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How might information have helped us in a short-lived family Covid crisis
Welcome to Plugging the Gap (my email newsletter about Covid-19 and its economics). In case you don’t know me, I’m an economist and professor at the University of Toronto. I have written lots of books including, most recently, on Covid-19. You can follow me on Twitter (@joshgans) or subscribe to this email newsletter here.
We had a Covid-19 exposure event in our household this week.
Below is a diary of my past week. I decided to write it so I could more accurately reflect on what I was thinking at any point in time. When some certainty — good or bad — is revealed, I would then publish it.
Just to preface the conclusion, we all ultimately tested negative so the outcome was favourable this time around. But our experience tells us something about another cost of a lack of an information solution to the pandemic: days of anxiety surrounded by uncertainty.
It began with a flurry of texts around 2pm in our family iMessage group. Our 16 year old had just been informed by her biology teacher that there had been a positive Covid-19 case in her class. She goes to a Toronto public school so classes are staggered with one day (really a morning) in-class and the rest online in alternating days. (Actually, she has two days on and one day off but that is beside the point). The now confirmed positive kid had been with her in class the previous Wednesday but had not been there for the next one today (Monday).
We were told that she had to stay home for 14 days which would carry us effectively through to the holidays. So that was that for in-class school for the year. The rest would be streamed or whatever. That was most of it anyway so this wasn’t a big change except that she liked going to school every other day.
If we got a negative test, she could return earlier but our expectation was that even if we had that, we likely would just go with the isolation. But our time horizon was not out that far. More significantly, she was due to have her wisdom teeth out in 13 days from the date of potential exposure. We didn’t want to have to postpone that was it was timed for the holidays. That meant a test was in order.
As it turns out, our local Shoppers Drug Mart had walk-in tests. So that is what we decided to do immediately. I read on the site that it was for asymptomatic cases so I figured that was what she was. But, instead, she was a confirmed contact and so that system could not be used. (It used the less invasive nasal swab).
That meant that we had to go through the public health system. Those appointments were online due to a surge in cases in Ontario and with it people getting tested. The earliest appointment I could confirm would be for 1pm. I decided to book all four of us who were in the house for a test. But I did the calculations. We would be lucky to have a test result by the weekend. But we would likely have it by next Tuesday (her wisdom teeth removal date) and by next Wednesday (her 20-year-old brother’s wisdom teeth removal) — we are big believers in economies of scale in dealing with pain. (I had just had a tooth pulled last week which you can read here as a plot point).
One complication now was that her 22-year-old sister was due to come home from college on Thursday evening. So we wouldn’t have a result then. We would need as if we weren’t going to do otherwise, monitor our symptoms.
That is where the fun began. About 3:30, I took temperatures. Everyone had a mild fever (between 37.1 and 37.9 degrees). The blood oxygen measure was only working for two of us (with darker skin) and those were normal. But my temperature was not a fair representation as I had taken Advil as part of trying to reduce swelling as a result of my tooth extraction that had only started to go down after three days. Over the course of the day, our temperatures hovered around 37 degrees with normal for the two adults who were both taking Advil.
Interestingly, I had another ‘ace in the hole.’ To deal with potential swelling I had been prescribed Dexamethasone the steroid used to treat Covid-19. I had been using it since Sunday but had decided to stop after this morning (Monday) as the swelling had gone down. I wondered if I should keep going. The WHO listed it as a pretty decent treatment with few side-effects. It had made me feel great but I had also had trouble sleeping so I had stopped using it.
With this type of thing, anything unusual cases worry. After lunch but before I had heard the news, I had a two-hour long hiccup fit. I am not prone to this so it was weird. I also had a call coming up and didn’t want to still have it. So I did the usual thing and tried various internet remedies for it. (By the way, my theory is that you try several of these in a row and somehow they all add up to a cure). The hiccups went away.
After my afternoon coffee (which was after hearing the news), they were back. This time I researched whether hiccups were a Covid-19 symptom. The first link was to a study that showed that extended hiccups may be a symptom. Now that study suggested that it was prolonged — 2 to 4 days — but those days had to start sometime didn’t they? It took me longer — 90 minutes — to get rid of this bought. Then I had another later on and then another before bed.
This, by the way, sent my family, including my potentially soon-to-be ex-wife into hysterics. I was not amused.
Sans Advil my temperature at 6:30 am was up to 37.9 degrees. I decided to start writing this diary to keep track of my worries. Also decided to take Dexamethasone as still had some swelling but really because I was paranoid.
Got a call early from a panicked doctor who was worried that I had registered a 4-month-old for a test. What I had done is entered her DOB as 2020 rather than in 2004. Oops. Nonetheless, got us in for a test today. That was as fun as advertised although we were thankful for their being no queue.
Another piece for good news came in with the first result from someone else who had been exposed in class. It was negative.
My hiccups continued. Found out the key is to act as soon as you get the first one. That can stop an extended session. So there’s something I learned.
We woke up to our results (they were there at 2am, 10 hours after the test). We had signed up for the testing centre app and so were notified of our negative status. Immediate relief, especially regarding her result. Had that been different we would not have been out of the woods. We would still have another week of isolation and would need to talk to various dental surgeons regarding what they wanted to do. But, as far as we were concerned, the crisis was over.
Well … not quite. It still could be that another kid in my daughter’s class contracted Covid-19 from Patient Zero. There was a class on Monday which means, if that happens, we have to do this all again. Testing is recommended but not mandatory so this will keep the issue alive. So there is a little more waiting for us but many orders of magnitude lower in terms of anxiety. That said, my daughter’s wisdom teeth extraction was one day (!) inside her continued isolation period and so had to be postponed until March.
I am also hiccup free. My daughter now claims she gave us placebo Covid symptoms.
How it could have been
All through this, I reflected on all of this worry and wonder: what if the pandemic information gap had been solved and we had the kind of rapid testing regime I had been advocating in place? What would have been different about this day (and I presume I will revisit this every day of this thing)?
Let’s work backwards. We would already have test results for ourselves. But would that be informative given that those tests only pick up a shorter period when you have a relatively high viral load? If my daughter had contracted Covid-19 on Wednesday she would likely be infectious between Friday and Sunday. But on Monday would have still registered as positive and a negative result after 4 days would make it pretty likely she was negative. For the rest of us, we would add a day or two window, so a negative test would be less informative right now but her negative test would reduce our own likelihood that we were all infected. If her had been positive, we probably could have accelerated testing for all of us. Either way, our uncertainty would have been resolved in short order. This ‘worry diary’ would have been pointless.
Instead, that information is coming in drips and drabs. We will likely not know about ourselves for days. But the information network through her class is strong. One kid had already been tested and we were awaiting that result. Others would be as well. If there was exposure, because it was in a classroom setting — wearing masks would help little — there would be more than one case if there were any. They had already identified Patient Zero because it didn’t take a genius to work out who was there on Wednesday and not there on the next scheduled — especially with classes of 15 kids due to the rotation schedule. This was likely something the school principal (who had called us about 4pm) was monitoring too.
But let’s turn to Patient Zero. Their test result came in on Monday, 4 days after class. If this test result had been earlier, it is likely the Monday class would have been cancelled. This may have reduced follow-on exposures in that class which is something we will have to monitor too. But that is unlikely a big change in risk.
More critically, what if the school had rapid testing frequently. Let’s say once per week. Then Patient Zero may have been tested on Monday , Wednesday or Friday. If it was Monday, this test may not have picked her up if Zero had just contracted Covid-19 and was infectious on Wednesday (our day of concern here). Although for all we know Zero was infectious on Monday but the distance there makes that a scenario currently less concerning to us. If Zero had been tested the previous Friday, the same issues would have held. Thus, it is only if Zero was tested on Wednesday that it would have made a large difference. I’ll take that as a 50% reduction overall in terms of actually spreading the virus in the school.
Even that is an overstatement as we don’t know how Zero was infected. That 50% reduction applies to Zero’s chances of getting Covid-19 too. But we could play that game all the way to this not being a problem. That is, of course, my point. But my other point is that even access to better information could help us know. If Zero had a Ct score associated with a PCR test we could use that to work out if Zero was infectiousness on any day at school — particularly Wednesday. This would provide important information. But those Ct scores aren’t reported or even collected.
Finally, contact tracing has already got us this far. So it helps. But it didn’t help in terms of app alerts. My daughter has the Covid-Alert app. Zero either did not or hasn’t reported the positive result. And if they had all had the Novid app, then perhaps there would have been an earlier warning.