Okay, so you have put your cast and crew through every circle of COVID-19 hell: they’re masked with more layers than a lasagna; they’ve applied so much Purell their hands are getting hangovers; and maybe their nostrils have seen more lovin’ than you have in the past six weeks. And, after all that, a positive case has still slipped through the cracks. Well, you are not alone. With Omicron ripping through the country like a California wildfire, many productions are scrambling to caulk the proverbial holes in the ship. Is it time for productions to prop open the storm cellar and hide or continue to ride out this variant spike? With the right protocols and even right-er information, we can help you make sure your film production stays safe, sane and unswerving from its course.
What To Do When Omicron Debuts on Your Set:
Step 1: Panic! Only kidding… while this might be your first instinct, it’s important to stay calm.
“Oftentimes in these situations, emotions trump rationality,” says Dr. Paul Heinzelmann, the CEO of SetMD. While the knee jerk instinct may be to immediately retest everyone, the science says otherwise. “Retesting everyone on set is likely not necessary from a strictly public health perspective. Admittedly, it may be the only way to calm the masses who are demanding some kind of intervention. In those instances, think of it more as ‘therapeutic group testing’,” Dr. Paul jests. But from the standpoint of a level headed scientist (or a nervous accountant), the only people who should be retested are actual close contacts, those people who were possibly within six feet of the positive individual for fifteen minutes or more (this includes being in close proximity for one minute fifteen times!).
So how does one come up with a close contact list? “Coming up with a list of possible close contacts requires starting two days before the individual tested positive (or developed symptoms), and retracing their steps,” Dr. Paul tells me. “It also means they should construct this list themselves – and not allow everyone else who heard there was a positive (or worse, know the identity of the positive case) declare themselves as a close contact.”
Because of uncertainties, heightened emotions and sleep-deprived recollections, the final list of “possible close contacts” is usually longer than the list of those who strictly met the definition of “close contact”. That said, erring on the side of caution is probably a best practice for mitigating infection and minimizing finger-pointing hysteria.
Step 2: isolate the individual regardless of vaccination status. “But what if it’s a false positive,” you ask. You have heard through the grapevine that your friend’s grandma’s cousin’s cat had a false positive, and the positive individual has experienced no symptoms.
Couldn’t they just test again? The answer is, “eh, it depends” and “it’s complicated.”
Scenario 1. You have popped positive on a lab-based PCR and you have never tested positive before: If you were tested with a lab-based PCR and you have not had a COVID-19 infection in the past ninety days, the chances of a false positive are extremely slim. The lab-based PCR is known as “the gold standard”, meaning it is the test that all other types of tests are compared to because it is so accurate.
Scenario 2. You have a positive result on a lab PCR or any rapid molecular test (i.e. PCR or LAMP) but you have had a COVID-19 infection in past 90 days: If you tested positive on a lab-based PCR or a rapid molecular test (such as rapid PCR or rapid LAMP) and have tested positive in the past ninety days, it is possible that the positive result is just an annoying reminder of the previous infection. In this case, you should dig up the actual report, and review the situation with a medical provider. Kindly ask them for a waiver from testing during that 90-day period after you received your positive test.
Scenario 3. You have tested positive on a rapid antigen test: If you tested positive on a rapid antigen test, there is a higher chance you might have a false positive than if you tested with a molecular test. This result ought to be followed up with a lab-based PCR test. If you have symptoms suggestive of COVID-19 and you are positive, the chances are very high you are indeed infected.
Say you just tested positive with a PCR. Would a negative rapid test reverse this result?
No. A lab-based PCR holds more weight than a rapid molecular test (PCR or LAMP) and a rapid antigen test. The timing of the test, the accuracy of the test, the current prevalence of COVID in the community, the presence or absence of symptoms and a prior history of infection are all important factors when interpreting a test result. The best rule of thumb is to assume that a positive result is accurate until proven otherwise by a healthcare professional.
Should you take the best two out of three results?
The science says, don’t hedge your bets. The chances of a false positive are fairly slim. (Though when it does happen, Murphy’s Law dictates that it’s going to be one of your lead actors.) In some cases repeat testing can be used to demonstrate a false positive, but this needs to happen on a case by case basis and may involve looking at other factors such as the cycle threshold (Ct), presence/absence of symptoms, vaccine status, etc. This practice is generally not recommended by state boards of health, but could be considered as a possible option if your production is at risk of shutting down due to a positive test above the line.
Step 3: You are certain you have a positive case. What should they do next?
- Isolate from everyone. As the Elizabethan poet, John Donne, once wrote, no man is an island … until they catch COVID-19 that is. According to the CDC you must now isolate yourself for at least five days. On the bright side, you will have no interruptions as you finish that epic screenplay you got rattling around your head or as you lose yourself in that macrame you abandoned on the crafts table. You are not going anywhere until your symptoms reside (including no fever for at least 24 hours without medication). If your symptoms persist past five days or begin to worsen during isolation, it’s time to call your healthcare provider. If you’re one of the lucky ones that cryptically have no symptoms at all – you will still need to isolate.
- Test with an antigen on Day 5 and wear a mask for five days. Alright, so maybe five days wasn’t enough to finish that epic screenplay, but you feel good and you are ready to get back to work; what do you do next? Use an antigen test (not a PCR or LAMP) to confirm that the infection has resolved. If you are positive again, well, hey, that’s another five days in isolation to work on that macrame. If you are negative, you can re-enter the world with the proviso that you must wear a mask around others for at least another five days. If your production is abiding by stricter regulations other than the CDC’s guidelines, please isolate for the prescribed duration (usually 7-10 days rather than five).
- Breath a sigh of relief if you are vaccinated. If you are vaccinated and boosted, you should be reassured that your chances of seeing ICU nurses is slim. If you are not vaccinated for any non-medical or religious reason, please put ‘vaccinate’ in your Google task list. Make sure you get an official report of a positive test if you are between productions.
Step 4: Relax?
Congratulations, you have successfully navigated a positive case on set. As close as you were to losing your head, your semblance of cool has kept your production from careening off the rails. Sure, it’s right back to the constraints of COVID hell, but now you can continue with renewed confidence. You have learned that all positive cases must isolate; certain tests are more accurate than others; you have isolated your target and interrogated them for close contacts while keeping hysterics at bay; you have isolated the positive individual for at least five days or until symptoms resided and an antigen test read negative; and you made sure a mask was part of their ensemble for at least five days after their release.
I know what you’re thinking now: “is it time to sit down and sanitize my insides with alka seltzer and gin?” It’s no time to rest on your laurels. Forecasts predict at least another half dozen groundhog days of COVID, but at least now you are equipped to meet the next positive case head on.
Whether your production hails from Hollywood, California or Deadhorse, Alaska, SetMD has got you covered with the CDC’s latest and greatest pandemic updates. Our tireless team of experts strives to provide rapid and reliable medical solutions that keep your cast and crew healthy, safe and sane, whether they are working through pandemics or pimples. SetMD works with leading institutions, including Harvard and MIT affiliated laboratories, to provide the highest quality of COVID-19 testing services while improving your turnaround time and bottom line. Our hand-picked team of medical professionals are deployable in a pinch when your production inevitably finds itself painted into a corner. Request our COVID-19 services today.