What you should do if a household member tests positive for COVID-19, according to an expert

By Katia Hetter, CNN

(CNN) — First lady Jill Biden has tested positive for Covid-19 and is experiencing mild symptoms, the White House has reported, just as coronavirus cases and hospitalizations are increasing. President Joe Biden has tested negative thus far.

Jill Biden’s diagnosis comes as a new variant, BA.2.86, has also raised concerns and spurred urgent laboratory studies. Early results suggest that the variant may not be a major cause for concern and the updated vaccine, expected to be made available later this month, will work well against it.

While some experts have encouraged a return to masking, others have called for an individualized approach to risk reduction, with a focus on protecting older adults and individuals most vulnerable to severe disease.

As more people contract Covid-19 again, people have questions on what precautions they should take. How long should someone stay in isolation if they get the coronavirus? What steps can individuals take to prevent transmitting it to others in their household? What if someone has “rebound” symptoms? What should people exposed to someone with Covid-19 do — must they also stay away from others and how often should they be tested?

I turned to Dr. Leana Wen for her guidance. Wen is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s health commissioner.

CNN: How long should someone stay in isolation if they get the coronavirus?

Dr. Leana Wen: The length of isolation depends on the severity of symptoms, according to the US Centers for Disease Control and Prevention.

People who have had no symptoms and were diagnosed with Covid-19 with a positive test can end isolation after day five, with day zero being the day they got the test. Those who have mild symptoms can also stop isolating after day five as long as their symptoms are improving and they are without a fever for at least 24 hours, without the use of fever-reducing medications.

Individuals who had at least moderate illness and experienced more severe symptoms such as shortness of breath need to isolate through day 10. The CDC cautions further vigilance for those who had illness so severe that they had to be hospitalized and for those who are immunocompromised. People in these groups should isolate at least through day 10 and are asked to contact their health care provider regarding when they can end isolation.

CNN: Does ending isolation mean that people can resume normal activities?

Wen: Not according to the existing CDC recommendations. Let’s take the case of someone with mild symptoms, such as first lady Jill Biden. The CDC recommends that someone like her completely isolates until after day five. If her symptoms began on Sunday, that would be day zero, so day five would be Friday. She should not be around people until Friday. After that, assuming her symptoms are improving and she is fever-free, she needs to take precautions for another five more days, until the following Wednesday.

Specifically, she should wear a high-quality mask any time she is indoors around others, and she should stay away from those who are more vulnerable to severe illness, which would include her husband, who is considered higher risk by virtue of being 80 years old. The CDC also cautions that individuals currently in that day five to day 10 period should not go to places where they are unable to wear a mask, such as a restaurant.

CNN: Can you test to end isolation?

Wen: According to the CDC, you can take rapid at-home antigen tests if you wish to end masking sooner than day 10. The protocol calls for two sequential negative tests taken 48 hours apart. If both are negative, you can stop masking at home and in public spaces.

CNN: What steps can people diagnosed with Covid-19 take to prevent transmitting it to others in their household?

Wen: It’s important to keep in mind that the coronavirus is an extremely contagious respiratory pathogen that is easily spread from person to person. That said, it is not inevitable that everyone in the house gets Covid-19 if one person has it. A 2022 CDC report found that the household attack rate is about 1 in 2, meaning that half of people exposed to a sick family member do not end up contracting it.

The ideal scenario for isolation is for the person with Covid-19 to completely separate from other family members during the initial five days. The individual should stay in their bedroom and use a separate bathroom. They should not dine with others or share utensils, cups or towels. For the next five days, through day 10, the person should still be masking and not sharing indoor spaces unless they have two negative tests.

This is not always practical. If, say, there are two roommates in a small apartment with a shared kitchen and bathroom, and one has Covid-19, they should try to take turns using the shared spaces. Both individuals should mask while in the kitchen and bathroom, and they should open the windows as much as possible to increase ventilation.

Families with young children face additional challenges. An infected parent who has to take care of children should wear an N95 or equivalent mask when indoors with their uninfected kids. If the kids are the ones who are infected, parents can care for them while wearing a mask. Good handwashing is also essential; caregivers should wash their hands and those of their kids well and often.

I want to add one more practical note here. At this point after the start of the pandemic, many people have stopped the level of caution that the CDC recommends for isolation. A lot of family members may not be isolating within their homes. In these situations, I urge them to identify the household members who are most vulnerable to severe illness — for example, an elderly grandparent or a family member undergoing chemotherapy. Those individuals should be the ones separating themselves from others in their home to make sure that they do not contract Covid-19.

CNN: What if someone has “rebound” symptoms?

Wen: “Rebound” can occur, meaning that someone could get better and then have a recurrence of their symptoms. Essentially, the isolation clock resets, so day zero becomes when the rebound happens. This reset should happen regardless of whether it happened after taking antiviral treatment or if no treatment was given.

CNN: What should people exposed to someone with Covid-19 do — must they also stay away from others and how often should they be tested?

Wen: If someone finds out that they were exposed to an individual with the coronavirus, the CDC recommends that they immediately mask around others. That includes in the home and public spaces. The individual should monitor for symptoms and get tested if they develop them. The person can also test five days after exposure — although, according to the CDC, they should keep masking for the entire 10 days even if they test negative.

Again, though, I am not sure these are recommendations that are widely followed at this point in the trajectory of Covid-19. To me, the most important precaution is for those exposed to Covid-19 to stay away from people vulnerable to severe illness. The quarantine period after exposure is not the time to visit a family member in a nursing home, for example.

CNN: Should people exposed to Covid-19 take Paxlovid?

Wen: Paxlovid is not authorized for use as a preventive medication. Someone who has not yet tested for Covid-19 should not take it. However, someone who has tested positive and who is older with chronic medical conditions should take it as soon as possible after diagnosis, if they are eligible. This antiviral treatment has been shown to reduce the risk of hospitalization or death by up to 80% when taken within five days of symptom onset.

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