Q&A: Someone in your family has COVID. Now what?
After more than two years of dealing with the pandemic it's time to revisit best practices for testing, treating and recovering from the newest strains of coronavirus, and how to protect your household from unnecessary infections.
With persistently high case rates, and new extra-contagious omicron strains, what exactly are you supposed to do now in the growing eventuality that someone in your home tests positive for COVID-19?
Can you and others in your home avoid infection? And when are you in the clear?
The answers to some of these questions have changed with the dominant BA.4 and BA.5 variants often evading immunity for even the double-boosted. So let’s revisit what we know now, and how best to use the new tools available amid this latest, lengthy surge.
Q: First, how widespread is the virus these days?
A: The Bay Area’s COVID case rates have been over 30 daily cases per 100,000 residents for over two months, during the sustained crest of what some have called the “silent wave” of new omicron strains. Luckily for those testing positive now, widespread vaccinations, boosters, and therapeutics have improved outcomes and lowered hospitalizations and death rates from the virus, dramatically for the elderly.
Q: Someone in your home was exposed to a person who tested positive. What should you do?
A: Step one, wear a mask and stock up on at-home rapid tests. Dr. John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology at UC Berkeley’s School of Public Health, says that your response to a COVID exposure or a positive case in your home should depend on how vulnerable members of your house are to severe disease, hospitalizations and death.
He suggests finding a “sweet spot” between isolating and continuing your normal behavior, that matches that vulnerability. Homes with elderly family members, immunocompromised residents, or unvaccinated people should fall on the more careful side of the spectrum, while others might choose to isolate less severely or for less time.
Q: Are you doomed to get COVID if somebody else at home tests positive?
A: Even with close contact with infected family members, secondary infection is not guaranteed. So if someone in your home is sick or tests positive, but others in your house aren’t feeling sick and are negative on a rapid test, it’s worth it to try to prevent further exposure.
Masking, opening windows and using a HEPA air filter are all good tools, as well as isolation when space allows it.
“Best practice is not what everyone can do, which is (to isolate the sick family member in) a dedicated bedroom and bathroom,” said Dr. Peter Chin-Hong, UCSF professor of medicine who specializes in infectious diseases.
Q: What’s the best strategy for testing at home?
A: “If I was exposed, I would test on day three and day five,” Swartzberg said, pointing out that the incubation period for the newer omicron strains is shorter than previous versions, and many people who get infected feel sick within two or three days. “If you’re testing negative after day five, you’ve probably avoided getting infected,” he said, but you might want to be careful for a few extra days, especially if someone close to you is vulnerable.
The CDC recommends five days of isolation and an additional five days of masking for those with known exposures to COVID.
Q: What if you’ve already had COVID?
A: “That one’s easy these days,” said Chin-Hong. “They’re still at risk.” Even if you had COVID as recently as early June, he said, “that’s the superpower of BA.5,” someone who had COVID just four weeks ago is at risk of reinfection, while early in the pandemic those infected could expect up to three months without a possibly reinfection.
Q: Where can I get free rapid tests in the Bay Area?
A: Every household in the U.S. should be able to order up to 16 free rapid tests from the federal government, through the Covidtests.gov website, after the Biden administration recently announced a third round of free tests kits.
You might also be able to get free rapid tests through your healthcare provider. People covered by insurance through Kaiser Permanente can request free tests, as can those covered by Medi-Cal and Medicare. And most large pharmacy chains have ways to request free tests from their insurance for those with employer-provided plans.
Q: You took a rapid test that showed negative. Are you in the clear?
A: Not if you’re experiencing symptoms, says Swartzberg. “If you’ve got a cough, sore throat, runny nose,” he said “then you have a respiratory virus. It may not be COVID, but it could be, and if you have an infectious respiratory disease you should be staying away from other people.
Chin-Hong recommends swabbing both the back of the throat and the nose when doing a rapid test, which might help catch the virus earlier, a common practice in the UK but not yet officially recommended here.
Bottom line, if you or a family member has been exposed and is experiencing symptoms, it’s best to assume you have COVID, even if a rapid test has shown negative in the first days of symptoms.
Q: Do you need a PCR test from a lab if you tested positive on a rapid test?
A: Chin-Hong and Swartzberg see little reason to seek a PCR test if you test positive on an at-home test. You don’t need a positive PCR to confirm the infection, or to seek treatment, and false positives are very rare.
Q: Is it important to notify your healthcare provider you tested positive for COVID-19?
A: Yes. “The most important thing is a pragmatic thing, your healthcare provider can help you decide if you need to take paxlovid,” the most common anti-viral for COVID, said Chin-Hong. And even if you aren’t seeking treatments, “you should tell them and they can enter it officially” in your medical record.
Q: You have COVID. How can you best recover?
A: The good news for those getting infected now is that you should be able to access therapeutics that lessen the severity of your illness.
“If you’re a candidate for paxlovid or any of the other three treatments, make sure you avail yourself of them,” Swartzberg recommends. “Get plenty of rest, eat as well as you can, and drink fluids,” he said, sound advice for any viral respiratory infection.