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COVID-19 – Isolation and Quarantine

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What is Isolation and Quarantine?

  • Isolation means that after you develop symptoms of Covid-19 and/or test positive for the SARS-CoV-2 virus, you need to stay apart from others so as to not spread the virus to them. This includes asymptomatic people who have a positive test.

 

  • Quarantine means that after you have had a high-risk exposure to Covid-19 (i.e. close and prolonged (more than 15 minutes) contact without prevention strategies (e.g. wearing of face masks or good ventilation), you need to stop being in contact with people and stay apart. This is in case you have contracted Covid-19 from your initial exposure.
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Protocol

  • You should isolate for 10 days after the start of suggestive symptoms (unless hospitalised, see below) or testing positive, and
  • quarantine for 14 days if you are exposed to a high-risk situation.
  • There is no need for you to test if you are asymptomatic (unless you are being screened as a frontline healthcare worker).
  • There is also no need to test or retest at the end of quarantine or isolation periods.
  • Do not rely on a negative test result to say you are safe, especially if you may expose vulnerable people, like the elderly or people with chronic medical conditions or cancer.
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Advice

  • Both isolate and quarantine mean stay at home; get someone else to shop for you if you can; try to keep away from people you live with and avoid all people in case you infect them. Open windows and wear a mask when you can’t avoid being in a space that others will use.
  • quarantine transforms into isolation if you get symptoms. For practical purposes, they mean similar practical steps – stay away from people as best you can!
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Quick Scenarios

It is useful to start thinking of a clock (a calendar or diary is useful) – and these possible scenarios that will help guide 99% of your decisions:

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Case Studies

SCENARIO 1

  • Someone with no symptoms goes to a drive-through testing station. The result is positive. How long do they have to isolate themselves for?

Recommendation

  • First of all, please stop testing if you do not have symptoms! As explained above, it does not help with decision making. But now we have the test, 10 days from the date of the test.

SCENARIO 2

  • A woman tests positive after she starts coughing. She self-isolates for 10 days, but on the 10th day her husband, who lives with her, also tests positive. When can she go back to work?

Recommendation

  • It is likely that she passed the virus to her husband some days before, and that she is now recovering. She can go back to work.
  • He should isolate and must observe the 10-day isolation from the start of his symptoms (or the day of his test if he has had no symptoms).
  • The test on him, especially as it probably took a few days to come back, adds almost no value here – he could have quarantined for 14 days from the last close contact with his wife, if she was isolated from everyone except him.

SCENARIO 3

  • A family of six, with one elderly person, one diabetic, and two children (one aged four, one six), are informed that their domestic worker, with whom they had close contact, is ill in hospital and tested positive for Covid-19.  The family enters quarantine, but the 6-year-old gets sick and gets tested positive. What should the family do?

Recommendation

  • The key question here is, how do you protect vulnerable members of the family from a member who is infectious to them? Isolation within family units is often difficult, especially with young children who may not understand physical distancing.
  • It seems the most effective way to deal with this is to either:
  • Ideally, quarantine the elderly and diabetic family members (higher-risk persons) elsewhere;
  • Distance them within the household as much as possible – stay in one room, open lots of windows, and wear masks).
  • Common spaces such as kitchens and bathrooms should be ventilated as much as possible; wait for some time (30 minutes with lots of windows open) after an infectious person has used these areas, and wipe surfaces.
  •  Flush the toilet with the lid down.
  •  If symptoms develop, watch them closely – any difficulty in breathing should trigger a trip to the hospital.

SCENARIO 4

  • A couple living with a 2-year-old child all have symptoms and test positive over a period of a week. One partner and the child get better, but the remaining partner has persistent symptoms. The well partner needs assistance with childcare from her elderly parents – when can the two parents leave the house safely?

Recommendation

  • The 10-day rule above applies.
  • Even the partner with symptoms (as long as improving) could de-isolate after this period.
  • But be aware that being elderly is high risk (as is diabetes, hypertension, obesity and HIV, as well as other chronic conditions), and being as careful as practical around the elderly parents seems sensible.

 

SCENARIO 5

  •  A domestic worker is involved in looking after an elderly man with Covid-19. How long should she quarantine for?

Recommendation

  • 14 days from her last close contact.

SCENARIO 6

  • Someone at work tests positive. When should the employer test everyone?

Recommendation

  • Don’t test ANYONE. Assess people’s exposure to the case, and, if significant (see above), quarantine them for 14 days. If not, carry on with the usual precautions.
  • We have found the first cases are often the wake-up call in the workplace you need, sadly, for employees and managers to take this seriously (tea rooms are notorious for people to relax their guard).
  • Use the opportunity this case affords to ensure strong adherence to interventions that we know work – physical distancing in the workplace, universal masking, proper hand hygiene, regular cleaning of routinely used surfaces, and checking for symptoms on a daily basis with employees staying home and seeking medical advice, if symptoms develop.

SCENARIO 7

  • Someone is returning from the overseas, how long should they quarantine for?

Recommendation

  • Current SA guidelines forcibly quarantine people for 14 days on return from international flights. This was based on when our epidemic was largely linked to people infected in other countries. It does not make sense now we have such widespread infection.
  • Air travel in general appears relatively safe, and it is unclear whether local and international travel risks are different (coming from a low-risk area may be safer than coming from an area in SA where the pandemic is raging). These guidelines need updating – but if you want to be super-safe, treat the travel as an exposure and quarantine for 14 days. DM/MC
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The Scientists Collective: 

Dr Nomathemba Chandiwana, Professor Francois Venter, Dr Joana Woods, Dr Bronwyn Bosch, Mohammed Majam, all at Ezintsha, University of the Witwatersrand; Dr Jeremy Nel, University of the Witwatersrand, Professor Marc Mendelson, University of Cape Town; Prof Shaheen Mehtar, University of Stellenbosch, Dr Elijah Nkosi, Dr Morgan Chetty, both family doctors; Professor Yunus Moosa, University of Kwa-Zulu Natal; Professor Shabir Madhi, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand; Dr Halima Dawood, University of Kwa-Zulu Natal; Dr Lucille Blumberg, National Institutes of Communicable Diseases; Professor Lucy Allais, Department of Philosophy, Wits Centre for Ethics, University of the Witwatersrand; Professor Glenda Gray, South African Medical Research Council; Professor Andy Gray, Division of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal; Dr Angelique Coetzee, South African Medical Association.

Courtesy of Daily Maverick 

Medical References

  • Wolfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Muller MA, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020.
  • Liu Y, Yan LM, Wan L, Xiang TX, Le A, Liu JM, et al. Viral dynamics in mild and severe cases of Covid-19. Lancet Infect Dis. 2020;20(6):656-7.
  • Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with Covid-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.
  • Xu K, Chen Y, Yuan J, Yi P, Ding C, Wu W, et al. Factors associated with prolonged viral RNA shedding in patients with Covid-19. Clin Infect Dis. 2020.
  • Bullard J, Dust K, Funk D, Strong JE, Alexander D, Garnett L, et al. Predicting infectious SARS-CoV-2 from diagnostic samples. Clin Infect Dis. 2020.
  • Arons MM, Hatfield KM, Reddy SC, Kimball A, James A, Jacobs JR, et al. Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility. N Engl J Med. 2020;382(22):2081-90.
  • Lui G, Ling L, Lai CK, Tso EY, Fung KS, Chan V, et al. Viral dynamics of SARS-CoV-2 across a spectrum of disease severity in Covid-19. J Infect. 2020.
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COVID-19 – Isolation and Quarantine

Quick Notes
Source: Daily Maverick
By The Scientific Collective