Carey Roach, MD
Internal Medicine and Pediatrics-Combined
Are you confused about when or how long to quarantine with Covid 19? Even as a physician, I have been confused at times, so I would like to simplify the latest guidelines.
The new guidelines for Covid 19 quarantining have been out for the past month. I am more acutely aware of them, because my wife and I just had Covid 19 upper respiratory infections. Joy.
I have been wanting to write about Covid 19 quarantine guidelines and their evolution for some time, but I have been very busy as a physician, and the guidelines keep evolving. Ironically, getting Covid 19 has allowed me to slow down enough to comment.
As a physician, and as a person living in a pandemic, making sense of quarantines is often difficult. Mainstream media, social media, and hearsay make it worse. Sometimes reading state health departments’ guidelines and CDC guidelines themselves take a bit of time to interpret.
So, in December 2021 the CDC came out with the guidelines that if you are not immunized, and exposed to Covid 19, quarantine; and if you show no symptoms after 5 days, and test negative for Covid, come out of quarantine. Very simple and making sense.
Then it evolved in late December to the ability to come out of quarantine after 5 days if you are symptom-free, even if you are positive for Covid. Just wear an N95 mask for the remaining 5 days. I could still handle that.
But during this time, this interpretation was getting morphed by media and some employers to allowing us to come out of quarantine for 5 days, even with a Covid diagnosis and still symptomatic, albeit wearing an N95 the rest of the 10 days. I think that is giving into the pressure of work-force shortages, or simply giving up altogether about limiting the spread of this virus. Are they going to tell me that I’m okay to sit next to my coworker coughing his head off, with everything short of coughing blood, and that I’m okay?
I think some of us have drifted into a Free-Love movement of germ theory now. Just let it happen, because you are going to get it anyway. I’m not ready for that. I’m not ready for one of my patients or loved-ones to not get timely help for their chest pain because there are no rooms in the nearest hospital, and they have to be diverted to another hospital.
Bottom line, under the new guidelines, when to Quarantine.
Here are the four basic scenarios that determine when to quarantine, based on vaccination status and symptoms.
Fully vaccinated and exposed to Covid 19 without symptoms.
The guidelines are ultimately simple: If you are fully vaccinated against Covid 19 and are exposed to Covid 19, and you do not have symptoms, do not quarantine, but watch for symptoms and wear a mask.
Fully vaccinated and exposed to Covid 19 and with symptoms.
If you develop symptoms, immediately quarantine for 5 days, testing for Covid at day 5. If positive, quarantine for a total of 10 days. If negative, come out of quarantine, but wear an N95 mask the rest of the 10 days after symptoms began.
Not fully vaccinated and exposed to Covid 19 without symptoms.
If you are not fully vaccinated and are exposed to Covid 19, quarantine for 5 days, preferably testing at day 5. If you have no symptoms after 5 days, come out of quarantine.
Not fully vaccinated and exposed to Covid 19 and with symptoms.
If you develop symptoms, immediately quarantine for 5 days, testing for Covid at day 5. If positive, quarantine for the full 10 days. If negative, come out of quarantine, but wear an N95 mask the rest of the 10 days after symptoms began.
What is fully vaccinated?
Fully vaccinated: You have had all three of the Pfizer or Moderna vaccines, or two of the Johnson and Johnson vaccines, OR, you have had two of the Pfizer or Moderna vaccines, or one of the Johnson and Johnson vaccines, and are not due yet for the final booster injection.
No symptoms: When I mean no symptoms, I literally mean NO symptoms. Any runny nose or scratchy throat or nausea is a symptom that warrants quarantine and testing. It’s not your grass allergy in the middle of January. Don’t just assume it is something you ate that day. Without exaggeration, I cannot tell you how many times someone told me their runny nose or congestion is "just my sinus infection I get this time every year", only to discover they are positive for Covid 19.
If you are negative for Covid 19 and your symptoms are worsening, remain in quarantine longer than 5 days, but breaking quarantine after day 10 or between day 5 and 10 if you have a rapid improvement in symptoms for two days and are fever-free for two days.
Most of us must abide by an employer’s quarantine policies, which may have us come out of quarantine after day 5, even with symptoms. It is possible to be safe in some scenarios, but not always; therefore, if you can, remain in quarantine after day 5 following symptoms, and try to break quarantine later, between day 7 and 10 once you have had improvement in symptoms, including being fever-free, for two days. Again, wear an N95 mask for the rest of the ten days.
When in doubt, Quarantine.
Unfortunately, some of you will fall into a situation that does not fit any of the above, but at the end of the day use common sense: if you have symptoms, Covid positive or not, the wise thing is to quarantine for 10 days if you can. If needed, get a work- or school excuse from your physician if possible; but ultimately your employer’s policies may still win-out.
My personally curated, nuanced quarantine.
Now, when I developed Covid, I developed a scratchy throat on a Thursday late-morning, and immediately quarantined to home by noon and isolated from my family. Unfortunately, my wife developed her symptoms that night. We isolated from everyone else in the house. I have been doing telemedicine from home. I coughed and was fatigued, 9 of the 10 days. My wife improved at day 7. Neither of us severe or worsening, but not better, and I cannot imagine either of us NOT being contagious to others.
So I stuck with the old-fashioned quarantine. Ten days. I didn’t have to second-guess. But my wife and I were sick together, and I got to hang out with her and cuddle with her, and when we got new energy, did early Spring Cleaning, so it has its upsides.
For those of you who are interested, let’s look at the evolution of the Covid 19 quarantine and find out how we got here:
The evolution of Covid 19 quarantine is interesting to me as it has become simpler; because it did not start that way. The unknown, as always, amps things up. It started, like most pandemic quarantines, like a kid using a golf club to open a piñata: it will ultimately achieve its desired goal and come to an end, but the events in between are somewhat unpredictable.
March-April 2020
The original guidelines in March-April 2020 were to quarantine for 10 days after exposure to Covid 19. And it sounded dire and akin to the pre-penicillin days, before the mid-1940s, when people had scarlet fever, and parents would burn their kids’ clothes or toys (read The Velveteen Rabbit) to avoid spread. In the first two months of Covid quarantine, the reaction was of sealing a loved one in their room with a bottle to pee-in, and sliding pizzas under the door for food. In China, health officials would literally sack-up a person, and haul them to an undisclosed location for a rather prolonged, well, quarantine.
After the first two months, we quit flipping-out and quit watching Contagion or I Am Legend and were more of quarantining at home and staying in opposite parts of the house, and everyone wearing a mask while around each other.
Also, we were to quarantine for 10 days after developing symptoms of Covid 19 if you test positive for Covid 19. In some ways life was simpler then. Ten days and you were done. There was no “But what if my symptoms were mild, like nasal congestion and a twitchy eye?” The answer was “No. See you in 10.” “But what if I was on the other side of the room, and not next to her when she coughed.” “No. Don’t let me see you back for 10 days. Go start a blog.” “Go binge The Crown or The Queen’s Gambit.” We got caught-up on The Mandalorian last year when my wife had Covid the first time.
Simple, but we started losing work staff or students to quarantine. Of course, the global shutdown solved much of that for a while. Most people were home. The quarantine mess mostly fell on us essential workers and healthcare workers; us few, us unhappy few, us band of brothers and sisters still navigating the pandemic and finding enough PPE (personal protection equipment) to wear.
August-December 2020
Then along the way health departments and the CDC realized that people were testing too early, like the second someone sneezed in the room, or suddenly thought they might have Covid 19 just because it was an existential moment, “I live, therefore I might have Covid,” not giving the virus time to replicate (rapidly grow in numbers) in the body enough to be detected on testing.
Then it changed at bit to quarantining for 10 days unless your Covid 19 test was negative, and you had to wait 5 days before testing. Now, that started to make sense because it takes 2-5 days for the virus to replicate after exposure.
February-March 2021
Covid vaccinations began in December 2020, and as we saw the infection rate drop by February-March 2021, the quarantine requirement changed somewhat to a more workable guideline, especially for any of us who are employers trying to determine who had to stay at home or return to work. If you were vaccinated and had no symptoms, you did not have to quarantine after exposure to Covid 19, but you would quarantine if you had symptoms after exposure, and again, testing for Covid 19 on day 5 after symptoms began. Now we’re talking.
Welcome to The Delta. July 2021
Then the weird times began when the Delta variant arose this past Summer 2021. Two months before, May 2021, we were all free at my son’s wedding and without masks. Then we went into “What do we do when we are vaccinated and have symptoms?” “Is it Covid or the Flu or Germain Measles?” “How did we get Covid now that we’re vaccinated?” My family and I were at Walt Disney World and Universal Studios in Orlando when this all started pouring out through the fan, by the way. We went from not wearing masks on the first weekend of our trip to “Mask!” everywhere at the end of the week. Try interpreting Covid guidelines through a theme park, in Florida, where public nudity was less likely to draw attention than wearing your mask. “No clothes, No problem.” “Mask? Pansy. Orwellian Kool-Aid drinker.” I credit it to the Lord Himself that none of us got Covid on that trip.
During this time, it seemed like everyone, including some health care workers, were disoriented by it all “Because it can’t be Covid, can it?” and also forgetting that other common illnesses still existed, such as Strept Throat or RSV (respiratory syncytial virus). We were so focused on Covid for over a year that we forgot that we still must be serious about symptoms and investigate them, both for Covid and for other diseases; and frankly this past Summer, I think we as a country got lost for a while, thinking it could not be Covid, but also with an amnesia about anything else that could make you sick.
“Doctor, what do you think he has?” “I don’t know…” then a bit of a soap opera pause and looking away, then turning back to his patient’s family and uttering “Maybe Ptomain or the Consumption.” What, are we diagnosing out of Dr. Livingstone’s Journal, or with chicken bones and Ouija boards? We had dealt with Covid and nothing else for too long.
Then we all started using our brains again, well 52% or so of us, and continued testing for Covid 19, and sure enough it was still here, and Worse Than Ever.
Fortunately, a few more people got vaccinated, but not enough, and not in time, and allowing Delta to get a foothold.
Omicron. November 2021
Then comes Omicron, the Omni-everywhere variant, which has brought us all-time numbers; but fortunately, at the time of my writing, not as great a percentage of hospitalizations or deaths per numbers of infected. Omicron seems to be the Copperhead of Covid: poisonous, but not always deadly, unless you are that guy that happens to die of Copperhead bites.
But let me be clear: Omicron is still serious, and infects more children, and it can kill; and just as importantly, it can still tie up hospitals from the sheer volume of those who get it.
On a slightly optimistic note, I think Omicron has brought us to a point of some rationality in a way. Its intensity and virulence is more like the Common Cold, is widespread, very easy to catch but not the Black Death of this past Summer 2021 or of March/April 2020. I think it gives us some mind space to get some perspective on quarantine, and not feel that it will automatically put us in the hospital.
Wow! Did you get all that!? That was a lot of information, but I am hoping that it demonstrates that the U.S. and global medical community are learning as we go; and I am sure the guidelines will continue to change as we learn more.
Carey Roach, MD is Board Certified in both Adult Internal Medicine and Pediatrics-Combined. Translated, he specializes in generalities and, sometimes, freaky medical problems of people from birth until 116 years. After 116, you're on your own. He practices primary care medicine at the Barg Family Clinic in Little Rock, Arkansas. Currently, his hobbies include learning to kayak, finishing reading The Lord Of The Rings trilogy, dating his bride of 23 years and experiencing first-hand her excellent culinary skills. He also gets to share with her in teaching and mentoring soon-to-be married couples. When there is not a global pandemic, he loves to travel with his wife and kids. His views are his alone, although based on research and experience; and do not necessarily reflect the views of the management or staff of the Barg Family Clinic (although he thinks they should.)
As with any medical information, verify it with your physician before making major medical decisions that would affect your health or the health of others.
Comentarios