What if a child tests positive – how should parents and guardians care for that child safely? What if a parent has COVID-19 but does not have a child? How long should one stay in isolation? When should people be tested? What if everyone in the family contracts COVID-19 – do they need to 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. Lena Wayne: There is a big difference, and it is important to differentiate between the two. The guidance is very 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 been diagnosed yet. The CDC has very different guidelines for isolation versus quarantine, so specific terminology is important.
CNN: A lot of families are facing situations where someone is testing positive. If a family member—the parent—is diagnosed with COVID-19, what should they do next?
Wayne: That person should be immediately isolated from the others. A person who was just diagnosed with COVID-19 should be considered potentially infectious. Everyone else in the family should also get tested immediately. It is possible that the person who tested positive was not the first to contract COVID-19, and other members may also test positive.
CNN: What if everyone tests positive? Do they need to be separated from each other?
Wayne: If everyone has Kovid-19 then they do not need to be isolated from each other. This is because it is highly unlikely that they have different types of coronavirus; Presumably they all got the same strain from each other, and they’re not going to reinfect each other so quickly. Of course, the whole family should be isolated from other people.
CNN: What if it’s one child who tests positive, and everyone else is testing negative? Who will take care of the child?
Wayne: This is very difficult, especially if it is a young child who cannot take care of himself. I will see the condition of the house. Let’s say there are two parents or primary caregivers, and both have been vaccinated, raised and are generally healthy. Suppose there is another child who has not been vaccinated, and is therefore at higher risk for serious consequences from COVID-19 than the one who is vaccinated.
In that scenario, I would recommend dividing the household so that one parent takes care of the child who has COVID-19 and the other takes care of the child who does not. The two different “pods” should not interact with each other during the isolation period. If possible, they should not share any indoor space. They should sleep in different rooms, should not share the same bathroom and should not be found indoors at all during this time. Parents caring for a child with COVID-19 should wear a mask to reduce the chance of infecting themselves with the child.
CNN: Does isolation mean you must stay inside the whole time? Can you still go outside and get some fresh air?
Wayne: Technically, isolation means you have to stay inside 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 need to pass around a shared space to get some fresh air, you can move out. Please be careful, keep a very good distance from others, and do not share indoor space with people. None of us want to infect others unintentionally.
CNN: How long should someone be in isolation?
Wayne: The new CDC guidelines reduce the isolation period from 10 days to five days, with an additional five days of mandatorily wearing a mask. This means that you must remain in complete isolation for the first five days. After that, you can go out – to work, to the grocery and so forth – but you should wear a high-quality, well-fitting mask when out in public. Do not go to a setting where you will be without a mask, such as a restaurant.
When it comes to people in the same family, this guidance means that you really shouldn’t eat meals together or have other casual, masked encounters with uninfected members of your family in a 10-day period. . If the family is in two pods, the two should not be mixed inside their home for 10 days.
CNN: If someone had symptoms on Monday, got tested on Wednesday and then got results on Friday, when would the five-day clock start?
Wayne: Monday. The five-day clock begins when someone first starts getting symptoms. If someone is tested and they are asymptomatic, but their result is positive, the five-day clock starts from when they first got the test. If you’re unsure—for example, if you’re feeling a little lethargic on Sunday but don’t really have full symptoms until Tuesday—use the date you’re sure about symptoms.
Remember that counting starts from day zero. The first day is the first full 24 hours after the onset of symptoms or after testing positive.
CNN: When should you get tested again?
Wayne: The CDC is not recommending the test to rule out isolation. What they are saying is that you can take a rapid antigen test in five days, but if it is positive, you will have to be in isolation for five days.
I disagree with the CDC here. If you have rapid tests readily available, I think you can test from day five. If it is negative on the fifth day and negative on the next day (day six), I think it would be appropriate to end the separation. This can be important for families for whom being separated from each other is a major inconvenience. Importantly, a PCR test, while more accurate for early diagnosis, is not a test to use once your diagnosis has been confirmed. This is because the PCR test is so sensitive that it captures small fragments of the virus, and people infected with COVID-19 can still test positive by PCR, as they are no longer contagious.
CNN: What about those who initially tested negative for Covid-19? When should they get tested again?
Wayne: The CDC recommends that people who come into contact with someone with COVID-19 get tested no earlier than five days after their exposure. The agency breaks it down further by whether you’ve been vaccinated and raised, versus if you haven’t. It also considers people who had COVID-19 in the past 90 days as being vaccinated and extended. If you are not, you need to quarantine until a negative test result after at least five days and then wear a mask for five more days in public. If you are, you don’t need to quarantine, but you should still get tested in five days.
Here I’ll add a little more specifics to the CDC guidance. First, if you have quick tests readily available, I think it’s worth testing family members every day. They may not be taken out of quarantine until at least five days later, but if they test positive soon, it will change how family members interact with each other. Perhaps the entire family has already been exposed and will test positive in a day or two, eliminating the need to isolate each other.
Second, even though the CDC says those exposed are not required to quarantine if they are up to date on vaccines, employers and schools may have different guidance. Be sure to check with your kids or yourself before sending them back to school and work.