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When Covid Enters the House, What Should We Do?

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.

Should we swab our noses and throats?

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.

Is a rapid test enough?

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 aftertaking the test that turned positive or developing symptoms, according to Centers for Disease Control and Prevention rules).

In our case, after my son tested positive on a P.C.R., the rest of us did only home tests. We also used rapid tests again to determine when we were no longer contagious — which many, but not all, experts agree is a best practice to keep others safe. Most people test negative by Day 10, but that time period could range from five to 14 days, meaning a person could be contagious for all that time.

“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.

Should I wear a mask in public if anyone in the house is sick?

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.

People who have been exposed to the virus through family members should wear masks in indoor spaces or crowded outdoor ones.Credit…Hiroko Masuike/The New York Times

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.

If a vaccinated child is highly exposed to Covid at home but is still healthy, parents might consider keeping that child home to protect others. Masks do come off at lunch. But this measure would be going above and beyond the federal recommendations, and only one expert I spoke with recommended it.

Should I try reduce exposure in the household, even if it seems futile?

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.

How can I protect the most vulnerable?

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 positive! 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.”

What do I need on hand?

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.

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