When someone in the family tests positive for the coronavirus, there are some guidelines to follow. By Sharon Otterman

Though I have been writing about Covid-19 for The New York Times for the past two years, I still felt overwhelmed when my son was sent home from school sick in mid-March and tested positive. Suddenly, I was in a cluttered New York City apartment with my husband, first grader and third grader, a lot of virus particles and no clear plan.

We did try to isolate positive from negative family members at first and wear masks, but we all got sick anyway. The rolling series of infections lasted for about three weeks, and my symptoms included a 102-degree fever, sore throat and congestion. We were all fully vaccinated, and my husband and I were boosted.

Could we have done a better job at limiting the virus’s impact on our household?

To answer this, I reached out to seven experts for practical tips for families with young children who test positive for Covid, as the highly transmissible Omicron subvariant BA.2 is circulating.

Here are answers to some of the questions that I grappled with.

Early detection is vital to slow down transmission, and in Canada and Britain many authorities recommend swabbing the throat, then nostrils to find the virus sooner. “A good five seconds on each spot, and each side, is best,” said Dr. Kashif Pirzada, an attending emergency physician in Toronto. “There’s some good research showing an improvement with the combined approach in the sensitivity of these tests.”

In the United States, however, there was disagreement. Several experts I spoke with recommended against using nasal rapid tests to swab the throat, largely because the Food and Drug Administration hasn’t authorized it. “We have seen false positives from throat swabs based on the acidity of recent food and beverage consumed,” said Dr. Eric Ascher, a family medicine doctor affiliated with Lenox Hill Hospital. Others backed trying the method.

If family members test positive on a rapid test, it is safe to assume they have Covid, and they should begin isolating and taking precautions, the experts agreed. If they test negative, they should retest frequently while exposed, if possible, and assume they are positive if symptoms begin.

“It is important to know that some people do not test positive during the first one to three days of infection,” said Dr. Michael Mina, an authority on Covid-19 testing and the chief science officer for Emed.

The experts disagreed about whether it was necessary to also get a P.C.R. test to confirm rapid test results; several said that rapid tests were sufficient. Dr. Pirzada said that confirming results with a P.C.R. is advisable when the first family member gets a positive rapid test or shows symptoms but is not necessary after that. Dr. Kevin Slavin, the head of pediatric infectious diseases at Joseph M. Sanzari Children’s Hospital said that he prefers the whole family to get the more sensitive P.C.R. test. The bottom line, though, is that people should not wait for positive P.C.R. results to begin isolating and taking precautions.

Each person who becomes symptomatic or tests positive should begin isolating for at least five days, and longer if they are still feverish or not improving. (Pro tip: Day 1 is the day after taking the test that turned positive or developing symptoms, according to Centers for Disease Control and Prevention rules).

“The assumption is that if you don’t have enough virus in your nose to trigger a positive result, that you’re probably not very contagious. But these things are on a continuum,” said Dr. Gigi Gronvall, who runs the COVID-19 Testing Toolkit project at the Johns Hopkins Center for Health Security.

P.C.R. tests are also helpful in other ways, such as to document disability if you get long Covid. But the downside is, you generally have to leave the house to get them.

Yes. No matter what, once someone in the household has Covid, everyone — even the vaccinated who are still negative or asymptomatic — should wear a well-fitting, high-quality mask for 10 days in public in indoor or crowded outdoor situations.

Family members who have recently been exposed to Covid and are still testing negative should avoid seeing high-risk people. They should also take precautions while traveling, according to the C.D.C.

Deciding whether to send well children to school if a household member has Covid is more complex. Unvaccinated children should, according to the C.D.C., stay home for at least five days and then take a virus test. Most districts permit fully vaccinated children to attend school unless they are symptomatic or test positive, but they should wear high-quality masks and get tested at least on the fifth day after exposure, preferably every morning before school, Dr. Mina said.

As parents know, the term “close contact” takes on a whole new meaning with young children, who seem to have an uncanny ability to sneeze in your face. Even so, the experts agreed that reducing exposure to each others’ illnesses is still worth the effort.

There is a small window of time when this is particularly important — between exposure and when the immune system begins to fully engage.

Parents have to care for children, and some siblings simply can’t be kept apart. Still, there are steps you can take. Whoever gets sick first should be in his or her own room, if possible. Put a HEPA filter in there, if you have one. Try to get the sick person to stay in there for meals. Wear high-quality masks when family members are together.

Open the windows. Place another HEPA filter, if you have two, where other family members are spending time. Another pro-tip: Keep the air at 40 to 60 percent humidity, which helps stop aerosol transmission, Dr. Pirzada said, by using a hygrometer or a humidifier to measure the level.

Use common sense. Once the air filters are running, the windows are cracked and masks are worn when possible; attempting more may feel like too much if a young child is ill. “If my kid were sick, my natural instinct would be to care for them,” said Dr. Linsey Marr, a leading expert on viral transmission. “I could see throwing my hands up, relying on the vaccine and my good health to keep me from falling seriously ill and cuddling with my kid.”

The good news is that once you test positive, exposure to other family members who are also positive is unlikely to make you sicker, the experts agreed. And it isn’t likely that the family members who recover first will be reinfected by those still sick.

Five days after the last family member who had Covid tests negative, others in the household are almost certainly in the clear.

 

Covid can be spread before symptoms begin. Within a household, that may mean that everyone has already been exposed even before the first cough or positive test.

Still, if there is a particularly vulnerable person in the household, like a grandparent, you should focus on keeping the family member safe, even out of the house once someone tests positive. (Keep in mind, though, that the family member may sicken others if already infected.) If the vulnerable person stays in the house, put a HEPA filter in the room if possible and keep the family member separated from others. Contact a doctor for possible treatment possibilities. And of course, wear high-quality masks when interacting and try to keep hands and surfaces clean.

With Omicron being so contagious, the percentage of household members who get sick once Covid enters the house is higher than with earlier strains. But it is still not 100 percent (one C.D.C. study placed it at between 40 and 70 percent, depending on precautions taken). So stay optimistic! It is possible to remain uninfected.

“I got Covid-19 last year and have a new baby in the house,” said Dr. Mina. “Between constant wearing of N95s, using HEPA air filters in my home and keeping windows open, I’m the only one in the house that ever contracted Covid.”

The experts had some suggestions for a plan to have in place for when someone gets sick:

  • Have ready HEPA filters — or a less expensive, D.I.Y. version you can build yourself, known as a Corsi-Rosenthal box. Decide which bedroom could be an isolation room.

  • Have comfortable masks, preferably N95 or KN94 or KN95 masks, for the whole family to wear indoors until they recover.

  • Stockpile a few other supplies. Some you might want to consider: a humidifier, a thermometer, Mucinex for adults, Tylenol or Advil, pulse oximeter, sanitizer, rapid tests, disinfecting wipes, electrolyte drinks like Gatorade and Vitamin D3 to boost immunity.

  • Ensure family members are up-to-date with their vaccinations.

  • Have your doctor’s phone number and emergency contacts at hand. If you call right after someone tests positive, your doctor can advise if the family member qualifies for Paxlovid or other new treatments to aid in recovery. Doctors can also tell you when it’s time to seek another level of care.

If you don’t have a doctor and live in New York City, call 212-COVID19. There are also now “Test to Treat” sites around the country.

 

Sharon Otterman covers health care and the pandemic for the Metro desk. A reporter at The Times since 2008, she has also covered religion and education, and won a Polk Award for Justice Reporting for her role in exposing a pattern of wrongful convictions in Brooklyn. @sharonNYT

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When should you wear a mask? By Amelia Nierenberg

On Monday, Philadelphia reinstated its mask mandate as cases there rose. (New York City may soon follow.) Hours later, a federal judge struck down the federal mask mandate for planes and public transit.

Since then, it’s been an absolute scramble.

Public health experts are dismayed by the ruling, which the C.D.C. said today it had asked the Justice Department to appeal.

Some large U.S. transit systems are keeping mask mandates in place, a decision supported by a new poll. But many airlines quickly complied with the new rules, and Uber ended its U.S. mask requirements. When asked whether Americans should wear masks on planes, President Biden said it was “up to them.”

Here’s some guidance, taking into consideration your environment, your individual risk factors and those of the people around you — and the fact that masks protect the wearer, even when others around them are mask-free.

Airplanes: A mask is a good idea.

Most planes pump the cabin air through high-efficiency particulate air (HEPA) filters, which work pretty well. But in December 2021, researchers found that passengers sitting in the same row and more than one seat away from someone who had Covid-19 still had a high risk of being infected through direct respiratory droplets. Wearing a mask reduced the risk of infection by 54 percent.

Your seat may not be in the most dangerous spot, either. Boarding and deplaning areas and airports generally may be worse for circulation of the virus. And as experts reminded me: You don’t want to ruin your trip by becoming infected and having to quarantine, even if your risk of severe illness remains low.

Public transportation: Probably a good idea.

Unlike a plane, few buses or trains have fancy ventilation systems.

“I know everyone talks about planes, but I would say buses are probably the riskiest, then trains, and then planes, in order of highest to lowest,” said Linsey Marr, an expert in airborne transmission of viruses at Virginia Tech.

Schools: It’s a tough call.

It’s a difficult and deeply personal call for parents, especially when schools or school systems do not have hard and fast mask mandates.

Children very rarely suffer severe symptoms, whether or not they’re vaccinated. (Vaccination helps: Unvaccinated children from 5 to 11 years old were hospitalized with Covid at twice the rate of vaccinated children during the winter Omicron surge) Many students have gone to school without masks during the pandemic, and very few children have gotten seriously sick.

The jury is also still out on whether masks impede social development, and several studies do suggest that masks make communication difficult.

Shopping: Depends on the store.

If the business is mask optional, consider the space, the crowds and the airflow.

Take a big box store with high ceilings. “Those tend to have good ventilation, and because of the high ceilings, there’s a lot of dilution,” Dr. Marr told me.

“If it’s a smaller space and crowded space — Trader Joe’s, for example, or some New York market with tiny aisles and people are really packed in there — the risk is higher,” she continued. “You might want to wear a mask.”

And in general: Consider case numbers.

You’re not the only person affected by your mask choices.

Take a second to wonder about the risk you pose to others, especially as cases rise. What role does my mask play in protecting others? What is my responsibility to the people around me, especially if I’m healthy?

How dangerous is Covid, really?

Throughout the pandemic, we’ve all tried to quantify the actual threats we face from the coronavirus, fumbling around with iffy statistical analyses.

Scientists have struggled to make and communicate comparisons as well. The coronavirus remains new enough, and its long-term effects unpredictable enough, that measuring the threat posed by an infection is a thorny problem.

But with the information we have now, my colleague Benjamin Mueller tackled questions of quantifying your individual risk.

Here are some takeaways from a few recent estimates:

  • War: The average vaccinated and boosted person 65 or older had a risk of dying after a Covid infection slightly higher than that of someone serving for a year in the military in Afghanistan in 2011.
  • Drugs: An average unvaccinated person 65 or older is roughly as likely to die from an Omicron infection as someone is from using heroin for a year and a half.
  • Driving: An average 40-year-old vaccinated more than six months ago faces roughly the same chance of being hospitalized after an infection as someone does of dying in a car crash in the course of 170 cross-country road trips.

 

Any comparison to an average is inherently limited, however, because different groups of people have different vulnerabilities. Children and the immunocompromised, for example, face very different risks:

  • Children under 5: The risk of dying after a Covid infection was about the same as the risk of a mother dying in childbirth in the U.S. (Importantly, that’s a national average; there are large racial discrepancies in maternal mortality statistics.)
  • Organ transplant patients: An unvaccinated 61-year-old with an organ transplant is three times as likely to die after a Covid infection as someone is within five years of a diagnosis of stage one breast cancer. That transplant recipient is twice as likely to die from Covid as someone scaling Mount Everest.

 

Tips for travelers in a mask-optional world-Worried about the COVID risk? The CDC’s chief medical officer has advice. Prevention’s mask mandate for public transportation. (David Zalubowski Associated Press) By Melissa Healy in the LA Times.

Your bags are packed, you’re ready to go . You’re standing there, outside your door. And you’re thinking, “If I catch COVID-19 on this trip, I could get seriously ill or die.”

You got a fresh N95 respirator for the trip. And you were counting on most of your fellow travelers to cover their noses and mouths too: the driver of your ride-share, the people in the airport, and passengers packed tightly inside the plane.

But last week, a federal judge in Tampa, Fla., issued an order that voided the Centers for Disease Control and Prevention’s mask mandate for those on public transportation. The U.S. Justice Department is appealing the decision at the CDC’s behest. Until the issue is sorted out in court, most commercial airlines, airports, bus lines and public transit systems have stopped requiring travelers and employees to mask up.

That means you’re likely to be surrounded by maskless faces .

The most transmissible strain of the coronavirus yet — the BA.2 subvariant of Omicron — dominates the landscape now. It may be slightly less lethal than its forerunners. But older people, those with medical conditions, and the unvaccinated face a heightened risk of serious disease or death if they become infected. Although full vaccination offers some protection against becoming severely ill, that protection is leakier if you haven’t been boosted, or if your last shot was more than four months ago.

Now what do you do? Dr. John Brooks , the CDC’s chief medical officer for the COVID-19 response, has some practical advice:
Arm yourself.

Get vaccinated, and if you’re fully vaccinated, get boosted. If you’ve had two or three shots of Pfizer’s Comirnaty or Moderna’s SpikeVax vaccine and it’s been four months since your last shot, another dose is advised. Give yourself a week or so for another jab to refresh your immune system’s supply of antibodies.
If you have certain medical conditions, can’t be vaccinated, or take medications that weaken your immune system’s ability to fight off infections, see if you can get a dose of Evusheld , a form of passive defense that can help protect you.

Patients in active treatment for cancer, or people who received a stem cell transplant for blood cancer in the last two years, may not have mounted a strong response to the vaccine. They need the extra boost of immunity that the monoclonal antibodies in Evusheld provide. Patients who take long courses of high-dose steroids or a range of other medications to treat autoimmune diseases such as lupus, rheumatoid arthritis or multiple sclerosis may be in the same boat. And anyone who has had a solid organ transplant needs more protection to compensate for the medications they take to prevent rejection.

Just over a million doses of the protective medication have been distributed , mainly to hospitals and healthcare systems across the country. That won’t cover everyone who probably needs it. If you think it could help you, the rheumatologist, oncologist or transplant team that treated you is best positioned to help you get it.

Do wear your mask, and make sure it’s a good one.

In a crowd, the more people are masking, the less virus will be suspended in the air to be breathed in. But correct and consistent wearing of a mask that molds close to your face can protect you from breathing in those lingering viral particles, or limit how much you take in. That, in turn, could mean the difference between warding off infection and becoming ill.

ou’ve heard this before, but it’s worth repeating: A cloth mask won’t cut it, given how readily the Omicron variant spreads. If you love your cloth mask, put a disposable surgical mask over it: they’re designed to draw in and trap virus on their surface. But your best bet is to wear an N95 respirator, which pinches around your nose and has ear loops or head straps that hold the mask tight to your face.

“Before you go on an airplane, practice at home to make sure you can wear it comfortably, correctly and consistently,” Brooks said. “They’re itchy and scratchy and the air is hot for some people. But millions of healthcare providers have learned how to wear them, and you can too.”
Mind the transitions, and take a direct flight if you can.

The filtration systems of most commercial jets are fully engaged when they’re traveling above 10,000 feet, Brooks said, and they are powerfully effective at cleaning the air under those conditions. But when jet engines are idling on the ground (and passengers are boarding or deplaning), those systems are not doing that job. And the efficiency of those air filtration systems also suffers as the plane ascends or descends.

So be sure to wear your mask during those transitions. And taking direct flights where possible limits the amount of time you’re sitting in a crowded metal tube with a filtration system that’s going to let more virus slip through than it will at cruising altitude.

Reserve a window seat, board last, and sit near the front so you can deplane quickly .

The principle here is to spend the least amount of time possible on a plane that’s still on the ground, Brooks explained. You also want to sit where any virus emitted by passengers and staff in the aisles is least likely to reach you.

Seeking special favors from airlines is either costly or difficult. But most will let you choose your seat for an extra charge, and if you can do that, look for one that gives you some distance from passersby but also lets you make a fast getaway.

Eat or drink with caution.

You’ll probably be hungry and thirsty if you’re taking a long trip. But if other travelers are largely unmasked, your snack or swig of soda is an opportunity for their virus to enter your respiratory tract.

Brooks notes that a straw can be inserted right under a mask, limiting the broken seal. He suggests eating in the airport rather than on the plane, and munching your meal in an unpopulated corner of the gate area. Wash your hands before eating.

Know the community transmission level where you’re going, and behave accordingly.

Going to a hot spot of new cases, or passing through one on the way to your destination? Find out before you go so you know where masking and social distancing are still a good idea and where you can afford to loosen up. Visit the CDC’s community website and click on the counties you’ll be traveling from, to and through.

Stock up on rapid tests and prepare to spring into action if you test positive.

It makes sense to test yourself before you travel, to make sure you’re good to go. But bring another test and take it four days or so after you’ve been in a high-exposure situation like an airport, or if you develop COVID-19 symptoms.

Getting the earliest possible indication of infection is all the more important because antiviral medications such as Paxlovid and molnupiravir are now available, and they can shorten the duration and/or lessen the severity of an infection. But they must be taken as soon as symptoms start , and no more than five days after symptom onset.