Replace Fear with Facts
MEDICAL AND MENTAL HEALTH UPDATE
Happy Friday! I’m getting lots of questions about quarantining, contact tracing, and testing. To help quell some anxiety, today I’ll share answers to some FAQs from patients, friends, and family.
Indeed, the combination of COVID-19 and information overload is (naturally) adding fuel to the fire of anxiety, uncertainty, and feelings of vulnerability. My first piece of advice? Further prune your media inputs. Unsubscribe, delete, whatever it takes. Keep only the essentials. Next? Turn your phone off for long stretches of time, especially before bedtime. And then? Get outside every day even if it’s hot as Hades. Move your body every day. Even a sweaty, limp walk around the block will do you some good. Be sure to look up and observe nature’s blissful cluelessness about the pandemic. Squirrels, butterflies, and trees have NO idea. Imagine that. Then check out these FAQs:
Q: How long do I have to isolate if I test positive for COVID?
A: Whether or not you have symptoms, if you have a positive test you need to isolate yourself from other people for 10 days from the date of the first symptom or positive test AND have 3 days without fever and no fever-reducing medication AND have improving respiratory symptoms.
Q: What if I have symptoms (sore throat, body aches, stuffy nose, congestion and/or diarrhea) and have tested NEGATIVE for COVID? Is it still 10 days?
A: Yes. You need to ASSUME that you have COVID until a) your doctor can prove your symptoms are from something else or b) 10 days has passed.
Because the viral RNA (nasal swab) tests still have a 20-30% false negative rate, I can’t assume that a negative test in a symptomatic person is a true negative. In July, there’s not much else circulating other than COVID!
Q: But if I had a negative COVID test, couldn’t this just be the cold I get every summer?
A: Not so fast, partner. Think about it for a minute. You get a cold (which is also a virus) the very same way you get COVID. Person-to-person contact. And if you’ve noticed, the new kid in town is the novel coronavirus—and it’s much more contagious than the common cold. So if you think you might have contracted a non-COVID virus, you really ought to consider the notion of having COVID itself. And then call your doctor.
Q: But what if I feel well before the 10 days are up AND I had a negative COVID test?
A: The CDC says you can leave isolation early if you have two negative tests 24 hours apart, but I respectfully beg to differ. Because each clinical situation is different and because the tests still have a 30% false negative rate, I can’t assume that a negative test in someone with symptoms is real unless we have a good alternative explanation for symptoms. This is where you should call your doctor to help make smart decisions.
Q: So why should anyone get tested if you quarantine them anyway if the symptoms suggest COVID?
A: You are catching on! Testing is useful for epidemiologic purposes, but in practice right now, testing is helpful only if we understand its limitations and take them into account in our decision making. Testing is more useful if it’s positive (there are very few false positives), but negative test(s) in a symptomatic patient should not serve as a green light.
Q: If I have a positive COVID test (or my doctor suspects COVID even though I tested negative), who in my household needs to quarantine?
A: Everyone in the household needs to quarantine for 14 days because they are close contacts. Recall that spread is more likely to occur when people are in close contact, unmasked, indoors, for sustained periods of time. And yes, even if you tested negative, you can’t assume you DON’T have COVID. (This may seem like beating the proverbial dead horse, but it’s really worth repeating. The lack of good testing is in part why we have a pandemic: people often think that a negative test means they don’t have COVID.
Q: But why do my non-sick family members need to quarantine for 14 days when I, the sick person, only have to isolate for 10 days?
A: Great question (not that the others weren’t good). It’s because it can take up to 14 days after exposure for contacts to develop symptoms. Plus, by the time you got sick, you most certainly had the virus percolating in your body for 2-5 days and were contagious for two days before symptoms—if you had them.
Q: Can I get out of quarantine early with negative testing?
A: Sorry, no. See above.
Q: Who else needs to quarantine after I test positive for COVID?
A: All close contacts. CDC says close contact is “6 feet or closer for 15 minutes without masks.” But this is vague and there are nuances to each encounter. Examples:
If you recall vigorously coughing, sneezing, singing near someone for even less than 15 minutes without a mask (particularly indoors), that contact should be notified and quarantined.
If you ate at an indoor restaurant with masks off (even if you were over 6 feet apart from others), all people in the restaurant should be notified and consider quarantining depending on the room size, table set-up, and ventilation system, etc.
If you ate outside with friends, unmasked but STRICTLY distanced at least 6 feet from others and didn’t touch each others’ food/utensils, you may not need to quarantine those contacts, particularly if you are an asymptomatic COVID case (that we think has a lower viral load therefore less likely to infect others). However if you tested positive after developing a fever, for example, and the BBQ was within two days of you developing symptoms, I’d tell those folks to quarantine for 14 days.
If you are a teacher and test positive, it’s not absolutely necessary for the students in your classroom to quarantine IF masks were worn, distancing was maintained, and hands washed—even if the class was 45 minutes long. And vice versa if a student tests positive. Clearly a decision to not quarantine a classroom contact is dependent on the situation, and you will hear more on this when I discuss school reopening on Monday with Dr. Ackerly (see below).
(There are nuances to every situation which is why this blog post cannot be a substitute for specific medical advice.)
Q: What happens if one person in the family is exposed to COVID but feels fine? Does the whole family need to quarantine?
A: Technically, no. Only the exposed person needs to quarantine. Currently the CDC states that CONTACTS OF CONTACTS do not need to alter behavior. However, there is so much variability in the extent and timing of exposures—plus unique medical vulnerabilities for each of us—that this is where I suggest you call your doctor for specific advice.
Q: What if the exposed family member ends up getting sick?
A: Then the sick person needs to isolate for 10 days, starting at day 1 of symptoms. And the rest of the family needs to quarantine for 14 days.
Q: What if we can’t feasibly isolate my family member with COVID (e.g. what if I am caring for him/her while sick or don’t have space to fully isolate or even socially distance)? How long is my quarantine then?
A: First, be sure that all family members wear masks indoors and wash hands. Your 14-day quarantine would start at the last day of your loved one’s 10-day isolation period.
Q: Why are some states like Maine telling people that if they have a negative COVID test they don’t have to quarantine for 14 days upon entering the state?
A: You’d have to ask the leadership up there. From a public health standpoint it doesn’t make a whole lot of sense to me (and others). If we end up catching some positive cases and those people act appropriately on the result, great. But again, you can catch COVID anytime, anywhere. A negative test is a only snapshot in time—and an imperfect one.
If we were to have 100% accurate, rapid turn-around, easy-to-administer, free testing, then surveillance testing would be an essential public health measure and would help shut this virus down.
Q: What in the heck is the difference between isolation and quarantine?
A: Isolation means the sick person is fully and strictly separated from other people. Quarantine means separating and restricting the movement of people exposed to COVID (or other contagious diseases) to see if they become sick.
Q: Will I ever be able to take Advil or Aleve again? This information is giving me a headache!
A: Yes! We are now confident that these medications do not add risk for bad outcomes from COVID. The original data from France has been overridden after the WHO reviewed 70 studies on the effects of NSAIDs like Advil, Aleve, Motrin, Ibuprofen.
In a confusing and ever-changing landscape, I hope this provides some clarity and calm. I’m heading out for a walk with my pup, Leo, but I will see you again soon. Until then, be well.
Programming note: JOIN me and Dr. Clay Ackerly (one of my go-to sources for medical wisdom) for a Facebook LIVE Q & A at 8 pm on Monday, July 13! Click HERE to submit your questions in advance. See you there!