Question: The organization I work for provides in-home services for children and teens with severe mental health issues. After suspending in-person services for 6 months, we are now returning to homes with a lot of safety precautions in place. One question that has come up — what is the best course to follow if the family has had known exposure to Covid (one of our screening questions prior to each visit)? On the one hand, we know testing is not always accurate; a family can get tested following exposure and be negative whereas a few days later they might actually show as positive. On the other hand, we can stay out of the home for 10 days as we allow the family to monitor for symptoms, however after 10 days they could be asymptomatic while still being Covid-positive and contagious. What is the best way to provide services to families with as little disruption as possible while also keeping our employees safe?
Answer: This question reminds me of the Q&A from 7/4 #Assymptomatic Transmission. You are right that the risk of false negative results, particularly early on in the infection, is real. This is why testing alone is insufficient; testing + self-quarantine is the best approach. As far as I understand it, the best course to follow if a family has had known exposure is to:
- Find out when that last known exposure transpired;
- Ask that the family member(s) who had the exposure get tested, ideally 4–5 days after exposure or as soon as symptoms appear (see Q&A of 10/22 #Testing);
- Assuming that the test is negative and 14 days have passed since the exposure, you are safe to interact (note: the self-quarantine period remains 14 days, per CDC guidance).
If the family cannot get tested and remains without symptoms for the 14-days post-exposure, it’s also *likely* safe to interact, but please take as many public health precautions as possible (wear a mask and ask that everyone you meet with wear a mask, keep 6+ feet apart, meet outside, if possible). I make this “likely” statement based on two pieces of current knowledge: 1) This 14-day window is the outermost window that symptoms could appear; 2) People who are asymptomatic are not considered contagious 10-days after testing positive. In instances where there is no test, I’m assuming that the asymptomatic person would have tested positive a few days after exposure; add 10-days to that and we basically get to the 14-day self-quarantine window. The problem here, however, is knowing whether the exposed family member who becomes asymptomatic has in turn exposed other family members. Such exposure would basically reset the clock. All that to say, please encourage the family to get tested in addition to self-quarantine!