Unfortunately, King Corona missed the memo and decided to stick around for the summer. In fact, he has decided to vacation in our quaint seaside community.
At some point, you may receive (or know someone who has received) an email similar to this: “Dear Mr. Smith: We regret to inform you that your (son/daughter) may have been exposed to COVID-19 at (summer camp/day care/school). Please contact your doctor for medical advice.”
Or, you may get a text message like this from your buddy: “OMG. Bad news, bro. Was fun hanging, but I got the ‘Rona when we drank Corona. Go get a test.”
COVID-19 is here, and if you don’t know someone who has had it or has been exposed, you probably will soon.
What Happens If You Test Positive for COVID-19?
If you take a nasal swab test and it comes back positive, expect to hear from your doctor first. Your doc will check on you, answer your medical questions and offer you some instructions. You will be asked to reach out to anyone whom you have been in contact with during your contagious period.
Soon after, you should expect to be contacted by a “contact tracer.” Contact tracers are representatives of our local health department who work to minimize the spread of infectious disease by identifying people who have been infected/exposed to an illness and help limit their contact with other people. Their guidance will help keep you, me, our loved ones, friends and co-workers as safe as possible.
What Is a “Case,” and What Is Isolation?
When a person tests positive, or is suspected of having COVID-19, they will be asked to isolate from others (including family members) during the time that they are contagious. The contact tracer may refer to you as being a “case” of COVID-19.
A person may be contagious two days before feeling sick and for at least 10 days after the start of their symptoms.
Isolation is intended to separate sick people from healthy people. The isolation period usually lasts a minimum of 10 days, but it could last longer if a person continues to have symptoms.
If a person feels better by day 10 and has had no fever within the past three days, they may be allowed to leave isolation. (A repeat nasal test is not needed to clear you from isolation if you have met the 10-day symptom criteria.)
Isolation is necessary for everyone who has a positive test, even if they are not experiencing any symptoms. A contagious person with no symptoms is known as an “asymptomatic carrier” and may account for up to 40 percent of all cases. Even though an asymptomatic carrier may feel perfectly normal, he or she can still spread virus to another person. And just because the asymptomatic carrier didn’t get really sick, the next person to catch it may not have such a mild course.
What If You Are Exposed to COVID-19, and What Is Quarantine?
If you are exposed to COVID-19, you may start to feel sick two to 14 days later. Contagiousness may begin two days before you develop any symptoms, so staying away from others during this time will help keep your friends, co-workers and classmates healthier.
You may be considered to be a “contact” if you were exposed to someone with COVID-19 during the time they were contagious (two days before they first felt sick and for at least 10 days after). You are more likely to catch COVID-19 if you live in the same house, had any physical contact, were within 6 feet of a sick person for more than 15 minutes or you were in the same room with a sick person for an extended period of time.
Quarantine is intended to restrict the movement of a healthy person who feels well but has been exposed to someone who has COVID-19.
“Contacts” are asked to stay home and quarantine for 14 days from the last time that they had exposure to an infected person. A contact who does not develop symptoms during the 14-day quarantine period may be cleared to return to school or work.
What About Testing?
Unlike most of the medical tests that we are used to, COVID-19 tests are still in their infancy. Nasal swab tests can still have a significant “false negative” rate (some estimates range from 20 percent to 30 percent). This means that even though your test may come back “negative,” you could still have COVID-19. If you suspect that you have COVID-19 or you were exposed, then you should not rely on a single negative test to release yourself from isolation or quarantine.
I know this is frustrating. Very frustrating.
The Centers for Disease Control and Prevention is working on guidelines that could eventually utilize a series of negative tests to “clear” a person, but with testing in such high demand and in such short supply, this strategy is not commonly used.
Timing of Testing
The timing of your nasal test may play an important role in the reliability of your results. For a person who is sick, the nasal swab result may be more reliable three days after the onset of symptoms. Testing too early (on the first day of fever) may be more likely to result in a false negative, meaning that you may really have COVID-19 but the test could not detect it.
For those who may have been exposed to COVID-19 but are feeling well, their test results may be more accurate if they are tested seven to 10 days after the time they were exposed.
Keep in mind that because the test has a substantial false negative rate, a single negative test is not enough to “release” a person from quarantine if they were really exposed. “Contacts” really do need to wait out the 14 days in order to best protect their friends, neighbors, classmates and co-workers.
Case scenario #1:
Bobby is a 20-year-old student who lives by himself. Five days ago, he went to a backyard party at Scott’s house. Today, Bobby received a text from Scott. Scott started to feel sick the day after the party and has tested positive for COVID-19. What should Scott and Bobby do?
Scott calls his doctor and is told that he needs to isolate at home, away from others, for 10 days from the time that he started feeling sick. The doctor asks who else Scott was with, starting two days before he started to feel sick, and asks Scott to reach out to those individuals. The doctor also tells Scott that a contact tracer from the health department will likely contact him to follow up.
Bobby calls his doctor and explains the situation. The doctor advises Bobby to stay home and quarantine for 14 days from the day of the party. He also sets Bobby up for a nasal swab test to be done seven to 10 days from the time of his exposure. A contact tracer calls Bobby the next day and continues to check on him through the 14-day quarantine to make sure that he does not develop symptoms.
Case scenario #2:
Sammy is a 3-year-old who attends preschool. Sammy’s mom receives an email that someone at Sammy’s school tested positive for COVID-19. What should Sammy’s mom do?
Mom calls the pediatrician and explains the situation. The doctor goes through the timeline of exposure and determines that Sammy was likely exposed to COVID-19 at school and recommends that Sammy quarantine at home for 14 days.
The next day, Sammy develops a fever and mom calls the doctor back. The doctor arranges a nasal test for Sammy for three days after the onset of his fever. The doctor recommends that anyone exposed to Sammy be quarantined for 14 days from the last time that they had contact with Sammy.
Sammy’s test comes back positive for COVID-19, and he is asked to isolate for 10 days. By day 10, he is feeling much better and has not had a fever in the past 72 hours. Sammy is cleared to be out of isolation.
But, what should Sammy’s mom do?
Since she has been caring for him during the past 10 days, mom’s 14-day quarantine period actually starts after Sammy reaches day 10 and is no longer contagious. (Remember, the 14-day quarantine begins for a “contact” the last time that they were in contact with the infected case.) In this scenario, mom would have to stay home through the 10 days of taking care of Sammy before starting her 14 days of quarantine — for a total of 24 days!
Each Scenario Is Unique
What I have found during the past several weeks is that testing, tracing, isolation and quarantine are unique for each case. In order to help keep infection rates to a minimum, doctors and contact tracers have to carefully consider all of the details. The more we all cooperate, the more effective these techniques will be to keep our community safe.
If you own a business, run a school or you are just curious, I highly recommend that you take the free online contact tracing training course through Johns Hopkins. It will help you better understand when it is safe for your employees and students to return after recovering from their illness.
How to Keep You and Your Loved Ones Safe
Regardless of local ordinances, the best way to keep yourself safe is to stay at home as much as possible. If you have to go out, put on a mask, take care of your errand and come right back home. Try to limit socialization to only the people in your bubble.
Doctors and contact tracers are learning that family and friend gatherings are a common source of transmission. Your loved ones don’t intend to get you sick, but sometimes it is just too hard to resist a hug from your grandma or to hold your new baby niece or nephew.
It is summer time, and we are all looking for a break. We all have COVID fatigue. Unfortunately, King Corona decided to vacation in our backyard, and we must do our best to accept this reality and do all that we can to keep our friends and neighbors safe.
— Dr. Dan Brennan is a board-certified pediatrician at Sansum Clinic who thanks you for staying home to help prevent the spread of COVID-19. Please contact Dr. Dan at 805.563.6211 or drb@sbpediatrics.com, or visit www.sbpediatrics.com.