COVID CHRONICLES Day 21
Making Sense of Confusing Advice
Friday, April 10
Three weeks ago today, we received word that my wife tested positive for the COVID-19 virus and I began this diary. Since then, information and recommendations have evolved, as I’ve documented.
The most confusing thing in our experience lies in determining how long people need to remain in isolation or quarantine. We received NO LESS than four different recommendations from two sources!
Here’s a note I received today, reprinted with permission, with slight changes for copyediting and formatting.
“My husband tested negative but continues to work so we never know what he may contract. We have a 28-year daughter with developmental disabilities who lives in a large group home setting; they have 50 residents and many staff members who come and go for three shifts per day. They had a few residents test positive last week so we had her tested.
“We found out today that she tested positive. The residents were not allowed to leave the facility other than to go outside and no visitors were allowed for the past three weeks. Since last weekend all residents have been isolated in their rooms. There are now 8 residents who tested positive. I’m told they will be isolated for 14 days from testing (which was this Tuesday). But I don’t know what their plans are after that. As of now, none of the 8 residents are showing any symptoms.
“You have written a lot about the numbering system of days and I’m so confused because no one here (in New Jersey) seems to know the details like you have explained them. I’m wondering about your thoughts on our timeline.”
No wonder people are confused. IT IS CONFUSING! Let me summarize my understanding here.
- Here are some relevant facts to consider:
a. Those infected may never show any symptoms.
b. Those infected may exhibit only a few of the symptoms.
c. Transmission can happen via direct contact, through the air or from a variety of surfaces. - Here are the relevant dates to consider:
a. Date of exposure (this is often the hardest to pin down)
b. Date of isolation or quarantine (either before or after 2c and 2d)
c. Date of first symptoms (may have to look back if/once more serious symptoms appear)
d. Date of confirmation of COVID-19 infection (if a test is administered)
e. First day symptom-free. (this is THE most important date, and can only be determined on the second day because symptoms can disappear and return)
f. Fourth, seventh, or 14th day symptom-free depending on your specific circumstances.
g. Fourteenth, 21st or 28th day after the first day of isolation. - Here are my working assumptions.
a. If in doubt whether you have it, presume you do, and respond accordingly.
b. If you’ve potentially been exposed, assume you have it and respond accordingly.
c. Consult with your personal medical professionals, follow their directions, and trust their decisions on testing.
d. If you live with people at risk, be extra conservative and diligent by staying in isolation, wearing gloves and masks, and cleaning surfaces.
e. There is nothing to rush back for. The world is shut down. Act accordingly.
Ok, let’s take the specific example in the question above.
- “We found out today that she tested positive.”
That’s April 10 under 2c. - “The residents were not allowed to leave the facility other than to go outside and no visitors were allowed for the past 3 weeks.”
That’s March 20 under 2b, Quarantine. - “Since last weekend all residents have been isolated in their rooms.”
That’s April 3 under 2b, Isolation - “There are now 8 residents whom tested positive. As of now, none of the 8 residents are showing any symptoms. I’m told they will be isolated for 14 days from testing (which was this Tuesday).”
That’s April 7 for testing and April 21 for them to come out of isolation. - “But I don’t know what their plans are after that.”
They may not either!
Ok, let’s break that down further. First, testing.
The value of testing in this case is that it gives one a date certain from which to start counting BACKWARDS to help determine the date of infection. The date of test or results are USELESS when determining when it is safe to come out of isolation. So, I’m sorry to say that this advice on 14 days after testing is WEEKS old (which in the course of information about this virus is a lifetime).
How should they be counting instead?
The latest the residents of the home were exposed was April 3, when everyone entered isolation. Symptoms should appear within 14 days of that. That means anyone who is going to develop symptoms is extremely likely to do so by April 21. HOWEVER, there is evidence that someone with the virus may remain contagious for up to 21 days.
So, especially in a group living situation, the EARLIEST anyone should be allowed out of isolation is April 28.
But wait. There’s more. What if someone DOES develop symptoms between now and the 21st? Then their clock starts completely over. That means they are in isolation indefinitely. When their symptoms are gone, they again start counting until day four or seven or whatever else is being recommended by their doctor at that point in time.
There are several official sources to help keep up with evolving developments (beyond my blog, which I will continue to keep up-to-date)
County and State Departments of Health — Start local. Our county health department is tracking local cases and the most up-to-date recommendations from CDC. Our state is helping lead the way in providing daily updates. But the quality of your local and state information may vary.
Centers for Disease Control (CDC) — As a federal government agency, there are unfortunately some politics involved in what the folks from CDC can say publicly about policy. But this agency is still the definitive source of information for the U.S. and most health department are depending on CDC data and recommendations for guidance.
World Health Organization (WHO) — For a global perspective, they are the go-to source.
I hope this helps clear up some of the confusion without causing more! Let me know if you have further questions about this topic, or other questions you’d like to see my answer. Community-sourcing is what is making this work!
