Thursday, April 2

To begin, I’m sorry to say we got a little ahead of ourselves. My wife needed her inhaler last night and again today. Just one puff each time. After consulting with medical professionals and family, we are now all on the same page. Inhaler use indicates she is still experiencing some shortness of breath. She should continue to use it as needed. The first complete day she goes without her inhaler

So, will be Day 0. So, let’s say we’re at Day -1.

I’ve had to remind my wife that this isn’t a “failure.” There is no value judgement. As long as she needs the inhaler, she should use it. When she doesn’t anymore, we’ll know she’s really ready. It’s not like we have anyplace to run off to. And at this point, what’s another day or two?

On a related note, I received the following today (reprinted with permission, edited slightly for clarity):

My family had a scare yesterday when we thought my sister-in-law was coming down with the coronavirus. She and my brother live with my 101-year-old mother, who is on hospice due primarily to respiratory issues. It turns out it was a false alarm, but we realized the need to put together an “isolate at home” protocol.

I have been following your quarantine posts and you have alluded to a moving target on the quarantine period for you and your wife. I have found literature on how to self-isolate but not so much on when you can come back out.

I found this article that quotes a doctor’s adviceThese precautions are (luckily) only temporary for as long as you or the person in your household is ill. “[People] can come out of isolation when at least seven days have passed since symptoms first appeared, it’s been at least three days without a fever (without use of medications), and respiratory symptoms are improving,” says Dr. Meyer.”

Can you share what you know? Like everything else with this virus I’m guessing it’s very fluid.

Well, how completely relevant to our current situation! And, yes, the information is challenging to sift through. Because we’re all still learning. But here goes.

On one hand are the treating doctors and nurses. They are speaking from three main perspectives.

  • First is treating the individual patient. What are the symptoms? What’s the course of the illness? What are the warning signs? What does it take for a person to get completely well?
  • Second, they are considering the latest anecdotal evidence being gathered in real time along with the patient data. What are we seeing in the patients we’re treating and what can we learn from that information? They add that information to the knowledge base as they see more patients.
  • Third, prevention. How can people protect against getting the illness and keep it from spreading if they have it?

On the other hand, public health professionals are first and foremost interested in how the illness is spreading and how to flatten the curve. The two women we’ve dealt with from the Santa Cruz County Health Department have certainly been compassionate and caring. But their priority is different. The information they collect feeds into the state and federal systems. And that’s also where they get their guidance, starting with the CDC.

To make matters even more challenging, the two have different scales and language. As I’ve discussed, we’ve adopted a counting system that uses the END of symptoms as the operative indication. This is certainly the most conservative approach. We’re taking it in part because we live with my wife’s 86 year-old father. While in relatively good heath, he does have medical challenges that put him at risk. So, our primary motivation is to — not to put too fine a point on it — KEEP MY FATHER-IN-LAW ALIVE.

At this point, the earliest we will be released is Tuesday, April 7. Let’s compare that with what the release date would have been if we followed the advice of the good Doctor Meyer quoted above.

“[People] can come out of isolation when at least seven days have passed since symptoms first appeared, it’s been at least three days without a fever … and respiratory symptoms are improving.”

My wife’s symptoms first appeared on Wednesday, March 11. Seven days later was March 18, which is two days before her tests came back. By the day she got her test results back, her fever had been gone for three days. If we followed the good doctor’s advice, we would have been out of quarantine THAT DAY. Her respiratory issues hadn’t even shown themselves yet. Instead we were told by our doctors she could be released 14 days after taking the tests. That was this past Monday. We had previously heard 14 days from the test RESULTS. That would have been today.

See the problem? We’re getting differing information from the medical professionals each time we talk with someone, let alone what is found with a Google search. And none of them was very specific about what “improving” or “gone” meant. The only thing that’s clear is that “14 days” is NOT A MAGIC NUMBER. It depends on when you start counting and your individual case.

To summarize, here’s what we have done. This is what I recommend you do.

  1. If you have the basic symptoms, presume you have it. There aren’t enough tests for everyone. So, behave “as if.” That means immediately going into self-quarantine.
  2. If a loved one comes down with symptoms and you have been in close proximity to them within the previous five days, assume you have it, whether you have symptoms or not. That means immediately going into self-quarantine. REMEMBER: half of the people who will contract the virus will be asymptomatic like me. That means you may never get sick. But you can kill someone else. On a related note: We entered quarantine together. We have not practiced six-foot social distancing but have taken some precautions. I took a risk by doing this. Plus, neither of us is leaving until both of us leave. This may not be what’s best for everyone.
  3. If you live in a household in which others are quarantined, practice social distancing and take other precautions. My father-in-law has not been allowed anywhere near us. The teens are designated Sherpas. The bring us food and supplies. When they do, they wear a mask and gloves, and spray the area with disinfectant. They leave us whatever is being delivered, then shout or text us that things are there. When things come into the house, they wipe them down before delivery. With laundry, I have a large, heavy duty “ziplock” bag I use for dirty clothes while traveling. So, I sealed dirties up in that, they wiped it down, and returned the finished clothes in a different plastic bag.
  4. No one else comes within a dozen feet of us. Most of our conversations within the house are by text, phone or Facetime. There are no exceptions.
  5. If symptoms worsen, ESPECIALLY respiratory-related ones, call your doctor immediately. If you need to go to the Emergency Room, call ahead and let them know you are coming. Prepare a sign indicating that you are COVID-19 positive if you have been tested, say suspected if that’s the case. They will want to send you to a location away from non-virus patients.
  6. BE CONSERVATIVE. Where are you going to run off to with everything on relative lockdown. I highly recommend the 0–1–2–3 counting system we’re using, which is the Public Health recommendation
  7. If in doubt, seek help! Our social networks can be more valuable than ever. HOWEVER, do not trust friends for medical advice. Go to trusted sources who are professionals or have done the research.

I hope this proves useful. I encourage you to contact me with individual questions. And please continue to send me ideas, suggestions and sources. Besides this being a record, I really want these posts to provide practical information. And I appreciate hearing people’s reactions.

Edited on 4/4 to correct timeline



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