Welcome to Not a Doctor, the only newsletter about health and science that has become fascinated with hermits lately.
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.
Today, I want to talk about how to quarantine after you’ve come into significant contact with someone who has a confirmed case of Covid-19.
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When should you quarantine?
The purpose of quarantining after Covid-19 contact is to monitor your symptoms and to keep from spreading the virus to others before you even know you’re sick.
This is different from isolation, which is what you do after you have a positive diagnosis. (I’ll talk more about isolation in another update.) However, if you live with someone who is high-risk, you might consider isolating instead of quarantining in order to protect them.
Often, you start quarantining when someone — a friend who tests positive or your local department of health — lets you know you’ve come into significant contact with an active case of Covid-19.
My advice here is for the ideal situation, but I know it can be extremely difficult, if not impossible, for some people to follow it. Hopefully, you can find a way to incorporate at least some of this advice.
You should also quarantine before seeing family for the holidays or before merging bubbles, even if you don’t have confirmed contact, in order to make sure you don’t have an asymptomatic case.
Photo: Mario A.P.
What does “significant contact” mean?
The general rule is, if you were within six feet of a positive person for more than 15 minutes, you have had significant contact.
It’s possible that exposure can happen at further distances, in less time. A student in South Korea contracted the virus from someone at a 20-foot distance after only 5 minutes. (Honestly. Don’t dine indoors right now.)
But most of the cases we know about happen in close quarters for more than 15 minutes total. Outdoors, anything closer than six feet (ten is better) is too close. Indoors can be much riskier, especially if the windows or doors aren’t open. The virus can float in the air for hours in places where there is not a good air flow. So that means if you’re in a room for a long period of time with someone 10 feet away or 12 feet away, that could count as significant contact.
Masks reduce the risk of transmission, but they don’t eliminate it entirely, no matter how great your mask is. N95 masks are called that because they filter 95% of very small particles — but that means 5% can get through. Nothing is perfect.
Masks definitely, definitely help, and you should be wearing them anytime you leave your house right now. However, they are not going to protect you fully in risky situations, especially indoors for long periods of time.
Here’s what to do
So what do you need to do when you get that call (or email, or text, or you see a Facebook post)?
1. Stay home.
This one seems pretty straightforward, in concept if not in execution.
You should stay home for 14 days, if possible, or 10 days if not. If you have financial hardship and you test negative with no symptoms, the CDC says you may end quarantine after 7 days, but that’s not recommended unless you absolutely have to. Many people develop symptoms within five days, but for some people, it takes up to 11 days.
This means: don’t go to school or work, and don’t run errands to the store. Try to have food and medications delivered to your home or via curbside pickup. If you can, ask a friend or family member to deliver what you need and leave it on your doorstep with a friendly long-distance wave. This is related to my next point…
2. Avoid other people.
Don’t see anyone outside your household. Nada. Zilch. Even with masks on. Don’t do it.
Even within your household, you should try to limit contact as much as possible with others who were not exposed. If you can, sleep in another room and use a separate bathroom.
Channel your inner hermit. Binge on Netflix. Read all those books you’ve been meaning to. (Oh, hi!)
3. Monitor your health.
I recommend ordering a thermometer and a pulse oximeter now, before you need it. Once you start quarantining, take your temperature and check the pulse ox twice a day, and write those numbers down.
Here’s why you should take your temperature even if you don’t feel warm. First, you can establish a baseline for what your normal temperature is. This is especially helpful with at-home thermometers, which aren’t always super accurate. Second, not everyone has a fever with Covid-19, but some people report having an elevated temperature — maybe a degree or two above your normal, but not actually a fever. That could be a potential symptom.
A pulse oximeter measures your pulse and the oxygen levels in your blood. You can buy one at most big stores and pharmacies. If you have the newest Apple Watch, it takes these measurements with some fancy graphics thrown in. But a $20 or $30 pulse ox can do the same thing for less.
The typical readout for most healthy people is a blood oxygen level of at least 95. If you have pre-existing conditions or if you just ran up the stairs and your asthma is acting up, you might temporarily dip below that. But if you are staying below 95, you should call your doctor.
Some people also report higher heart rates with Covid-19, so it can be useful to measure your pulse as well and get a baseline for what’s normal before any symptoms set in.
Dips in oxygen and higher heart rates can be symptoms — and for some people, they might be the only symptoms. Some people report feeling just fine, but their oxygen levels are actually cratering and they had no idea.
You probably know about the most common symptoms: cough, fever, shortness of breath. But some people also lose their sense of smell and taste, or those senses are altered. Others feel tired, have body aches and headaches, discover sores on their fingers and toes, and more.
But about 40 percent of people who have the virus never develop symptoms. At all! It’s wild, honestly. Dr. Anthony Fauci (I assume you know who he is by now) says this is one reason why the pandemic has spiraled out of control.
That means if you’ve had exposure, and you never develop symptoms, you’re not in the clear until you have repeat negative PCR tests or 14 days have passed.
Should I get tested?
You can! If you develop symptoms, definitely. If you need (not want, need) to end quarantine earlier, a negative test technically clears you. You might also choose to get tested while you continue quarantining just so you know if you had the virus or not; that’s up to you, really.
If you are relying on tests to end quarantine, get tested twice (or more), at least two days apart. A PCR test is going to be more accurate than an antigen test, especially if you don’t have any symptoms. (A blood test will not help you here.)
It’s really important to know that one negative test does not mean you don’t have the virus. Positive tests are really accurate in most cases, but negative tests are a lot trickier to interpret. (I’ll go into this more in a later post, but I also wrote about this for The Washington Post recently.)
But the key takeaway on testing: you can’t rely on a single negative test for the all-clear. You will have a much better idea of your status if you test at least five days after exposure and then again 2 to 5 days after that.
Okay, I think that’s enough for now. Next time, I want to talk about isolation after you have a confirmed case, and I’d also like to talk more about testing (I always want to talk more about testing!) another time, too.
I hope you’re all staying as safe as you’re able to, and that the end of the year is bringing some peace and respite. We’ve all earned a break.
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As always, very clear and helpful information. Thank you.