Help me rip the mask off: Immunocompromised 2024

May 9, 2024 4:27 PM

I need to rip the mask off: I need a quick peace of mind (or not) on Covid risk and apparently remedial Covid education 2024 edition

As background context, I’m Immunocompromised (3 autoimmune diseases which are mostly controlled) and only really broke my Covid bubble in February when I flew from Boston to Seattle and back to get a critical bi-lateral leg prosthetic (which is going well but challenging!).

I did not get Covid, and have branched out to do so more with that confidence with the rule of thumb to mask indoors in public, go facenaked outdoors like a feral lady. Thing is, I mostly do stuff outdoors so it’s been great!

Anyway, I am considering going to a brewery in an upcoming weekend or so and was thinking about trying this as my first maskless indoor visit since beginning of Covid. I’m excited for re-entry and knowing me will spend 3 hours indoors. Yes, yes, I know I should know all this by now, but I’ve had stuff going on with major life changes and it’s hard to follow Covid guidance change/news with anxiety about it. I got a second vax booster of the current Pfizer in April as my 6-month booster/Immuno schedule (those of us with super wonky immune systems get boosters every 6 months fyi). Anyway, does this seem like a good way to re-renter the indoor maskless?

Also, WTF is the best reference site for any of this anymore? I have a hard time with some of the estimator sites because they aren’t really practical.

Also, thanks - this is scary but necessary and seems low risk and I’m scared/excited!

posted by floweredfish to Health & Fitness (35 answers total)

Here in the bay area most folks have ditched masks and it's impossible to get good numbers since folks take home tests if they test at all. It's not helpful but I wanted to wish you good luck and hope you have fun!
posted by just.good.enough at 4:41 PM on May 9 [1 favorite]

There's not a lot of good risk data out there anymore, because a lot of municipalities have stopped tracking. I also don't think MetaFilter is a good source of medical advice. Can you ask your doctor?
posted by capricorn at 4:41 PM on May 9 [16 favorites]

Best answer: I've been keeping an eye on wastewater surveillance (latest by state) and it looks like Massachusetts is doing just fine. Data on the number of cases of covid/hospitalizations are much more uneven since a lot of hospitals/states are no longer required to collect and/or share such data, but Barnstable County MA also looks in great shape by those numbers.
posted by spamandkimchi at 4:43 PM on May 9 [6 favorites]

It is SO hard to find any reasonable references.

Here's my generalized advice as someone pretty covid-averse who managed to dodge it until I played bad games (brunch in NYC on a rainy day) and won bad prizes (birthday covid) early this year: Keep a sharp eye on the room. If this is a typical brewery, it's probably high-ceilinged and that's a good thing, it's more air volume. The more crowded the room gets, the worse your risk gets. You may want to think in advance what kind of people density is past your comfort level and then mask or go outside.

This is how we're living now. I like breweries for their roominess, and spaces where there's outdoor areas I can take a break to or even spend more of my time in.

We have started using ePothex nose spray, and I'll just shrug exhaustedly and point you toward googling that and enovid and xylitol and povidone iodine and carrageenan. It doesn't appear to hurt, and it's impossible to say if it has officially helped, but I have been to a few indoor spaces (art museum, bookstore, restaurant mid-afternoon or late morning) and haven't gotten covid again.
posted by Lyn Never at 4:46 PM on May 9 [8 favorites]

Another reason to be vigilant, though: there is SOMETHING going around that is showing up negative on covid and flu tests but is fucking brutal. My mother and I got it from one of her friends (my husband did not get it) in March, and I'd had covid the month before and my mother has COPD so maybe it hit us a little extra hard, but I have noticed friends on social media mentioning also getting some kind of wipeout two-week cold. I would call my covid experience pretty mild but unpleasant, whatever this cold was (I am really afraid it's just a variant we don't know about) was worse.

There's also bad flu afoot. Definitely set boundaries and have an exit strategy in case you decide it's wise to bail.
posted by Lyn Never at 4:51 PM on May 9 [8 favorites]

Promising early results from use of intranasal Neosporin in animals and humans suggest a cheap option for trying to improve your safety.
posted by praemunire at 4:58 PM on May 9 [5 favorites]

If you'll be drinking, you might want to consider how alcohol is likely to encourage you to take risks you might not take sober.

Is there a particular reason you need to be indoors maskless in public now? And specifically for this event? It's not like you'll build up immunity or something. It's not a required step, or something that will help long-term. Being immunocompromised (I am as well) is not like a phobia, where you get over it if you have enough exposure. If it's your best friend's wedding or something then the risks vs rewards might make it make sense regardless, but it doesn't sound like that's what you're talking about.
posted by lapis at 4:59 PM on May 9 [20 favorites]

Best answer: I'm immunocompromised and I would not do this. This does not seem like a good way to re-enter the world maskless. I would go somewhere where you aren't eating or drinking, that has high ceilings, and fewer people. Like an art museum, or maybe a mall in the morning. Or just somewhere that isn't 0 to 100 like a brewery, crowded, relaxed inhibitions. Although the ceilings are probably pretty high?

We also know that it generally comes in waves, with a large winter wave and a smaller mid- to late-summer peak. So in my family we plan our lives, travel, and indoor time around this for now. If you're going to go indoors, do it now, because mid to late summer is looming.
posted by twelve cent archie at 5:11 PM on May 9 [11 favorites]

Best answer: Something like this would also be an option, for drinking while masking.
posted by blue suede stockings at 5:29 PM on May 9 [3 favorites]

I don't understand why you need to rip off the mask. Nothing especially has changed about COVID to make this safer now. We wear masks out for drinks all the time, just get a sippy mask. Learning to live safely with this virus means with masks on, generally speaking.
posted by shadygrove at 5:31 PM on May 9 [14 favorites]

I'm immunocompromised. I would not do this.
posted by hydropsyche at 5:38 PM on May 9 [5 favorites]

I got this--recommended by a Mefite--it's a little lunchboxed-size portable HEPA filter. If you're nervous about eating indoors, you can pull this out, turn it on, have it sit on the table.
posted by jenfullmoon at 5:47 PM on May 9 [3 favorites]

I’ve been bringing my mini CO2 detector to restaurants these days and now I feel more empowered to determine which places inside are higher or lower risk for catching airborne illnesses. Some restaurants have bad ventilation, period, but others have decent ventilation depending on where you sit and how many people are in there. I got an Aranet which connects via Bluetooth to my phone, and it’s pretty unobtrusive. Maybe you can start out without the mask, keep an eye on your phone app, then if the numbers jump higher throughout the evening you can put the mask back on. Or you can start out wearing the mask and look at the device to decide later if you want to take it off.
posted by oxisos at 6:28 PM on May 9 [2 favorites]

Best answer: I'm not immunocompromised. I would not do this.

I just had covid for the first time three weeks ago; it was mild by all accounts, but can almost guarantee it was because I forgot my fucking mask to go to the grocery store, and just kind of shrugged it off at the time. Having had it, and dealt with trying to keep my family from getting it has honestly made me double down on precautions. But I am an internet stranger, and can’t make that call for you.
posted by furnace.heart at 6:54 PM on May 9 [8 favorites]

Best answer: The data just isn't reliably available anymore. Wastewater data is probably still the best you can do and that's mostly just going to give you an idea of the trend directions.

For whatever anecdata is worth, over the past six months or so I have occasionally needed to be unmasked indoors for short periods of time for work reasons. I use a nasal spray, time these events where possible to be at less crowded places or times of day or in places with good ventilation, wear a mask for as much of the effect as possible, and try to space such events far enough apart in time so that if I do get covid I'm only taking it home with me and not becoming a link in a chain by going into another classroom a few days later and getting other people sick. I don't know that that's the right set of precautions and compromises but it's where I've landed for the time being.

My immunocompromised loved ones are not going maskless indoors at all, for any reason.
posted by Stacey at 7:06 PM on May 9 [4 favorites]

I am not immunocomprised. I still wear a mask anytime I am in a communal air space. Why not?

When I go to the Westy with my old soccer mates, I'm the only one still wearing a mask. Though with the beer and all, I should wear it more...
posted by Windopaene at 7:41 PM on May 9 [3 favorites]

I think wearing a mask is a great idea if you are immunocompromised. You're vaccinated, so if you get Covid, your odds are pretty good. A good friend has an autoimmune disorder, has had Covid twice and has found it unpleasant, but did not require medical care, just fluids and rest at home. I still have one remaining Enro mask, which claims to be N95 level, and is comfortable and washable. I wear it in big crowded events, because I haven't had Covid, and that's nice. You can draw the line on precautions where you choose. Congratulations on feeling confident about going out, Covid isolation is/ was so hard.
posted by theora55 at 8:50 PM on May 9

Best answer: I have a hard time with some of the estimator sites because they aren’t really practical.
I still check in with the microCovid estimator. It is not as finely tuned (it just has low, medium, high and very high options) and the numbers haven't been been adjusted for any variation in the latest version of the COVID virus but it still does a better job of multiplying out the risk probabilities than you can do informally in your own head.

At first, i was shocked that something that seemed pretty low risk to me was still scoring very high but then I realized that my risk tolerance has changed. Their "harm reduction" level of risk means you have more or less a 90% chance of getting covid of the course of whole a year if you do that level of risk taking once a week. Honestly, at this point, I would be comfortable with 80% (4 out of 5) annual chance of not getting it. So, that means taking the number of estimated microCovids (their unit of risk) and comparing it the number that matches your risk level. (200 microCovids per week = 1% annual risk exposure so 4000 per week would equal a 20% risk)

The point is that outdoors is still much safer than indoor. Masked is much safer than unmasked. Ventilation (if it brings outdoor air in) and HEPA filters also help some. I would add social factors (knowing how careful the people around you are about COVID, whether you can ask them to stay home/mask/warn you if they feel sick at all) are also powerful at reducing the odds but still no guarantee.

A model like microCovid can help you do the math - it is a very very rough approximation but it can help you see the difference between outdoors/indoors masked and indoor unmasked) For example,
if you are meeting with 8 other people within 15 feet outdoors, moderate community prevelance then the risk factor is 140 (where 2000/week = 10% chance per year - pretty safe. Take it indoors with a mask and it goes it up to 930 (still pretty safe, especially if you don't do it very often) but indoor without a mask is 2800 (a little risky but not outrageous if you are ok with a small chance of getting it.
posted by metahawk at 9:27 PM on May 9 [1 favorite]

Have you talked to your doctor about what happens if you do get COVID? The problem with being immunocompromised is the risk of getting a debilitating illness or life threatening symptoms. Most of us, if we get sick with COVID will probably be sick for a week or less with another week of feeling suboptimal and a certain chance of getting long COVID but little risk of ending up in the hospital. So while I don't want to get COVID (and I haven't yet) the odds are excellent that it would have a limited impact on my long term well being. I don't know what immunocompromised means for your body but even a 1 in 10 chance of getting COVID this year might be too much if the result is likely to be weeks or months of serious illness or possible death.
posted by metahawk at 9:33 PM on May 9 [3 favorites]

I have a couple of immunocompromised friends and they have fully returned to normal maskless life, going to gigs indoors, cramped pubs, big sports events, Taylor Swift, etc. I say this not to advise you follow them — just to make the point that "immunocompromised" means very different things, and only your doctor can give you meaningful advice calibrated to your own health conditions.
posted by Klipspringer at 12:35 AM on May 10 [5 favorites]

You can get a Sipmask and still enjoy drinking indoors.
People seem to forget that risk is cumulative, a series of low risk events becomes the equivalent of a high risk event. When nothing happens from a low risk event we tend to think it's ok to keep doing it, which is the normalization of deviance. Astronaut Mike Mullane has a great talk on youtube, gets to the heart of it at about 14 minutes.

Two good places to start getting info is Laurieallee's collection and
JW's list.
posted by Sophont at 3:41 AM on May 10 [1 favorite]

Best answer: I am not immunocompromised and I would not go to a brewery event indoors. There are going to be a lot of people, there is going to be a lot of aerosolized spit and mucous, there will be a lot of laughing (because alcohol) making even more aerosols, and there will be alcohol which would make me and other people do risky things, like take off the mask they came with in order to drink and laugh more easily. A room full of laughing, drunk people, one contagious person could infect everyone.

This internet stranger says don't even go at all, masked or not. It's not worth it.
posted by seanmpuckett at 5:38 AM on May 10 [4 favorites]

For information, I rely on TWIV, particularly the weekly clinical update by Dr Dan Griffen. They have mostly moved on from the crux of your question, though. Dr. Dan does refer to the CDC wastewater data - which you can find on the CDC website without much trouble.

The good news is that all the signs are that new cases are down to numbers similar to the low point last summer. They expect it to remain low for the summer with upward blips for summmer camp, July 4, etc.

They stress that the most important thing, even more important than masking, is to have a rock solid understanding with a doctor that they will prescribe, and a pharmacy that will supply, Paxlovid. Every day that passes between first symptoms and Paxlovid reduces its effectiveness.
posted by SemiSalt at 5:40 AM on May 10 [2 favorites]

At this point, you’re only going to get answers from the extremes - people who rarely/never wear masks anymore (like myself, I stopped after 2.5 years) and people who always still do. There is little data to definitively support one decision or the other clearly, because the data analysis depends on your personal priorities and risk profile.

I encourage you to speak with your doctor to understand your personal risks.

Why did I dip masking? I felt the cumulative effects on my mental health to continue masking in a society that doesn’t mask were too great.
posted by samthemander at 6:38 AM on May 10 [6 favorites]

Best answer: I’m immunocompromised and get a vaccine booster every six months too. The vaccines mainly prevent against severe infection and hospitalisation, and don’t offer enough protection against long covid for me to feel like we’re out of the woods at all. Your chances of long covid increase significantly with every infection. I hope you find a way to go that you’re safe and comfortable with.
posted by ellieBOA at 7:11 AM on May 10 [4 favorites]

There is absolutely something non-COVID going around, and mine turned into pneumonia in the left lung by the time I was able to make a trip to the doctor last week. This is going on a month now, and although I'm halfway through my course of antibiotics, I'm still coughing and my voice is still scratchy. I don't have any advice beyond what has already been shared as far as how to handle yourself at the brewery, but don't go by negative COVID tests or low COVID numbers overall.
posted by emelenjr at 7:15 AM on May 10

Best answer: Looks like a big place with lots of outdoor space. I'd try to stay outdoors and enjoy yourself. If you can be outdoors seems like a great option to stop the mask.
posted by tiny frying pan at 7:16 AM on May 10 [1 favorite]

emelenjr, mine also turned into mild pneumonia. That's not wildly out of character for me - really bad sinus infections are prone to doing this to me as well - but yeah. It's nasty out there, y'all.
posted by Lyn Never at 7:56 AM on May 10

Nth’ing talking to your doctor. They will best be able to give you suggestions based both on “chances of getting covid (or any other illness that’s going around)” and “what might happen to you if you get covid/other illness” in context of their abstract medical knowledge, your specific situation, and, ideally, what they know of their other patients’ experiences. Yeah, yeah, the plural of anecdote isn’t data. But anecdotal experience/info from a doctor who works with patients like you(/anyone) may be the best background for good advice that you(/anyone) can get these days.

I am not immunocompromised but my doctor helped me decide what to do when based on my general health and local conditions. And I have a friend who is immunocompromised whose doctor helped her make the same decisions for her specific medical situation.
posted by 2 cats in the yard at 8:15 AM on May 10

Response by poster: Thanks all - I actually appreciate the gut check here. I’m wondering if I’ve let others (I.e. non-Immunocompromised people close to me) influence my thinking - a few continue to be persistent to push me to drop the mask. That and it’s hard to keep doing it when it feels like the world has moved on and tells me I’m crazy for doing it, even with legit reasons. I think my recent plane ride likely added a little confidence as well.

Maybe it’s more realistic to call to see if I can take a beer out to their patio and enjoy it out there, even if the patio isn’t yet “open”. Plus, duh, I can add a few squats of Enovid to be extra safe and this way can mask inside and unmask outside. Thanks all.
posted by floweredfish at 8:39 AM on May 10 [7 favorites]

I'd let the venue know your thinking - they may make an exception to being outside if you explain your concerns. Unless that's a rule of the area or something. Worth an ask!

(Keep in mind that AskMes about covid bring out very strong reactions here, and may not be representative of a non-MeFi space)
posted by tiny frying pan at 8:57 AM on May 10 [2 favorites]

I've done that before, asking to eat outside even if it doesn't seem actually open. "I'm immunocompromised and can't eat or drink inside. Can I sit outside?" tends to work.
posted by lapis at 10:17 AM on May 10

I'm not IC and wouldn't do this.

I get my info from Patreon and Substack email newsletters now, and Reddit. Violet Blue (Patreon) is my new favorite. The Sick Times is focused on LC. Eric Topol's stuff is still good. Your Local Epidemiologist is worth reading (but sometimes too sunny IMO).

I started copying in some info but ran out of time, but the Violet Blue Patreon (which I believe is completely free) is a good way to get caught up.
posted by slidell at 11:37 AM on May 10 [5 favorites]

Best answer: So. I am very immune compromised (think rare freakydeaky T cell disorder) and we've been life alteringly careful for years. But it was really starting to impact our two young kids and we decided to risk ending masking in many situations because numbers in MA are down. And...guess what? As of yesterday, I have COVID. And feel pretty crummy. And am definitely annoyed. And definitely worried.

But! During all those years when I was so, so careful and avoided getting infected, things changed. This is not Delta. I am vaxxed to the max. I had Paxlovid and Metformin at home ready to go so I could leap into action as soon as I had a positive test. (I assumed it would happen at some point, just maybe not this quickly.) I don't know what is going to happen, but I know that I am as prepared as possible and that by delaying this infection for so many years, I've improved my odds of a positive outcome-- fingers crossed, spit three times, etc.

Ultimately a very personal decision with too many factors to be adjudicated by even people as awesome as those on AskMetafilter or even the experts of the internet- although input from both is invaluable. I'm immune compromised but I'm also a person living my life and I, at least, have reached a point where to me that is worth the risk (as least some of the time.) But I would also totally understand someone making a different call.

No matter what you decide, I wish you luck and good health.
posted by jeszac at 4:38 PM on May 10 [6 favorites]

I continue being way on the cautious side (multiple autoimmune things, also seriously cranky lungs already, they do not need more help being cranky.)

For me, I continue to watch the wastewater (I'm also in the Boston metro: if you click through on the MWRA page, you can get additional things they're scanning for, including flu and norovirus, both of which have spiked so far this year, and neither of which I want.)

My basic take is to continue to be careful indoors around anyone where I can't have a conversation about their recent possible exposures, current symptoms, etc. in advance with everyone in that space. (So, yes to spaced out, thoughtful visits with friends unmasked in their homes, no to being unmasked in a restaurant or a meeting at work.) I mask in the hallways at work, unless I'm alone in my office with the door closed and the air filter going. I do go to doctors appointments and other things that involve some waiting inside, but otherwise try to keep inside time with unknown humans to a minimum.

Obviously, the unmasked parts are taking a risk, but for me that's a reasonable compromise that lets me do most of the closer social stuff I want. (And we do cancel stuff about a third of the time for illness reasons.)

I did do a trip for the eclipse that involved eating on site (indoors), and I took a risk for that (but literally, that's a "extremely unusual event").

To reduce risk, I masked except when actually eating (or in my own room), used Covixyl (nasal spray) before eating, and did a bit of an allergy med protocol via a friend whose research I trust, that seems to be good. (And I'm allergic to a bunch of stuff that comes up more in travel, so it didn't hurt).

I wouldn't want to keep the latter two up day to day, but for "short-term unusual set of things I know are coming", they feel like an extra helpful layer and there's enough evidence for both that I feel it's worth the effort. The friend I was driving with and I both took Covid tests before getting in the car for a 5ish hour drive on both ends.

I'm going to a summer cabin with friends in July, and I'll probably do the same thing there, though with a certain amount of "these are friends I trust, they have reasons of their own to be cautious" in the cabin itself, but continue masking/being cautious in other indoor spaces in the camp, etc.
posted by jenettsilver at 6:05 PM on May 10 [2 favorites]