Thanks to the RACGP for this post:
So you have been asked to self-isolate or quarantine. What now?
GPs Dr Wendy Burton and Dr Kat McLean write about what coronavirus-affected people can expect if they have to go into isolation or quarantine.
First off, what’s the difference between self-isolation and quarantine?
Let’s go through them.
- You are at risk of having the COVID-19 infection (coronavirus), but not actually known to be infected. You may or may not end up with it
- You are asked to wait it out in isolation until 14 days have passed if you remain well. This reduces the chances of the infection spreading and applies if you have come back from the growing list of countries with a lot of infection or if you have had contact with someone who is positive
- If you become unwell during the 14 days, testing is done and if positive you move into isolation phase (or into hospital if very unwell)
- If unwell but testing is negative, we still want you to stay in quarantine until the 14 days are up, as the infection may take that long to show
- If well at the end of the 14 days, you may resume normal contact, providing you stay well
- You have tested positive for COVID-19
- You are well enough to be looked after at home
- At time of initial publication (9 March 9), in Australia, you can come out of self-isolation if all of the following apply
- more than seven days since you became unwell
- at least two days with no fever
- at least one day of feeling better/having no symptoms
- two tests 24 hours apart that are both negative
Please take care. It seems highly unlikely that you can be reinfected, but we don’t want you getting another infection so soon after having COVID-19.
What about the new two weeks’ quarantine for people arriving from overseas?
What does that mean?
Remember the above definitions. Quarantine means you are at higher risk; you don’t necessarily have the infection and you may or may not get it. You are not in isolation.
This is an important distinction – quarantine and isolation are being confused by too many commentators
This means your close contacts do not need to be quarantined with you, unless they qualify for quarantine because they were also traveling.
If you become unwell and upon testing are found to be positive for Covid-19, you are now in isolation and those who have been in close contact with you will have to go into quarantine.
If you have been in strict quarantine and they have not had 15 minutes’ face-to-face contact or two hours in a room with you in the 24 hours before you became unwell, they do not need to be quarantined.
If they have been in close contact, and if we assume you are only infectious for the 24 hours before you became unwell and you had testing as soon you knew you were unwell, the community is buffered by the incubation period which is, on average, five days.
Your close contacts will, however, have to be quarantined as soon as your test becomes positive.
So if your test is back in one day, it should be at least three days (assuming they are infectious before they are unwell) before they become infectious; two days’ buffer if it takes two days; one day’s buffer if it takes three days, and if the test takes four days or more we have a potential problem.
These are assumptions, they are not always right, but they will have to do for now.
Rules for living in isolation
If you live alone, the situation is relatively straightforward:
- No visitors
- No trips to the shops, school, university, work, park, library, movies, church/place of worship, GP, chemist, etc
- No family gatherings
- Stay at home
If you are sharing a room or home with your partner or family, there are a few more things to consider in addition to the above:
- If you are able, isolate yourself from others. Ideally, stay in your room and have your partner sleep in another room
- If you can isolate yourself from others within your home, do so – for 14 days. Sorry, that will be a long two weeks
- If you cannot isolate yourself within your home, cover your mouth when you cough, wash your hands frequently, wipe touched surfaces or wear disposable or clean gloves if you need access to communal areas (ie kitchen) and wear a face mask when others are around (further advice below)
Keep in mind that most of your family will be in quarantine, as they are likely to have been in close contact with you.
We still want you isolated in that situation in order to reduce the risk they get it (we don’t want them to get sick because that will reset everyone’s 14 day self-isolation time). This will change if/when the infection becomes more widespread.
Why 14 days?
This seems to be the longest time in which this virus can be incubating before people become sick. If you are not sick 14 days after exposure then, as far as we know, you have not got this infection.
Keep your distance
Stay 1.5 m from others.
Imagine a bubble. Stand up, arm above your head and out to the side, then spin around. That’s your bubble.
If you’re unwell, try to keep your bubble intact. If you’re well, don’t pop the bubble of sick people.
What are we trying to achieve with isolation?
We are trying to slow down the spread of the infection.
This is important because the health system will find it much harder to manage if everyone gets sick at the same time. People are at a higher risk of getting sick with COVID-19 if they have close contact with someone who already has it.
Close contact is defined as having the following contact with someone who has COVID-19 (this includes contact in the 24 hours before they became sick):
- Fifteen minutes or more of face-to-face and/or
- More than two hours in the same room
This is particularly important for people at higher risk of complications from COVID-19. If you have, or think you could have, COVID-19, it is vital you stay away from people who:
- are older (highest risk in people over 80, but the risk starts to seriously climb from 50)
- have heart problems
- have diabetes
- who have lung troubles (eg asthma, emphysema, chronic bronchitis, bronchiectasis, cystic fibrosis, etc)
- have high blood pressure
- have cancer.
We are also concerned about people whose immune systems are low, including because of medication that they take, and Aboriginal and Torres Strait Islander people.
The Washington Post has made a coronavirus simulator to help us understand the difference social distancing can make in dealing with the virus.
Ideas on what to do while in isolation
If you are unwell, you will need to manage your symptoms. For most of us, this will be like managing a cold:
- Eat well (fruit and vegetables, not those tempting chips and lollies)
- Keep your fluids up, use paracetamol or ibuprofen for pain or high fevers
- Get some sleep
- Low-grade fever in someone who is otherwise feeling okay does not have to be treated; it is part of the body’s immune response and we get better quicker if we let it be
- Let us know if you are getting worse, especially your coughing is worsening and/or if you are having trouble breathing (phone your GP or emergency department for advice, or state or national help lines or 000 in an emergency)
You will need to eat
Think about what you have in the pantry/fridge/freezer.
If you need more supplies, can someone drop fresh food over? It can be home delivery from family or friends, or deliveries from the supermarket or restaurants.
It is important to note, however, that anyone who does drop anything to your house should avoid direct contact with you by dropping the food at the doorstep and leaving.
You will need to clean
This is more important if others are sharing the space with you, but at some stage the house will need to be cleaned.
Based on what we know about previous coronavirus outbreaks (SARS and MERS), coronaviruses can live on surfaces for an average of 4–5 days. But some have survived at room temperature for up to nine days.
For cleaning surfaces, the US Center for Disease Control and Prevention (CDC) recommends you wear disposable gloves. If you are using reusable glove, do not use them for any other purpose.
This may be difficult for most, but do what you can with what you have. Either way, wash your hands aftercleaning.
Use a detergent first. For suitable surfaces, follow with diluted bleach, such as White King Bleach (sodium hypochlorite 4% chlorine) at a ratio of one-part bleach, seven parts water.
A combined commercial spray is fine to use instead of the above two-step process. Most household disinfectants are based on benzalkonium chloride, with 0.05% the concentration recommended.
Alcohol wipes or sprays are suitable alternatives, for example, for phones, where Apple does not recommend bleach.
Wipe benches and frequently-touched surfaces such as tables, doorknobs, doorbell if getting deliveries, light switches, cupboard and drawer handles, desks, toilets, taps and sinks twice a day.
Once finished cleaning, dispose of/remove the gloves and, again, wash your hands.
Further resources are available on the CDC website.
Other cleaning essentials
After using the toilet, close the lid, flush and wash your hands. The virus can be detected in faeces and closing the lid before flushing reduces the risk of the virus becoming airborne and spreading the infection further.
If there is only one toilet in the household, clean (as above) the toilet seat, flusher, tap, sink, door handles (ie any surface that may have been touched) each time it has been used by the person who is sick.
If you have two toilets, the sick person gets one and everyone else uses the other one. Ditto for shower/bath.
Change sheets and towels regularly, keep the towel of the sick person separate from other towels, eg in their room, and have a separate towel for on which they can wipe their hands after washing.
Wash the floors once a day. This is especially important if you have young children.
Regularly clean down hand-held devices such as gaming controls, mobile phones, tablets, keyboards (with alcohol spray or alcohol wipes).
The sick person should be excused from setting the table, cooking, washing up and unpacking the dishwasher. They should also eat away from others who are well, preferably in their own room. (It is also important they wear their face mask when in the same room as people who are not sick.)
There should be absolutely no sharing of food or drink that has been in contact with the sick person – into the bin with their leftovers.
You can wash clothes the usual way. You don’t need to separate out the clothes or towels from the sick person, but make sure you wash your hands after putting the washing into the machine.
But please don’t shake the clothes out before washing – this increases the risk of viral particles becoming airborne. Dry clothes well before putting them away. Use a disposable or washable clothes bin liner.
The sick person should have their own rubbish with a disposable liner. It is good practice to wear gloves when emptying the bin, and wash hands well after taking the rubbish out.
If you have an unwell young child, try to have one person providing their care. That person should be very careful about how they interact with others who are well.
In the event of a sick child, now is the time to consider extending their electronic time (just for now). Most kids will be excited about this and it helps by keeping them occupied and distracted.
You will need to keep occupied
In the event you are quarantined, see if you can work or study from home.
Maintain connection with friends, family, neighbours, others in your community – consider setting up regular phone calls to check in with and check on others. There are many options.
It is important to keep active. Consider ways to do this from home, such as spring cleaning or organising the house, downloading an exercise app, checking out YouTube exercise or dance classes. Movement matters.
In terms of following the news, be aware that there are some weird suggestions out there and stay mindful of the effect it can have on children.
Australians can call the national coronavirus health information line on 1800 020 080. Information is also available on the Department of Health website.
Mental health considerations
Keep your mind occupied with meaningful and creative pursuits.
It is okay to not be okay, but try not to panic. Panic will not help.
Head to Health has some great online mental health resources. There are also lots of great free/low-cost apps or websites, including a number you can work through with your children:
- This Way Up ($55 – you will need a referral from your doctor)
- Smiling Mind (free, for children and adults)
- Mood Gym (free, for adolescents and adults)
- The Brave Program (free, for children aged 7–17)
All advice and information current as of 15 March.
A version of this column first appeared on GPs can.