With the rates of COVID-19 infections across the US, most of us know someone who has had an infection, whether it was asymptomatic, mild illness, or even a significant infection. I am getting more and more questions about what families should do if a member of their household is exposed or confirmed to have COVID-19. The recommendations may change at any time as we learn new information, but since it’s confusing, I thought I’d share the current recommendations.
Some general terminology reminders:
Isolation is used to separate sick people from others.
Anyone with symptoms of illness should isolate from others as much as possible to avoid spread of infection.
What does home isolation look like? As much as possible, have the person who is isolating stay in a room alone with a means of communication to others. Open windows to increase circulation of air to the outside (add a window fan set to pull air outside if possible) if they must share a room with others. When people are in the same room, everyone over 2 years should wear a mask. If you eat in the same room, sit as far apart as possible since masks cannot be worn while eating. Replace masks as soon as you finish eating. Wash hands and surfaces carefully and often.
Quarantine is used to limit spread by restricting movement of a person who has been exposed.
If a person is potentially exposed to someone with COVID-19 they should quarantine at home.
These people can also isolate from family members to protect them.
Exposure is currently defined as a distance of less than 6 feet for more than 15 minutes. (Some locations consider 10 minutes.)
Although masks are helpful at limiting spread, mask use in the community is not factored into these recommendations due to the various materials from which masks are made and inconsistent techniques used.
Presume anyone could have COVID-19, even if they have no symptoms.
This is especially important if the community rates are high but we’ve learned that it can spread rapidly if given the chance. It takes a couple weeks to recognize the spread, so be cautious until we have the situation under control.
Test results are not to be relied upon. There are a significant number of false negative tests. This means that a person is infected but the test result does not show it.
If you learn that you’ve been exposed to COVID-19 you should go home and remain there to quarantine for 14 days. Talk to your doctor and consider testing if you become symptomatic or after 4-5 days from the last time of exposure. It is important to wait until this time to minimize the risk of a false negative test, but it does not guarantee a true negative. Remember that the negative test does NOT allow you to leave quarantine early.
If someone in your household has COVID-19
Any household members or other close contacts should quarantine at home and talk to their physician for guidance. They should follow one of the the exposed scenarios below, depending on if they have symptoms or not.
This screen shot from the CDC website shows that if you are exposed at home, you will require quarantine and not be able to leave the home for quite a while.
To protect against further spread to others, everyone should isolate within the home as much as possible. Have everyone over 2 years of age wear a mask when this is not possible.
Symptom and Test Based Recommendations
The following scenarios are discussed separately:
- Symptomatic and a positive test
- Symptomatic and known exposure but negative test (or test not done)
- No known exposure but mild symptoms and negative test
- No symptoms but positive test
1. Symptomatic and a Positive Test
It is required to isolate at home until
- a minimum of 10 days after the first symptoms appeared and
- fever free for 24 hours and
- improving symptoms.
Follow home isolation precautions and the athletic return to play.
2. Symptomatic and Known Exposure but Negative Test (or test not done)
If the COVID-19 test was negative or not done but there was a known exposure to COVID-19 and there are symptoms suggestive of COVID-19, it is quite possible that this is COVID-19.
Because we know that false negative tests occur with significant frequency, we cannot rely upon a negative test with symptoms and known exposure.
It is recommended to quarantine and isolate at home. Use precautions to avoid spreading to others.
The quarantine should continue for
- a minimum of 14 days after the last known exposure and
- fever free for a minimum of 24 hours and
- improving symptoms.
This is a longer duration than those with a positive test because it is possible that the symptoms were from another source but you were still exposed and the test was negative. Much like those who are not symptomatic, you need to wait 14 days to allow time to pass to no longer be contagious.
If there is strong suspicion, which there should be with known exposure and symptoms, you may request a second test to see if it is positive. This would benefit your contacts, such as friends and family, who would then need to be alerted, quarantined and watch for symptoms.
Follow home isolation precautions and the athletic return to play. I recommend this due to the strong suspicion and high risk for the athletes. The risk to the athlete can be considerable if this was a false negative test and the symptoms really were COVID-19.
3. No Known Exposure and Symptoms of Mild Illness and Negative Test
This is by far the most difficult situation for me to advise personally.
We are headed into the typical cough and cold season. I know that kids will still get the common illnesses. Can we really keep them out of school and parents off work for the recommended quarantine time every time they get sick and still keep classrooms open?
Can we afford to not be cautious?
What if a person is exposed to COVID-19 unknowingly and is in the presymptomatic phase but also has allergies? The sneezing will spread COVID-19 more easily even if it’s not from COVID-19 but occurring along with COVID-19.
Even if test results show another viral infection, such as influenza, studies show that it is possible to have both COVID-19 and other illnesses. Over half (51%) of the children with COVID-19 in this study had a second infection!
This is one of the most compelling reasons for those who don’t usually get an influenza vaccine to get one this year. If you can protect against getting influenza you might spare the confusion as to whether or not symptoms are due to COVID-19. Get your flu vaccine!
When to treat like it’s allergies or a typical cold or cough
If the COVID-19 test is negative and suspicion is low for COVID-19 infection, some propose that traditional return to work/school guidelines should be in place. This means fever free for 24 hours and other symptoms improving.
My local Children’s Hospital has put forth this Guidance for School Re-opening During the COVID-19 Pandemic. The following images are from this document. They could be used for return to activity, not just school.
4. No Symptoms but COVID-19 Test is POSITIVE
If a person is tested due to surveillance or exposure and found to be positive, they should quarantine for a minimum of 10 days from the test.
If symptoms develop, they need to be fever free for 24 hours and improving symptoms as above in #1.
Any household members or other close contacts should quarantine at home. To protect against further spread to others, everyone should isolate within the home as much as possible. Have everyone wear a mask when this is not possible.
If no symptoms develop during the quarantine period, athletes can begin gradual return to play 14 days after the test date.
Follow the return to play guidelines.