Protocols for Coliving House (7 Roommates!)

In an effort to escape the chaos and depression of urban environments during the pandemic, six friends and I have moved to a mansion in Hawaii until the world returns to normal.

We’re all pretty happy with our decision and slowly adapting to our new lives but one question that remains is what protocols we should put in place regarding visitors to our house, given that any one individual’s actions can impact many of us. That said, our island (Maui) has an extremely low incidence of COVID, and anyone that flies into Maui must, by law, take a COVID test 72 hours prior to flying or quarantine for two weeks.

All that being said, our current rule is that any newcomer to the island must wait 5 days before being allowed into our house. We do not have standardized screening questions but we do ask about risk factors. And we do have newcomers take a blood oximeter reading before entering after the 5 days too.

What could we improve about our protocol to be more science-based? I realize in an ideal world no visitors would be allowed at all but that’s just not realistic (and also Maui is very low risk b/c it’s an island where everyone has taken a test) so I’m turning to you all to help me with harm reduction and making the best of the situation.

All visitors, or really anyone landing on the island (even people that live there and are returning after being gone), goes into quarantine for 2 weeks minimum by themselves with no physical contact with anyone else.

A covid test 72 hours before arriving doesn’t help since they could be sick, but not at the point where they’d test positive and besides, they could get sick between taking the test and flying out.

If they’re stationed on their own for two weeks, that should give them time, even if they caught it as they were flying out, to get through the contagious part of it. If you want to be extra sure, make it 3 weeks.

This doesn’t really help us for casual visitors. Friends that live on the island and want to visit the mansion. Given the ultra low incidence of COVID here, I don’t think it’s unreasonable to have some visitors like this and would like to simply mitigate risk.

In that case, I think people should segregate themselves when a friend is visiting. For example, if this friend visits you and one of the other roommates, the three of you stay confined to one area of the mansion, or better, yet, stay in the guest house. You then remain quarantined for a period of time after the friend leaves. I’m thinking two weeks, but if you friend gets a negative test within X hours, you could return to the main house. Basically, before your friend arrived we ‘know’ you’re negative. If your friend gave you the virus, this gives you time to get through the contagious period (symptomatic or otherwise), but if your friend can prove they didn’t have it while they were visiting, you’re safe. I understand that would involve working out some details about when exactly that window to be tested is, but I think it would work.

Save yourself the bother of the oximeter reading. If the O2 reading is low enough to tell you anything useful the person would be too sick to walk in the door. It’s false security, theater.

This is a super interesting insight Bippity, I definitely want to research/validate your point some more but intuitively you’re probably right.

Masking, hand-washing, and social distancing.

The blood oximetry study posted is good information, but it doesn’t support predictive screening value of isolated O2 testing of visitors to avoid contagion. The value of it is paired with regular, sustained O2 measurements and temperature over a period of time and correlating positive tests and symptoms with a drop in O2 and a rise in temperature. Tracking those in the person over a sustained time period, not a single moment at the door. Add to that the specter of asymptomatic and presymptomatic contagiousness and O2 and temperature checks outside of that very particular setting don’t offer any real-time benefit.

And it so very sucks that we even have to think twice about welcoming visitors into our homes. FWIW, I wish none of us anywhere were having to think about any of it.

Since it’s an easy test, I’d add a non-contact thermometer. Although oxygenation leads fever in respiratory COVID, there is also non-respiratory COVID. Although that is less infectious… it’s an easy test.

The biggest danger is from pre-symptomatic carriers. Because people with symptoms shouldn’t be in your house, and a-symptomatic carriers aren’t very infectious.

So you can keep in touch with visitors, and if any come down with symptoms, you should individually self-isolate from your house-mates.

Inside your house, you can open all the windows and doors when and after you have visitors. Cleaning and sanitation seem to be much less important than ventilation. If you are in the same circulation area, distancing is no replacement for ventilation.

Distancing and PPE are alternatives for each other. You can trade them off, depending on what you are trying to do. Obviously, the cost/benefit depends on the local infection rate, so you can trade that off too. If you’re worried about infection, you still should have ventilation, even if you have strict distancing AND ppe.

People are known to indulge in risky behavior, and loud obnoxious behavior, when drunk. which, along with being crowded and poorly ventilated, is one of the reasons why bars are centers of infection. If the reason you have rented a house is to have loud drunken parties, it is what it is. If not, avoid that scenario.

But what of this then?

According to the CDC, 24% of people who transmit the virus to others never develop symptoms and another 35% were pre-symptomatic.

While asymptomatic carriers aren’t responsible for most of the transmission, isn’t 24% pretty significant?

With Hawaii having such great weather, I would suggest saying all guests have to generally stay outside during their visit. I’m assuming there is a patio or something which be sufficient. It’s probably ok to have guests use the bathroom or go on a quick tour, but extended visits would be much safer done outside.

I haven’t had a visitor in my house since March. And I live alone. What do you mean it’s unrealistic for 7 of you not to have additional people come inside the house?

How about you just meet with them outside, wearing masks, and staying distanced?

And an oximeter test has got to be next to useless. It’s perfectly possible to be infectious or even actively ill and not have low blood oxygen. Those may be useful to help judge whether somebody needs to be in the hospital; but not whether somebody’s infectious.

If you’ve come to an island specifically because it’s got a low infection rate – it would be really nasty of you to set off a round of infections there by encouraging a batch of additional people to come in from elsewhere to visit you.

My phone (Android) has a pulse-ox and heart rate monitor built in. I think some iPhones have it, but I’m not sure. I’m wondering if the OP mentioned checking pulse-ox levels because they already have the feature built in to their phone, so it’s not an extra expense.

Here’s one piece of info on iPhone pulse ox apps. Not worth using-could actually mislead you into not recognizing low O2 levels. I looked into it because I have an iPhone. Not going to now.

The utility of iPhone oximetry apps: A comparison with standard pulse oximetry measurement in the emergency department

[from PubMed]

A pulse oximeter can be gotten on Amazon very readily for $20-30 if needed for asthma or COPD. I have several in my nurse work bag.

Again, temp checks and pulse ox checks are theater, like one way aisles in stores and drive through window clerks wearing gloves.

This. I live with my husband and adult daughter, but we haven’t had any guests indoors since March, either. Hawaii has nice weather. If it’s a mansion, surely you have a lanai or patio or something where you could entertain your masked visitors.

Also, 5 days is the wrong amount of time. That’s just enough time for someone to go from “just exposed” to “highly infectious and about to show symptoms”. someone who has JUST been tested and tested negative might be incubating the virus, but probably has low levels. Someone who has been away from sources or exposure for 10 or 14 days is likely safe. But 2-5 days is probably the peak risk time.

One thing about temp checks, though, it’s a way to stop people that are very clearly symptomatic, at the door. These people, who have a fever, likely already feel like crap (because of the fever) and many have probably already assumed they have the virus and are trying to get one last shopping run done knowing they’re not going to be leaving the house for at least the next few days.

I know it’s not going to stop asymptomatic people or people that have the virus but no fever, but it may catch a few people. I’d say it’s leans towards the theater side of the spectrum, but it’s not entirely useless.

Clerks wearing gloves, at the very least, may protect them, provided they don’t let the contaminated exterior of the glove touch themselves. The useless glove wearers are the ones that are under the misconception that as long as they’re wearing gloves, they’re invincible. These are the people that are using winter/outdoor/work gloves that they’re almost certainly not washing from one day to the next, regularly touching the outside of and tossing them in places like their kitchen table. Similarly, the people that wear disposable gloves, but I watch them handle the tube at the bank/walk out of the store, get into their car and drive off with the gloves still on. If you wear disposable gloves, it’s fine, put them on before you touch the door to walk in and as soon as you exit, throw them in the first (outside) garbage you see…not on the ground, not left in a shopping cart, not in a display, put them in the garbage.
If you still have them on when you’re driving, unless you ALWAYS wear gloves while driving, you bringing all the contaminants into your car.

It’s tough when I know people really want to do the right thing, but they’re doing it so wrongly.

Well, the biggest danger is the other 76%.
The 24% comes from the small infectiousness of a large number of asymptomatic carriers, so it’s also true that the asymptomatic carriers aren’t very infectious.

Some of them are infectious, and if you only let into your house people who are not symptomatic and have not had any known contact with COVID, then the remaining danger has to be from asymptomatic people and the contacts of asymptomatic people, who will cause 100% of any infections.

Yeah. Gotta use the gloves right. If you are touching your nose or face (which we all do), you are doing it wrong.

I’ve been taking my mom to a wound clinic a few times a month. Now these people know how to use gloves and are constantly changing them. They change them every time they touch my mom and have to input some info into a computer. Every time they leave or enter the room too.

But, this is a wound clinic, and I suspect concerns about infection and cross contamination of just about anything has been drilled into them for a long, long time. A nurse in that clinic probably changes their gloves at LEAST 50 times a day. Probably closer to 100.

It’s second nature for them. For the rest of us, not so much…

I would disagree that temperature checks are theatre at least for short visits. It shows whether they are truly asymptomatic at the moment. Lots of people might not notice a low grade fever. No, you’re not going to catch everybody but you can eliminate a fair bit of risk with little effort.