How to isolate, and how to deal with isolation

How do you cope with fear, anxiety, boredom, grief? Who or what refills your cup?

Welcome to Not a Doctor, the only newsletter about health and science that wants to hug you through the screen.

I’m Melody Schreiber, a journalist and the editor of What We Didn’t Expect: Personal Stories About Premature Birth. I’m not a doctor, or a scientist, or really an expert of any kind. I just like to ask questions and try to find the answers to them.

I promised in my last update to write about how to isolate if you have Covid-19. But even I couldn’t bear to talk about isolation right before Christmas. I felt, and still feel, perhaps the most isolated I’ve been since the pandemic began.

So, this week I want to offer practical tips about how to isolate, but I also want to hear from you about how you are dealing with the bigger sense of isolation that so many of us have felt, to varying degrees, this year.

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How to Isolate

First, let’s talk about the difference between quarantine and isolation. Quarantine is what you do when you have had significant exposure to the virus, and you are waiting to see if symptoms develop while also trying to halt the chain of transmission to other people in case you do have the virus.

Isolation is what you do when you develop symptoms or when you test positive for Covid-19.

As with my advice on quarantining, I know some of this is very difficult or downright impossible — especially if you don’t have a spare room or bathroom, or if you are a primary caretaker. But these are the ideal steps to take whenever possible.

And, if the title of this newsletter isn’t clear enough, I’m not a doctor. You should always get in touch with an actual doctor to monitor all potential symptoms and positive cases.

Get tested if you have symptoms.

If you experience symptoms and you have had potential exposure to the virus — which, in the United States, could pretty much happen in any public place these days, especially without masks — you should begin isolating and get tested within five days.

PCR and rapid antigen tests both have high false negative rates — meaning, they frequently tell you they haven’t detected the virus, but that doesn’t mean you don’t have it. However, they are usually more accurate when you have symptoms, especially a day or two after symptoms begin and up to a week or so later.

Even if you test negative, as long as you have symptoms (like a cough or a fever), you should continue taking precautions to avoid spreading whatever it is you have.

So, that’s what to do if symptoms develop. But what if you never get symptoms, despite a positive test?

If you test positive for the virus, you need to isolate.

Even if you don’t have symptoms, you need to stay away from other people if you test positive. This is true even if you were around them before, because it’s possible they weren’t infected yet.

Stay in a separate room, and try to use a separate bathroom. (If others have also tested positive, and you have limited space, you can stay in a room with the other positive people. There’s no evidence that being around other positive people will make you any sicker once you already have the virus.)

If you absolutely need to be around other people — for instance, if you’re walking through the house to go to the doctor’s office — everyone should be masked at all times.

This may be obvious, but: don’t share food, dishes, bath towels, etc. Negative people who are washing the dishes and linens of positive people should wear masks while doing so, and try not to shake the linens too much.

Try to keep your pets away, too; ferrets, cats, and dogs have also developed coronavirus cases.

Monitor your symptoms. As with my advice on quarantining, you can track your oxygen levels, heart rate, and temperature at least twice a day. Write it down so you don’t forget. You might also want to keep a record of when you feel better or worse — different times of day, or different activities. If you notice you are feeling markedly worse, especially in the second week, call your doctor.

Only leave the house for medical care. Don’t go ANYWHERE else, PLEASE, FOR THE LOVE OF GOD. Order delivery to be left outside your door, or ask friends/family to go shopping for you and to walk your dog.

When can I stop isolating?

You can stop isolating 10 days after your symptoms developed, as long as your symptoms are improving and you have been fever-free for 24 hours. If you continue to have symptoms, especially if they are getting worse, you should keep isolating and call your doctor.

If you never developed symptoms, you can technically stop isolating after 10 days after you first tested positive. However, I would continue quarantining for the next 4 days.

You can also get tested again to see if you are now negative. Right now, the CDC doesn’t recommend getting another test after testing positive the first time — in part to free up resources for other cases, and in part because sometimes you can test positive for weeks without actually being contagious, because the test is detecting old virus fragments.

However, some active infections can last longer than two weeks. If it were me, I would get a second PCR test to see if my Ct (cycle threshold) number is under 30. If it is, you are likely still contagious. If it’s higher than 30 at the end of an infection (not at the beginning, when the virus is just starting to replicate), then you’re probably not contagious anymore.

If you have a weakened immune system, you’re more likely to have a longer infection. Some immunocompromised patients have active, contagious cases for two months or longer. If that might be you, you should call your doctor to make a testing and treatment plan.

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How to Deal With Isolation

So, that’s the practical advice. As for the emotional aspects of dealing with isolation, all I can say is: I feel you.

I don’t have to tell you that 2020 has been hard. I’m not going to try to offer Six Great Tips on Feeling Less Isolated. If you’ve made it this far, you’ve done an incredible job. Full stop.

Photo: Henry Burrows

This season has been particularly hard in an already rough year. It’s a time when many of us gather with family, when we stop and reflect on what we’re thankful for. But for many of us, that was impossible. Others have been able to gather with some loved ones in our bubbles, but it’s not enough. It’s not the same. And it can’t be. That’s just how it is. It fucking sucks. It really, really does.

Sometimes weeks, even months, go by, and I think, it’s okay, we’ve got this, we’re making it work. Then I hit a wall — usually, it’s prompted by a milestone, like birthdays or holidays — and all of the uncertainty and pain rears up again.

Like I said, I don’t have any quick and easy advice. I have been giving myself pedicures, watching fun TV, reading books that take me away for a little while. These are Bandaids on gunshot wounds — but they are something to help in those moments of pain and loneliness.

I’ve also been thinking about the people and the experiences that “fill my cup” — who make my soul feel a little more complete, who impart joy even when we are crying together, the people who build you up simply by showing up. Those people are gold, and realizing who they are has been one silver lining to this otherwise unrelenting year.

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How do you deal with fear, anxiety, boredom, grief? Who or what refills your cup? Leave a comment below; I could really use any tips!

And, as always, please leave a comment or email me (melodyaschreiber@gmail.com) if you have any questions. You can also follow me on Twitter and Instagram, if you’re so inclined.

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