So Your COVID-19 Test is Positive: Now What?

At-home COVID-19 antigen tests are among the tools we all can use during this pandemic. Many of us have found or will find ourselves in the situation where someone in our household has a positive at-home test. There are times when a negative home test needs a back-up PCR test; however, if a home test is positive, it’s generally safe to assume the positive test is real. So what happens next?

When you or a loved one tests positive

First, take a breath, stay calm, and steady yourself. It can feel extremely stressful and discouraging when you have done everything in your power to keep COVID-19 out of your home and it arrives anyway, uninvited and unwelcome.

Next, you should isolate the positive person as much as possible. If the positive person is an adult or older child and you have space in your home, give him or her their own area to isolate. The less time you all spend in close proximity, the safer you’ll be.

When the positive person is going to be around others in the home (less than six feet, especially if it’s more than 15 minutes at a time), everyone should be masked if possible. If you are able and the weather is nice, activities that require a mask to be off (like eating) can and should occur outside. Likewise, if you can open windows and improve ventilation in the home, please do.

If you are the only adult in the home and you have children to take care of, isolating yourself clearly is not feasible. Put on a mask and do what you can. If your children are older, it will be easier to maintain space between you, but if your children are newborns, infants, or toddlers, this is much more difficult. In the same way, it can be near impossible to isolate young siblings from each other.

Children older than 2 years can wear a mask. However, as all pediatricians have seen, some young children take pride in wearing a mask like adults and others rip it off as soon as it covers their face. Again, do what you can. Children under 2 years of age should not wear masks.

If you are an adult with young children and you test positive for COVID-19, try to maintain distance and let your kids know what’s going on. For example, you might tell them, “Mom has germs right now so I’m trying to stay away to keep your body safe. When I’m not contagious anymore, can I have extra hugs to make up for this time I have to stay farther away?” Children can handle facts and truth, and by staying calm, you can help them stay calm, as well. After all, “COVID” or “coronavirus” is a part of every speaking child’s vocabulary. For some of them, a large percentage of their lives has been spent in the pandemic.

It’s easier to isolate a teenager or older child. In fact, a teenager will generally gladly return to her natural habitat of isolation in her room. You can bring food to her room or have her eat outside, if there is space and the weather is nice.

For younger children, let’s face it, you will not be able to isolate. In this situation, the caretaking adult should put on a mask and be as careful as possible.

The isolation and quarantine guidelines can be confusing. On Jan. 9, 2022, the CDC released updated quarantine and isolation guidelines that can be found at https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html.

Please remember that the above guidelines are for people who are able to mask. Those who are unable or unwilling to mask should isolate for 10 days when they test positive.

In all these situations, everyone should be vigilant about hand washing. Clean high-touch surfaces like iPads, door handles, remote controls, and light switches frequently. Avoid sharing household items like dishes or towels, and wash bedding and towels in warm or hot water.

Working with your doctor

Once the COVID-19-positive person is isolated, if possible, it’s time to take the next step. Adults who test positive should contact their own doctor for care recommendations. If a teenager, child, or infant is positive, please contact your pediatrician for care advice.

One of the benefits from the pandemic is the ability for physicians to offer telemedicine visits. Scheduling a video visit with your pediatrician is a good option, as you can stay in the comfort of your own home and ask any questions you might have about the positive COVID-19 test. You can receive care advice and guidance, and a return-to-school note if needed.

If you prefer, your pediatrician can see your child in the office for an exam. It can be reassuring to have someone listen to his chest, check his ears, and let you know the severity of the illness. Likewise, if your pediatrician sees your child on the video visit and is concerned about the way your child looks, he or she likely will ask you to bring the child for an in-person visit.

Once you have spoken with your adult doctor or your pediatrician and are feeling more comfortable that the COVID-19-positive person is stable, it’s time to start thinking about the rest of the people in the household. A good resource is to check the CDC website (www.cdc.gov/coronavirus) for recommendations. You also might need to contact your employer or your child’s school for isolation guidelines.

The importance of isolation

Remember that while the positive person generally is most contagious for two days prior to symptoms beginning (or a positive test) and for the first three days of symptoms, a COVID-19-positive person can be contagious for up to 10 days. An exposed person is most likely to develop symptoms within a week of exposure, but can exhibit symptoms up to 10 to 14 days from exposure. He or she should isolate as much as possible.

If your child is exposed but is not exhibiting symptoms, you can fill out an E-visit for coronavirus exposure through Texas Children’s Pediatrics. A pediatrician will order a test for the exposed person, which generally is recommended five to seven days after the last exposure, if the exposed person remains asymptomatic. If your child is exposed and develops symptoms, you can schedule a video visit to receive care guidance and have a test ordered.

Most importantly, remember that you are not alone. It can feel daunting to have COVID-19 in the house. Your pediatrician and all healthcare providers are working hard to see everyone who needs care, so please be patient with us. We will be there if you or your children need anything.

Specific CDC guidelines for quarantine with COVID-19

Here are the CDC guidelines as of Jan. 9, 2022. They can be found at the following website: https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html

If you were exposed to COVID-19 and are not up-to-date on your COVID vaccine:

1. Quarantine for at least five days:
   • Stay home:
     • Stay home and quarantine for at least five days.
     • Wear a well-fitted mask if you must be around others in your home.
   • Get tested: Even if you don’t develop symptoms, get tested at least five days after you last had contact with someone with COVID-19.
2. After quarantine:
   • Watch for symptoms: Watch for symptoms until 10 days after you last had close contact with someone with COVD-19.
   • If you develop symptoms, isolate immediately and get tested. Continue to stay home until you know the results. Wear a well-fitted mask around others.
3. Take precautions until day 10:
   • Wear a well-fitted mask for 10 full days any time you are around others inside your home or in public. Do not go to places where you are unable to wear a mask.
   • Avoid travel.
   • Avoid being around people who are at high risk.

If you were exposed to COVID-19 and are up-to-date on vaccination, or if you had a confirmed case of COVID-19 within the past 90 days (you tested positive using a viral test):

1. No quarantine: You do not need to stay home unless you develop symptoms.
2. Get tested: Even if you don’t develop symptoms, get tested at least five days after you last had close contact with someone with COVID-19.
3. Watch for symptoms: Watch for symptoms until 10 days after you last had close contact with someone with COVID-19.
4. If you develop symptoms: Isolate immediately and get tested. Continue to stay home until you know the results. Wear a well-fitted mask around others.
5. Take precautions until day 10:
   • Wear a well-fitted mask for 10 full days any time you are around others inside your home or in public. Do not go to places where you are unable to wear a mask.
   • Avoid travel.
   • Avoid being around people who are at high risk.

If you tested positive for COVID-19 or have symptoms, regardless of vaccination status:

1. Stay home for at least five days.
   • Stay home for five days and isolate from others in your home.
   • Wear a well-fitted mask if you must be around others in your home.
2. Ending isolation if you had symptoms:
   • End isolation after five full days if you are fever-free for 24 hours (without the use of fever-reducing medication) and your symptoms are improving.
3. Ending isolation if you did not have symptoms:
   • End isolation after five full days after your positive test.
4. If you were severely ill with COVID-19:
   • You should isolate for at least 10 full days. Consult your doctor before ending isolation.
5. Take precautions until day 10:
   • Wear a well-fitted mask for 10 full days any time you are around others inside your home or in public. Do not go to places where you are unable to wear a mask.
   • Avoid travel.
   • Avoid being around people who are at high risk.

Calculating quarantine (when you are exposed):

• The date of your exposure is considered day 0. Day 1 is the first full day after your last contact with a person who has had COVID-19. Stay home and away from other people for at least five days.

Calculating isolation (when you are sick or test positive):

• Day 0 is your first day of symptoms or a positive viral test. Day 1 is the first full day after your symptoms developed or your test specimen was collected. If you have COVID-19 or have symptoms, isolate for at least five days.