You can’t test out of your 14 day COVID-19 quarantine after you have been exposed to someone with COVID-19.
Breaking News – new CDC guidelines do offer options for ending quarantine early. (see below)
Most people understand that they can’t test out of quarantine, right?
After all, if they are around others before their quarantine is over, they could end up exposing others to COVID-19!
Why Can’t You Test Out of Your COVID-19 Quarantine?
But why can’t you just test out of your COVID-19 quarantine?
Basically, if you have a negative COVID-19 test early in your quarantine period, it doesn’t mean that you can’t develop symptoms or test positive later on.
“If you are tested and the test is negative, do you still have to be quarantined? Yes. Someone exposed to a person with COVID-19 needs a 14-day quarantine regardless of test results. This is because COVID-19 can develop between two and 14 days after an exposure.”
Coronavirus Questions and Answers
Testing negative doesn’t get you out of quarantine.
A negative test simply means that you don’t have an active infection. It doesn’t mean that the SARS-CoV-2 virus isn’t still incubating inside you. And no, we can’t test for that.
So why get tested?
“If you do not have symptoms, it is best to get tested between 5-7 days after you’ve been in a high-risk situation. If your test is negative, get tested again around 12 days after the event. It can take 2-14 days for COVID-19 to develop, so even if you test negative once, you could still develop COVID-19 later and spread it unknowingly.”
Symptoms and Testing: COVID-19
Getting tested can be helpful because some people can test positive even if they don’t have symptoms, they can still be contagious, and this can help with contact tracing and can help you warn others that you exposed them to COVID-19.
Ideally, since you are in quarantine, you would not have exposed anyone else though…
And if you test positive?
Well, technically that does get you out of quarantine, but only to move you to a period of isolation, which is basically a stricter form of quarantine and lasts at least 10 days.
New Options to Test Out of Quarantine Early
And although it is not without risk, the CDC has suggested some alternatives to the traditional 14 quarantine after being exposed to someone with COVID-19.
This includes ending quarantine after day 7 if you have tested negative within 48 hours and you have no symptoms, understanding that you will have to continue to monitor yourself for symptoms each day and that this strategy has a 5-12% risk of failure (you might still develop COVID-19).
Or even ending quarantine after day 10 without testing if you have no symptoms, understanding that you will have to continue to monitor yourself for symptoms each day and that this strategy has a 1-10% risk of failure (you might still develop COVID-19).
“Persons can continue to be quarantined for 14 days without testing per existing recommendations. This option maximally reduces risk of post-quarantine transmission risk and is the strategy with the greatest collective experience at present.”
Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing
For most people, 14 days of quarantine will likely still be the safest option.
Do you know what to do if you get diagnosed with COVID-19?
Do you know what to do if you think you might be sick or have already been diagnosed with COVID-19?
Hopefully you know that you shouldn’t host a party and expose lots of other folks…
What to Do if You Have Been Diagnosed with COVID-19
Unfortunately, lots of mistakes are being made that are causing COVID-19 cases to again rise.
“For COVID-19, a close contact is defined as anyone who was within 6 feet of an infected person for at least 15 minutes starting from 48 hours before the person began feeling sick until the time the patient was isolated.”
“If possible, have the person who is sick use a separate bedroom and bathroom. If possible, have the person who is sick stay in their own ‘sick room’ or area and away from others. Try to stay at least 6 feet away from the sick person.”
Caring for Someone Sick at Home
What happens if you don’t stay away from other people?
You may expose others, beginning in the days before you start to show symptoms (presymptomatic transmission).
Once you are diagnosed with COVID-19, be sure to tell all of your close contacts that they have been exposed, which includes everyone who was within 6 feet of you for at least 15 minutes starting from 48 hours before you began feeling sick. That way, they can begin to self-quarantine and avoid exposing others if they get sick too.
How Long Will Your Quarantine Last?
How long will you have to stay home, away from other people?
If you are in self-quarantine because you were exposed to someone with COVID-19, then you should stay home for 14 days after your last contact with that person. That’s the incubation period for the SARS-CoV-2 virus. Keep in mind that your quarantine restarts every time you have a new exposure, although there are now options to shorten your quarantine.
On the other hand, if you are in isolation because you have been diagnosed with COVID-19, then you should stay home until:
at least 10 days have passed since your positive test (if you have been asymptomatic)
you are fever free for at least three days, have improving respiratory symptoms, and it has been at least 10 days since your symptoms began
You might also be able to end your quarantine early if you have two negative tests in a row at least 24 hours apart, of course, while fever free and with improving respiratory symptoms.
If You Have COVID-19
What if you need to go to the doctor or ER after you have been diagnosed with COVID-19?
Call ahead so that they can be prepared and don’t end up exposing any staff or patients.
Hopefully you will have mild symptoms that will go away as you rest and stay hydrated, but if you develop emergency warning signs or symptoms (trouble breathing, chest pain, confusion, and trouble staying awake, etc.), then seek emergency care, being sure to mention that you have been diagnosed with COVID-19.
What if you need to go somewhere else?
You shouldn’t go anywhere or be around other people if you are in isolation after being diagnosed with COVID-19.
“People who are in isolation should stay home until it’s safe for them to be around others. In the home, anyone sick or infected should separate themselves from others by staying in a specific “sick room” or area and using a separate bathroom (if available).”
Isolate If You Are Sick
When in isolation, you should stay home except to get medical care.
What if you need food, medicine, or something else that you don’t have in your home? Ideally, you would order it and have it delivered, being sure to not expose the delivery person. If that isn’t an option, call your local support services for help.
Everything you need to know to reduce your risk of getting and exposing others to COVID-19.
We are far enough into this pandemic that there really is no excuse that folks still don’t know about the importance of going into quarantine after being exposed or why you should practice social distancing and wear a face mask.
And yet, cases are once again surging all over the country…
7 Things to Know About COVID-19
In addition to knowing that the pandemic isn’t over and won’t be over for some time, you should know that:
you could have been exposed to SARS-CoV-2 if you had close contact (less than 6 feet apart) to someone with COVID-19 (has symptoms or tested positive) for at least 15 minutes, even if you were both wearing masks (sure, there is much less risk if you were wearing masks, but to be safe, it still counts as an exposure). And with the latest guidelines, the exposure doesn’t have to for a continual 15 minutes, but rather “a cumulative total of 15 minutes or more over a 24-hour period.” So if you were close to someone with COVID-19 for 5 minutes each hour for three hours, then that counts as close contact.
you can develop symptoms of COVID-19 from one to 14 days after you are exposed to someone with COVID-19. This is the incubation period for the SARS-CoV-2 virus and the time you should be in quarantine after your exposure (although there are some new options to end quarantine early).
testing negative soon after you are exposed to someone with COVID-19 doesn’t mean that you can’t develop symptoms later in your incubation period! Although testing is a very important part of containing this pandemic, you don’t necessarily need to rush to get tested right after you are exposed. You can, but understand that a negative test doesn’t get you out of your quarantine early. A positive test will shift you into a period of isolation, but know that some COVID-19 tests, especially the rapid antigen tests, are more likely to give a false positive result if you don’t have symptoms. If you are going to get tested after being exposed and don’t have symptoms, the optimal time is probably about 5 to 7 days after your exposure and remember to continue your quarantine if it is negative.
you can be contagious for at least two days before you develop any symptoms of COVID-19 or test positive and will continue to be contagious for at least ten days, the time you should be in isolation (a stricter form of quarantine). If you had severe symptoms or have a severely weakened immune system, then you might be contagious for a much longer period of time though, up to 20 days. And remember that you can continue to test positive for weeks or months, long after you are no longer contagious, which is why repeat testing is no longer routinely recommended.
you can be contagious even though you don’t have symptoms, which is why you should try to always wear a mask and practice social distancing when you are around other people. You don’t know who has COVID-19!
if you continue to be exposed to someone with COVID-19 in your home, your 14 day quarantine period doesn’t start until they are no longer contagious, as you will continue to be exposed that whole time. That’s why some folks end up in extended quarantine for 24 days- the 10 days that the COVID-19 positive person was contagious + 14 days of quarantine, which started once the person was no longer contagious.
we can’t count on natural herd immunity to end the pandemic, as that would mean millions and millions of people dying. But understand that there is a middle ground between the extremes of total lockdowns and doing nothing. Wear a mask, keep six feet apart from other people (social distancing), and avoid crowds until we get safe and effective COVID-19 vaccines!
Most importantly, know that the more people you are around, the higher the risk that you will be exposed to and get sick with COVID-19.
Is it really essential that you have a family gathering with 25 or 50 people right now, as cases begin to surge in your area? Will you be able to keep everyone six feet apart? Will they be wearing masks the whole time?
Do you want to keep schools and businesses open, even if they aren’t at full capacity?
Then wear a mask, practice social distancing, wash your hands, avoid crowds, and stop acting like the pandemic is already over or never existed in the first place!
If your child doesn’t want to wear a face mask, your pediatric provider might be able to offer more help than just an exemption.
Some parents who don’t want their kids to wear a mask at school might think about asking their pediatrician to write a mask exemption for their kids.
Before they do, they might understand that there are very few real medical reasons for these types of exemptions for wearing a mask.
Masks Control the Spread of SARS-CoV-2
More and more, we are learning that masks can help prevent the spread of SARS-CoV-2, the virus that causes COVID-19, protecting both the person wearing the mask and the people around them.
“The prevention benefit of masking is derived from the combination of source control and personal protection for the mask wearer. The relationship between source control and personal protection is likely complementary and possibly synergistic, so that individual benefit increases with increasing community mask use.”
Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2
Still, that doesn’t mean that everyone has gotten used to wearing them…
Hopefully, most folks do now understand why they are important though.
Wait, why are they important, especially if you are healthy and the people around you don’t have COVID-19?
up to two days before they test positive, even if they don’t have any symptoms
So if you are waiting to put on a mask until people around you have symptoms, then you will eventually get exposed, probably without even knowing it, and you might get sick, ending up in isolation, not being able to go to school or work.
And if you wait to put on a mask until you start to show symptoms, then you will likely eventually expose other people to the SARS-CoV-2 virus.
The alternative, if you want to reduce your risk of getting sick, is to just wear a mask any time that you can’t social distance (stay at least six feet apart) from other people.
Mask Exemptions for Kids During the COVID-19 Pandemic
So what are the medical reasons that kids, like adults, can’t wear a mask all day while they are at school?
In general, a child over age two years should wear a face mask unless:
they have a physical or intellectual condition that would keep them from being able to remove their face mask by themselves
they can’t tolerate wearing a face mask because they have a condition such as autism spectrum disorder, intellectual disability, or a mental health disorder
they have a physical or intellectual condition and wearing a cloth face mask gets in the way of their ability to communicate
But shouldn’t these kids just do virtual school if they can’t wear a mask, instead of getting an exemption?
While that might be an option for some kids, others need the extra services that they get at school, which they can’t get with at home schooling.
In addition to a face mask exemption, some things that might work in some situations when a child won’t wear a mask include:
a face shield
a transparent face mask
using different fabrics for the mask
trying a bandana or gaiter
try to desensitize your child to wearing a mask
What about asthma?
In general, most kids with well controlled asthma should be able to wear a face mask. If your child’s asthma is so severe that it is made worse by wearing a face mask, then they likely need an evaluation by a pulmonologist and it might be best to avoid being around others during the pandemic.
If your child can wear a face mask, but just doesn’t want to, then it might help to allow them to pick their own mask, with a comfortable fabric and fit, maybe even getting a mask with a favorite character on it.
“Model it! Make it familiar by wearing a mask too.”
There are strict rules that dictate how long you are contagious and when you are most contagious when you have COVID-19.
Why is it so important to know how long you are contagious when you have COVID-19?
Of course, it is so that you don’t expose anyone else and get them sick too!
How Long Are You Contagious When You Have COVID-19?
Fortunately, knowing how long you are contagious when you have COVID-19 isn’t as confusing as it might seem.
In general, you are contagious until 10 days have passed since your symptoms first appeared, as long as you are free of fever and your other symptoms are improving.
But what if you never had any symptoms of COVID-19?
“If you continue to have no symptoms, you can be with others after 10 days have passed since you had a positive viral test for COVID-19.”
When You Can be Around Others
If you had a positive COVID-19 test, but no symptoms, then you will continue to be contagious until 10 days after the test.
Other things you should understand about COVID-19 include that:
although you are generally contagious for 10 days after your symptoms start or you had a positive test, you can be contagious even earlier, up to two days before you develop symptoms (presymptomatic transmission)
you are most contagious in the first days when your COVID-19 symptoms start when viral load peaks
it is possible that you could continue to test positive for up to three months, even though you are out of the range of time when you are considered contagious (viral load is too low to cause disease), which is why most experts don’t recommend retesting after someone is diagnosed with COVID-19, especially as a method to figure out when to end home isolation
you should start making COVID-19 antibodies within 5-10 days of getting sick, which is thought to make you less contagious
while you are likely contagious for at least 10 days (how long you should stay in isolation) when you are sick with COVID-19, if on the other hand, you are exposed to someone with COVID-19, you need to quarantine for 14 days – that’s the incubation period for COVID-19 – how long it might take to develop symptoms after being exposed
Don’t want to deal with any of this?
Wear a mask, practice social distancing, wash your hands, etc., and work to avoid getting COVID-19!
Do the risks of separation outweigh the benefits when trying to avoid SARS-CoV-2 with a new baby?
Breaking News – The AAP has updated their guidance on newborns whose mothers have suspected or confirmed COVID-19. (see below)
Most of us are getting used to the idea of social distancing, staying home to flatten the curve, and the need to enter isolation if we actually get sick with COVID-19.
“Isolation separates sick people with a quarantinable communicable disease from people who are not sick.”
Legal Authorities for Isolation and Quarantine
In most cases, even if you are in a home with other people, isolation is doable, as you just stay in your own room and keep away from everyone else.
When New Moms Have COVID-19
What about if a parent develops COVID-19?
Should they stay away from their kids?
Well, yeah. It might seem extreme, but you don’t want to intentionally get your kids sick!
Even if you just had a baby?
“It was devastating when they wheeled in the incubator. It hadn’t occurred to me they would even suggest it.”
New Mom who was treated as a PUI for COVID-19
That’s a tough one!
After all, we know that separating a newborn from their mother has consequences, just as there is a risk that a baby could get infected with SARS-CoV-2 if their mom has it.
The idea isn’t new though.
“If the mother has tuberculosis disease, the infant should be evaluated for congenital tuberculosis (see Congenital Tuberculosis, p 848), and the mother should be tested for HIV infection. The mother and the infant should be separated until the mother has been evaluated and, if tuberculosis disease is suspected, until the mother and infant are receiving appropriate antituberculosis therapy, the mother wears a mask, and the mother understands and is willing to adhere to infection-control measures.”
Tuberculosis – RedBook 31st Edition
We already recommend separating newborns from their mothers if they have active tuberculosis disease.
“The optimal length of temporary separation in the hospital has not been established, and will need to be assessed on a case-by-case basis after considering factors to balance the risk of mother-to-infant influenza virus transmission versus maintaining maternal-infant bonding.”
CDC on Influenza Guidance Prevention & Control in Peri- and Postpartum Settings
And if a mother “is ill with suspected or confirmed influenza,” which is another good reason to get your flu shot if you are pregnant!
“Mother-to-child transmission of coronavirus during pregnancy is unlikely, but after birth a newborn is susceptible to person-to-person spread.”
COVID-19 on Pregnancy and Breastfeeding
So what should you do?
Surprisingly, in this case, the answer depends on who you ask and where you live…
“The determination of whether or not to separate a mother with known or suspected COVID-19 and her infant should be made on a case-by-case basis using shared decision-making between the mother and the clinical team.”
CDC on Considerations for Inpatient Obstetric Healthcare Settings
The guidelines from the Centers for Disease Control and Prevention mentions the “risks and benefits of temporary separation of a mother with known or suspected COVID-19 and her infant,” and offers tips on what to do if separation is not undertaken.
What are the risks of separation?
Well, they don’t actually list any of them, but you might expect them to include:
trouble breastfeeding, especially if you are having to pump and someone else is feeding your baby formula or expressed breastmilk with a bottle instead of a supplemental nursing system
an increased risk for postpartum depression, especially as a recent stressful event, having inadequate social supports (social distancing makes getting help, even when you have a new baby, hard), and trouble breastfeeding are all risk factors for PPD. In this case, both COVID-19 and the separation would be stressful events that could put a new mother at increased risk for PPD.
If you are going to make an informed decision, in addition to understanding the risks about your baby developing COVID-19, which can certainly be more severe in newborns and infants, it is important to know the risks of trying to avoid it.
Fortunately, any kind of separation for babies is typically brief.
Not surprisingly, the advice from the American Academy of Pediatrics seems more concrete.
“While difficult, temporary separation of mother and newborn will minimize the risk of postnatal infant infection from maternal respiratory secretions.”
AAP on INITIAL GUIDANCE: Management of Infants Born to Mothers with COVID-19
The INITIAL GUIDANCE from the AAP recommended separation and then, after hospital discharge, that mother’s with COVID-19 “maintain a distance of at least 6 feet from the newborn, and when in closer proximity use a mask and hand-hygiene for newborn care until (a) she is afebrile for 72 hours without use of antipyretics, and (b) at least 7 days have passed since symptoms first appeared.”
“Other caregivers in the home who remain under observation for development of COVID-19 should use standard procedural masks and hand hygiene when within 6 feet of the newborn until their status is resolved.”
AAP on INITIAL GUIDANCE: Management of Infants Born to Mothers with COVID-19
They have since updated that guidance, and while they still recommend separation as the “safest course of action,” because it is a controversial issue and separation has downsides, they now offer guidelines on what to do if mom chooses to room in with her baby.
They still advocate testing newborns if a mother is positive at about 24 hours of age, with repeat testing at 48 hours if the first test was negative.
The advice from the World Health Organization is very different though!
They do not recommend any type of separation.
“Considering the benefits of breastfeeding and the insignificant role of breastmilk in the transmission of other respiratory viruses, the mother can continue breastfeeding, while applying all the necessary precautions.
For symptomatic mothers well enough to breastfeed, this includes wearing a mask when near a child (including during feeding), washing hands before and after contact with the child (including feeding), and cleaning/disinfecting contaminated surfaces – as should be done in all cases where anyone with confirmed or suspected COVID-19 interacts with others, including children.
If a mother is too ill, she should be encouraged to express milk and give it to the child via a clean cup and/or spoon – all while following the same infection prevention methods.”
UNICEF on Coronavirus disease (COVID-19): What parents should know
It is important to note that the WHO isn’t saying that you don’t have to take any precautions! Respiratory hygiene typically includes wearing a mask, as you can see described in the above recommendations from UNICEF, etc.
What about the American College of Obstetricians and Gynecologists (ACOG)?
“To reduce the risk of transmission of the virus that causes COVID-19 from the mother to the newborn, facilities should consider temporarily separating (eg, separate rooms) the mother who has confirmed COVID-19 or is a PUI from her baby until the mother’s transmission-based precautions are discontinued.”
ACOG Novel Coronavirus 2019 (COVID-19) Practice Advisory
They also recommend separation.
“Mothers with suspected or proven COVID-19 and their infants should not be completely separated. Mothers and infants should be allowed to remain together, after potential risks and benefits of rooming-in have been discussed and allowing for shared decision-making with families and their health care providers. There is some evidence to suggest that infants can be infected with SARS-CoV-2 postnatally.”
Canadian Paediatric Society on Breastfeeding when mothers have suspected or proven COVID-19
In contrast, pediatricians in Canada do not recommend separation!
“Mothers can practice skin-to-skin care and breastfeed while in hospital with some modifications to usual processes. Among the precautions, mothers should don a surgical/procedure mask when near their infant and practice proper hand hygiene before skin-to-skin contact, breastfeeding and routine baby care. Mother and baby should be discharged home as soon as they are deemed ready and then convalesce at home with guidance from the hospital.”
Canadian Paediatric Society on Breastfeeding when mothers have suspected or proven COVID-19
Like the WHO, they simply recommend advanced hygiene.
“If the mother has COVID-19, there may be more worry, but it is still reasonable to choose to breastfeed and provide expressed milk for her infant. Limiting the infant’s exposure via respiratory secretions may require more careful adherence to the recommendations depending on the mother’s illness.”
ABM Statement on Coronavirus 2019 (COVID-19)
It is important to note though that all organizations recommend continued breastfeeding, or at the very least that babies get expressed breastmilk if they are not able to actually nurse if separated from their mothers.
“SARS-CoV-2 has not been detected in breast milk to date.”
AAP on INITIAL GUIDANCE: Management of Infants Born to Mothers with COVID-19
“One must weigh the risk of the newborn getting severe COVID-19 infection, which is rare but likely finite, with the risk of undermining the establishment of breastfeeding and the consequences of breastfeeding failure, which can be significant, particularly in low-income settings. Failure to establish breastfeeding could put the newborn at risk of food insecurity and other infections.”
COVID-19: Separating Infected Mothers from Newborns: Weighing the Risks and Benefits
What’s going to happen if you have a baby and you test positive for COVID-19?
You will talk to your health care providers, who will help you make the best decision for you and your baby.
And know that both hospitals and your pediatric provider are well equipped to keep you and your baby safe from SARS-CoV-2.