How to navigate risk and exposure

With COVID-19 on the rise in the Bay Area and throughout the country as people travel and gather for the holidays, how should you navigate risk and handle exposures in the post-pandemic era?

Even though public health restrictions have long been lifted, general guidelines around risk and exposure established during the pandemic still apply, according to at least one well-known Bay Area health expert — and the U.S. Centers for Disease Control and Prevention offers an online calculator that can help you determine the measures you should take in your specific situation.

Dr. Bob Wachter, the chair of the department of medicine at UCSF, said that while decisions about risk tolerance are highly individual, he’s still operating in his “middle range” of risk mitigation, as “the threat of infection is rising but still nowhere near the kinds of surges we’ve seen in the past.”

For him, that means wearing an N95 mask in crowded, poorly ventilated places, especially when there’s no need to talk — places like crowded stores, airplanes or trains, elevators or theaters. But he’ll still dine indoors if outdoor dining is not an option, and he’ll be maskless at gatherings or holiday parties. 

Another factor he considers is what events he has coming up, either for work or in his personal life, that he’d rather not miss by being out sick with COVID. 

“If I had nothing of importance to do or could easily work at home, that would dial down my level of caution a little,” he said. “When I have things I really don’t want to miss, I’m a little extra careful.”

If you are exposed or test positive, here are the basic CDC guidelines:

• In case of exposure: Mask up for 10 days, watch for symptoms such as fever, and test yourself on Day 6. If you’re negative, continue masking until Day 10, after which you can stop.

• In case of infection: If you test positive or develop symptoms, you should isolate immediately, according to the CDC. The period when you are most infectious is usually the first five days after your positive test. If you must interact with others, wear a high-quality mask. 

• When to end isolation: Those who show no symptoms can end isolation after five days, the CDC says. But if you do have symptoms, you should continue to isolate until you are fever-free for 24 hours without the use of fever-reducing medication.

• If you had moderate or severe symptoms — ranging from difficulty breathing to hospitalization — keep isolating through Day 10. Stop masking only after two sequential negative tests taken 48 hours apart.

And if you do get exposed to COVID and don’t know what steps to take, the CDC offers an isolation and exposure calculator to help you navigate the latest guidelines. (It notes that if you have shortness of breath or difficulty breathing, have symptoms requiring hospitalization or are immunocompromised, the calculator’s guidelines do not apply and you should reach out to a health care professional.)

For example, if you were exposed to COVID on Christmas and have not had COVID within the past 90 days, the CDC says you do not need to stay home unless you develop symptoms. But it says you should get tested on or after Dec. 31, six days after the day of exposure, and you should wear a high-quality mask around other people through Jan. 4, or 10 days after exposure.

If you tested positive but have no symptoms, the CDC recommends isolating and staying home for five days after the day of the positive test if you don’t develop symptoms — so if you tested positive on Christmas but never developed symptoms, you can leave your home on Dec. 31. You should continue to wear a mask for 10 days after the positive test, unless you test negative on two at-home tests taken 48 hours apart, at which point you can stop masking. 

If you continue to test positive on at-home tests, you should continue masking, even if you don’t have symptoms, the CDC says. If you develop symptoms, you should restart your five-day isolation period.

If you were exposed to COVID and develop symptoms, you should isolate, even if you don’t test positive, the CDC says.

Reach Danielle Echeverria: [email protected]; Twitter: @DanielleEchev