Is it safe to have sex or be intimate with someone new during COVID-19?

After years of health officials and "sexperts" drilling home the importance of condom use to stop the spread of disease, there's a new prophylactic in town due to COVID-19, and it's one you might not expect: a face mask. 

"COVID-19 is not a typical sexually transmitted infection. In fact, it literally flips sexually transmitted infection work upside down, because we usually think about STIs as something that you worry about from the waist down, and this is a scenario where we're worried from the neck up," Dr. Demetre Daskalakis told Dr. Brian Goldman on the CBC podcast The Dose.

Daskalakis, an infectious disease expert and the deputy commissioner at the New York City Department of Health and Mental Hygiene, is one of the experts behind new recommendations on safe intimate relations during the pandemic. Last week, the department released guidelines on how to have safer sex during COVID-19. It comes at a time when candid and clear information for couples who want to hook up during COVID times is hard to find. 

Experts in Canada believe the document hits the right note and encourage its use. 

"[It's] a really great resource that I think should be broadly applied across the world," said Dr. Troy Grennan, physician lead for the BC Centre for Disease Control's sexual health programs.

Harm reduction more realistic than abstinence

As public-health departments start to publish recommendations on what safer sex looks like during COVID-19, experts believe the more information that's available, the better. 

"It's not just in COVID. It's in so many other diseases like HIV and other sexually transmitted infections, where we know that an abstinence-based model tends to be very unsuccessful in the long term," Daskalakis said. 

"And so, the more realistic part is to give people harm-reduction strategies to make sure that they're able to keep themselves as safe as possible if they choose to leave their homes and have new sexual partners."

Grennan said messaging that revolves around abstinence or contact between those who live together doesn't work for single people, those who may live alone or those who feel lonely.

"I think in some respects, it's not realistic to assume that everyone can stick to their own bubble with respect to having sexual partners," he told CBC. "Sex is an important and normal part of everyone's lives, and people are going to continue doing it."

In terms of public-health guidelines, Grennan said he wants to see sex-positive messaging.

"I think by using very firm language — for example, saying you absolutely should not be having sexual partners outside of your bubble — there's a concern that it's very value-laden, it can be seen as very judgmental," he said. "Often certain people will stigmatize them or make them feel shame and might lead to them kind of not seeking medical care."

Jessica Wood, a research specialist at the Sex Information and Education Council of Canada, also believes detailed information is important so that people can assess how much risk they're willing to take based on their circumstances.

"Do I live alone? Does my partner live alone? Is it just about the two of us, or do we each live with roommates? Do we live with aging parents? That's a very different context if you have someone in your home who is immunocompromised or is at an increased risk for challenges associated with COVID-19. People are at a different risk," Wood said.

It's also important to consider whether either partner lives in an area where there are a high number of cases, she said, in terms of what risk they're willing to take. 

COVID-19 test results and asymptomatic spread

Though COVID-19 tests are now more widely available to the public, Daskalakis cautions that asymptomatic transmissions still account for 30 or 40 per cent of cases. 

Also, a negative test result one week doesn't necessarily signal the all-clear, given limitations of the testing and the possibility of contracting the virus after the test was conducted.

"If you're sick, stay home, wear a face covering, wash your hands or use alcohol hand-based sanitizer, and avoid large crowds," the New York infectious disease expert advised.

"The harm-reduction stance is: The least risky thing is to avoid sexual encounters outside of your household," Daskalakis said. "But if you elect to have those encounters, then you really should try to be pretty good about these big four things that we have recommended."

New York's public-health guidelines advise people to use test results and symptoms to make decisions about risk. 

"People who have recovered from COVID-19 at least 10 days from the day their symptoms started, and who have not had a fever for at least three days, are likely no longer infectious," the recommendations state.

Researchers on both sides of the border agree that previous COVID-19 infections do not mean someone now has immunity to the virus.

"We think that people likely do have some level of protection for some amount of time after they have an infection. We just can't tell them how strong that protection is, or for how long it lasts," Daskalakis said.

Antibody testing is one of the hot areas of investigation right now, Grennan said. But he added that without years of study and a deeper understanding, we won't know if the presence of the antibody in a person's system truly means they're protected and present no risk to others.

Get kinky, creative and vulnerable

No matter how new your partner is, experts agree that the best way to engage in sexual contact with those outside your household or immediate bubble is to rethink traditional approaches to courtship — and that includes eliminating kissing.  

"In pre-COVID times, [kissing] would be the beginning of intimacy. I think that it's something that if you can avoid you should avoid, and think about other ways to initiate intimacy that may include face masks to prevent possible droplet transmission," Daskalakis said.

He noted that smooching is a pretty "efficient" way to transmit the virus, and that just as turning your face during a hug is a good strategy, so are sexual positions where partners aren't face to face. 

Wood suggests that people try using online spaces to communicate about things that would normally be reserved for in-person interactions. 

"You can reframe this as a time to build that connection together. Whether it's getting to know each other — you know, your favourite foods or your sexual likes and dislikes ... really getting to be vulnerable with one another. And being vulnerable with one another often builds intimacy. When we disclose information about ourselves and that's received well from another partner, that builds that connection," she said.

"So, I think it also provides us a really good opportunity to build new relationships in a way that is a lower risk for getting or passing COVID-19."

The New York guidelines also suggest couples consider introducing some kink, suggesting they get "creative with sexual positions and physical barriers ... that allow sexual contact while preventing close face-to-face contact."

Carlyle Jansen, a Toronto sex therapist and owner of the store Good For Her, suggests couples may want to consider sex toys that can be controlled by partners in different locations over an app.

"I think whether it be, you know, starting new relationships, being separated from people that you normally would see regularly, or it can be a fun thing even if you live together." 

Sex tips in the age of COVID-19 according to Dr. Demetre Daskalakis:

• Talk to your partners about sex. (This could include your preferences, desires, or just general comfort-level talking about something that isn't always discussed.)

• Figure out what risk level you're willing to accept. Are you a bungee jumper or are you scared of heights? Risk tolerance really dictates your next moves. 

• Face coverings are important; use them creatively. 

• Remember that COVID-19 is transmitted through droplets, so it's exposure from the neck up. Try having sex in positions that don't require face-to-face interaction.

• Use the internet, use the private messaging features of social media platforms, and if you decide to have a live encounter, just be smart, read the guidelines, and make a plan.

Produced and written by Arianne Robinson