Nearly one year ago, life forever changed. Weddings and graduations were canceled, handshakes and hugs were forbidden, and masks became part of our daily attire. With increasing vaccination efforts and declining case numbers, the light at the end of the dark tunnel has finally been illuminated.

During the Precision Wellness in the Time of COVID-19 seminar on March 15, Bonnie LaFleur discussed how continued testing and vaccination efforts support our return to a version of life as we once knew it. The research professor of biostatistics in the BIO5 Institute also emphasized the importance of socialization – both now and in a post-pandemic world – and specified aspects like honesty, trust and public health guidelines as essential to forming social cores.

Testing as a primary disease mitigation strategy

Both antigen and PCR viral tests are diagnostic, meaning they can detect active infection. These tests, typically either a nasal swab, saliva, or swish and gargle sample, provide results within one to 72 hours. A negative result indicates that while current infection was not detected, a person might still be at risk if not vaccinated. Conversely, a positive result indicates that a person needs to identify other potentially infected individuals through contract tracing, as well as quarantine to prevent disease spread. 

Testing is still recommended with known exposure pre-vaccination and if exposure occurs between the first and two-weeks post second shot (or before two weeks after the single Johnson & Johnson shot). However, if a person is fully vaccinated and exposed to an infected individual, they no longer need to be tested or quarantined – “great news” to LaFleur. 

In contrast to diagnostic tests, an antibody test detects past infection or vaccination. A simple blood draw is required, and results are given in 7-10 business days. Just like a diagnostic test, a negative antibody test indicates a person might still be at risk, while a positive test indicates the person has been previously exposed or vaccinated and thus not likely to contract future severe disease. Arizona residents are eligible for free antibody testing through the UArizona COVID-19 Antibody Testing Initiative. 

According to LaFleur, these three testing modalities comprise our primary mitigation strategy to prevent future disease spread and carry us towards a post-pandemic world.

Identifying risks and behaviors to inform decision-making

Socialization is essential to mitigating depression and “pandemic fatigue,” but to do our part to minimize further disease spread, we must relearn principles of social interaction. Before mingling with others, LaFleur explained that several aspects need to be considered. 

First, vaccination status. As of March 15, nearly one-quarter of Arizona residents had received at least one vaccine dose, while 13% had been fully vaccinated. If vaccination rates remain the same, the CDC estimates that 90% of the population will be fully vaccinated by early August. 

LaFleur reminded the audience that vaccination is critical to enabling our return to “normal” because it decreases risk of severe illness and lowers chances of viral replication and variant spread. Most importantly, widespread vaccination creates a “synergy” between individual protection and decreased transmission by decreasing the overall susceptibility of the population. Until we reach closer to 90% vaccination within the country, it’s important to continue adhering to public health guidelines.

“While we ramp up our social activities, we still need to continue to protect ourselves and others so vaccines can do their job!” LaFleur said. 

It’s also imperative we consider individual risk factors and risk tolerances, as well as those of the people with whom we would like to interact. 

A risk factor is an aspect such as age, health status, type of work, and how many other interactions an individual might have. Someone who works from home with no pre-existing conditions or interactions is low-risk, while a healthcare worker with children who attend school in-person is higher risk. 

Risk tolerance, on the other hand, is the individual risk a person is comfortable with enduring. 

Public health considerations must also be taken into account. LaFleur stressed that case trends and public health guidelines can change weekly, sometimes daily, so it’s important to stay up to date with the latest messaging from trusted sources, like The New York Times. 

Forming social cores and creating contracts

Once all members of a prospective social interaction have considered the above factors, they are ready to begin forming and regulating their social pods. Much like the “NBA bubble,” a social pod or core is a group of friends or family who agree to socialize together under the framework of certain rules or guidelines. 

Before forming a small pod, all risks, tolerances, vaccination statuses, and public health guidelines should be considered. If a group of people decides they would like to interact in-person, they should create a social contract – a “living document” of agreed behaviors when socializing with one another and in daily life outside the core. 

When creating such an agreement, all members of the group should consider aspects of interaction like frequency, location and duration of social events with each other, and how frequently they should revisit their social contract. They should also discuss how to navigate expansion or contraction of the group, testing plans, and changes based on vaccination status. In the event a member of the group needs to isolate, the group must also consider how to financially and emotionally support that individual. 

While this contract is not legally binding, LaFleur says it can be difficult to navigate. Because the pandemic landscape can change so rapidly, contracts need to be flexible to accommodate fluctuating group preferences and public health practices. She reminded the audience to not only consider their own needs and how they might change over time, but also to consider the changing risks of those around us – regardless of whether we interact on a regular basis. 

“It’s a balancing act,” LaFleur says. “We are in charge of this next step to maintain the balance between decreasing risk for ourselves and others while taking care of our emotional and social needs.”

LaFleur’s lecture is part of a five-symposia series hosted by the BIO5 Institute and The Precision Nutrition & Wellness Initiative (PNWI).