinated. The bright side is that very few cases in those who have been vaccinated have resulted in hospital visits.
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