San Francisco Chronicle - (Sunday)
Getting test to protect loved ones
When Gina LeeSatomi was thinking about driving to Southern California last month to help care for her elderly parents and 100yearold grandmother, she worried that she or her son might transmit the coronavirus to her relatives.
But LeeSatomi, who lives in San Francisco and had been carefully following stayathome orders, had struggled with a lingering, onandoff cough since February. She wanted to make sure it wasn’t the coronavirus before she reunited with her family. Both she
and her 10yearold son got a coronavirus diagnostic test, and tested negative, before proceeding to her parents’ home, where they plan to stay for a couple of weeks.
“I was like, ‘It would put my mind at ease,’ ” said LeeSatomi, 47. “It made me feel like I wasn’t going to accidentally kill my family.”
As the coronavirus pandemic stretches into its fourth month, keeping many families apart for longer than ever before, many people are getting tested, or considering getting tested, before seeing family and friends — especially if they have relatives and friends who are at higher risk of becoming gravely ill because of age or chronic health conditions like diabetes or autoimmune disorders.
Public health officials have not issued any guidance on whether people who do not have symptoms should get tested for this purpose. Officials generally advise testing for people who have COVID19 symptoms and for people who do not have symptoms but who regularly come into contact with sick patients, members of the public, or highrisk individuals — such as health care workers, essential workers and staff at nursing homes.
But now that access to tests has vastly improved, compared with the early days of the pandemic, infectious disease experts say it is reasonable for people to consider getting tested before coming into contact with a family member, especially if the family member is highrisk. But getting tested is not a foolproof way of ensuring you will not transmit the virus.
“If you’re going to see an older relative, I can’t say you must do it,” said Dr. Yvonne Maldonado, chief of pediatric infectious diseases at Stanford University School of Medicine. “I’d say it’s something you consider doing. There’s one main caveat. If you test yourself now and you’re negative, you don’t know you’re going to be negative when you see them. ... It’d be nice if we could say, ‘Just get a test and you’ll be fine,’ but we don’t know that.”
If someone gets tested and contracts the virus before coming into contact with their friend or family member, they may still spread the virus. To reduce the likelihood of that happening, experts advise getting tested as close as possible to the day you plan to come into contact with someone. And consider avoiding situations where you might be exposed during the window in between getting tested and seeing them. After LeeSatomi got tested, for instance, she canceled a planned cherrypicking excursion with her son because it was scheduled the day before they drove to see her parents.
If you do come into contact with family members before you’re able to take a test, or before you receive the results, wear a mask in the meantime, said Dr. George Rutherford, head of the division of infectious disease and epidemiology at UCSF. Rutherford’s daughter, who lives in Virginia, did just that when she came home to the Bay Area for a month in May to stay with her parents.
“It wasn’t practical to get a test there, so she got on a plane, came home, the next day we got her tested,” he said. “She wore a mask, the next day got the result, took the mask off, that’s where we are . ... I think getting tested just before you come, or when you first get there, makes perfect sense to me. Until you know you have a negative test, keep a mask on.”
There is another complication: It is possible to test negative and still be infected with the coronavirus. This can happen if someone gets tested too early in the virus’ life cycle, when the concentration of viral particles is too low to be detected in a test. It takes about three days from the time of exposure to when virus particles are at high enough levels to generate a positive result.
Most falsenegative results happen because people got tested too early, before there were enough virus particles to be detected, not because there was a problem with test performance, Rutherford said. Whether members of the general public who do not have symptoms should be tested for the purpose of reuniting with friends and family raises ethical questions. LeeSatomi did consider whether she would be using a resource needed by health care workers who should get tested regularly. She would not have requested a test had she been planning to stay home for the foreseeable future, she said, but felt it was worth doing because she was going to see her aging parents.
Rutherford said there are enough testing resources now for health care workers, and if someone is taking a test to prevent spreading the virus to a frail, highrisk person, they are not misusing it because it is for disease prevention.
People are also weighing other factors when seeking testing. Erik Utter just moved from San Francisco to his parents’ home in Calaveras County, and got tested within a few days after he arrived. Utter, 29, did not have any symptoms but sought testing “more as a peace of mind thing.” He tested negative.
He knows San Francisco has been much harder hit by the virus than Calaveras County — the city has about 2,600 cases, compared with Calaveras County’s 13 — and wanted to make sure he didn’t spread it to his parents and their friends in the community.
“God forbid I move up here and there’s an outbreak two days later,” he said.
There is no cutanddried strategy when it comes to getting tested before reuniting with friends and family, Rutherford said.
Someone who has been strictly following stayathome orders for months may not need a test as much as someone who has been out in crowds recently without a mask — such as last week’s Black Lives Matter protests. Someone who is planning to see a family member for 30 minutes in their driveway may not need a test as much as someone who is planning to move in to care for an ill, immunosuppressed relative.
“These are all judgment calls,” Rutherford said. “If I were at a protest the last three days and not wearing a mask, can I get a test and go see grandma? I’d say, that might make me worry,” he said. “I might want you to wait 14 days and get tested at the end of 14 days. If I’ve been sheltering in place and watching TV and sitting in my backyard for two months and I’d like to see grandma, I’d say, OK, go get tested and see her.”