This is post #4 in my COVID-19 series.

• #1 is here on general COVID info and precautions (somewhat outdated now)
• #2 is here on building a bubble/pod and navigating feelings, communication, and agreements (this info is still valid)
• #3 is here on specific risk management strategies using objective tools (this info is still valid too)
• #5 is here on how risk changes once you or your friends have been vaccinated (this info is still valid too)

Here we are a year in and things are looking up: we have a vaccine, and there’s other good news (see below).

But daily life in this strange time is still hard, and the new mutated variants of the coronavirus are real cause for concern.

It’s very reasonable if you continue to feel lonely even if you have a few close friends you still see regularly. Not only has there been so much stress over the past few months (Zoom fatigue, the Capitol riot, the continued fight for racial justice, etc.), but another major impact is that it’s much harder nowadays to connect regularly with our “weaker ties”—people we might not call “friends” but who we’d previously see regularly at events, sports bars, the gym, etc.

This is hard. But the end is in sight now.

In this post:

1. What you need to know about the B117 strain of the virus
2. The latest researched-backed precautions you should be taking (not just what the CDC says but what top researchers around the world are recommending)
3. Easy-to-read, quantified data on how your risk level will change with different adjustments you could make (e.g., switching masks, keeping 10ft apart instead of 6ft, etc.)
4. Why getting COVID might be worse than you’re imagining (and you should try to not get jaded about it or resign yourself to it probably happening)
5. Why the vaccine is safe and you should get it as soon as you can
6. Whether or not it’s safe to be around people who have had COVID and recovered or people who have been vaccinated
7. What specific masks I’m recommending now
8. What else you can do about all this

Reading time:

33 minutes

Summary of key points (TL;DR):

• There’s some good news too (see below).
• But, the new B117 “UK strain” is confirmed to be in the US and it’s 50-70% more transmissible. That’s a big deal. You need to take more serious precautions. Upgrade your mask. I like this KN95 (2/10 update: With the new strains, KN95’s are selling out quickly. If you can’t find any available, try using a “mask fitter” or “double-mask”: Wear a cloth mask on top of a tightly-fitted surgical mask—that will nearly double your protection over just using a single surgical mask.).
  • Side note: It’s not great to be referring to new strains of the virus by a geography-based designation of where they were discovered. By calling it the “UK” strain, it plants the idea in our minds (even subconsciously) that the UK is to be blame for it or that there’s something especially dangerous about British people (just like when people have referred to the coronavirus as the “China virus”). There’s no evidence even that the B117 strain originated in the UK. In fact, we should be thanking the UK scientists who discovered this new strain since they’ve developed some of the world’s most advanced genomic surveillance. In other words, B117 could very well have come from elsewhere but it’s simply that the British have awesome technology for discovering these new strains.
• Get the vaccine as soon as you can. It’s safe. It wasn’t rushed. Getting COVID is much worse than any side effect you might experience. Roughly 10% of COVID patients end up with symptoms that persist for months.
• If you’ve heard that having had COVID makes it impossible for you to pass it on again to others, your information is out of date. People who have had COVID and recovered might now have a lower viral load and thus be less dangerous to be around, but the danger is still especially acute for two weeks after they’re infected—and likely still present even beyond that. Wait at least 3 weeks after their first positive test to even consider being mask-less around them, and even then recognize that it’s still dangerous.  All we know at this point is that antibodies protect you from getting sick again.
• The vaccine is not fully effective until two weeks after the second dose. If someone gets the vaccine, it will protect them from getting sick from COVID, but it’s still not clear if their transmission rate will go down (i.e., if they’re safe to be around mask-less). Again, to be clear, there is not yet any proof that vaccinated people are unable to transmit the virus anymore, just that they won’t get sick themselves.

A note on privilege:

Communities of color and other marginalized populations have been hit a lot harder by the pandemic and might not have the luxury of limiting their exposure as I’ll be describing on this webpage. Many people who can’t work from home don’t have control over their work environments and are forced to take on more risk than they’re comfortable with. I feel lucky that I have the luxury of being able to take the precautions that feel safest to me.

Disclaimers:

I have no medical background. I’m simply someone who’s read a lot of articles and is skilled at summarizing and simplifying complex subjects. But, I’ve read at least 40 articles over the past couple of weeks to write this post (references at the bottom). I might very well have gotten some things wrong, but I’ve tried my best to double- or triple-check all the facts I present.

As you know, so much here changes regularly, but this is accurate as of the February 2nd, 2021.

Updates:

• February 4: Added more on categories of risk as well as vaccine info for pregnant women.
• February 9: Added some info on why it’s better to refer to strains by their scientific designation (e.g., B117) rather than by place of discovery (e.g., “the UK variant”).
• February 10: Added more info on double-masking.
• February 11: Added some hopeful news that the vaccine might reduce transmission, but still not proven.

Good news and bad news. There’s finally light at the end of the tunnel, but now is also one of the most dangerous times yet

“This is the part of the horror film where a happy ending seems in sight, but it is obvious, to those paying attention, that the monster is not dead, and that the worst may be yet to come.
—The NY Times, January 28, 2021”

Good news:

1. We have an excellent vaccine (more on that later). Over 26 million Americans have now received their first dose, which is more than the total number of Americans who have been infected with COVID.
2. The FDA recently approved at-home test kits that should be available soon for $30 and will get you results in 15-20 minutes at over 90% accuracy.
3. Now that more research has been done, it turns out that you probably don’t have to worry so much about getting COVID through surfaces. Nature published an article at the end of January arguing that the vast majority of COVID transmission occurs through the air, not from touching doorknobs or groceries. So yes, keep washing your hands just in case, but you probably don’t need to be taking more extreme measures to disinfect everything around you.

When will things start to feel more normal again?

Many experts feel like, if progress continues to be made, there’s a fair chance it might be as soon as Fall of this year. Think of the change in 3 stages:

1. Once you and your friends/family are vaccinated, possibly in mid-2021
2. Once your city/state reaches herd immunity level (~75% vaccination), possibly in late-2021
3. Once the world reaches herd immunity level, likely in 2022-2023

Bad news:

1. The virus has been mutating, and some of those new strains are very concerning (more on that shortly). This is a big deal. And sadly, compared to some other countries, the United States doesn’t have a strong national surveillance program in place to fully track its spread.
2. People are getting more lax with their precautions because it’s easy to feel like this is all almost over now that we have the vaccine.

The B117 strain of COVID is 50-70% more transmissible

It latches onto cells more efficiently, so it takes fewer viral particles and less time near an infected person to become infected.

For fellow Oregonians, the new strain is confirmed to be here. Across the country, B117 may become the dominant strain by March.

In the UK, it’s tripled the confirmed daily COVID deaths since December. In Portugal, it’s nearly quadrupled the daily deaths. In the United States, 441,000 people have already died of COVID, and the University of Washington’s pandemic forecasting team predicted on January 30th that around 200,000 more Americans will likely die between now and May 1st.

Paul Romer, Nobel Prize-winning economist, put it this way, “[Imagine] if a software update made self-driving cars crash into 70% more pedestrians.” We wouldn’t just continue on with business as usual. We would take dramatic action. Romer predicts that “if we continue on our current path, delivering one million vaccinations a day and growing fatigued of lockdowns and masks, more than 300,000 could die in the coming months.”

You might think a higher transmission rate isn’t a big deal if the lethality of the new strain isn’t much worse

That’s the wrong way to think about it because viruses spread at an exponential rate.

Here’s a comparative example from Adam Kucharski, a professor at the London School of Hygiene & Tropical Medicine who focuses on mathematical analyses of infectious-disease outbreaks:

Imagine 10,000 active infections. If you have a transmission rate of 1.1 and a fatality rate of 0.8%, we’d expect 129 deaths/month. If the fatality rate increased by half, the monthly deaths would rise from 129 to 193. But if the transmission rate increased by half instead, the monthly deaths would rise from 129 to 978.

What’s the most important thing you can do?

Get vaccinated as soon as it’s available to you.

People who get vaccinated (and wait two weeks for the second dose to take effect) will be able to safely do things that unvaccinated people can’t, like having meals together and hugging. You’ll protect yourself, your loved ones, and your community.

What else can you do? Keep reading.

Similar precautions as always, but take them more seriously

Most of us have become lax, especially with the vaccine on the way. We’re nearing the finish line, but please try to avoid the regret of finally getting COVID just a few months before you’re vaccinated.

Things to do:

• Remember that a lot more people have been infected now, so you’re statistically much more likely to encounter someone out in the world who has COVID, even if they don’t realize it (most transmissions are from asymptomatic people).
• If you go to the store multiple times a week, go once a week (or once every two weeks) instead. If a place is crowded, come back later. Don’t shop at peak times. If you spend 45 minutes at the store, make a firm list beforehand and reduce your time in the store to 15 minutes.
• If you’re still wearing a basic cloth mask, upgrade your mask to a P100, N95, KN95, or KF94. If you’re doing something that feels especially high-risk, consider wearing goggles or a face shield as well. More info on masks below, and this is an excellent highly-detailed guide.
• Instead of keeping 6ft apart, keep 10ft. You might have heard that you can only get the virus if you spend over 15 minutes with an infected person or get within 6 feet of them. That’s been proven false. The NFL has been doing rigorous contact tracing, and their data proved it. Instead, they changed their rules to say that you count as “exposed” to the virus if you’re indoors without a mask with an infected person for any length of time, and even at a distance of greater than 6 feet.
• Your risk goes up 20x if you spend time with someone indoors. 90% of transmissions occurred indoors (outdoor transmission still happens too, especially with close proximity and long duration).

“Shopping for five minutes in the grocery store is a lot better — six times better — than shopping for 30 minutes,” said Tom Frieden, the former director of the Centers for Disease Control and Prevention, since the odds of becoming infected rise the longer you’re exposed. “Picking up groceries at the curbside is even better, and having them delivered is even better still.”

If that whole list above seems too intimidating, taking even one of those precautions makes a big difference. For example, being indoors with someone with a good HEPA air purifier running reduces your risk by 75%, even if neither of you is wearing a mask.

Risk still comes down to the same core questions:

• Environment: Are you inside or outside? If inside, are you running a HEPA air purifier? Do you have windows open and fans running?
• Proximity: How physically close are you to other people?
• Density: How many people are nearby?
• Activity: Is everyone silent? Are people talking? Yelling? Singing? Facing each other?
• Others’ precautions: Who are you spending time with? Do they live alone? Do they interact with customers face-to-face regularly? How seriously are they taking the pandemic? What kind of mask are they wearing?
• Time: Are you passing each other on the street? Going on a short walk? Or sitting in the park for three hours?
• Protection: What kind of mask are you wearing? Are you wearing it properly? Is it tightly-fitting? Do you have eye protection too?

Each of those is a multiplier to your overall risk level. If you’re low in one, make sure you’re extra high in the others. For example, if you want to spend a long amount of time with a friend, make sure you do so in the right environment, with the right mask, etc. Or, if you want to be in a group of people singing together, make sure you keep a large distance apart, keep the time short, etc.

Here are some specific risk numbers so you can see how big a difference small changes can make:

This data is thanks to the absolutely excellent research done by the team at the microCOVID Project—they’re one of my most trusted sources of information.

Environment with other non-bubble people:

Distance from other non-bubble people:

Time with non-bubble people:

Volume of non-bubble people around you:

Mask you’re wearing around non-bubble people:

Note: The mask that others wear around you makes double the impact of the mask you wear. For example:

Getting COVID might be worse than you think

It’s easy to hear anecdotes from friends and family that “almost every case is mild” and believe that only a few rare cases end up being worse.

But the truth is this: The CDC reports that over a third of infected people have symptoms lasting beyond three weeks, and other studies show that over half of COVID patients who thought they had mild cases still reported fatigue 10 weeks later.

According to the Mount Sinai Hospital’s Center for Post-Covid Care, roughly 10% of COVID patients end up with symptoms that persist for months (which equates to 100,000 chronically sick people in New York alone). Some of these symptoms include heart and kidney damage that will be with some patients for the rest of their lives.

The NY Times interviewed COVID “long-haulers” and reported things like, “[a 32-year-old] sat on the floor weeping because she couldn’t recall how the doorknob worked,” “[it feels like] someone stuck an ice pick in my head,” and “[for a 34-year-old, it felt] not so much like brain fog, but a brain hurricane.”

Think about all of that if you’re worried about the vaccine being unsafe or not worth the trouble. Think about that if wearing an N95 or KN95 feels too uncomfortable compared to a cloth mask.

The vaccine is safe. Here’s why you should get it

“We have every reason to believe that these are among some of the very best vaccines that we have ever tested.”
—Aaron Richterman, a fellow researching infectious diseases at the University of Pennsylvania.

• I very much empathize if you’re feeling unsure about the safety of the vaccine. I remember reading about the initial announcements and being skeptical that corners were being cut in the name of profit and patriotism. It seemed early on that Trump was pushing the companies to skip important steps in the process. But, that didn’t end up happening. Remember too that the Pfizer vaccine was funded by Germany, not the US. Over 70,000 people were part of the clinical trials, and they followed all the right safety procedures.
• It also made me feel a lot better to hear the This American Life story about how a team of researchers at the University of Texas at Austin had been working on technology that would ultimately form the foundation of the vaccine ever since the MERS coronavirus that spread across the Middle East and Asia in 2012-2015. So again, this wasn’t rushed. It was thanks to years of rigorous work (if that hadn’t been done, there’s no way we would have a vaccine yet).
• It’s impossible to get COVID from the vaccine. The vaccine doesn’t change your DNA. As far as we can tell in typical healthy patients, there are no long-term negative effects from getting the vaccine. In contrast, there are a number of documented long-term negative effects from getting COVID: heart inflammation, abnormal lung function, acute kidney injury, smell and taste problems, difficulty with concentration and memory, chronic fatigue, and more
• The vast majority of the 10 million people who have received the vaccine have reported side effects no worse than a flu shot. According to the CDC, less than ~0.03% of Moderna (and ~0.12% of Pfizer) vaccinations resulted in any kind of adverse allergic effect, and less than 1 in 10 of those were severe. Most had a history of allergic reactions, and all recovered. There have been zero deaths from the vaccine, but COVID has killed more than 1 out of every 1,000 Americans.
• Israel has been a world leader in rapid vaccine roll-out, and their data so far shows that—with a sample size of 128,000—it reduced the infection rate to 0.015% (i.e., 20 people), which is 43 times better than the typical rate for people who haven’t received the vaccine. All 20 of those infected developed only mild cases, most were over age 55, and half had a preexisting condition. Also, 40-50% of COVID cases in this period in Israel were of the B117 variant,” which is great news for the efficacy of the vaccine against that too.
• The vaccines are 95% effective or more. That might not seem like enough, but keep in mind that flu vaccines are only 40% effective, on average. Moreover, it’s likely that the manufacturers are also underselling the effectiveness of the vaccines to be safe (and because they don’t want people thinking they’re 100% immune afterward and can totally ignore public safety measures).
• P.S. Even if you’ve had COVID, you should still get the vaccine once it’s available to you—it will offer improved and longer-lasting immunity.
• Warning: If you’re pregnant or breastfeeding, I suggest doing some additional research just to be safe. It’s a controversial topic and currently being studied, but the bottom line is this: Pregnant women weren’t included in the testing of the vaccine, so it’s not proven that there are no additional adverse side effects. However, there’s no specific reason to think that that population would be at greater risk, and groups like the American Society for Reproductive Medicine recommend pregnant women get the vaccine.

Vaccine immunity

• The Pfizer, Moderna and Oxford/AstraZeneca coronavirus vaccines require two shots. The first shot only gets you to 52% immunity (you might have heard some people dispute that number, but that debate is quite complex, so I wouldn’t worry about the exact number there). More importantly, know that the 52% number is slowly built up over the two weeks after you get the vaccine—it doesn’t happen immediately. So, after taking it (and even two weeks after), you should act as if nothing has changed—keep taking all the precautions you would otherwise. The second shot gets you to 95%, but not until two weeks after that second shot.
• In the clinical trials, the vaccine was tested to see if it prevented participants from getting sick from COVID, not how well it prevented them from transmitting the virus to others. So, we’re not yet sure how well it does the latter.
• The vaccines likely do work against the new variants discovered so far, but research is still being done on that and booster shots might be required eventually to keep immunity up.
• P.S. Once the vaccine is available to you, don’t take pain relievers right beforehand since that can reduce efficacy.

Do people stop spreading COVID once they’ve had it or gotten the vaccine?

If someone has had COVID:

Our best data on this comes from Public Health England’s Siren study, which was reported in January, 2021. Below are the most important takeaways.

• Bottom line: Having already had COVID gives you 83% protection against reinfection for up to 5 months.
• Not everyone with antibodies is protected from reinfection. It depends on their immune system and other factors. Some of the 20,787 study participants (aged 35-54) had the antibodies in their bodies but also still carried a significant number of coronavirus particles that they could pass on.
• (If you’ve heard that having had COVID makes it impossible for you to pass it on again to others, your information is out of date. The Siren study is the most recent credible one as of January.)
• If they do get COVID again, they’ll have developed antibodies (assuming they’re not immunocompromised), so their symptoms will be much less severe. (The antibodies are likely good against most of the COVID variants discovered so far, though there’s some preliminary evidence that the 501Y.V2 “South African” variant might be able to escape the antibodies.)
• Again, even if someone has the antibodies, studies have shown: If they come into contact with the virus again (any variant), they themselves might not get sick, but it can live in their nose and be passed on to others. They might have a lower viral load and thus be less dangerous to be around, but the danger is still especially acute for two weeks after they’re infected—and still potentially present beyond that as well.
• So, if you’re going to take the chance of being around them mask-less (which you probably shouldn’t), wait at least till at least 3 weeks after their first COVID-positive PCR test result came back. And, after 5 months, it’s safest to consider them to be the same risk level as anyone who hasn’t had COVID yet.

If someone received the vaccine:

• If the person got vaccinated (but never had COVID), it’s still not clear whether or not they’re safe to be around without the usual precautions (i.e., we still don’t know if the vaccine reduces your ability to transmit the virus).
  • Some researchers are hopeful that the vaccine will reduce transmissibility, but we just don’t know yet. The CDC is actively studying this, and there are some promising results coming out of Israel (which has been ahead of the United States in vaccine roll-out)—it seems likely that viral load (i.e., number of virus particles) is reduced after vaccination, but it’s not yet clear to what extend that will reduce transmission (even the current optimistic estimate from the manufacturer Oxford/AstraZeneca is that transmission might be reduced by up to 2/3, but not 100%).
• However, if everyone in a group has been vaccinated, it will be much safer to hang out together unmasked. Again, that’s why we need to encourage everyone to get vaccinated.
• Hopefully as scientists gather more data, it will turn out that vaccinated people have much reduced transmissibility as well, but for now we need to behave as if they don’t.

Other reminders regarding transmission:

• Again, remember that most spreading is asymptomatic and infected people are most contagious right before they show symptoms. Meaning, you can’t let down your guard around people outside your bubble just because they don’t appear to have symptoms.
• Also, be careful with COVID bubbles/pods. I wrote a whole post on that here. But one thing to know is that there’s only a 30% average chance of COVID being passed from one person in a household to another just by living in the same house. Let’s say you live in a house with several other people (your bubble), and you’re dating someone who lives in a different house with several other people (their bubble). It’s much safer for you all to think of it as “your bubble is connected to this one partner in the other bubble” rather than “your two bubbles have all merged into one big bubble.” In other words, even if someone in that other bubble got COVID, they’re not guaranteed to pass it on to your partner, and you’re even less guaranteed to pass it on to the other people in your bubble. But the trick is limiting your exposure to those other people in the other house. So, even if you choose to go mask-less when you’re being intimate with your partner, you can still wear a mask when you’re entering their house and only remove it when you’re in their bedroom with the door closed.

Here’s what you should know about masks

• It’s critical to cover your nose and to never lift your mask up to yell or sneeze (yes, please sneeze into your mask—sorry). In general, because of proteins found in the nasal passage, you’re more likely to get COVID through your nose than your mouth.
• Pick a style that actually feels ok to you. If you’re constantly fidgeting with it and lifting it up, that defeats the purpose.
• If you don’t have access to fancier masks or can’t afford them, wear two masks on top of each other (but don’t double- or triple-mask to the point where it’s hard to breathe, then air might leak through on the sides). If fashion is important to you, you can also wear a more protective mask underneath an attractive cloth mask.
• Mask manufacturers recommend that you throw out your “non-reusable” masks (i.e., surgical masks, KN95’s, etc.) after one use. Good masks aren’t cheap though, so I reuse mine. The best advice I’ve found is that they should be good for 8-12 hours total of wearing (the fibers wear out over time). So, if you go out to the grocery store for 20 minutes, you could theoretically use the same mask for that activity many times. Just be careful when you’re putting it on and taking it off to grip it by the sides since any viral particles are most likely to be on the front. Wash your hands after touching your mask. To be even safer, experts recommend putting a used mask in an envelope with the date, then leave it in there for 5-8 days to let any viruses die before using it again.
• Make sure your fit is snug. This makes a big difference (nearly 3x). Ear loops are good, and elastic headbands are even better. Make sure there’s a bendable nose clip too.
• Make sure it has at least three layers. If you’re using a reusable mask with a pocket for replaceable filters, make sure the mask is made of cotton, silk, or polyester. It has to be tightly-woven enough that you can’t see through it when held up to the light, you can’t spray water through it, and you can’t blow out a candle while wearing it.
• Here are the four best types of mask: P100, N95, KN95, or KF94. Here’s my specific recommended mask that I use most often nowadays. If you’re doing something that feels especially high-risk, consider wearing goggles or a face shield as well. More info on masks below, and This is an excellent highly-detailed guide with more details on masks.

What can you do about all this?

• Get vaccinated as soon as you can. Urge everyone you know to do the same. It’s critical that we reach herd immunity (~75% vaccination) for things to start to return to normal. If you have friends and family who are afraid of the vaccine because of general safety concerns, please send them this post. If you have friends or family who have gone further down the path of trusting conspiracy theories or believing that getting a vaccine is a display of weakness, consider sending them to this excellent Facebook post by Arnold Schwarzenegger (scroll down to his comment beneath the post itself).
• Take all the precautions seriously. Increase your vigilance. Upgrade your mask. Talk with friends and family who aren’t doing all that. It’s easy to think “yeah yeah, I’m being careful,” but are you truly following all the precautions I laid out earlier? Always 10ft away from people outside your bubble. Avoiding all non-essential visits to indoor locations outside your house. Avoiding gatherings of people. Wearing a KN95 or N95. This stuff makes a difference—the Institute for Health Metrics and Evaluation estimated that 30,000 fewer people would die by May 1st if most people followed social distancing and masking guidelines.
• Contact your elected representatives. Urge them to fight for more stimulus checks and subsidized at-home antigen test kits. Urge the Biden administration to obtain even more vaccines and to increase genomics surveillance and sequencing to better track and understand new variants.
• Share this post. The fastest way out of this is for everyone you know to upgrade their precautions and to get vaccinated as soon as possible.
• Keep breathing. Make sure you’re practicing self-care by getting enough sleep, eating nutritiously, going for walks, taking baths, or whatever helps you soothe the stress of all this. Keep talking with friends regularly. Have self-compassion—it’s very natural to feel the impact of all this on your mental and even physical health.

Thanks for reading.

References:

• https://www.nytimes.com/interactive/2021/health/coronavirus-mutations-B117-variant.html
• https://www.nytimes.com/2021/01/19/well/live/covid-b117-variant-advice.html
• https://www.reuters.com/article/us-health-coronavirus-israel-vaccines/early-results-on-pfizer-covid-19-vaccine-encouraging-says-israeli-hmo-idUSKBN29U2AZ
• https://www.wsj.com/articles/super-bowl-nfl-covid-cdc-11612104460?mod=e2tw
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• https://www.livescience.com/coronavirus-spread-after-recovery.html
• https://www.vox.com/22230667/covid-immunity-natural-infection-symptoms-asymptomatic
• https://www.cdc.gov/mmwr/volumes/70/wr/mm7004e1.htm
• https://www.vox.com/22249433/covid-19-vaccine-pfizer-moderna-safe-pregnancy-breastfeeding-baby-study
• https://www.ucsf.edu/news/2021/01/419691/covid-19-vaccine-fact-vs-fiction-expert-weighs-common-fears
• https://www.bbc.com/news/health-55413666
• https://www.rollingstone.com/product-recommendations/lifestyle/double-masking-for-covid-effective-1123217/
• https://www.statnews.com/2021/02/09/not-british-variant-call-it-b117/
• https://www.theguardian.com/science/2021/feb/09/pfizerbiontech-covid-vaccine-reducing-viral-load-data-israel-suggests
• https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-01/09-COVID-Fleming-Dutra.pdf