Many Americans are looking forward to making up for all those lost in-person holiday celebrations last year due to the coronavirus pandemic. But with the current seven-day daily average of nearly 83,600 COVID-19 cases, the reality of the coronavirus pandemic still looms.
While almost 200 million Americans are fully vaccinated, nearly one-third of the total U.S. population remains unvaccinated, according to the Centers for Disease Control and Prevention.
Adults who are unvaccinated are six times more likely to be infected with the coronavirus compared with someone who is vaccinated against COVID-19, according to the CDC. Vaccinated people are also far less likely to develop serious illness or die if they do contract COVID-19.
“If you get vaccinated and your family is vaccinated, you can feel good about enjoying a typical Thanksgiving, Christmas, with your family and close friends,” Dr. Anthony Fauci, President Biden’s top medical adviser, said Monday.
Dr. Leana Wen, emergency physician and public health professor at George Washington University, spoke to Yahoo News about what to do if you or someone in your household tests positive for COVID-19.
(Some responses have been edited for clarity.)
Yahoo News: What are the first steps you should take if you learn of a previous COVID-19 exposure?
Dr. Leana Wen: Let’s say that you were at a holiday gathering and you find out that the person who you were sitting next to at dinner all night the night before has just tested positive for COVID-19. Meaning that that person should have been in isolation, but they didn't know that they had COVID at the time, they just tested positive. If that's the case, you should now be technically in quarantine, depending on if you are vaccinated or not.
Let's go through these two scenarios. If you are not vaccinated and you were exposed to somebody with COVID-19 — meaning that you had at least 15 minutes of contact with that person within 6 feet of that individual for a cumulative of 15 minutes over a 24-hour period — if that's the case and you are unvaccinated, you need to quarantine immediately, meaning that you should not be around others; you should be separate from others in your household, staying in your bedroom, not sharing space, sharing air with other people in your household or anybody else. You should then get tested within five to seven days. If your test is negative after seven days, you are able to leave quarantine. But if it's not, or if you start developing symptoms, then technically you have COVID-19 after that point.
This is very different in that second scenario if you are vaccinated. If you are vaccinated and you are exposed to somebody who is known now to have COVID-19, you do not need to quarantine. What needs to happen at this point is that when you are out in public, you still need to be wearing a mask, but you do not need to be quarantining. You should still be getting a test at least five days after your initial exposure. And then after that, you can stop wearing a mask when around other individuals. But that's a big difference between if you are vaccinated versus if you are not.
What’s the difference between “quarantine” and “isolation”?
If you have symptoms and have been diagnosed with coronavirus, you should be in isolation, meaning that you should not be around other people because you could potentially infect them.
Quarantine is, by definition, something different. If you're in quarantine, you've been exposed to somebody with coronavirus, you could have COVID-19, but you do not yet have symptoms. You have not yet had a test that tells you that you for certain have COVID-19. If you do have COVID, you're in isolation. If you do not yet have symptoms and you've been exposed, you're in quarantine. That's important. These terms are sometimes used interchangeably, but they're actually quite different because of what happens if you're in either quarantine versus in isolation.
What is the timeline for isolation if you test positive for COVID-19?
The timeline is when you first start having symptoms. So you should be in isolation, away from others, 10 days after the onset of your symptoms. And so day one is the onset of your symptoms. You should be isolated from others for 10 days after, and the other criteria includes that you have to be fever-free at the time that you're clearing from isolation for at least 24 hours, meaning in the 24 hours before you're cleared from isolation, you cannot have a fever and you cannot be taking fever-reducing medications.
If you do not have symptoms, you just had a positive test. Then day one is your positive test, and you have to be in isolation for 10 days after that.
What do you do if a child in your household tests positive for COVID-19?
Let's say that your child or somebody in your family now has a known diagnosis of COVID-19. Regardless of whether they have symptoms, they should be in isolation. So that child ideally should not be around other members of your family, should be in a bedroom where they're not sharing the same air as other individuals. Now, young kids obviously cannot take care of themselves, and so if that's the case, if there is a young child who has COVID-19 and there are two adult caregivers, I would assign one caregiver to take care of the child who is known to be infected, and the other caregiver can take care of the others who might be exposed but have not yet had the diagnosis of COVID-19.
So try to split that family so that it reduces the chance of other people, including other unvaccinated children, being further exposed to COVID-19. Try your best to isolate the child who has COVID into their own bedroom. If they're going to be entering a shared bathroom with others, try to leave at least 30 minutes between when that child is using the bathroom and when other people are using that shared space. Open all the windows, blow a fan in that room to try to increase the ventilation in that space.
The caregiver that is caring for the child with known COVID should ideally be vaccinated and using an abundance of caution. That individual should ideally be masking every time they're in that shared space with the child as well. In the meantime, the entire family should be considered to be in quarantine for those individuals who are unvaccinated. So if there are other unvaccinated children, they should not be going to school. The parents and older kids, if they are fully vaccinated, they should still be masking when going to indoor shared spaces, although they should also be looking at local regulations and employer rules.
Many employers may not want the parent of a sick child who has COVID to still be going into work, even if they're fully vaccinated. The CDC says that they can go in to work. Many employers may not want them to, for fear that they could have COVID and spread it to other people in their workplace. All those other individuals in that household, regardless of vaccination status, should be tested within five to seven days of exposure to their ill family member. And that test is going to be critical for when they can clear their quarantines.
If you test positive for COVID-19, what timeline should you follow to determine which people you had contact with should be notified?
Generally you should be going back at least 48 hours, because the 48-hour period actually is about symptoms. So 48 hours before the onset of your symptoms is when you are potentially infectious. There are some studies to suggest that you could be maximally infectious even in that 48 hour window before your symptoms begin.
What becomes difficult is what happens if you have no symptoms and you have a test and that test is positive. Forty-eight hours I think should be more than sufficient because you were never symptomatic. And so it's possible that maybe you could have had your maximum level of virus five days ago and you're just now testing positive. You could go back three to five days or even seven days, but I think really that 48-hour period prior to your symptoms is when you should be the most concerned.
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