Early in the pandemic, Dr MacArthur's family worried he would get infected at work and bring the virus home. COVID-19 did come close to home and a few lessons were learned.
Early in the COVID-19 epidemic, I remember my family worrying about me getting infected and bringing the virus home to them as well. I teach at the Medical College of Georgia at August University and see patients at the Augusta University Medical Center. I followed a routine that involved taking off my hospital clothing in the hallway as soon as I walked through the door, changing into new clothes, and immediately washing the used clothes. We kept that routine going for about 6 – 8 weeks, when everything was new, then gradually relaxed it as we realized that there was a different degree of risk among those in the emergency rooms and intensive care units than there was for those of us who typically worked “behind the front lines.”
Now, the SARS-CoV-2 virus is more widespread than ever, with most of the infections occurring as a result of community spread, not from taking care of patients in the hospital.
So, who, in my family of 4, is at greatest risk? My family consists of me, my wife, and 2 adult children:
Imagine my surprise several weeks ago when I received a call from my daughter away at school complaining of a fever, sore throat, and fatigue. She tested positive for SARS-CoV-2 the next day. It turns out that 3 days before she developed symptoms, she attended a birthday party at an off-campus apartment with 10 other students. Of the 11, only 2 of them wore masks. Of the 11, all tested positive for SARS-CoV-2. No one was symptomatic at the party. My daughter did well, as most young people do, and has only residual anosmia and persistent loss of taste.
The main lessons from Surprise #1:
1. Private indoor events, with little social distancing, continue to be the major risk factor for the spread of SARS-CoV-2.
2. It is hard to predict who is going to be a super spreader, and which event will turn into a super spreader event.
3. Young people, who tend to socialize more than older people, will likely continue to spread the virus to others until a substantial majority of them are vaccinated.
Unfortunately, the most recent projections are that college students are not likely to get vaccinated until April (or later), and only about half plan to get the vaccine series.
Another COVID-19 “surprise” descended upon me several days ago when my son, hours before he was to travel to visit the girlfriend, found out that the SARS-CoV-2 PCR test he had the day before was positive. He was completely asymptomatic.
My wife, who had been complaining of a headache and fatigue for the past two days, was convinced that she was the source of the infection. She immediately got an appointment to get tested. However, I was not convinced that my son was infected, at least not acutely.
All tests have imperfections, including the SARS-CoV-2 PCR test. It is very sensitive, and often detects non-infectious viral particles for weeks or months after someone is exposed to the virus. On the other hand, the rapid antigen test, which is not as sensitive, detects only viral proteins from actively replicating virus. Per CDC guidance, either test can be used for screening, and asymptomatic persons do not need to confirm a negative antigen test with a PCR test.
The other possibility is that my son’s PCR test was a false positive. While uncommon, false positive results do occur, especially when the prevalence of the virus is low (as would be expected among those who do not venture out much). Antibody testing might help to distinguish between a false positive result and an asymptomatic remote exposure to the virus.
My son’s antigen test was negative, and he has remained asymptomatic. My wife’s PCR test also was negative. My son plans to get tested for antibodies within the next few weeks.
As for me, I plan to continue to advocate at the community level for increased vaccination uptake. In fact, within the next few months, our Medical College of Georgia students will be going throughout the State of Georgia, especially to rural areas, to talk about vaccine safety and vaccinate those willing to receive the vaccine. More than 95% of our medical students have received the vaccine series.
We are all in this COVID-19 mess together.
Rodger D. MacArthur, MD, is Professor of Medicine, Division of Infectious Diseases and Office of Academic Affairs, Medical College of Georgia at Augusta University, Augusta, Georgia. Dr MacArthur is an NIH-funded researcher and before arriving at the Medical College of Georgia, he headed the Wayne State University AIDS clinical trial program. He is widely recognized as an authority the development of antiretroviral treatment.