What if a child’s test result is positive – how should parents and guardians safely care for this child? What if a parent has Covid-19 but their children don’t? How long should a person be in isolation? When should people be tested? What if everyone in the family gets Covid-19 – should they be isolated from each other?
CNN: You’ve talked a lot about the difference between isolation and quarantine. What is the difference and why is it important?
Doctor. Lina One: There is a big difference, and it is important to distinguish between the two. The guidance is completely different, depending on whether you are in isolation versus quarantine. Isolation is what you do when you are diagnosed with Covid-19. Quarantine is what you may have to do if you have been exposed to Covid-19 but have not yet been diagnosed. The Centers for Disease Control (CDC) has very different guidelines for isolation versus quarantine, which is why specific vocabulary is important.
CNN: A lot of families face situations where someone tests positive. If a family member has been diagnosed – as a parent says – with Covid-19, what should they do next?
Wen: This person should be isolated from others immediately. It should be assumed that a person who has just been diagnosed with Covid-19 is potentially contagious. Anyone else in the family should also be screened right away. It is possible that the person who tested positive for the virus was not the first person to contract Covid-19, and other members may also have tested positive.
CNN: What if everyone tests positive? Do they need to isolate from each other?
Wen: If everyone has Covid-19, they don’t need to isolate from one another. That is because it is highly unlikely that they have different strains of coronavirus; It’s possible that they all got the same stress from each other, and they wouldn’t re-infect each other so quickly. The whole family, of course, must be isolated from others.
CNN: What if a child tests positive and everyone else tests negative? Who will take care of the child?
Wen: This is very difficult, especially if it is a younger child who cannot take care of himself. I was looking at the family’s circumstances. Suppose there are two parents or primary caregivers, both of whom have been vaccinated and fostered and are generally healthy. Suppose another child has not been vaccinated and is therefore more likely to develop severe outcomes from Covid-19 than a child who has been vaccinated.
In this scenario, I would recommend dividing the family so that one parent takes care of the child with Covid-19 and the other takes care of the child who does not have it. The different “pods” should not interact with each other during the period of isolation. If possible, they should not share any interior space. They should sleep in different rooms, not share the same bathroom, and not meet indoors at all during this time. A parent caring for a child with Covid-19 should wear a mask when with the child to try to reduce the possibility of infection.
CNN: Does solitude mean you have to be inside all the time? Can you still go out and get fresh air?
Wen: Technically, solitude means that you have to be indoors and away from others. However, this is where you can use common sense. If you live in a house, townhouse, or apartment where you don’t have to bypass any common space to get fresh air, you can go outside. Please be careful and keep away from others well and do not share the indoor space with people. None of us want to inadvertently infect others.
CNN: How long does someone have to stay in isolation?
Wen: The new Centers for Disease Control and Prevention (CDC) guidelines essentially shorten the isolation period from 10 days to five days, with an additional five days wearing a mask. This means that you must stay completely isolated for the first five days. After that, you can go out – to work, to groceries and so on – but you must wear a high-quality, well-fitting mask when out in public. Do not go to places where you will be without masks, such as restaurants.
When it comes to people of the same family, this guidance means that you shouldn’t really have meals together or have casual, mask-free encounters with uninfected members of your family in a 10-day period. If families are in 2 capsules, they should not mix for 10 days inside their home.
CNN: If someone had symptoms on Monday, got tested on Wednesday and got the results again on Friday, when does the five-day clock start?
Wen: Monday. The five-day clock begins when symptoms first begin. If a person has been tested and is asymptomatic but the result is positive, the five-day clock begins when the test is first taken. If you are unsure – for example, if you feel a little troubled on Sunday but don’t have full symptoms until Tuesday – use the date you are sure of symptoms.
Remember that counting begins on day zero. Day 1 is the first full day 24 hours after symptoms appear or after a positive test.
CNN: When should the test be taken again?
Wen: The CDC does not recommend testing to get out of isolation. What they say is that you can take a rapid antigen test on day five, but if it’s positive, you should continue to isolate for another five days.
I do not agree here with the CDC. If you have quick tests readily available I think you can test start on day five. If the result is negative on the fifth day and negative the next (the sixth day), I think it would be reasonable to end the isolation. This can be critical for families, for whom being separated is a major inconvenience. Importantly, the PCR test, while more accurate for initial diagnosis, is not the test to use after the diagnosis has already been confirmed. That’s because the PCR test is so sensitive that it picks up small parts of the virus, and people with Covid-19 can still still be PCR-positive weeks after they haven’t been infected.
CNN: What about those who initially tested negative for Covid-19? When should they be tested again?
Wen: The CDC recommends that individuals who have been exposed to someone with Covid-19 get tested no later than five days after their exposure. The agency also breaks this down into whether or not you’ve received a vaccination and booster. It also considers those who have contracted Covid-19 in the past 90 days as if they had been vaccinated and boosted. If you are not, then you need to quarantine until after at least five days a negative test result appears, and then wear a mask for another five days in public places. If you are, you don’t need to be quarantined, but you should still get tested within five days.
Here is where I can add more nuances to the CDC guidelines. First, if you have quick tests readily available, I think it makes sense to test family members every day. They may not be cleared of quarantine until at least five days later, but if they end up with a positive result sooner, it will change how family members interact with each other. Perhaps the whole family is already exposed and will test positive in a day or two, eliminating the need to be separated from each other.
Second, although the Centers for Disease Control and Prevention says that those who are exposed do not need to be quarantined if they know about vaccines, employers and schools may have different guidelines. Make sure to check with them before you send your children or yourself back to school and work.