This is post two of three to help address areas of confusion that I’ve encountered at my office over the past month. With COVID19 cases on the rise across the country, many states are in a worse place than they were this spring. Here is an interactive map from Dec 9th where you can type in your zipcode to see hospital capacity and ICU capacity for your location.

A number of individuals that I interact with when scheduling are understandably confused about who should stay home, when to stay home, and for how long. The confusion is natural. As new information regarding the COVID19 virus comes to light, we have to continually change our guidelines. We are also finding states and organizations trying to balance the harm of financial uncertainties against the public health risks associated with the current COVID19 caseload nationwide. This creates some confusing timelines.

It is still true that we continue to deal with a new virus. This means that we won’t know everything there is to know about it for many more months. We will also continue to see new information and guidance come out as the population starts to get vaccinated. Because of this situation, it is especially important to look for current information on guidelines from sources like the CDC, and WA State Department of health or your state’s department of health website for clear guidance. The best landing page for the CDC and COVID19 questions can be accessed here. There are clear guidelines for when you can return to work, what type of masks are effective and what masks are ineffective, and a break down of frequently asked questions on it.

Who Should Stay Home?

Anyone that has symptoms commonly associated with a cold or flu, no matter how mild, should stay home from work and appointments, as well as anyone that has had a family member with cold or flu symptoms in the past 14 days. COVID19 cases can present as mildly as just a runny nose. If you are questioning if you are getting sick, it is imperative that you stay home until you can get an accurate COVID19 test or wait out the recommended quarantine period. If you have a medical appointment and a household member woke up feeling ill within the past two weeks, it is important to answer ‘yes’ to the COVID19 screening survey question, “Have you had close contact with anyone with respiratory illness or a confirmed or probable/suspected case of COVID-19?” used at most medical offices.

Close Contact is defined as:

• You were within 6 feet of someone who has COVID-19 for a total of 15 minutes or more (regardless of whether or not you wore masks)
• You provided care at home to someone who is sick with COVID-19
• You had direct physical contact with the person (hugged or kissed them)
• You shared eating or drinking utensils
• They sneezed, coughed, or somehow got respiratory droplets on you

If a household member is sick or was sick within the past 2 weeks (such as your child, spouse, or roommate), it is best to reschedule appointments for 14 days after your first exposure to the ill household member. It is important that we remember to think about our family and household members when we answer the questions on the COVID19 screening survey employed by most health care facilities.

This also means that it is a good idea to avoid shopping, going out in public, etc until 14 days have passed after a household member became sick from any cold or flu symptoms— as long as you have not developed symptoms. If you develop symptoms, that changes your timeline of when you should go back out in public. Curbside pick up at grocery stores is an excellent option to avoid going into a grocery store during these windows of self isolation.

When Can You Return to Work or go back out into the world?

The CDC has clear guidelines for when people can return to work, or in the case of acupuncture or chiropractic appointments, when a person can reschedule to be back in the office for a treatment. For non-emergency medical appointments, it is best to follow the guidelines on return to work, or look into Telehealth appointments with your provider.

Return to work guidelines vary depending on the severity of your symptoms from COVID19. For mild and moderate cases you can return to work if three criteria are met.

• 1) You have been fever free without the use of fever-reducing medication for 24 hours
• 2) It has been at least 10 days since symptoms first appeared
• 3) Your symptoms are improving.

If your fever is gone, and it has been 10 days, but your cough is just as bad as it was on day four, you have to wait until your cough improves to return to work. Likewise, if it is day 9 and you still have a fever, you still can’t go back to work on day 10. Severe cases of COVID19 or for patients that are immunocompromised, the timelines are different. To read the details between mild, moderate, and severe cases of COVID19, return to work strategies, click here. Please note this timeline is for people with COVID19. The timelines are different if you were exposed and do not yet know if you contracted it from that exposure.

Ultimately though, if you were exposed to a respiratory infection it is best to assume it was COVID19 until proven otherwise, and to quarantine for 14 days after your exposure to that person. If no symptoms develop in 14 days, you can return to work and your regular pandemic activities. Now, I’ll tackle the next area of confusion.

There has been confusion over the recommendations of 10 days versus 14 days to end quarantine after an exposure. If you were exposed it is still considered safest to quarantine for 14 days or until a negative test result has been obtained. Here is a direct quote regarding the 10 day versus 14 days of quarantine after being exposed to an individual with COVID19: “CDC continues to endorse quarantine for 14 days and recognizes that any quarantine shorter than 14 days balances reduced burden against a small possibility of spreading the virus.” 10 days can be considered acceptable depending on local conditions and if the person has not developed symptoms. It is not risk free, and you must continue to monitor for symptoms of COVID19 developing. Again, this could be as mild as a runny nose as your sole symptom. To read the very well written and detailed description regarding 10 versus 14 days of quarantine after exposure to COVID19, click on the link here.

Accuracy of COVID19 Tests

If you read the link above, you’ll note that there is an additional option to end quarantine after 7 days if an individual gets a negative test result and continues to be symptom free. If you are asymptomatic, you must wait 5-7 days after exposure to get an accurate test result.

Please note that not all tests are created equal in accuracy. Please talk with your doctor about when you were exposed and which test will give you the most accurate negative that you can rely on given your timeline. If you work with or live with high risk individuals, it is best to get the most accurate test possible so that if you get a negative test result, you can believe in the results and ensure you are keeping those around you safe.

Some tests are more accurate closer to the exposure date if you have symptoms, while a different test may be more accurate later into your exposure timeline. If you are asymptomatic, that changes the timelines of which tests will give an accurate negative test result. Again, please talk with your doctor or medical site providing multiple options for COVID19 testing to assess which is the best test for you to get the most accurate result possible.

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