ALLISON AUBREY, HOST:
I'm Allison Aubrey, and this is NPR's LIFE KIT.
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AUBREY: We're still learning so much about the coronavirus and how it spreads. Many of us are still trying to stay at home as much as possible. But lots of us are eager to visit parents or grandparents. So if you are thinking of making a trip, it's best to ask yourself some questions.
RAVINA KULLAR: Have you been following all the social distancing practices? Have you been wearing your mask? Have you been staying away from mass crowds? And is your elderly parent - are they - do they have other preexisting conditions?
AUBREY: Ravina Kullar is an epidemiologist and an infectious disease physician based in Los Angeles. For this episode of LIFE KIT, she's here to talk through best practices for if or when you decide to visit elderly relatives during the pandemic.
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AUBREY: So as we've all been hearing, regardless of your health or where you are, you should be washing your hands, wearing that mask and keeping your distance. That's what we need to do all the time.
Now let's talk a little bit about the health of the people you'd be visiting. A recent CDC analysis finds that people with a number of conditions, including Type 2 diabetes, chronic heart disease, chronic lung disease, are 12 times - 12 times - more likely to die from the virus if they get it compared to people who don't have those risks. So this issue of how healthy someone is or what kind of chronic conditions they have seems like it's a big factor to consider.
KULLAR: It definitely is. And I also want to throw in there smoking, too, which I think hasn't gotten enough light - that if you're a chronic smoker, you also have a 12 times higher risk of acquiring COVID-19 and also having a worse outcome if you do get the virus. So I think it's so dependent on how healthy the individual is that you're visiting. Do you want to put them at that high of a risk depending on, you know, what conditions you've been around as well?
AUBREY: Another part of this is that if you do want to go visit elderly relatives - say you consider the risks and you say, oh, well, my - you know, my parents or grandparents are in their early 70s; they're healthy. You make the calculation that it will be safe for you to travel to see them. What do you need to do? When do you need to start thinking about that visit, and what do you need to do, say, two weeks ahead of time?
KULLAR: Two weeks out, I would recommend on staying away from mass crowds and making sure that you have a face mask on and a face shield on at all times whenever you go out, as well as physically distancing yourself from others. I would also recommend that you get a PCR test, which is the nasopharyngeal swab, the deep nose swab, to make sure that you don't have an active infection. And I would also recommend getting an antibody test. All those measures should put you at a little bit more of a better mindset whenever you go in and visit those elderly parents.
AUBREY: Let's talk a little bit about those tests. The PCR test you mentioned - that would be a test to see if you have an infection. Now, if you get that test and it comes back negative, you know that you're negative at that time, or you have pretty good assurance if it's a good test that you're negative at that time, but it doesn't mean that you are free of risk of infection between the interim, between getting the test and making the visit. Is that right?
KULLAR: Correct, yes. And even getting that test - the thing with PCR tests is that it's prone for false negatives because you have to have a higher - high enough virus in your body where that PCR test can actually detect it. So that's something to be mindful of. That PCR test might come back negative, but you need to monitor your signs and symptoms leading up to that visitation as well. Take your temperature before as well. If you are displaying any signs and symptoms - shortness of breath, you have a fever, you have a dry cough, you have a weird taste in your mouth, that taste disturbance - do not go and visit your family member.
AUBREY: So tests are not 100%. You also mentioned a different kind of antibody test. That looks for antibodies in the bloodstream to suggest whether you may have been infected to the virus at some time in the past. Is that right?
KULLAR: Correct. It detects whether you may have been infected at some point in the past or if you may have an acute infection. So I think it's something that not a lot of people know - that antibody tests can also detect if you have an active infection one to two days within your infection. So that's something that can tell you that acute stage or if you've had it in the past.
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AUBREY: So let's pause and talk about the science for a second. This will help you make better decisions.
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AUBREY: I know a lot of the studies looking at other coronaviruses that were similar - at least genetically similar - to the virus that causes COVID-19 have found that immunity tends to last for a while - one to maybe two years - but eventually drops off. Is it reasonable to assume that people who test positive for the antibody test have some partial immunity for, say, three to six months, maybe up to a year but eventually will not be protected against the virus?
KULLAR: Correct, yeah. So that's a great point that you bring up. The MERS and SARS viruses, which are very similar to SARS-CoV-2, which is responsible for COVID-19, have been found to show - offer protection for up to three years, actually. MERS was three years. So I think we can maybe assume that, but there was a recent study done out of China that actually showed that immunity died off a lot quicker, within one to two months. That sample size was small, so I think we still need to see larger sample sizes. We need to follow patients for a longer period of time to really extrapolate how COVID-19 relates to SARS and MERS.
AUBREY: So bottom line is positive antibody test does not equal full protection from the virus going forward.
Now, if you're going to make a visit to the grandparents or to elderly relatives, another thing to think about is how you're going to get there, especially if it's not the same state. People are used to hopping on airplanes, flying. Is there a safer route of transportation other than air travel?
KULLAR: Yeah. I mean, I - if you can, I would definitely suggest taking a road trip. In a plane, you have so many other variables in terms of being in the airport, how many people you're in contact with that you don't know, how many surfaces that you touch that you may potentially acquire that virus. So traveling by car is a much safer route to go.
AUBREY: And along the way, you might be leaving, say, an area that has a low spread of the virus, depending on where you live, and you might be traveling to a different area that has a different risk. I know that there are various ways to look at the risk in your own community. A new tool out now allows you to hover over a map, look at your county and see a risk level of green, orange, yellow or red. That's something you can see at globalepidemics.org. What is the value, do you think, of these color-coded alert systems?
KULLAR: You know, I think it's actually a good tool where it gives you a way to assess your community's risk level compared to others, and then it can encourage you to potentially modify your behavior accordingly. So I think it is a good level to see, you know, where your county looks in comparison to others, and even where you're going.
But I think - I hope it doesn't give a false sense of security for those counties that may be shaded green, which is, you know, really not that high of a risk, versus one that's red because, you know, we are living in a world here in the U.S. where air traffic is constantly going. So if you might be in a green area, or someone may be in a red area and they travel to your area, you're just as prone to potentially acquire that virus. So I think we need to be mindful of that as well.
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AUBREY: So you decide to make the visit. You get there. You're trying to be cautious. But, of course, grandparents are going to want to hug and kiss their grandchildren. What's your recommendation here?
KULLAR: I think it's really important to have the discussion with the kids before going there to let them know that there is this virus in the world and the reason why they might not potentially be able to hug their loved one is because they may put them at higher risk, you know, to just let them know that we have to limit those hugs and close contact because, you know, they're older and they may be at a higher risk for getting an infection.
AUBREY: But if you're staying with them and you've effectively kind of let each other into your small bubbles, is hugging and kissing adding that much more if you're already living in the same house, working out of the same kitchen, using the same bathroom, sleeping in the same home?
KULLAR: Yeah, it is. You know, that's why physical distancing is important in this virus. So even though you might be sharing the same space, you need to keep in mind that anything that you may touch, make sure - also, hand sanitizer is important, and sanitizing all surfaces after you touch them. So I think it's just being mindful about every surface you touch, clean it afterwards. Everything that you touch, wash your hands afterwards, either with soap and warm water or with hand sanitizer.
AUBREY: Or you could think about a hotel or an Airbnb or camping out in their yard. Is that something to consider as well?
KULLAR: It is. Getting an Airbnb or hotel is a great tactic to really decrease the risk 'cause, you know, what we also know, beside from wearing a mask and physical distancing and sanitizing, is that your risk is also tied to the amount of time that you spent close up. So, you know, that's something you will prevent because you're going to be in an Airbnb, a hotel, you know, decreasing your amount of time with that loved one. What I would recommend is that when you're in that Airbnb or hotel, I would sanitize it. Use a Lysol disinfectant. Sanitize all surfaces to make sure that they're fully clean before you touch anything there.
AUBREY: Got it. So it's really prolonged indoor contact that can increase the risk.
KULLAR: Correct. Prolonged indoor contact definitely increases the risk of exposure. I would also recommend on staying outdoors as much as possible if there's an outdoor backyard, spending time in that outdoor area, as the virus is most likely to disperse and, really, you have a lower risk of getting the virus.
AUBREY: In fact, a recent study done in a laboratory - a federal laboratory found that when they took the virus and exposed it to various intensities of sunlight, in intense sun, say like on a June warm day in the middle of the day, the virus becomes inactivated in six to seven minutes. In the early morning sun, the virus becomes inactivated in about 14 minutes. So sunlight does seem to be a good disinfectant here.
KULLAR: I think sunlight has some effect, but I hope that that doesn't give, again, a false sense of security where people are going to be laying out in the sun or being in tanning beds, hoping that that will kill the virus and potentially use it as a prophylactic measure as well. So I think we have to be very mindful about using that statement that sunlight might kill the virus. Meanwhile, it can really do some drastic negative effects to your body.
AUBREY: Perhaps maybe the more useful way of thinking about it is to think if you're outdoors - and we often hear outdoors is better than indoors - the idea that a surface outside - say, if somebody yesterday were sitting at the same outdoor table, I wouldn't have to necessarily be worried about that table being a source of contamination. Yeah?
KULLAR: I think that's a great way to look at it. And, again, also, when you're outside, there's more probability for that virus to disperse, unlike if you're in an enclosed environment, it's just going to sit there for extended period of time.
AUBREY: You mentioned several times that it's important to stay masked, that being masked is better than not wearing a mask. I know we're at a point in time where there's some resistance around the country. Some people see it as a political statement, an infringement of rights to be forced to wear a mask. One way to sort of frame this issue differently is to look at what the effect on the economy might be if everyone were to wear a mask. And a recent analysis from Goldman Sachs finds that if there were nationwide masking that it could save the U.S. economy from taking a 5% hit to its GDP. That's something that Goldman Sachs analysts have estimated. Do you think that this helps make the case, hey, it's worth it to wear a mask?
KULLAR: I think it does help. I mean, we need to be looking at what is a way that we can reopen the economy 'cause right now, we're going backwards because people are taking off those masks, and they're loosening their - what they've been doing.
And I think there - also what might help is some compelling case reports that have really shown the benefit of masks. There was one case where a man flew from China to Toronto, and he subsequently tested positive for COVID-19, but he wore a mask on the flight, and everyone next to him - they tested negative for COVID-19. Everyone around him was protected from acquiring that infection solely because of that mask.
And another case which I think has gotten a lot more press is that two hairstylists in Missouri had close contact with over 100 clients while sick with COVID-19. Everyone wore a mask, and none of the clients tested positive. Those case reports, I think, really shed a light of how beneficial these masks can be.
AUBREY: So really increasing evidence that masks not only protect you, they protect the people around you.
KULLAR: Correct. These masks are miracle prophylactic measures, and it's as simple as just putting on that mask.
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AUBREY: Well, listen; thank you very much, Ravina Kullar. We really appreciate it.
KULLAR: This has been great, and thank you for having me on.
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AUBREY: For more NPR LIFE KIT, check out our other episodes. We have an episode on how to talk to your parents about racism, another on raising happy houseplants and lots more. You can find those at npr.org/lifekit. And if you love LIFE KIT and want more, subscribe to our newsletter at npr.org/lifekitnewsletter.
And here, as always, is a completely random tip, this time from Natalie Stillwell (ph).
NATALIE STILLWELL: I'm a huge houseplant enthusiast but for the longest time felt that I would never have a green thumb. My tip for anyone who's new to houseplants is to start with just a few plants or a few types of plants. It's easy to get overwhelmed if you buy too many at once, so maybe search Instagram or peruse your local nursery to see which plants you're most drawn to. Take one or two home, and learn from there. I promise it will help you grow your confidence.
AUBREY: If you've got a good tip, leave us a voicemail at 202-216-9823 or email us at lifekit@npr.org. This episode was produced by Andee Tagle. Meghan Keane is the managing producer. Beth Donovan is the senior editor. Our digital editor is Beck Harlan, and our editorial assistant is Clare Schneider. I'm Allison Aubrey. Thanks for listening.
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