July 21, 2020

Isolation vs quarantine

The CDC today adjusted its recommendations for how long to isolate after a positive test for COVID-19. The recommendation is now 10 days from when symptoms started or 24 hours after the fever breaks. If you have no symptoms, the period is 10 days after testing. This is based in better data. I am glad to get clarification to help my patients understand better. It has been confusing. The old recommendation was to have two (!?) negative tests before leaving isolation. It has been difficult enough to get even one test; but to get 2 more? Impractical and nearly impossible! Especially in some states. Keep in mind, though, that some people may have symptoms for longer, but almost everyone doesn’t have transmissible virus after 10 days. There is a difference in viral particles or RNA and a viable virus that can infect and reproduce.

Quarantine is essentially the same activity as isolation but for people actually exposed, so they don’t transmit COVID-19 before they get symptoms. The recommendation is still 14 days, the same you would need to quarantine yourself if you went to New York from Washington State. (We have now been added to the undesirable list based on our high R0 which has gone up). Of course, if someone develops COVID-19 their isolation is extend for 10 mores days from when symptoms started.

One of the big failings in testing I see is that people get tested, often after a known exposure or with mild symptoms, but then they don’t isolate or quarantine themselves while waiting for results. I hear these stories so often- in the news, congressmen, patients, co-workers. I am not sure what they are thinking or if they worry about exposing someone else. When they find out they are positive, most feel horrible they exposed others. I don’t necessarily blame that person. I think the testing site needs to educate and emphasize safety. But somehow we need to educate better on why physical distancing and mask wearing are important, in particular after possible exposure and after testing.

Last night I awoke from a vivid dream and could not get back to sleep. In the dream, I started coughing and knew I had COVID-19. That scared me; but what really upset me was that I coughed near Jamie without a mask and I was afraid I had given it to him. Such an awful feeling that stuck with me. I hope and pray that none of you every get that feeling. And I am grateful that it was just a dream.

The interesting news is that OB/GYN’s in several countries have noted a significant drop in premature births during our shutdowns. The reasons are unknown and at this point there is only speculation. However, many researchers, who have studied pre-term births and the causes, are now hoping to use this to seek possible preventive measures. Hopefully some good will come from this.

Wash your hands, cover your nose, stay 6 feet away from others, and be kind.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.

https://www.seattletimes.com/nation-world/how-long-should-you-isolate-if-you-test-positive-for-covid-19-new-cdc-guidance-says-10-days-not-14/

https://www.nytimes.com/2020/07/19/health/coronavirus-premature-birth.html