What if a child tests positive — how should parents and guardians care for that child safely? What if a parent has Covid-19 but their children don’t? How long should someone be in isolation? When should people be tested? What if everyone in the family contracts Covid-19 — do they need to be isolated from one another?
CNN: You’ve talked a lot about the difference between isolation and quarantine. What’s the difference and why is it important?
Dr. Leana Wen: There is a big difference, and it’s important to distinguish the two. The guidance is very different, depending on if you’re in isolation versus quarantine. Isolation is what you do when you are diagnosed with Covid-19. Quarantine is what you might have to do if you are exposed to Covid-19 but have not yet been diagnosed. The CDC has very different guidelines for isolation versus quarantine, so that’s why the specific vocabulary is important.
CNN: A lot of families are facing situations where someone is testing positive. If one member of the family —say a parent — gets diagnosed with Covid-19, what should they do next?
Wen: That person should immediately isolate from others. The person who was just diagnosed with Covid-19 should be presumed to be potentially infectious. Everybody else in the family should also get tested immediately. It’s possible that the person who tested positive was not the first person to contract Covid-19, and other members may also test positive.
CNN: What if everybody tests positive? Do they need to isolate from one another?
Wen: If everyone has Covid-19, they do not need to isolate from each other. That’s because it’s highly unlikely that they have different strains of coronavirus; they probably all got the same strain from one another, and they aren’t going to reinfect each other so quickly. The entire family, of course, should be isolating from other people.
CNN: What if it’s a child who tests positive, and everybody else is testing negative? Who’s going to care for the child?
Wen: This is very difficult, especially if it’s a younger child who can’t care for themselves. I would look at the circumstances of the household. Let’s say that there are two parents or primary caregivers, and both are vaccinated, boosted and generally healthy. Let’s say that there is another child who is not vaccinated, and therefore at higher risk for severe outcomes from Covid-19 compared with one who is vaccinated.
In that scenario, I’d recommend splitting up the household so that one parent cares for the child who has Covid-19 and the other one cares for the child who does not have it. The two different “pods” should not interact with one another during the isolation period. If possible, they shouldn’t share any indoor space. They should sleep in different rooms, not share the same bathroom, and not get together indoors at all during this time. The parent caring for the child with Covid-19 should wear a mask when with the child to try to reduce the likelihood of getting infected themselves.
CNN: Does isolation mean that you must be inside the whole time? Can you still go out and get fresh air?
Wen: Technically, isolation does mean that you have to be 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 have to pass any shared space to get fresh air, you could go outside. Please be careful, stay very well-distanced from others, and do not share indoor space with people. None of us wants to infect others inadvertently.
CNN: How long should someone be in isolation?
Wen: The CDC’s new guidelines essentially shorten the isolation period from 10 days to five days, with an additional five days wearing a mask. This means that you should stay fully isolated 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. Don’t go to settings where you will be maskless, such as restaurants.
When it comes to people in the same family, this guidance means you really shouldn’t have meals together or have other casual, maskless encounters with uninfected members of your family in the 10-day period. If families are in two pods, the two shouldn’t mix for 10 days inside their house.
CNN: If someone had symptoms on Monday, got tested on Wednesday and then got results back on Friday, when does the five-day clock start?
Wen: Monday. The five-day clock starts when someone first starts getting symptoms. If someone is tested and they are asymptomatic but have a positive result, the five-day clock starts when they first got the test. If you are unsure — for example, if you are feeling a little rundown Sunday but don’t really have full symptoms until Tuesday — use the date that you are certain of the symptoms.
Remember that the count starts at day zero. Day one is the first full 24 hours after the onset of symptoms or after the positive test.
CNN: When should you get tested again?
Wen: The CDC is not recommending testing to get out of isolation. What they are saying is that you can take a rapid antigen test at day five, but then if it’s positive, you must keep isolating for another five days.
I disagree here with the CDC. If you have rapid tests readily available, I think you can test starting day five. If it’s negative on day five and negative the next day (day six), I think it would be reasonable to end isolation. This could be crucial for families, for whom being separated from one another is a major inconvenience. Importantly, a PCR test, while more accurate for initial diagnosis, is not the test to use after your diagnosis is already confirmed. That’s because the PCR test is so sensitive that it picks up on small fragments of virus, and people infected with Covid-19 could still be testing positive by PCR weeks after they are no longer infectious.
CNN: What about those who tested negative for Covid-19 initially? When should they get tested again?
Wen: The CDC recommends that those individuals exposed to someone with Covid-19 get tested no sooner than five days after their exposure. The agency further breaks this down into whether you are vaccinated and boosted, versus if you are not. It also considers those who had Covid-19 in the past 90 days to be the same as if they are vaccinated and boosted. If you are not, you need to quarantine until a negative test result at least five days after and then wear a mask for five more days in public. If you are, then you do not need to quarantine, but you should still get a test in five days.
Here’s where I would add a bit more nuance to the CDC guidance. First, if you have rapid tests readily available, I think it’s reasonable to test family members every day. They may not be cleared from quarantine until at least five days later, but if they end up testing positive sooner, it would change how family members interact with one another. Perhaps the entire family is already exposed and will test positive in a day or two, which eliminates the need to separate one another.
Second, even though the CDC says that those exposed do not need to quarantine if they are up to date on vaccines, employers and schools may have different guidance. Make sure to check with them before sending your kids or yourself back to school and work.