18/06/2020
Dr Daniel Israel from Dr Israel & Associates, Melrose, explores what to do if you've been exposed to a COVID positive patient :
𝗛𝗶 𝗗𝗼𝗰. 𝗜'𝘃𝗲 𝗯𝗲𝗲𝗻 𝗶𝗻 𝗰𝗼𝗻𝘁𝗮𝗰𝘁 𝘀𝗼𝗺𝗲𝗼𝗻𝗲 𝘄𝗵𝗼'𝘀 𝘁𝗲𝘀𝘁𝗲𝗱 𝗽𝗼𝘀𝗶𝘁𝗶𝘃𝗲 𝗳𝗼𝗿 𝗖𝗢𝗩𝗜𝗗-𝟭𝟵. 𝗪𝗵𝗮𝘁 𝗺𝘂𝘀𝘁 𝗜 𝗱𝗼??
The first important consideration is to ascertain whether you have indeed been in contact. 𝗦𝗶𝗴𝗻𝗶𝗳𝗶𝗰𝗮𝗻𝘁 𝗰𝗼𝗻𝘁𝗮𝗰𝘁 is defined as exposure to a positive patient for at least 15 minutes, in a confined space or at a distance of less than 1.5m, even if both people were wearing masks.
If you were greater than 1.5 metres away from the positive patient, for a short duration of time and particularly if you were wearing masks, this is not considered a significant risk. I am often asked : 'Doctor, there is a colleague who works on the same floor as me who was just diagnosed with coronavirus. I didn't come anywhere near her, and I've worn a mask at work throughout the day. I've shared neither utensils, food nor workspace with her. What must I do?' The simple answer to this question is 'Do nothing. This is 𝗻𝗼𝘁 𝗮 𝘀𝗶𝗴𝗻𝗶𝗳𝗶𝗰𝗮𝗻𝘁 𝗿𝗶𝘀𝗸.'
Admittedly, coronavirus exposures come in various shades of grey. The situation could have entailed one person was wearing a mask; the distance between the contacts may have been less than a metre; the exposure was already 10 days ago the duration of the exposure may have been 15 minutes.
My advice to patients is as follows :
If the exposure was >15 minutes, and there was close proximity, the most important intervention to implement is 𝘀𝗲𝗹𝗳-𝗾𝘂𝗮𝗿𝗮𝗻𝘁𝗶𝗻𝗲. Quarantining refers to removing oneself from all other people for 14 days and expectantly watching for the classic symptoms of COVID-19 during that time ie. fever, dry cough, fatigue, loss of smell, loss of taste and sore throat.
If the exposure was definitely less than 15 minutes, you were wearing a mask and you kept a good distance from the patient who has now emerged as being positive, you have 𝗻𝗼𝘁 had an exposure, and you may continue the 𝘀𝗼𝗰𝗶𝗮𝗹 𝗱𝗶𝘀𝘁𝗮𝗻𝗰𝗶𝗻𝗴, 𝗺𝗮𝘀𝗸-𝘄𝗲𝗮𝗿𝗶𝗻𝗴 and 𝘀𝗮𝗻𝗶𝘁𝗶𝘀𝗶𝗻𝗴 that we are all currently practicing.
If your scenario is in-between, it is prudent and, I believe, your personal responsibility to 𝗾𝘂𝗮𝗿𝗮𝗻𝘁𝗶𝗻𝗲 yourself as if your exposure was significant. This recommendation is in view of the drastically rising number of cases in South Africa and the desperate need to continue to flatten the curve, and to protect the vulnerable groups in our population.
The key here, is that the correct response to an exposure is 𝗻𝗼𝘁 𝘁𝗼 𝗿𝘂𝘀𝗵 𝗼𝘂𝘁 𝗮𝗻𝗱 𝗴𝗲𝘁 𝘁𝗲𝘀𝘁𝗲𝗱. The evidence shows that the mean incubation period for the SARS-CoV-2 virus (which causes COVID-19) is 5 days. 80 percent of cases exhibit viral DNA in a PCR test by 7 days and this approaches 90 percent by 10 days. Due to the current limited supply of testing kits, the NICD recommendations are to test after an exposure 𝗼𝗻𝗹𝘆 if you develop symptoms.
Let's be honest though. Many of us have easy access to testing. So after an exposure, the knee-jerk reaction to allay anxiety is test quickly. However, if the test is going to have any reasonable 𝗽𝗼𝘀𝗶𝘁𝗶𝘃𝗲 𝗽𝗿𝗲𝗱𝗶𝗰𝘁𝗶𝘃𝗲 𝘃𝗮𝗹𝘂𝗲, you should wait at least 7-8 days until you test. A negative test at this point is a good reassurance, but still does not obviate the need to isolate for 14 days, if the exposure was significant.
In the case where you may have had an exposure and then become symptomatic, an 𝗶𝗺𝗺𝗲𝗱𝗶𝗮𝘁𝗲 𝘁𝗲𝘀𝘁 is far more justifiable and this prompt timing then would be far more appropriate.
The key to managing post exposure to a coronavirus patient is.
1. 𝗘𝘃𝗮𝗹𝘂𝗮𝘁𝗲 how real the exposure was.
2. 𝗤𝘂𝗮𝗿𝗮𝗻𝘁𝗶𝗻𝗲 if it was significant exposure and
3. 𝗧𝗲𝘀𝘁 only if and when appropriate.
Even if the test is negative, you may still need to continue to isolate and retest later appropriately.
Speak to your doctor to guide you with these decisions
Daniel Israel
Dr Daniel Israel & Associates
