Covid and influenza: who should test, how and when?  How is the isolation?  - 01/11/2022

After all, is it five, seven or ten days of leave? Since Monday, 10th, when the Ministry of Health released new recommendations for those who caught the covid-19 virus, this is the question that does not want to be silent.

The text mainly confuses people who are without or almost without symptoms – today, this is the case for a good part of those infected, thanks to the advance of vaccination, which manages to contain precisely the aggravation of the disease.

Now, I say that it confuses because these people who are barely feeling the covid-19 or who don’t even feel anything appear in the three possibilities of isolation duration.

This can lead many people, without really understanding what is to be done or pretending to be ignorant, to think that they can get rid of the punishment as soon as possible – imposed not by doctors, nor by politicians on this side or that, nor by the media. , but by the virus.

As they generate more doubt than clarification in several passages, it is good to detail these new recommendations, which I did with the help of infectious disease specialist Demetrius Montenegro, from the Oswaldo Cruz University Hospital of the University of Pernambuco and the Real Hospital Português, in Recife, which is also consultant for SBI (Brazilian Society of Infectious Diseases).

SBI, which, by the way, already manifested itself the day before yesterday, 11, with a letter to CONASS (National Council of Health Secretaries) recommending seven days of isolation – without any discount, that is, nothing of five days only – from the date of the diagnosis for asymptomatic patients and indicating seven to ten days for symptomatic patients.

In the case of these, the symptomatic, what would determine being isolated for seven, eight, nine or ten days would be to spend 24 hours without coughing, feeling pain, sneezing and, importantly, without having a fever. Of course, it’s not worth running out of fever just on the basis of antipyretic pills.

It is a guideline that is easier to keep in mind and that takes into account a fundamental fact: infected people transmit the virus for about seven days after the onset of symptoms. The virus is what it is, despite our burning desire to get back to life as usual.

And why should you also engrave the number “10”, which is discreetly repeated even in the Ministry’s own recommendations? Because these people were already spreading the disease two or three days before any smoke or covid-19 sign. Making the sum of these three days of incubation with the seven of symptoms…

Good to clarify: the text of the Ministry of Health is, yes, based on the recommendations of the acclaimed CDC (Centers for Disease Control and Prevention), in the United States. But the American version is a little more detailed. There, for example, the story is one for those who have a complete vaccination schedule, including the third dose, and another for those who did not get there. It is worth noting that, if this were considered here, many younger Brazilians are still waiting for their third injection.

The CDC’s recommendations also differentiate between what is quarantine and what is isolation—a point that Dr. Montenegro highlighted in our conversation—and what you can do in one or the other. It also scrutinizes how each one should act if they leave the house before completing the maximum attention span that is non-negotiable: ten days.

“But neither the American document, nor ours — by the way, nor that of any corner of the world — points out that, for every rule, there are exceptions”, comments Dr. Demetrius Montenegro. “If you, with or without symptoms, have a pregnant woman at home, better not have any contact with her for the entire ten days”, thinks the doctor, who also confesses that he doesn’t feel safe, under any circumstances, telling someone infected that is not feeling anything coming out of isolation on the fifth day, despite current recommendations.

For him, the biggest reason to ask for patience and caution would not only be the risk of passing on Sars-CoV 2 with a premature release, but the explosion of omicron cases, many of them under the rug because they are asymptomatic, causing the emergence of new variants that perhaps, tomorrow or the day after, will escape vaccines.

Because the truth is this: the virus gains a beautiful chance to mutate in every organism it infects, whether it shows symptoms or not.

Five days?!

The five-day part is the most confusing—and controversial. According to the new recommendations, if you are at a normal temperature without taking any antipyretic medication and also without respiratory symptoms for at least 24 hours, you should be tested.

If the result, in turn, is negative, it is to “come out of isolation and keep the additional recommendations until the tenth day”, it is written. And, if it is positive, continue in isolation until completing the famous ten days.

What are the “additional recommendations” for those who tested negative? Would it be the usual ones, like wearing a mask, sanitizing your hands and everything else? Strange, because these are beyond the ten-day deadline, until this pandemic gives us real peace. And other, more severe measures would not apply to those who tested negative on the fifth day, when a false result is unlikely.

“We can assume that, in this first point, the recommendations refer to those who were close to people who were proven to be contaminated”, observes Dr. Demetrius Montenegro. It would make sense: then, the test on the fifth day is recommended. In this case, the date of the meeting with the person who tested positive would be “zero” and the count to “5” would start the next day. Before that, the result may be a false negative.

However, according to the text, this five-day recommendation would be even for people known to be infected with mild and moderate conditions. Could it be that they are recommending two tests, a second one on the fifth day after the first, which gave the diagnosis? Between ourselves, that doesn’t seem to be feasible, even for lack of tests. Not to mention that, between doing one and the other, it could take more than ten days.

“The worst thing is that, by not being able to schedule the exam, the person without symptoms may think that this would be just a detail and leave isolation in such a short time without it”, worries Dr Montenegro. Well, that wouldn’t be a good idea.

Isolation versus quarantine

At first glance, it is good to understand the difference, although the Brazilian recommendations do not enter into this merit. “Whoever has a positive test should do isolation, that is, if possible, be alone in a room in the house”, explains the infectologist. The toilet would need to be sanitized after each use as well.

The quarantine, in turn, is for those who know that they have had contact with someone with covid-19. In principle, this person should also stay at home until they are sure that they have not been infected, but without the need to isolate themselves in a single room.

“This would be a situation similar to that of someone who, to visit a certain country, needs to spend time in a hotel, until it is proven that they do not have the covid-19.”

Just note that, for the American CDC, those who have their complete vaccination schedule, considering additional doses, are released from quarantine, if they crossed paths with someone infected.

The reality is that, here or there, as today it seems that half the planet has an omicron and the other half has been with someone infected by this new variant, the viable idea is for everyone who has had contact with contaminated individuals to continue with their routine, but being much stricter with the use of a mask and always attentive, if you feel something different.

The isolation, now, of seven days

According to the new recommendations, on the seventh day of isolation, if the person no longer has symptoms, they can stop being isolated and, attention, without the need to take a new test. Before, it was ten days of isolation every time.

What can be overlooked in reading the text are the so-called “additional recommendations until the tenth day”. What would they be? “The mask, very well adjusted, needs to be used all the time during these other three days”, explains Demetrius Montenegro.

It is not possible, exemplifies the doctor, to have lunch with the work staff in the cafeteria or in the restaurant near the firm, since it is inevitable to take off the accessory to eat. “You can’t even sit at the table with your family,” he adds. “Or have that coffee with a colleague, talking for a few minutes. The problem is that, as the orientation is vague, in the end each one will act according to their criteria”, laments the doctor.

the old ten days

According to the Ministry of Health, those who have symptoms on the seventh day should take the PCR or antigen test. If he is negative, he can come out of isolation 24 hours after the fever or other malaise disappears, which may happen before ten days.

A positive result a week after the onset of symptoms would confirm the need to isolate for ten days. The text also says that, even after all this time, it would be important for the person not to be feeling anything wrong anymore.

For those who do not have any symptoms, it is the same guidance that appears in the isolation of seven days: after the tenth, it is possible to leave the house without doing any new test. In other words, it’s almost like a personal decision to isolate yourself for a week or a little longer.

But here, even more considering that several sectors of basic services for the population are blocking so many people away, the common sense pointed out by SBI infectologists is valid: seven days, taking extra care in the subsequent three days, can be a good length.

Leave a Reply