COVID-19 quarantining

Hx has been asked for COVID-19 advice by the De En temple staff with respect to whether people recovering from the virus should be allowed to visit the temple, or whether continued quarantine is necessary.

The short answer is that it continues to be complicated. The CDC has assembled all current evidence to date on this webpage, but there are always exceptions with unique clinical scenarios. Different hospitals have adopted different institutional policies, with some cases requiring epidemiological specialist input on a case-by-case basis. If you ask 20 doctors for their advice right now, you might get 21 different opinions.

Here is hx’s own opinion based on CDC guidance and the currently understood risks.

A person who definitely was infected with SARS-CoV-2 and did in fact test positive can be deemed “not contagious” if they meet ALL of the following criteria.

1. It has been more than 11 days from date of symptom onset. (CDC uses 10 days, but hx would like to be more conservative. It is also not unreasonable to use 14 days, which was the old CDC recommendation.)
2. They have been without a fever for >72 hours (WITHOUT the help of fever-reducing medications such as Tylenol or ibuprofen).
3. Their symptoms (cough, shortness of breath, fatigue, body aches) are improving. (These symptoms may linger for weeks due to complications from COVID-19, but patients are usually not contagious during this timeframe. As long as symptoms are improving and the above criteria are met, this gives us a reassuring picture.)

This guidance goes out the window if a patient has a dysfunctional immune system, such as if they are an organ transplant recipient on immunosuppressives, if they have an immunodeficiency virus such as HIV, or if they have another not otherwise specified immune system disorder.

A person who has already experienced a SARS-CoV-2 infection and has since tested negative for COVID-19 by PCR should not be contagious. But the PCR testing modality is very important. “Rapid” tests are less sensitive (less accurate) and should not be deemed as sufficient. If someone gets a test outside of a hospital and is not sure, they need to call to ask. However, a patient who is infected with SARS-CoV-2 and who meets the criteria of the above (and is otherwise healthy with no other complicating factors as above described) generally do not need to test negative by PCR before coming out of quarantine, as long as they meet all the above criteria. Hx say this very cautiously because we have seen some exceptions to this, but it does appear to be quite rare.

The above people hx would deem safe to invite to the temple, but they MUST continue to maintain social distancing >6 ft apart and wear masks at all times (just like everyone else). If there are any other sticky situations, hx is happy to provide advice on a case-by-case basis.