Personal indicators for COVID19 best practices

There’s CDC or other institutional guidance, and there’s “what this person does” guidance. Both can be informative for how individuals manage their behavior during a deadly, global pandemic. Judging from a recent conversation I’ve had elsewhere, there might be some value in sharing a bit more of the latter.

First some demographics: white male in his “extremely early mid-50s” (nod to Martin Short) with no known co-morbidities, no immediate family members immunocompromised, my entire family was able to be fully vaccinated against SARS-CoV-2 as soon as vaccines became available (team Moderna.) We are very lucky in these regards.

I am a scientist and educator whose life goal is to help people better understand the natural world and their place within it. I’m also a long-time student of and advocate for evidence-based critical thinking – not contrarianism – but real and scholarly critical thinking. If there’s an opinion I’m sharing on some important matter, there’s a good chance I’ve done a fairly deep dive on the peer-reviewed literature associated with that subject and have looked for specific examples that might weaken the strength of evidence in one way or another. 

So how have I personally managed my behavior during the COVID19 pandemic?

My objective is to not get COVID19. I don’t want seasonal influenza either and this is why I seek vaccination against it every year – who wants to lose a week of productivity feeling like you’ve been run over by a dump truck? So I don’t want COVID19. I’m confident that if I did I would survive the ordeal (although plenty of folks ostensibly healthier than I am have not), but I am loathe to serve as a potential vector for this virus. This is where emotion seeps into the equation for me: I refuse to be the source of an infection to someone else who might not be as robust in immunity and I refuse to help this $%&# virus spread death and destruction where it goes. Sorry pal, but I’m not enabling you.

Okay, but literally what am I doing? What are the benchmarks I’m looking for to adjust my behavior? Often on social media I’ll encounter people asking questions like “Is anyone still masking in public?” People are seeking guidance on day-to-day behaviors of others. So here’s what I, at least, do.

Personally, I want to know how much SARS-CoV-2 virus might be circulating in my community. That’s a combination of three things: What’s my “community”? Am I confident that we’re testing enough? How many active cases do we have right now?

My community includes the people with whom my family and are I likely to be interacting. In our university town of Stillwater, OK that’s likely a mixture of folks from 5 or 6 counties. So my city and my county might make sense as my community, but it’s a bigger pool of people than that. I also don’t want the hassle of aggregating data from multiple sources – assuming such data even are available. So to me it makes the most sense to simply look at data compiled for our state. 

Are we testing enough? No way, and it’s not even close. Here on campus at Oklahoma State University, testing has never been compulsory, randomized, or regular. Those are the data I would want to have confidence we were tracking outbreaks well. As a result, there’s a huge bias in people seeking tests when they think they either have or have been exposed to a COVID19 infection. This means that our “percent positive” skews very high compared to other states and to where we need to be for assurance that the general infection rate among our population is low. All I can look to, therefore, is a level of testing that is outpacing the percent positives data. “Are we testing more people per 100,000 in population than we have active cases of COVID19 per 100,000 in population?” This is a horribly obtuse metric as a guide to behavior, but it’s the best we have available in our state.

The actual benchmark I’m looking for is a confident estimate that we’ve got <100 infections statewide/100,000 people. That would work out to a bit less than 4000 total, active infections statewide, in our state of just under 4 million in population. 1 in 100 with COVID = too risky. 1 in 10,000 = feeling confident playing those odds. 1 in 1000? That’s confidence eroded to the point at which I’m masking again.

[Note that if you don’t have such metrics readily compiled for you the formula is simple to calculate yourself: (number of cases/population) * 100,000. For example, the current number of active cases for the state of Oklahoma is 20,093. Our state’s population (2019 estimate) is 3,957,000: 20,093/3,957,000 = 0.00507784. That’s 508 cases per 100,000 people. Our current testing rate is 188/100,000 and 19.9% of those tests are positive for SARS-CoV-2.]

So how many cases? Okay so statewide, if we are testing at a higher rate than people are suffering infection… that’s only happened in 6 months out of the 19 since March 2020. Four of those 6 months were April–July 2020, during which time I was maximizing my isolation from any people outside our immediate family bubble and donning a cloth mask any time I went out in public. Cases were steadily growing during this time too, and by August 2020 the infection rate increased beyond the testing rate and did not fall below the testing rate until May 2021.

My family was vaccinated by April 2021, and by May 2021 we finally had data in keeping with my criterion of testing > infections. Our testing rate had dropped very low, down below 100 tests/100k people for the first time since April of 2020. But cases were lower still: 37/100k by the end of May 2021 and 50/100k by the end of June. By the end of June case counts were increasing again and by the end of July the trend had reversed as delta variant COVID19 swept through our majority unvaccinated state: July closed with 250 cases/100k while testing at just 74/100k. 

When did I change my behavior? After 14 months of masking and avoiding people, May and June 2021 were glorious. We simply didn’t have much virus circulating in our state and, though testing rate was so low, cases were low enough that I had confidence that we could detect a new outbreak. I returned to my office for daily work, I started going to restaurants again, etc. I did these things mask-free. I usually kept a mask handy, but was out and about without wearing one.

When did my behavior change again? July 2021. By the beginning of July it was already clear that cases were steadily increasing and that delta COVID19 had been unleashed in Oklahoma. At some point in July, I started masking in public again. I’ll keep doing that until testing outpaces cases and I’ve got confidence that we’re consistently lower than 100 cases per 100,000.

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