Home repair: immunocompromised edition
November 17, 2021 2:54 AM   Subscribe

My partner and I need to have a repairman at our house next week for 4 hours and I am immunocompromised. Can you help me understand my risk so I can relax and stop jumping out of my gourd with fear/anxiety?

We live in South Boston, MA in an ancient home built in the 1800s that is not well ventilated and not terribly modern. I have a rare autoimmune disease that has left me without an immune system. I have had three shots of Pfizer (not the booster - just a third shot due to being immunocompromised) and my partner recently got their booster and is otherwise healthy.

We are having a repairman to our house next week to do 4-6 hours of work in our (extremely not ventilated, not finished) basement to fix our heating system and it is very necessary due to impending winter. Partner is dealing with this, but also tends to drop the ball a lot. Partner knows I feel anxious and scared shitless. Repairman told us that he is vaccinated after getting COVID last year…but then added that he is in peoples houses all day which was panic inducing for me. (As an aside, I don’t fully trust this but am also really untrusting these days about vaccination status after my own mother lied to me about being vaccinated just to get me to engage with an extremely estranged toxic family member who tried to full on steal my identity and wipe out my bank accounts years ago…oh yeah, and in that same conversation I learned they are both qanon believers - needless to say we will not be spending Thanksgiving Day with them). Anyway, repairman stated he will wear a mask the whole time, but it’s still our _house_. We plan to have two Coway air purifiers running on full tilt on our first floor which is directly over the basement. The basement door is on that floor and we will put down plastic from the front door to the basement door. Our first floor is about 800sq feet and has high ceilings and an open floor. The basement door is about half the length of that from the front door. We cannot open windows on that floor due to living in the middle of the city - every smoker that walks by exhales directly in our windows - this is something we can’t even do during non-COVID times. We can open windows on the second floor though although it will be raining heavily that day so most likely won’t because it’s supposed to be a windswept rain. We will will turn bathroom vents and the kitchen hood on. I feel like a jerk, but I already told partner that I’m not comfortable with Repairman using our bathroom because it’s too risky for me. I plan on being on the second floor during all this - do you think I need to wear a mask as well on the second floor while repairman is working in the basement?

I am TERRIFIED of getting COVID because for me it would likely result in hospitalization and possibly worse. How safe do you think I will be in this situation given our plan? I think the challenge is that all the data we can find is on “normal” people. What else can we do to keep me safe in this situation? FWIW, when I go outside stupid early in the mornings to exercise when no one else is around, I still wear a mask and bring a spare because I have to be that cautious.

Finally, how long do you think I need to wear a mask indoors in my own home on the first floor for after the repairman leaves? I realize that everything has risks but I’m trying to make it so that I’m not in an anxiety tailspin for days afterwards and feel comfortable cooking and eating on the first floor. It’s not sitting well with me how scared I feel right now and it’s in my home which has been my safe space this entire pandemic. Being immunocompromised has really limited me since COVID. I’m only in my 40s but have been living like I’m 80. Thank you so much in advance.
posted by anonymous to Health & Fitness (14 answers total) 3 users marked this as a favorite
This sounds so scary for you, and I'm sorry you are going through it.

I think having a masked repairperson in the house is very low risk, and your ventilation plans make the risk even lower. If it would make you feel better, you could open windows on the first floor on the side of the house sheltered from the wind, and put fans in them to vent your air (and keep smoke out).

One thing that will help a lot is figuring out what engaging thing you can do while this is happening so you aren't panicking the entire time. Is there a movie you can stream that you are looking forward to? A vide game/ phone game you find really engaging? A cleaning or organizing project you can do upstairs?
posted by metasarah at 3:41 AM on November 17, 2021 [5 favorites]

If this were me, on a practical level I would put fans facing out in the most sheltered windows downstairs - this won't bring in smoke from outside, it will pull the basement air up and out - and leave them on for a while after the guy leaves before you go downstairs. Box fans facing out will fill the window space.

Do you think running the air purifiers in the basement would be better? That's where the bulk of the aerosols, if any, are going to be.

If you want the opinion of an anxious person, I think that this is pretty low risk, especially if you avoid the basement for 24 hours afterward. The guy simply isn't going to be breathing unmasked upstairs, and while aerosols do circulate, they are not magic.

I'd wear a mask the whole time because it would cut my anxiety level, and I'd wear one for 24 hours afterward when downstairs, ditto.

Here's something else: there are actual studies suggesting that betadine/povidone nasal spray and gargle cut your risk if you're actually in a situation where you're exposed to covid. These studies have focused on healthcare workers (and I suspect that they are where that whole myth of 'iodine prevents covid' got started.) When I have had to be in situations where I felt my risk of exposure was high, I used both the gargle and the nasal spray before (once) and after (for a day or so). The idea is that these literally kill viruses in your nose and throat - it's not a magical "drink the bleach" mechanism of action.

At the link below, they have the nasal spray for delivery by the 20th:
https://www.amazon.com/ BETADINE-Defence-NASPAL-Canadian-Packaging /dp/B082331GXK/ref=pd_lpo_1? pd_rd_i=B082331GXK&psc=1

The gargle is also available:
https://www.amazon.com/ Betadine-Antiseptic-Throat-Relieve-Symptoms/ dp/B088LBWDH1

I have purchased both - from Amazon, sadly, but needs must when the devil drives. I feel good about having them, because my assumption is that they are one more layer in a protective strategy.
posted by Frowner at 4:55 AM on November 17, 2021 [3 favorites]

COVID only stays airborne for about three hours, from what I have read in the past. So if you stay on the second floor for a few hours after he leaves (and while he's in your house) I think there's very little risk. Maybe to be extra careful, avoid the basement for a day after he's there.
posted by pinochiette at 5:10 AM on November 17, 2021 [9 favorites]

I think your plan sounds very low risk, and probably doesn't actually increase your, say, annual or monthly risk of getting COVID by anything noticeable. I certainly don't see any *harm* in wearing a mask for as long as you want (plenty of people wear a mask all day every day for work), but after a few hours most of the aerosols will have settled and after a day or so almost all of the virus will be dead/inactivated. IF there was virus to begin with. Even with the currently high transmission rates in the Boston area, the chance that your individual repairman is infected on that specific day is still quite low.

If it will make you feel better you could also ask to see the repairman's vax card (have him text you a photo) and ask him to take a rapid test (provided by you) on arrival at the house. Honestly those sound like lesser asks than having him not use the bathroom for 4-6 hours.

Also have you talked to your care team recently about what *they* think you should be doing, and what you should be doing that's different from your regular old flu season routine? (I'm assuming the immunodeficiency is not a new problem for you - if that's the case, yikes, how terrifying to get an immune deficiency diagnosis during a pandemic!) Remember, although COVID is deadlier than the flu, we also have arguably better treatments for COVID than we do for the flu right now - monoclonal antibodies and the new Pfizer pill which reduces hospitalization rates by 89% (!) in populations at risk of severe COVID (and unlike vaccines, these don't depend on your own immune response to work).

And maybe you've done this already but if not: it might relieve your anxiety some to have a plan for what will happen if you *do* have a known exposure and/or infection (e.g., I get PCR-tested three days and five days after a suspected exposure; if I test positive, I immediately contact my primary care physician for an oral antiviral prescription, which Partner should be able to pick from pharmacy X; if I develop further symptoms I can get monoclonal antibody treatment at hospital Y or hospital Z).
posted by mskyle at 5:40 AM on November 17, 2021 [15 favorites]

I agree that you should check with your medical team for guidance on this.

As a datapoint: I'm immunosuppressed with a transplant, and like all transplant patients I'm part of the highest risk group, with three full moderna shots that sadly most likely did nothing. Transplant patients are a few hundred times more likely to be hospitalized from covid than the average fully vaccinated person. My Infectious Diseases doctor knows I have zero interest in getting sick, so here's the current guidance she gave me for here in southern Colorado, which has higher incidence rates than where you are:

- Inside my home, everyone must mask. I mask, they mask, we all mask. The one unmasked exception I'm currently granted is my 3x full dose fully vaccinated family member, who is fully masked everywhere in public. She still masks up with me after seeing her other vaxxed family at their home unmasked.

- Outdoors, I don't have to mask unless I'm in a crowded area.

- In stores or at appointments, I avoid crowds and limit visits to uncrowded shopping hours, and I don't go out often.

- I don't eat at restaurants or go to any events, concerts, movies, museums, etc.

Your concerns are valid. It's such an uncertain and scary time for the medically vulnerable, and the feeling of safety at such a time can be so subjective. I just wanted to leave my datapoint here as an example of workable boundaries -- the advice you get from your team may be different. In your position, everyone would be masked, I would avoid the basement for the day, and I'd ventilate the area well during (if possible) and after. But a quick call to your medical team should give you some peace of mind.
posted by mochapickle at 6:03 AM on November 17, 2021 [9 favorites]

Here's something else: there are actual studies suggesting that betadine/povidone nasal spray and gargle cut your risk if you're actually in a situation where you're exposed to covid.

Frowner, I googled this (since I'm always interested in learning about additional precautions) and all I found were articles about doctors warning against it, like this one. Not that this is some crazy myth, there was a study or studies showing in killed COVID in a lab, and it doesn't sound dangerous if you're using a product the same way it would be used for its intended purpose (rather than using tons of it). And I would be happy to find out I missed more recent information!

OP, if I were in your position I would stay on the second floor, in separate room with windows open/window fans if possible, with an n95 mask, and stay there for several hours after the guy leaves while all the aerosols I'm imagining in the basement fall to the ground. Have partner wear an n95 mask too, they can deal with the repair person and clean things after he goes. (You could also provide the repair person with a high quality mask--there's a big difference between those and the cloth masks or flimsy imitation surgical masks most people wear.) This is almost certainly way more precaution than necessary.

Alternately, can you leave the house and be outside while he's there, and for some time after? Not sure if you live in a place where you can count on reliably being able to avoid others outside.
posted by Squalor Victoria at 6:12 AM on November 17, 2021 [1 favorite]

I'm immune compromised. When the cleaning ladies come, I leave the house, but I dont take additional precautions after I return. The likeliest transmission, by far, is being at speaking distance for an extended period.

As mskyle suggested, you need to know the best protocol for getting the monoclonals if you should get sick. In my case, it's via my pcp, and if he's unavailable, it's the ER. You should ask your pcp.
posted by SemiSalt at 6:13 AM on November 17, 2021 [4 favorites]

I think you being floors away with everyone involved vaccinated and masked this is going to be extremely low risk. The microCOVID Project doesn't even register people more than 5 m away.

But can you just leave the house during the repair? Then you won't have to worry about it at all.
posted by grouse at 6:50 AM on November 17, 2021 [10 favorites]

I agree with others that the risk here is very, very low. However, if you want the best ventilation system to minimize that risk, what you want to do is set up the airflow in the house so that fresh air flows in on the second floor, where you are, and flows out downstairs and in the basement. That way, the fresh air is coming in upstairs and flowing away from you downwards. To that end, I would run bathroom and kitchen fans on the main floor (but not upstairs) and, if you can, open any basement windows and put a fan pointing out in them. Then open a few upstairs windows near you slightly. Ideally, you're in an upstairs room behind a closed door with a window slightly open. By doing this, you control the direction of airflow.

But again, I think if you're on the second floor and the worker is in the basement, the risk is already very low.
posted by ssg at 8:35 AM on November 17, 2021 [2 favorites]

I'm also immunocompromised, a transplant recipient, and I take very similar precautions as mochapickle above. I agree with everything she says, this pandemic sucks.

I've had a few repair visits in our apartment; often closer to an hour than four, but with uncertain vaccine status (and in some cases certainly workers with no vaccine, given the rollout and timing). I focused on masks and ventilation to the degree possible. I'm sure given your level of caution that you've upgraded to high quality masks; I found N95 masks with head straps rather than ear straps are better for long term wear (and have much higher performance).

Were I you, I'd feel safe enough with the precautions you outlined. Being two floors away from someone is almost as good as being next door to them. If you've got Coway air purifiers, the odds are you've read the Wirecutter article about them -- note that they did do testing in a large room of similar dimensions to your main floor. My modifications would be, along with improving ventilation to the degree possible:
- I would run one of the air purifiers in the basement, if that's feasible.
- I would let the repairman use a bathroom unless you only have one; if there is an upstairs bathroom, then I'd have no problem letting them use the main floor one. If there was only one, I'd still probably let them use it as long as there would be some time (30 mins plus) after they used it before I did, and I'd run one of the air purifiers in there for the 30 minutes.
- I would give the main floor an hour or so before I came down from the second floor.

If it won't make you worry more in general, I'd consider getting an air quality monitor (I have a Temtop P1000) that monitors PM2.5, which are relatively small particles of potentially similar size to hypothetical covid aerosols. I'd then have my partner burn some incense in the basement after the repairman had left, and then have them track the PM2.5 as the air purifier cleans it up. The incense smoke after the repairman will be much denser in the air than any potential covid particles, and once it's gone, you can be pretty confident that any virus particles have also been filtered.

Also note that the odds are very high there will be zero covid particles; the vast majority of people aren't infected (microcovid suggests current prevalence in your area is around 1 in 450 people). It's good to be cautious and assume everybody is infected for the purposes of planning mitigation strategies. But you don't need to assume everybody is always infected for the purposes of establishing your mental level of concern.
posted by Superilla at 10:14 AM on November 17, 2021 [5 favorites]

Frowner, I googled this (since I'm always interested in learning about additional precautions)

To answer the question even though this is an Ask:

There have been several perfectly reputable studies conducted in India which suggest that povidone/iodine reduces risk during covid exposure. I don't have time to find them all - here is one, I've read another which was a study among healthcare workers in one hospital system but don't have time to google and there are several good safety studies about long-term use in general. There are several ongoing clinical trials. My feeling is that nasal sprays have literally been shown to reduce virus in actual noses, so this isn't some kind of "it has a mechanism of action but not as we know it" thing, such studies as we have are positive and I know I'm not going to drink iodine or give up on masks and vaccines in favor of nasal spray.

In fact, I was genuinely surprised when everyone was all "oooh, dumb people think iodine spray prevents covid" when I had already seen a couple of studies from India. My assumption has been that this is more "the public can't handle complexity, we don't want people drinking pure iodine so we'll tell them a half-truth" stuff.

If memory serves, I saw the first study around March, possibly as a pre-print. I mean, bigger studies may be contradictory (as with statins and covid) or show that it's actually totally ineffective. But it's harmless when used over a couple of days and it's a fairly plausible use for an existing, reasonably effective product.
posted by Frowner at 11:31 AM on November 17, 2021 [2 favorites]

Make sure a medical quality mask is provided, partner should explain that a person in the house is dangerously susceptible. Many old houses have windows in the basement that might be painted shut but can be banged open. If so, open at least 1. Smoke is horrid, but if you can crack even 1 window, do that. Outside air is so dynamic that it makes a difference. Upstairs, if any window can be open even a little, do that.

UV light seems to kill covid, and you should be able to get one for a not ridiculous sum, and could put it in the basement steps or nearby.

I'm sorry you have to endure this worry; surely Covid anxiety is exponential for you.
posted by theora55 at 3:04 PM on November 17, 2021

Oh gosh, I really feel for you. I've got an underlying condition that makes me concerned in a similar way (and probably to a similar degree). It's agonizing thinking about people in your space like this.

You're very fortunate that your repair person is both vaccinated and so willing to wear a mask. I've had few people come fix things here that are as open and accommodating. (We have one person who installs UV protective film on windows who screamed about "not getting jabbed for anyone" and then refused to work with us when we said we needed to have only vaccinated workers in the house, for example.)

Reading what you've described, I think you're doing everything you can. I would feel relatively safe and comfortable with the situation as you've described it.

From my perspective, wearing a mask on the second floor won't be necessary. I don't really think wearing one on the first floor will help you much, as it seems like COVID infections are dose-dependent, and there's little chance you'll get a large enough dose from a vaccinated and previously infected worker in the basement. I think this is all fine.

That said, if you can get out of the house while the repair person is there, maybe drive somewhere else or walk in a less-crowded place, that might be a great idea.
posted by yellowcandy at 10:09 AM on November 18, 2021

My assumption has been that this is more "the public can't handle complexity, we don't want people drinking pure iodine so we'll tell them a half-truth" stuff.

Now that makes a lot of sense! It did seem weird that the articles were couched as "warnings" when the content was more like "we don't really know enough to officially recommend it but don't do anything crazy." Thanks for the additional info.
posted by Squalor Victoria at 11:19 AM on November 18, 2021

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