When was the First Case of COVID-19 in the United States?

SARS-CoV-2 was not around last winter. COVID-19 truly is a novel infection.

Why do some folks continue to believe that COVID-19 has been around for a while and that it isn’t as novel a virus as the rest of us know it really is?

Jay Gordon thinks that he might have been seeing a lot of kids with COVID-19 in January, well before the first confirmed cases in the state.
Jay Gordon thinks that he might have been seeing a lot of kids with COVID-19 in January, well before the first confirmed cases in the state.

The usual suspects…

When was the First Case of COVID-19 in the United States?

While some are wondering if they were seeing COVID-19 in January, some think they were seeing in even earlier.

#COVidiots are spreading the idea that COVID-19 has been in the United States since December.
#COVidiots are spreading the idea that COVID-19 has been in the United States since December.

Were the first cases of COVID-19 here in December?

“Yeah, me too. I’ve been telling almost every patient I see that, well, you know it’s flu season, but it doesn’t seem like you have the flu, it seems like you have a really bad cough. And everyone I’m seeing, it’s like their coughs are worse this winter. And their coughs are lasting for 3 or 4 weeks, instead of 1 or 2 weeks. And something went around this winter that was not the flu. Flu went around too, but there was a really terrible cold going around and you’re right, it is really possible in hindsight that coronavirus has been here this whole time.”

Bob Sears

What do you think of when you hear Bob Sears talk about seeing kids with a “really bad cough” that lingers for a month?

Since he wrote a book pushing a non-standard, parent-selected, delayed protection vaccine schedule, my first thought is pertussis too…

That isn't the COVID-19 type of coronavirus they are talking about in the cold and flu reports from December!

This has been a fairly bad flu season though, and as early as December, there were high rates of flu in many parts of the United States.

That isn’t the COVID-19 type of coronavirus they are talking about in the cold and flu reports from December!

And since it was cold AND flu season, there were already high rates of other cold viruses, including RSV, adenovirus, rhinovirus, enterovirus, and non-COVID-19 types of coronavirus.

Still, that doesn’t prove that the SARS-CoV-2 virus that causes COVID-19 wasn’t around in December or earlier.

So what evidence do we have?

Well, we have the evidence that the first strains of SARS-CoV-2 emerged in Wuhan, China in November.

“From very early on, it was clear that the nCoV genomes lacked the expected genetic diversity that would occur with repeated zoonotic events from a diverse animal reservoir. The simplest parsimonious explanation for this observation was that there was a single zoonotic spillover event into the human population in Wuhan between mid-Nov and mid-Dec and sustained human-to-human transmission from this point.”

Trevor Bedford on Early warnings of novel coronavirus from genomic epidemiology and the global open scientific response
The first case of 2019 Novel Coronavirus was detected in Washington in January.

And we know that the first cases in the United States were seen in Washington in mid January.

Genomic epidemiological analysis traced the first case in Washington to a traveler from China in mid January.
Genomic epidemiological analysis traced the first case in Washington to a traveler from China in mid January.

Wait, how do “we” know that?

“The field of genomic epidemiology focuses on using the genetic sequences of pathogens to understand patterns of transmission and spread. Viruses mutate very quickly and accumulate changes during the process of transmission from one infected individual to another. The novel coronavirus which is responsible for the emerging COVID-19 pandemic mutates at an average of about two mutations per month.”

Trevor Bedford on Cryptic transmission of novel coronavirus revealed by genomic epidemiology

We know that because experts can examine the small mutations in the SARS-CoV-2 virus when it emerges in an area.

“We know that Wuhan went from an index case in ~Nov-Dec 2019 to several thousand cases by mid-Jan 2020, thus going from initial seeding event to widespread local transmission in the span of ~9-10 weeks. We now believe that the Seattle area seeding event was ~Jan 15 and we’re now ~7 weeks later.”

Trevor Bedford on Cryptic transmission of novel coronavirus revealed by genomic epidemiology

That has helped them track where and when the SARS-CoV-2 virus pops up in each part of the country.

The SARS-CoV-2 virus in each area is different enough that they can trace where it came from, but no, the differences aren't large enough to affect immunity.
The SARS-CoV-2 virus in each area is different enough that they can trace where it came from, but no, the differences aren’t large enough to affect immunity.

No we don’t have a time machine to test folks in November or December or even earlier, except to test those who submitted specimens in flu studies (which will be done as folks get caught up with testing new samples), but by examining the mutations in the virus, they can tell how long the virus has been spreading in each area.

And that has allowed them to create fairly detailed timelines of SARS-CoV-2 outbreaks in the United States.

Do any of these timelines show COVID-19 cases in the United States in December or early January?

Nope.

Is there any good reason you should be listening to the folks pushing misinformation about COVID-19?

Of course not!

Not surprisingly, these are the same folks who are well known to push misinformation about vaccines.

But why do they want you to think that SARS-CoV-2 has been around for awhile?

It’s propaganda to make you think that getting COVID-19 isn’t that serious.

Don’t believe them.

More on the First Case of COVID-19 in the United States

When New Moms Have 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.
  • having difficulty bonding with your baby once you get reunited, especially if it is a long separation

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.

In parts of the world where clean water is not guaranteed, exclusive breastfeeding might be essential to a baby’s survival. Did that influence the WHO’s guidance?

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

Confused?

“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?


UWMC Infant Care Guidelines 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.

More on When New Moms Have COVID-19

Are Kids Spreading SARS-CoV-2?

While new studies suggest that kids may transmit SARS-CoV-2, some other studies say they don’t…

Why do some folks think that kids aren’t spreading SARS-CoV-2, the virus that causes COVID-19?

Paul Thomas doesn't talk about any of the studies that do suggest children can spread novel coronavirus to others.
Paul Thomas doesn’t talk about any of the studies that do suggest children can spread novel coronavirus to others.

The usual suspects…

Are Kids Spreading SARS-CoV-2?

As Paul Thomas highlights, there have been studies and case reports that suggest children are not spreading SARS-CoV-2 to others.

“Studies of multiple family clusters have revealed children were unlikely to be the index case, in Guanzhou, China, and internationally A SARS-CoV2 positive child in a cluster in the French alps did not transmit to anyone else, despite exposure to over 100 people.”

An evidence summary of Paediatric COVID-19 literature

On the other hand, there are studies that suggest they do.

Another study found viral loads in children which suggests that they could pass the virus on to others.
Another study found viral loads in children which suggests that they could pass the virus on to others.

Something Paul Thomas doesn’t mention!

“Prolonged shedding of SARS-CoV-2 in stools of infected children indicates the potential for the virus to be transmitted through fecal excretion.”

Prolonged presence of SARS-CoV-2 in feces of pediatric patients during the convalescent phase

So what’s the answer?

Like much about COVID-19, we don’t know yet.

“Asymptomatic infection is least likely to pass on the infection, with a chance of 33 per 100,000 contacts.”

Modes of contact and risk of transmission in COVID-19 among close contacts

It would make some sense that kids might not be a big source of COVID-19 infections though, as they often are asymptomatic or only have mild symptoms when they get sick.

“Two new studies offer compelling evidence that children can transmit the virus. Neither proved it, but the evidence was strong enough to suggest that schools should be kept closed for now, many epidemiologists who were not involved in the research said.”

New Studies Add to Evidence that Children May Transmit the Coronavirus

But we won’t know until more research is done, especially as much of the current research is contradictory.

Research that will be important as we consider opening up schools again.

More on Kids Spreading SARS-CoV-2

Getting a Covid-19 Test Before Going to Summer Camp

Who told your child’s summer camp to test all of their kids for COVID-19?

Are your kids among the 11 million kids who usually go to a summer camp or day camp each year?

Do you have any memories about summer camp from when you were a kid?
Do you have any memories about summer camp from when you were a kid?

Are they going this summer?

Did you plan for a COVID-19 test?

Getting a Covid-19 Test Before Going to Summer Camp

While many parents are likely thrilled that their kids can still even go to camp, they might be confused on why they need to get a COVID-19 test if their child hasn’t been sick.

Your pediatrician is likely shaking their head about it too.

Memories of summer camp this year might include a weekly nasal swab for COVID-19 testing.
In addition to pushing tests while staff and kids are at camp, some camps want to have kids tested before they arrive.

After all, there is no recommendation for general testing in the guidelines for opening up summer camps.

Instead, the CDC says to “screen children and employees upon arrival for symptoms and history of exposure.”

“He said that optimally camps would retest each camper upon arrival and several times more through the summer: six times for a seven-week session and four times for a five-week session.”

Summer Camp Kids Are America’s Coronavirus Test Subjects

The CDC guidelines on Youth and Summer Camps do mention testing.

“Some camps might have the capacity to conduct COVID-19 testing. CDC has guidance for who should be tested, but these decisions should be made in conjunction with state and local health departments and healthcare providers.”

CDC on Suggestions for Youth and Summer Camps

But still, that guidance isn’t to test everyone, but only those who are high risk, with symptoms, or with suspected COVID-19.

What’s the problem with testing everyone at camp?

It could lead these camps to rely too much on testing instead of cleaning and disinfecting and encouraging hand hygiene, respiratory etiquette, cloth face coverings, and social distancing, etc.

Remember, COVID-19 tests can give false-negative results, so some people might actually be infected with the SARS-CoV-2 virus and have a negative test. Without a healthy environment at camp, that person might get many other kids and staff members sick.

And a true negative test just means that you are negative when the test was done. It doesn’t mean that you will remain negative until you have your next test.

Also, just because you aren’t testing everyone doesn’t mean that you can’t test those kids and staff members once they begin to show symptoms.

Are your kids going to summer camp this year?

Do they need a COVID-19 test before they go and while they are at camp?

More on COVID-19 Tests for Summer Camps

Those COVID-19 Death Comparisons

Don’t be mislead by the folks making false comparisons about COVID-19 deaths.

Have you seen folks trying to compare COVID-19 deaths to other things?

What other things?

All Dr. Phil revealed was that he shouldn't have been talking about COVID-19...
All Dr. Phil revealed was that he shouldn’t have been talking about COVID-19…

Basically anything and everything, from smoking, drowning, and car accidents to the flu…

Those COVID-19 Death Comparisons

It’s not that surprising that those comparisons were made when the COVID-19 pandemic first got going.

It’s like Jenga?

But it is disappointing that some folks are still making these arguments.

“I’m not denying what a nasty disease COVID-19 can be, and how it’s obviously devastating to somewhere between 1 and 3.4 percent of the population. But that means 97 to 99 percent will get through this and develop immunities and will be able to move beyond this. But we don’t shut down our economy because tens of thousands of people die on the highways. It’s a risk we accept so we can move about. We don’t shut down our economies because tens of thousands of people die from the common flu.”

Senator Ron Johnson of Wisconsin, chairman of the Senate’s Committee on Homeland Security and Governmental Affairs

What’s even worse, they seem to be using the arguments to discourage others from social distancing and wearing masks!

Fortunately, most people understand that you can’t really compare COVID-19 deaths to those other things.

It is like comparing apples to oranges. Sure, they are both fruits, but they aren’t the same kinds of fruits.

So why do some people make these false comparisons?

They do it to make you think that both sides of the argument are the same or are equal. After all, it makes easier to downplay COVID-19 deaths if ‘they’ can make you think they are the same as deaths from car accidents, drownings, and the flu, etc.

Instead of the death rate, it is more appropriate to use the case-fatality rate, which factors in the folks who actually had COVID-19.
Instead of the death rate, it is more appropriate to use the case-fatality rate, which factors in the folks who actually had COVID-19.

So why shouldn’t you make these comparisons?

For one thing, deaths from COVID-19 spiked suddenly. They haven’t been spread out over a year or many years, like deaths from car accidents, drownings, and cigarette smoking, etc..

“The demand on hospital resources during the COVID-19 crisis has not occurred before in the US, even during the worst of influenza seasons. Yet public officials continue to draw comparisons between seasonal influenza and SARS-CoV-2 mortality, often in an attempt to minimize the effects of the unfolding pandemic.”

Faust et al on Assessment of Deaths From COVID-19 and From Seasonal Influenza

Also, unlike car accidents and drownings, COVID-19 is contagious.

And don’t forget, we go to great lengths to reduce deaths from car accidents and drownings, with everything from seat belts, air bags, and life jackets to fencing around swimming pools and laws against distracted driving.

Does anyone say “life is about risk,” while throwing their toddler in the pool and walking inside?

We make efforts to reduce that risk!

What is your risk of being in a car accident?
What is your risk of being in a car accident?

We also go to some effort to understand those risks…

“If we overestimate our risk in one area, it can lead to anxiety and interfere with carrying out our normal daily routine. Ironically, it also leads us to underestimate real risks that can injure or kill us.”

National Safety Council on Odds of Dying

So what is your risk of being in a car accident?

Believe it or not, it is fairly low, with the average person filing a claim for a car accident once every 17.9 years.

And since only about 3 in 1,000 car accidents are fatal, the chance of you being in a fatal motor vehicle accident is also fairly low.

“The total number of confirmed COVID-19 deaths in the U.S. exceeds 115,000, outnumbering each of the leading causes of preventable injury death (58,908 preventable drug overdose deaths, 39,404 motor-vehicle deaths, and 37,455 fall deaths in 2018). However, the full impact of COVID-19 is even greater than the number of deaths and confirmed cases. The rapid increase in COVID-19 cases, the uncertainty regarding how long the pandemic will last and the disruption to normal everyday activities is impacting society like no other safety issue in modern history.”

COVID-19 Cases in the United States

How does that compare to getting and dying from COVID-19?

Where do you live? Are folks around you wearing a mask?

If you are working from home in a small town with few COVID-19 cases, then your risk is obviously much, much lower than someone who works around the public in a bigger city with rising case counts.

Do you have any risk factors for a more severe case of COVID-19?

While the overall case fatality rate is about 1%, that starts to go up as you approach age 50 and is higher for those with many chronic health conditions.

Most importantly, what are you doing to lower that risk?

Just like your risk of dying in a car accident is going to be much higher than average if you drink and drive, don’t wear a seat belt, talk on your phone, and speed, your risk of getting and dying from a SARS-CoV-2 infection is going to be higher if you live in or travel to an area with a lot of cases, are around a lot of people who aren’t social distancing or wearing masks, and you are in a high risk group.

The bottom line though, whatever your risk, are you going to take steps to increase that risk for your self and those around you or are you going to lower that risk?

More on COVID-19 Deaths

Getting Tested for COVID-19

Do you want or need to get tested for COVID-19? Do you know which test to get?

We have been hearing it over and over for some time now – anyone who wants a test can get a test.

The CDC is now shipping its laboratory test kit for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to qualified state and local public health laboratories.

As testing has become more widely available, that is somewhat true.

There are still some problems with COVID-19 testing though.

Chief among them is making sure you get the right test!

Getting Tested for COVID-19

First things, first.

Do you really need a test?

Many people who are not hospitalized might not need to be tested for COVID-19.

“Most people will have mild illness and can recover at home without medical care and may not need to be tested.”

Testing for COVID-19

The main reason that testing can be important though is that it can help limit your exposing others to SARS-CoV-2 once you have been exposed or suspect you are infected. And it can also help trace the people you have already been in contact with before you knew that you should be in quarantine.

Which COVID-19 Test Do You Need

If you think you are sick and want to get tested, do make sure you get the right test though, a viral test for current infection.

You do not want the antibody test (blood test), even though it may give rapid results, if you think you are sick now. The antibody test only checks for past or recent infections.

“CDC does not currently recommend using antibody testing as the sole basis for diagnosis of acute infection, and antibody tests are not authorized by FDA for such diagnostic purposes.”

Overview of Testing for SARS-CoV-2

Once you have narrowed down your test to the viral test for current infection, you might still have a choice to make, as there are several types, including:

  • Molecular Diagnostic Tests for SARS-CoV-2 – uses nucleic acid amplification techniques (PCR) to detect the RNA of the virus. These tests don’t necessarily take long to run, but since samples typically have to be sent out to a lab, that slows down the time to get results, sometimes up to 7 business days.
  • Antigen Diagnostic Tests for SARS-CoV-2 – detects fragments of proteins that the virus makes. Can give rapid results, in 15 minutes, but are more prone to false negatives than molecular tests.

Ready to get tested now?

There is still the problem of where to get tested…

Ideally, you might want to go to some kind of mobile, drive-through testing site, so that you don’t have to expose anyone else as you get tested. Unfortunately, those kinds of testing centers are not widely available.

Another ideal choice would be your own pediatrician. Are they doing COVID-19 testing?

With the Sofia2 analyzer, pediatricians can get rapid test results in just 15 minutes.

Lastly, you might just have to see if you county or state health department has a list of places doing testing.

What to Do After Your COVID-19 Test

What happens after your test is done?

  1. You are waiting for test results. Stay in isolation until you know the results!
  2. You are positive for COVID-19. You should stay home, in isolation, unless you need medical attention, only ending your isolation until you have gone 3 days without fever AND your respiratory symptoms have improved AND it has been 10 days since your symptoms first appeared. You should also tell all close contacts (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) that you tested positive so that they can self-quarantine for 14 days.
  3. You are negative for COVID-19 and don’t have symptoms after a recent exposure. Since the incubation period for SARS-CoV-2 is 7 to 14 days, a negative test before the end of the incubation period doesn’t mean that you won’t eventually develop COVID-19. You should likely remain in self-quarantine.
  4. Your COVID-19 antigen test was negative and you do have symptoms. Since this might be a false negative, depending on your health care provider’s suspicion that you could actually have COVID-19, they might now do a molecular diagnostic test for SARS-CoV-2. Or they might just recommend that you remain in self-quarantine.
  5. Your COVID-19 molecular diagnostic test was negative and you do have symptoms. Although more accurate than the antigen test, there is still the possibility that this could be a false negative. Whether or not you remain in self-quarantine depends on your health care providers suspicion that you could have COVID-19. Did you have a known, close exposure to someone with SARS-CoV-2, for example?

Are you ready to get tested?

More on Getting Tested for COVID-19

5 Things You Need to Know About COVID-19

5 things you need to know to protect yourself, your family, and your community until we finally get COVID-19 beat.

As cases start to rise again after our initial efforts to flatten the curve, you are either ready to throw up your hands, wondering what’s next, or are resigned to staying home for awhile.

“Plan A, don’t go in a crowd. Plan B, if you do, make sure you wear a mask.”

Dr. Anthony Fauci

But what if you do have to go out?

5 Things You Need to Know About COVID-19

While a lot of folks are making mistakes, it’s certainly not time to throw in the towel.

“It is important to remember that anyone who has close contact with someone with COVID-19 should stay home for 14 days after exposure based on the time it takes to develop illness.”

When You Can be Around Others After You Had or Likely Had COVID-19

Here are 5 things you need to know to protect yourself, your family, and your community until we finally get COVID-19 beat.

  1. While people probably aren’t contagious if they don’t have symptoms, they can be contagious in the days just before they develop symptoms. Unfortunately, you don’t know when that might be, which is why it is important to self-quarantine after you have been exposed (or think that you might have been exposed) for a full incubation period.
  2. Understand that SARS-CoV-2 is typically spread through close contact with someone who is infected (again, this is also in the days before they show symptoms). That means you can likely avoid getting sick if you practice social distancing (stay 6 feet away from other people), wash your hands often, and avoid touching your face, etc. To protect others, you should also cover your coughs and sneezes and wear a mask.
  3. Protect yourself if you are caring for someone at home with COVID-19, limiting contact, shared spaces, and shared personal items, etc.
  4. Avoid other people if you have COVID-19 until you are fever free for 3 days AND your respiratory symptoms are improving AND it has been at least 10 days since your symptoms first started.
  5. Get a viral test for current infection (not the antibody test) if you think you are sick and want to get tested for COVID-19.

Why is all of this important?

You can reduce your risk of COVID-19 by wearing a mask, washing your hands, and watching your distance.

Because there are still no real treatments for COVID-19, so while we wait for a vaccine, our best hope is simply to keep from getting sick.

More on COVID-19

What to Do if You Have Been Exposed to COVID-19

Folks need to understand that they should begin self-quarantine as soon as they learn that they have been exposed to someone with COVID-19.

Do you know what to do if you have been exposed to someone with COVID-19?

Because they could have been exposed to SARS-CoV-2, the virus that causes COVID-19, anyone who attended the party should self-isolate.
Because they could have been exposed to SARS-CoV-2, the virus that causes COVID-19, anyone who attended the party should self-isolate.

Hopefully you already know that you shouldn’t go to a party and expose lots of other folks…

What to Do if You Have Been Exposed to 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.”

COVID-19 Frequently Asked Questions

One of them is that many people simply don’t understand the importance of self-quarantining themselves after they have been exposed to SARS-CoV-2.

In addition to watching for symptoms, it is important to self-quarantine for 14 days after a COVID-19 exposure, the incubation period for SARS-CoV-2, something the Florida Department of Health forgets to mention...
In addition to watching for symptoms, it is important to self-quarantine for 14 days after a COVID-19 exposure, the incubation period for SARS-CoV-2, something the Florida Department of Health forgets to mention…

What happens if you don’t self-quarantine?

You may expose others in the days before you start to show symptoms (presymptomatic transmission).

But can’t you just get tested after your exposure to see if you have it?

Sure, you can get tested, but if it is negative and you are early in your incubation period, it doesn’t mean that you still won’t become sick later on. For example, you could have a negative COVID-19 test four days after being exposed to the virus, but then develop symptoms of COVID-19 two days later.

“Yes, you are still considered a close contact even if you were wearing a cloth face covering while you were around someone with COVID-19. Cloth face coverings are meant to prevent someone from transmitting the disease to others, and not to protect someone from becoming infected.”

COVID-19 Frequently Asked Questions

What if you’re not sure if you have COVID-19 and you are waiting on your test results?

That should be a no-brainer.

Self-isolate yourself why you are waiting for your COVID-19 test results!

Ideally, folks would be getting this information to self-quarantine after their COVID-19 exposure from a contact tracing team.
Ideally, folks would be getting this information to self-quarantine after their COVID-19 exposure from a contact tracing team.

And if you think you have COVID-19, be sure to tell all of your close contacts, which includes everyone who was within 6 feet of you for at least 15 minutes starting from 48 hours before you began feeling sick.

Of course, social distancing and wearing a mask are important too.

But folks need to understand that they should begin self-quarantine as soon as they learn that they have been exposed to someone with COVID-19. That’s the easiest way to limit the spread of SARS-CoV-2 and the size of outbreaks.

More on COVID-19

Why There is Still So Much COVID-19 Confusion

Cognitive biases, heuristics, and logical fallacies are likely affecting how you are viewing information and advice about COVID-19.

Early on, it was easy to understand why there was so much confusion about COVID-19, after all, it took some time before we even got a real name for the new or novel virus that is causing this pandemic.

And now?

While there is still a lot more research to do, we have already learned a lot about the best ways to help prevent and treat COVID-19 infections.

Do you know who to turn to for trusted information and advice about COVID-19?

Too many people don’t seem to understand that though…

Why There is Still So Much COVID-19 Confusion

Many people also don’t understand that advice and recommendations often shift and change as we get new information.

“It is irrational to hold any view so tightly that you aren’t willing to admit the possibility that you might be wrong.”

What would it take to convince you that you were wrong?

And of course, you have to expect that to happen when you are dealing with a brand new disease!

So what are people confused about?

Everything from the effectiveness of face masks to prevent the spread of the SARS-CoV-2 virus (they do) to whether our COVID-19 death counts have been inflated (we are probably seeing under-counts).

Surprisingly, some people are still confused about just how deadly COVID-19 infections really are.

If you think made-up news and information is true, you might want to rethink where you regularly get your news and information from...
If you think made-up news and information is true, you might want to rethink where you regularly get your news and information from

Why are so many people still confused?

“Compared with other Americans, adults who “often” use social media to get news about COVID-19 report higher levels of exposure to the conspiracy theory that the pandemic was intentionally planned.”

Three Months In, Many Americans See Exaggeration, Conspiracy Theories and Partisanship in COVID-19 News

Where are they getting their information???

Who do you trust for information and advice about COVID-19?

I’m guessing it isn’t from experts…

Who to Trust About COVID-19

Adding to a lot of the confusion we are dealing with are folks pushing misinformation.

As you learn who to trust for information about COVID-19, you will hopefully develop the skills you need to be more skeptical about all of the things you see and read.

“Although my main message is that awareness of cognitive biases can lead to more effective messages and measures to mitigate the effects of the pandemic, where cognitive bias is regarded as harmful, it may be helpful to take steps to reduce such bias. Education and awareness of cognitive biases are key, so that individuals and organisations question flawed or traditional thinking habits and try to promote evidence based thinking. At an individual level, the additional advice is to slow down in your thinking, pause and reflect, and seek external views.”

Covid-19 and cognitive bias

And you will hopefully turn to sources that many of us use, including:

Still confused?

Check your biases.

Don’t let them get in your way of following the advice from the experts that could protect you and your family from getting and spreading the SARS-CoV-2 virus.

What does that mean?

Well, if you don’t think anyone should tell you to wear a mask, then you will likely look for information and advice that says masks don’t work and aren’t necessary (confirmation bias).

You will also likely not believe any information and advice that says COVID-19 is deadly.

Why?

Well, if you believed it was deadly, then you would work to avoid it and try to keep those around you safe, including doing things like wearing a mask. Instead, cognitive dissonance, the anxiety you get from believing in two things that contradict each other, will push you towards believing things that reinforce your idea that you don’t have to wear a mask.

What to Know About COVID-19 Confusion

Tired of being confused about COVID-19 and other things?

“It’s sobering to note all the ways in which human brains distort decision processes; perhaps it’s a wonder that any good decision is ever made.”

How to Make Better Decisions About Coronavirus

Be more skeptical and look for new sources of information and advice and understand how cognitive biases, heuristics, and logical fallacies affect our decision making.

More on COVID-19 Confusion

What to Do if You Have Been Diagnosed with COVID-19

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?

What's worse than having a party when you have symptoms of COVID-19? How about refusing to cooperate with contact tracers who are trying to control an outbreak?
What’s worse than having a party when you have symptoms of COVID-19? How about refusing to cooperate with contact tracers who are trying to control an outbreak?

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.”

COVID-19 Frequently Asked Questions

One of them is that many people simply don’t understand the importance of staying away from others if they have been diagnosed (isolation) or exposed (self-quarantine) to SARS-CoV-2.

“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).

Ideally, folks would be getting this information to self-quarantine after their COVID-19 exposure from a contact tracing team.
Ideally, folks would be getting this information to self-quarantine after their COVID-19 exposure from a contact tracing team.

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?

It depends…

The CDC provides a variety of scenarios to help explain how long folks should stay in quarantine.
The CDC provides a variety of scenarios to help explain how long folks should stay in quarantine.

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.

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.

More on COVID-19