By Kara Gavin / U-M
Remember those “Choose Your Own Adventure” books from grade school?
The ones where you turned to a different page, depending on what you wanted a book character to do?
If you find out you or your child has been around someone who has COVID-19, you might feel like you’re living in one of those books.
What should you do next?
And unlike the books, there’s a lot more at stake if you make the wrong choice. Plus, you can’t turn back to the page you started on.
So, here’s a simple Choose Your Own Adventure-style guide to get you through the current surge in cases, and the next few months, safely.
For full details, follow the Choose Your Own Adventure text below.
Wait! This guide doesn’t agree with what I was told before.
That’s right! Experts have learned a lot in the past year about this coronavirus, how it spreads and who’s most likely to get sick or spread it to others. And more people are getting vaccinated, which protects them from serious illness and death if they get infected.
So the rules about who needs to do what, after they get exposed to a person with COVID-19, have changed.
And the rules apply to children and teens as well as adults. Younger people may not be as likely to get sick, but they can still spread the virus. So where we say “you” below, you can also substitute “your child or teen.”
You find out that you were exposed to someone who developed COVID-19 symptoms, or who tested positive for coronavirus even if they don’t have symptoms.
- What counts as an exposure or close contact? A general rule of thumb is you were within six feet of someone with COVID-19 for 15 minutes or more (masked or unmasked, indoors or outdoors) during their contagious period. Even if it was a shorter encounter, but the person sneezed near you or you ate or drank from shared dishes or utensils; that counts too. Sharing enclosed spaces with such a person, especially ones that don’t have good ventilation or for prolonged times, also can be counted.
- What counts as the contagious period? It starts two days before a person’s symptoms began. Or, if they have no symptoms, it started two days before the day they got tested, if their lab test (called PCR) was positive. It lasts through the end of the 10th day after their symptoms started, unless they still have a fever on the 10th day. In that case, they’re still contagious until the fever has been gone at least 24 hours, without fever-reducing drugs. Or if they have no symptoms, it lasts 10 days after the day of the lab test (PCR) that came back positive.
Your adventure begins:
- First, you need to get tested. It can take a couple of days after your exposure for you to become infected. Because of this, you should be tested not with a rapid test, which is less accurate in the early stages of infection, but with a lab test (called a viral or PCR test) using a swab up your nose. You can get such a test for free from most pharmacies and public health departments, and many clinics. It may take a day to get scheduled, and results could take a few days to come back.
- Stay home until you can get tested, and keep staying home until you get your test results back. This is called quarantine. Then follow the directions below for negative or positive results.
- Tell the person at your school or work who tracks COVID-19 exposures that you had an exposure.
- Tell the people you live with, and anyone you were around in the past few days, that you had an exposure. They don’t have to get tested or quarantine if you test negative. But if you test positive or develop symptoms, then they need to follow this guide, too.
- If you’ve been fully vaccinated: If it’s been at least two weeks since your final or single vaccine dose, your school or work may let you come back right away unless you develop symptoms. Ask them.
- If you live with someone who is at high risk of serious COVID-19: Stay distant from them, and wear a mask at home. Meanwhile, the person you were exposed to should stay home in isolation until their contagious period is over. (What’s isolation? See Adventure 2 below.) The person you were exposed to should also tell their school or work, and tell people they live with and people they were near recently, so that all their other close contacts can also get tested and stay home.
You just got your test results. Time to choose an adventure:
Adventure 1: Your lab test comes back negative and you have no symptoms.
Report your test result to your school or work, and to people you live with or were near recently.
But you’re not out of the woods yet.
Now, choose which one of these situations applies to you to find out what happens next:
- If you’ve been fully vaccinated: “Fully vaccinated” means it’s been at least two weeks after you got the second dose of a two-dose vaccine, or two weeks after you got a single-dose vaccine. If that describes you, then good news: You do not need to stay home, unless you start getting symptoms! Your chances of developing COVID-19 are very low, but it’s still possible because the vaccines are not a total guarantee. If you do develop symptoms, skip to Adventure 2.
- If you’ve recovered from a confirmed case of COVID-19 within the past 3 months: You don’t need to stay home after a new negative test, unless you start getting symptoms, which is still possible because your protection from a past infection is weaker than a vaccine’s protection. If you do develop symptoms, skip to Adventure 2.
- If you haven’t gotten vaccinated at all yet or you’re only partly vaccinated: You could still be infected, but the test might not have detected it yet. So, you need to stay home as many as 14 days from the time of your last exposure to the contagious person. This is true even if you tested positive for COVID-19 in the past, but it was more than a few months ago, because your immunity has likely decreased. If you stay symptom-free for 10 days, your local public health department may allow you to leave quarantine and go back to school or work, and out in public. If it does, you should still monitor yourself for symptoms on days 10 through 14, and skip to Adventure 2 if you have any. As long you are symptom-free, it’s now time to schedule your vaccination if you’re eligible. If you’re partly vaccinated, you can continue with your next vaccine dose as scheduled.
- If you weren’t planning to get vaccinated or you aren’t eligible yet: You need to follow the same directions as an unvaccinated person and you’ll have to quarantine every time you get exposed, until you’re fully vaccinated. Consider the inconvenience of that when you’re making your vaccination decision. Talk to a health professional if you have concerns.
Adventure 2: Your lab test comes back positive or you develop symptoms.
There’s no way to sugar-coat this: you need to go into isolation.
Isolation means staying home at all times and avoiding others, even the people you live with.
It means staying in a closed room (though you can have a window open.) It means wearing a mask to use the bathroom. It means having people leave you food, drink and medicine at your door. It means treating any symptoms you might have, such as fever and pain. And of course, it means seeking medical care if any of your symptoms become serious.
Tell your school or work what’s going on. Tell people you recently had close contact with, so they can get tested with a lab test (PCR) and stay home while they wait for their results.
Don’t leave isolation until your contagious period is over.
This means your adventure in isolation must continue 10 days after your positive test or the start of your symptoms. At that point, you may be ready to go back to school or work. But if you’ve had a fever, you must also wait until you are 24 hours after the fever has gone away, without fever-reducing drugs.
Then, and only then, can you go back to school or work. You might have some lingering symptoms like a reduced sense of taste or smell, but you are not likely to be contagious unless you have a compromised immune system.
You should still monitor yourself for symptoms until 14 days, and go back into isolation if they come back.
Now, choose which one of these situations applies to you, to find out what happens next:
- If you’re fully vaccinated: Thank science that you probably just had a much milder case than you would have if you hadn’t been vaccinated. Encourage others to get vaccinated.
- If you’re partially vaccinated: Wait a week or two until you go get that second dose of a two-dose vaccine. If you already had an appointment, you may need to delay it. Just make sure you get it.
- If you haven’t started the vaccination process, now’s the time. Schedule your appointment for a week or two after your contagious period ended.
- If you weren’t planning to get vaccinated, please consider doing it after all. Wait a week or two and then start the process. Talk to your doctor or a trusted medical professional if you have questions. Be wary of negative claims on social media.
- If the person who tested positive or had symptoms is under age 16: Vaccination isn’t authorized for this age group yet, but once it is, it’s important to get vaccinated, even after having COVID.
Keep reading for the final chapter.
The final chapter: Life after a COVID exposure
No matter what your test result, vaccination status or COVID history, you still need to wear a mask in public, avoid large gatherings, and avoid being near people who you know are contagious whenever possible. As vaccination increases, this guidance will likely change.
If you are traveling, taking part in sports, preparing for a medical procedure, or working or attending school in person, you may be asked or required to take antigen tests once or multiple times.
These screening tests give results in minutes and are useful for spotting undiscovered cases, but they are also much more prone to giving “false negatives.” So, getting a negative result on one of them does not give you a “free pass” to stop paying attention to COVID precautions.
If you test negative on an antigen test, but you then develop symptoms or find out that you had an exposure to a contagious person, you should get a lab test (PCR) and quarantine until you get your results.
If you test positive on an antigen test, immediately follow up by having a lab test (PCR), and quarantine until you get the results. In either case, use your lab test results to guide you on Adventure 1 or Adventure 2 above.
The less the virus spreads, the less chance it will have to sicken and kill people, to mutate, and to prompt new limits on schools, activities and businesses.
Public health experts will tell us when we can ease up on these practices, based on vaccination rates and case counts.
Because that’s the only way we’re going to close the book on COVID-19.
Thanks to Michigan Medicine experts Emily Somers, Ph.D., and Jonathan Golob, M.D., Ph.D., for assistance in the preparation of this story and the accompanying flowchart.