Contact protocol with no known exposures
May 11, 2020 12:16 PM   Subscribe

If you need to have close contact with Person A who lives with Person B, and Person B has had a one time extended visit with Person's B's parents (with no known symptoms or positive test), how long would you wait to have close contact with Person A, assuming no other close contacts with others?

Our household has been staying home for the past two months and obeying our city's stay home orders, which provides an exception for family caretaking.

We have a family member, person A, that we know and trust who has equally been vigilant about obeying the orders who has been coming by twice a week to help us take care of family members who need care because their normal care providers no longer can provide services due to the crisis.

Person A's SO, B, has also been staying home - this behavior needed to occur on all of our parts since we could be just as much of a vector to B as B is to us. B, over the weekend felt it important to visit B's parents for mother's day without consulting A, and spent a couple hours over dinner at home with them. We are not upset about this - we just want to think through next steps.

By B's account, B's parents are also staying home for the past month, and are obeying guidelines, wearing a mask and gloves when outside, but at the same time had a recent visit from their other child who is an essential worker. We're not going to blame B for deciding to visit their parents - however, we have to think through what's the right protocol here. Nobody's symptomatic, but nobody's had tests either. One of B's parents was still going to in-office work a month ago and heard about a person at their workplace that was tested positive, but was not given instructions to self isolate.

What date do we ask A to return?We've asked that A stay away for the next two weeks, but I'm not even sure if this is sufficient time for isolating contact. The protocol with known exposures seems to be isolate for two weeks after exposure date, but wouldn't it take time for person B to become a carrier and then transfer to A, assuming B's parents were carriers? Doesn't that mean two weeks is too short of a time period for A to stay away? What other things can we do to make for a safer return date?

Given that our nation's leaders can't even get their shit together with a protocol even when they are knowingly exposed AND tested, I've found their failure to role model extremely confusing so I've decided to ask Mefi for advice.

I'm not looking for answers to stop having Person A come entirely. It's not sustainable for us to be able to conduct the care of family members on our own full time for the remainder of the crisis. We can safely assume that B will return to isolation.
posted by Karaage to Health & Fitness (13 answers total) 1 user marked this as a favorite
Well if you think two weeks is not long enough and forever is too long, will you be comfortable with 3 weeks? Four weeks? How long can you sustain doing the work without Person A?

It is a terrible question. I would never forgive myself if I didn't wait long enough and then the family member for whom I was caring got sick. I have a friend whose daughter is a front line worker and he is in a very high risk category. She refuses to come up even to hang out in the driveway yards away from each other wearing masks, etc. She does not want the responsibility on her if he gets sick. He wants to see his daughter.

Then, it becomes a factor of your own risk tolerance. I personally would probably not even wait the two weeks, but certainly the two weeks seems sufficient. If any of you are going to to grocery store even with protection and vigilance, you are exposed then.

On the other hand, isolating for 3 or 4 weeks seems like you have waited long enough to know if Person A or B is sick or a carrier. There is no perfect or absolutely correct answer. I guess the best answer is at least two weeks but as long as you can handle doing the caregiving without person A.
posted by AugustWest at 12:55 PM on May 11, 2020 [1 favorite]

kickingtheground makes a good point - I'm not sure where you're located but I know my area has opened up testing to anyone who wants it. See if the same is true in your area, or if not a doctor will give a referral since there is contact with someone immunocompromised involved. Persons A & B can get tested this week and, assuming a negative result, this can be resolved much more quickly and with much more certainty.
posted by brainmouse at 1:04 PM on May 11, 2020 [1 favorite]

Best answer: I think you would be safe somewhere between 2 and 4 weeks. If B caught it from their parents, guidelines would be to self isolate for 2 weeks. Then since A and B are continuously exposed to each other, assume A caught it/was "exposed" at the very end of those 2 weeks, and guidelines would be for A to self isolate for 2 weeks. If neither of them are seeing anyone else I think a max of 4 weeks makes sense.

You could also assume A would catch it before 2 weeks - even if B was asymptomatic they would still be contagious. But I do not know how quickly people become contagious (besides that it's before showing symptoms, or even when never showing symptoms), and even if it's immediate, I don't know how long it would likely take A to catch it.
posted by sillysally at 1:04 PM on May 11, 2020 [3 favorites]

There are a variety of health information resources posted to the MeFi Wiki Disaster Planning & Recovery page, Medical / Pandemic section, and your question may be addressed by health education materials posted by the Washington State Department of Health.

Testing is unfortunately not a perfect method of ensuring safety, so I encourage you to consult with a medical provider about how to proceed. There are also informational materials from NECSI in the Stopping the Coronavirus Pandemic section of their website, including risk reduction recommendations in this article: Respiratory Health for Better COVID-19 Outcomes (Apr. 18, 2020).
posted by katra at 1:21 PM on May 11, 2020

Whole countries are betting their futures on 2 week quarantine periods, I think you would be safe to do the same.
posted by Tell Me No Lies at 1:30 PM on May 11, 2020 [2 favorites]

This is something I'd reach out and ask any physician to whom you have access. I would try to summarize it to a very tight wording -- assuming I understand your issue, maybe something like (let's call A "Joseph"):

"A's SO visited with their parents over the weekend. Their parents were exposed to their sibling who is an essential worker. No one wore masks while visiting, but no one was symptomatic. We're concerned about how long A should isolate from my _ who is (immunocomprised? age group?). Is it two weeks, or would it be longer considering time for his SO to become symptomatic and *then* time for him to also become symptomatic?"

The medical facts of this situation are too detailed -- and medical guidance is too unclear -- for I think the Ask Mefi populace to be in a position to good advice.
posted by WCityMike at 1:38 PM on May 11, 2020 [1 favorite]

Best answer: Do you know when B's parents' other child visited? Was it for Mother's Day? Was it two weeks ago? I'm thinking that, because they are older, B's parents would be more likely to be sick than a younger person. If they go two weeks without symptoms, it seems like they are less likely to be carriers. Which is to say, if they go two weeks after that visit without getting sick, and then A goes two weeks from B's visit without getting sick... that would maybe feel a bit better to me.
posted by bluedaisy at 2:56 PM on May 11, 2020

The medical facts of this situation are too detailed -- and medical guidance is too unclear -- for I think the Ask Mefi populace to be in a position to good advice.

I disagree.

For countries still accepting travelers, 14 days is absolutely the standard.

They do not ask about your medical history. They do not ask you who you visited, or who you had dinner with, or who had the chicken or who had the fish. They do not ask you any detail at all, the only thing that matters is that you go into quarantine for 14 days.

It is undoubtedly a larger hammer than is needed in some situations, but the people who do this professionally on the largest scale imaginable will tell you without even having met you: 14 days.
posted by Tell Me No Lies at 3:08 PM on May 11, 2020

If you think you can count on the people in this chain to tell you if they begin to get symptoms, then I'd consider 14 days more than adequate. Because odds are good that someone who picked it up even earlier (B's sibling, B's parents) would develop symptoms if they're all infected.
posted by metasarah at 6:38 PM on May 11, 2020 [1 favorite]

For countries still accepting travelers, 14 days is absolutely the standard.

I would note, in response to Tell Me No Lies (TMNL)'s disagreement, stating that a professional opinion is not necessary if 14 days are observed, that the 14-day standard is for one person to manifest symptoms, not for one person to transmit to someone else and for that second person to show symptoms. That second scenario could quite easily be longer.

I would also note that neither TMNL nor I are medical doctors, epidemiologists, or infectious disease specialists, and as such, I would reiterate my suggestion to consult a medical professional given the weight of the potential outcome: that the answer to this could possibly influence whether your family member lives or dies.

I would respectfully disagree with any individual suggesting that a medical professional's opinion is unnecessary in this circumstance.
posted by WCityMike at 9:10 PM on May 11, 2020 [1 favorite]

Response by poster: Per the WCityMike's advice to send a truncated message to my medical professional, I sent a message via the app and received a message from a PA-C and was told "Anyone who may have had a potential exposure should isolate for 14 days," and does not go into the intricacies of my B's sibling -> B's parents -> B -> A -> us timeline.

It was accompanied by a form message to get a test if someone has had "prolonged, close contact with someone suspected of or diagnosed with COVID-19 in the last 14 days."

While nobody in my city has publicly announced testing for anyone whenever they want it and still has the previous guidelines and priority list up, I wonder if it's loose enough for A and B to both get a test next week by saying B had prolonged contact and we suspect they may have it.
posted by Karaage at 5:25 AM on May 12, 2020

I wonder if it's loose enough for A and B to both get a test next week by saying B had prolonged contact and we suspect they may have it.

I would advise against asking them to lie in this situation. While it may be unlikely they would have negative consequences (I don't think anyone is even suggesting or attempting to enforce mandatory self-quarantine), I don't think it's a good idea for them to fib their way to a test.

Could A reach out to their doctor about this? But I also think you are looking for a guarantee you aren't going to get quickly.
posted by bluedaisy at 2:57 PM on May 12, 2020

Best answer: What happened prior to B's visit with parents in terms of timing (sister, office, etc) is not relevant for your question.

The important piece is: Were either of B's parents infected at the time of the visit.

If one or both was infected, there is a chance that B could be infected. The average time to onset of symptoms is 5 days but can be as long as 14 days (possibly longer at the extremes), hence the advice to isolate for 14 days after possible exposure. The 14 days of isolation starts at the time of possible exposure, so B needs to isolate for 14 days after the exposure. If you want to be really certain and accounting for possible extremes, sure, add another week or two.

However if B or A become ill (or test positive) during this time, the calculus changes and you would need to isolate from them for N days after they recover. I'm not sure how long N is.

All this assumes that after the single visit, everybody has returned to their normal pre-visit behaviour.
posted by lulu68 at 4:01 PM on May 12, 2020 [1 favorite]

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