How long to quarantine after Covid?

[CLLdaughters]

Hello, My parent has CLL and tested positive for COVID for 12 days and has now been testing negative for 48 hours. He hasn’t had any symptoms for a week, except “Covid toes”, which we think are slowly improving. We are trying to decide if he should leave quarantine or not. The CDC still has a page up that says people who are moderately to severely immunocompromised should quarantine for 20 days. The hospital and oncology doctors are avoiding our calls and failing to call us back as promised. Seems like they don’t want to weigh in on this. We don’t want to isolate him longer than necessary but we also don’t want to expose my other parent or any of the grandkids. Thanks in advance for any advice!

[EmilyLondon]

Negative for 48 hours sounds pretty good. Maybe some elementary precautions? Are they coughing still?

[CLLerinOz Administrator Volunteer]

I'm sorry you're dealing with Covid in your family and that your parent has had a case of "Covid toes". I've only seen photos of it but it doesn't look pretty. I'm glad to hear it's on the mend.

We know that those who are immunocompromised can take longer than others to clear the virus.

On the one hand, your parent has recorded two consecutive negative tests after isolating for fourteen days and nearly all their symptoms have gone which is very encouraging. On the other, they are still inside the minimum 20 day isolation period recommended by the CDC advice.

I wonder how many people are actually checking or following the advice these days, to be honest and testing is difficult to access now, too. Having said that, the advice still recommends that those who are not immunocompromised should isolate and take precautions for 10 days if they are moderately ill, 5 days if they are mildly ill and at least 20 days if they are moderately or severely immunocompromised, regardless of severity or symptoms . All should undertake certain steps before clearing isolation and that involves testing and, in some circumstances, precautions beyond the isolation period.

It's possible that the two negative tests in the past 24 hours that your parent has recorded are sufficient to indicate that they have cleared the virus even though they're still inside the CDC's recommended time period. Recommendations are made on the basis of what works in the majority of cases. However, because of the risk of rebound and perhaps the possibility of missing a low viral load on a rapid test, it would be prudent to take the recommended time to be sure.

If your appetite for risk copes with the idea, you might adopt a masking protocol with everyone concerned masking to enable some mixing with others in controlled circumstances, or perhaps meet outdoors and distanced, until the risk has definitely passed.

It's not an easy situation with one parent having to stay apart while the other recovers or for grandparents to be separated from their grandchildren. I guess the good news is that, one way or another, you're nearly there.

CLLerinOz

[CLLerinOz Administrator Volunteer in reply to CLLerinOz]

Below is the CDC advice for others reading this. It states that, regardless of severity of infection or symptoms:

"People who are moderately or severely immunocompromised should isolate through at least day 20. Use of serial testing and consultation with an infectious disease specialist is recommended in these patients prior to ending isolation."

"Moderately or severely immunocompromised patients may remain infectious beyond 20 days. For these people, CDC recommends an isolation period of at least 20 days, and ending isolation in conjunction with serial testing and consultation with an infectious disease specialist to determine the appropriate duration of isolation and precautions.

The criteria for serial testing to end isolation are:

Results are negative from at least two consecutive respiratory specimens collected ≥ 24 hours apart (total of two negative specimens) tested using an antigen test or nucleic acid amplification test.

Also, if a moderately or severely immunocompromised patient with COVID-19 was symptomatic, there should be resolution of fever for at least 24 hours (without the taking fever-reducing medication) and improvement of other symptoms. Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation​.

Re-testing for SARS-CoV-2 infection is suggested if symptoms worsen or return after ending isolation and precautions.

If a patient has persistently positive nucleic acid amplification tests beyond 30 days, additional testing could include molecular studies (e.g., genomic sequencing) or viral culture, in consultation with an infectious disease specialist."

cdc.gov/coronavirus/2019-nc...

CLLerinOz

[noeagaman]

I have been wondering about the same thing lately with COVID cases creeping up here at work lately. I work for the Air Force and they go by CDC guidelines of 5 days at home and then 5 days back at work with a mask on. It was good to see CLLerinOz's post of the CDC guidelines here. I have pointed this out to my supervisor and am waiting to see if they want me to follow these 20 day guidelines for immunocompromised people or not.

Chris

[CLLerinOz Administrator Volunteer in reply to noeagaman]

Hi Chris

The CDC guidelines "do not apply to healthcare personnel in the healthcare setting, and do not supersede state, local, tribal, or territorial laws, rules, and regulations" so that may impact the response you get from your employer.

Ideally, I hope you can avoid COVID-19 and don't have to isolate.

CLLerinOz

[noeagaman in reply to CLLerinOz]

Thanks for this reply CLLerinOz. Yes, things tend to work a little differently when working for the US government so we'll see. I still haven't gotten an answer from anyone. My main task lead is on vacation right now so hopefully I will hear something when he get's back. And, yes I agree, it would be best if I can avoid COVID all together. I plan on retiring in May and won't have to worry about this, but until then I guess that I will just have to continue to be careful. At least some people have begun to wear masks again here at work.

Chris