happenings at achiezer
Achiezer Quarantine Guidelines Monday 3/23/20
March 23, 2020
Current guidelines for quarantine (these guidelines are subject to change):
THE DECISION TO LEAVE QUARANTINE MUST BE MADE ONLY WITH APPROVAL OF A DOCTOR. LEAVING QUARANTINE PREMATURELY CAN HAVE DIRE CONSEQUENCES AS YOU NO LONGER HAVE THE SAME FEAR FACTOR AND CAN SPREAD THE VIRUS TO OTHERS. WE CAN'T BE SURE THAT THOSE CLEARED FROM QUARANTINE ARE TRULY NO LONGER CONTAGIOUS, SO PLEASE CONTINUE TO TAKE ALL POSSIBLE PRECAUTIONS.
* One who themselves has tested positive, or- has presumptive infection due to symptoms consistent with Covid19 even without having been tested:
Must quarantine for 7 days after the start of symptoms- provided that he has at least three days without fever (without use of fever-lowering medication) and three days since almost complete improvement in other symptoms (some very mild symptoms may remain). It is then advised to wear a regular mask (no need for N95 mask) and practice strict social distancing for an additional 7 days when in public. Current evidence indicates that while one does become immune to the virus after he recovers from it- there is uncertainty as to the duration he remains contagious.
It is especially important for those who are cleared from quarantine to continue to act with the awareness that they may still be able to pass the virus to others for several weeks.
* One who tested positive for Covid 19 but did not exhibit any symptoms at any time:
Must quarantine for 7 days from the date of testing. It is then advised to wear a regular mask (no need for N95 mask) and practice strict social distancing for an additional 7 days when in public.
* One who had "direct contact" with someone who is assumed to be infected with Covid-19 but the symptoms of the infected patient developed more than 48 hours after the day of contact:
Only requirement is to self-monitor. You must quarantine only if you develop symptoms.
* One who had "direct contact" ("direct contact" includes hugging them or having been within 6 feet of them for approximately 5-10 minutes) with someone who is assumed to be infected with Covid-19 but the infected person had symptoms at the time of contact or developed symptoms within 48 hours of contact:
You must quarantine for 14 days from the day of contact. This is regardless of whether the contact developed mild or severe symptoms- as it is only one virus that manifests itself differently in different people- and is capable of causing critical illness in someone who received it from someone with mild illness.
(This guideline admittedly seems counterintuitive- as it allows a Covid-19 positive patient to be free from quarantine before asymptomatic contacts and family members are free. The reason for this is that the infected patient is assumed to no longer be contagious to others 7 days after onset of symptoms; while the asymptomatic family member may be carrying the virus and remain contagious for 14 days from contact).
Family members who live with a Covid 19 patient and have repeated "direct" contact must quarantine for 14 days from the day of last contact with the patient while he was experiencing symptoms. This seems very strict but is the current guideline and must be adhered to.
Those in this category will be in an uncertain state after being released from quarantine- as they will not know if they "had" the virus and were among those who simply did not exhibit symptoms, or if they are still able "get" it. Until widespread testing becomes available, all people in this category will have to treat themselves as susceptible.
* Everyone else- including teenagers and children:
Everyone must practice "social distancing" to the greatest degree possible. There are thousands of people walking around who are sources of infection even though they are not symptomatic. This is even more important for children and teenagers- who may not develop symptoms at all yet are capable of transmitting the virus to others for weeks. Children of different families may not play together and teenagers cannot get together. We implore you and your families to not take lightly the precautions that are needed to slow the spread of the virus so that it does not infect elderly or immunocompromised people or those with underlying medical conditions. Do not go anywhere where you will see other people unless absolutely necessary (solitary walks outside or time in your own backyard is acceptable).
* FAQ's:
1) Pregnant or nursing women:
There is insufficient data regarding increased risk or management of pregnant or nursing women- please contact your Ob-Gyn physician for guidance. Otherwise- follow same guidelines as above.
2) Hydroxychloroquine (Plaquenil) and Zithromax:
Hydroxychloroquine (Plaquenil) and zithromax are medications used at this time only for severely ill hospitalized patients and has not been approved or recommended for stable Covid-19 patients in an outpatient setting. Medications such as this can only be prescribed and dispensed by your primary care physician.
3) Food preparation:
Currently there is no evidence to support transmission of COVID-19 associated with food itself. Before preparing or eating food it is important to always wash your hands with soap and water for 20 seconds for general food safety. It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it but because of poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from food products or packaging that are shipped over a period of days or weeks. Of course, you must be wary of food packaged in local establishments and ensure that their workers are exercising proper hygiene. It is also important to note that one should not visit restaurants but rather arrange for home delivery or pickup. At home, a person with Covid-19 may cook and prepare food as long as hands are frequently washed or cleansed well and mask is worn to avoid contaminating non-food surfaces.
4) Cleaning help:
There are two areas of concern:
The risk that they pose to you: It is certainly preferable to avoid opening your home to a possible carrier of the virus. If they have no symptoms and no positive contacts, they may come at your own risk.
The risk that you pose to them: You must notify them of your status and they may choose to work at their risk with precautions.
5) Covid -19 Testing:
Testing for Covid-19 is not recommended and is also not available. Just stay home, drink fluids, rest, and follow guidelines for quarantine. Please contact your primary care physician if you experience any symptoms for specific guidance.
We thank Dr. Akiva Bergman and Rabbi Dr. Aaron Glatt for reviewing and approving the foregoing. If you have case-specific inquiries, we urge you to consult with your primary care physician.
THE DECISION TO LEAVE QUARANTINE MUST BE MADE ONLY WITH APPROVAL OF A DOCTOR. LEAVING QUARANTINE PREMATURELY CAN HAVE DIRE CONSEQUENCES AS YOU NO LONGER HAVE THE SAME FEAR FACTOR AND CAN SPREAD THE VIRUS TO OTHERS. WE CAN'T BE SURE THAT THOSE CLEARED FROM QUARANTINE ARE TRULY NO LONGER CONTAGIOUS, SO PLEASE CONTINUE TO TAKE ALL POSSIBLE PRECAUTIONS.
* One who themselves has tested positive, or- has presumptive infection due to symptoms consistent with Covid19 even without having been tested:
Must quarantine for 7 days after the start of symptoms- provided that he has at least three days without fever (without use of fever-lowering medication) and three days since almost complete improvement in other symptoms (some very mild symptoms may remain). It is then advised to wear a regular mask (no need for N95 mask) and practice strict social distancing for an additional 7 days when in public. Current evidence indicates that while one does become immune to the virus after he recovers from it- there is uncertainty as to the duration he remains contagious.
It is especially important for those who are cleared from quarantine to continue to act with the awareness that they may still be able to pass the virus to others for several weeks.
* One who tested positive for Covid 19 but did not exhibit any symptoms at any time:
Must quarantine for 7 days from the date of testing. It is then advised to wear a regular mask (no need for N95 mask) and practice strict social distancing for an additional 7 days when in public.
* One who had "direct contact" with someone who is assumed to be infected with Covid-19 but the symptoms of the infected patient developed more than 48 hours after the day of contact:
Only requirement is to self-monitor. You must quarantine only if you develop symptoms.
* One who had "direct contact" ("direct contact" includes hugging them or having been within 6 feet of them for approximately 5-10 minutes) with someone who is assumed to be infected with Covid-19 but the infected person had symptoms at the time of contact or developed symptoms within 48 hours of contact:
You must quarantine for 14 days from the day of contact. This is regardless of whether the contact developed mild or severe symptoms- as it is only one virus that manifests itself differently in different people- and is capable of causing critical illness in someone who received it from someone with mild illness.
(This guideline admittedly seems counterintuitive- as it allows a Covid-19 positive patient to be free from quarantine before asymptomatic contacts and family members are free. The reason for this is that the infected patient is assumed to no longer be contagious to others 7 days after onset of symptoms; while the asymptomatic family member may be carrying the virus and remain contagious for 14 days from contact).
Family members who live with a Covid 19 patient and have repeated "direct" contact must quarantine for 14 days from the day of last contact with the patient while he was experiencing symptoms. This seems very strict but is the current guideline and must be adhered to.
Those in this category will be in an uncertain state after being released from quarantine- as they will not know if they "had" the virus and were among those who simply did not exhibit symptoms, or if they are still able "get" it. Until widespread testing becomes available, all people in this category will have to treat themselves as susceptible.
* Everyone else- including teenagers and children:
Everyone must practice "social distancing" to the greatest degree possible. There are thousands of people walking around who are sources of infection even though they are not symptomatic. This is even more important for children and teenagers- who may not develop symptoms at all yet are capable of transmitting the virus to others for weeks. Children of different families may not play together and teenagers cannot get together. We implore you and your families to not take lightly the precautions that are needed to slow the spread of the virus so that it does not infect elderly or immunocompromised people or those with underlying medical conditions. Do not go anywhere where you will see other people unless absolutely necessary (solitary walks outside or time in your own backyard is acceptable).
* FAQ's:
1) Pregnant or nursing women:
There is insufficient data regarding increased risk or management of pregnant or nursing women- please contact your Ob-Gyn physician for guidance. Otherwise- follow same guidelines as above.
2) Hydroxychloroquine (Plaquenil) and Zithromax:
Hydroxychloroquine (Plaquenil) and zithromax are medications used at this time only for severely ill hospitalized patients and has not been approved or recommended for stable Covid-19 patients in an outpatient setting. Medications such as this can only be prescribed and dispensed by your primary care physician.
3) Food preparation:
Currently there is no evidence to support transmission of COVID-19 associated with food itself. Before preparing or eating food it is important to always wash your hands with soap and water for 20 seconds for general food safety. It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it but because of poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from food products or packaging that are shipped over a period of days or weeks. Of course, you must be wary of food packaged in local establishments and ensure that their workers are exercising proper hygiene. It is also important to note that one should not visit restaurants but rather arrange for home delivery or pickup. At home, a person with Covid-19 may cook and prepare food as long as hands are frequently washed or cleansed well and mask is worn to avoid contaminating non-food surfaces.
4) Cleaning help:
There are two areas of concern:
The risk that they pose to you: It is certainly preferable to avoid opening your home to a possible carrier of the virus. If they have no symptoms and no positive contacts, they may come at your own risk.
The risk that you pose to them: You must notify them of your status and they may choose to work at their risk with precautions.
5) Covid -19 Testing:
Testing for Covid-19 is not recommended and is also not available. Just stay home, drink fluids, rest, and follow guidelines for quarantine. Please contact your primary care physician if you experience any symptoms for specific guidance.
We thank Dr. Akiva Bergman and Rabbi Dr. Aaron Glatt for reviewing and approving the foregoing. If you have case-specific inquiries, we urge you to consult with your primary care physician.
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