Guidance on exposures, quarantine, and testing

Prior to the Thanksgiving and Christmas holidays, I wanted to send out the set of standard guidance that I’ve been offering up for patients concerning exposures, testing, and quarantine. Our local cases are skyrocketing, as they are nationally. In characteristic fashion, once the infection enters a household, I’ve seen it spread through all family members in short order. Those older than 60, men, and individuals with co-morbid conditions like diabetes, COPD, and heart disease are definitely the highest risk for a serious course and complications from COVID-19. Pulse oximetry remains the best home tool to measure the severity of illness and need for hospitalization or advanced care.

Exposures and Testing:
An exposure is defined as spending 15 minutes or more within six feet of someone who tests positive within two days of that contact. Example: Lunch with a friend on Wednesday who then develops suspicious symptoms on Friday and subsequently tests positive. Masking by either party does not alter exposure definition but does lessen the risk of transmission. Meeting outdoors versus indoors also does not alter the exposure, but, again, lessens the risk of transmission.

With an exposure, one should quarantine at home for 14 days from the date of last contact. Do not leave the house for anything other than medical care. Household members in contact with you are not themselves in quarantine unless they have their own exposure. An exposure to an exposure is technically nothing. However, I’ve been recommending household members of an exposure reduce their time out of the house in order to reduce the possible spread of infection if the exposed member has contracted the infection.

With an exposure, no testing is needed unless one develops symptoms consistent with COVID-19. Testing when asymptomatic is not recommended as one can develop symptoms any time during the 14 day quarantine. One cannot test out of quarantine.

Exposure then develop symptoms suggestive of COVID-19:
If symptomatic, obtain testing. It is recommended that negative rapid tests be confirmed with a NAA or PCR swab. These are the send out tests we currently do in office and available many other places. In practice, not many rapid testing centers confirm negatives but it is the recommendation. Positive rapid tests do not require confirmation. My office is in the process of obtaining rapid testing and I’ll keep you updated to that process. I will be confirming all negatives with a PCR swab. Additionally, most rapid tests are only indicated for the first 5 to 8 days of symptoms. After that only the PCR swabs should be used.

If one tests negative, they remain in quarantine the full 14 days from last contact with a positive case. Again, one cannot test out of quarantine.

Symptomatic with positive test result:
If one is symptomatic and tests positive, then they should be in self isolation for at least 10 days. This is no contact with the outside world except for urgent medical care and limited contact with household members. Stay in one room if possible. Do not share household items. Remain masked at all times if unable to isolate in a single room. The three criteria that must be met to end self-isolation are as follows: 10 days have passed from the first symptoms, no fever for at least 24 hours without medications, and any symptoms are improving day to day.

As you prepare for the holidays, I urge you to plan carefully how you interact with your most at risk family members and how you travel. Our ‘safe’ bubbles overlap widely and within a few instances the number of people with whom we are in regular contact is very large. Exercising self restraint in your activities in order to protect your high risk family members and friends is a noble thing. “Greater love has no one than this, that someone lay down his life for his friends.” John‬ ‭15:13‬ ‭ESV.

Over the holidays, the Pillar PC team and I will be available to help you get through this time. We’ll be offering testing in the office as much as we can do it safely and announce when rapid testing comes online. Feel free to reach out by phone, text, or email as the situation warrants.

In the meantime, here are some helpful websites for you to keep on hand.

Symptom checker tool:
https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/coronavirus-self-checker.html

Quarantine guidance:
https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html

What to do if you are sick:
https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html

When you can leave self isolation after being sick
https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/end-home-isolation.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprevent-getting-sick%2Fwhen-its-safe.html

Knox County COVID Testing Locations:
https://covid.knoxcountytn.gov/covid-test-sites.html

Mark B McColl, MD
Internal Medicine and Pediatrics
Mark 2:17

Pillar Primary Care, PLLC
“Healthcare without hassles, built for you.”
10437 Hardin Valley Rd
Knoxville, TN 37932
Phone: 865-244-1800
Fax: 865-444-6002
www.pillarpc.com

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