How to Actually, Effectively Quarantine

Though it’s been part of everyone’s vocabulary since March, it’s become increasingly clear that while people throw around the word “quarantine” regularly, not everyone actually seems to know what it means—including people at the highest levels of our government who are in charge of making the rules.

One advantage of living this way for the better part of 2020, though, is that researchers and infectious disease specialists have better, more elaborate understandings of how COVID-19 spreads, and how long it takes to infect those who’ve been exposed, which means we now know a lot more about how to properly quarantine than we did six months ago.

Quarantine is now an essential part of traveling, meeting up with groups of friends, and taking care of yourself after potential exposure to COVID-19. The broad, national-level guidelines give the basic rules, but leave too much room for interpretation. To clear things up, VICE spoke with an infectious disease specialist who answered, in detail, all your loophole, nitpicky quarantine questions.

Quarantine, by definition, is separating a possibly exposed person from everyone else, so they don’t inadvertently get others sick. It is different from isolation, which is when a person who has tested positive is kept completely separate from other people. Peter Chin-Hong, a medical professor who specializes in infectious diseases at the University of California San Francisco, told VICE to think of isolation as hermetically sealing an infected person off from the rest of society, to the extent that that is possible.

CDC guidelines designate a 14-day quarantine for COVID-19 based on the virus’s incubation period; while most people display symptoms around day five, some don’t start feeling sick or have enough virus to test positive until 14 days after known or possible exposure. But as our understanding of COVID-19 improves, along with testing capacity, it’s possible that you can feel safe about a slightly shorter quarantine. More on all of this below.

Nowhere! This is the entire point of quarantine and of state travel mandates.

Or, mostly nowhere. Chin-Hong said a proper quarantine means no going to the grocery store, drugstore, nearby park, walk-up neighborhood bar, etc. You can get things delivered as long as you don’t interact with the delivery person face to face (through the door is fine). If you live in a more rural setting without a multitude of delivery options, a neighbor, friend, or roommate should grab essentials for you (and then leave them outside your door).

Quarantining also means that anyone who lives outside your household isn’t allowed to visit you.

I mean, that would be extremely cool and probably useful going forward, but no, no need to be so dramatic. While Chin-Hong said walking your dog in public spaces is a no-go during quarantine, you’re free to take your dog in a private backyard (that belongs to you, not your friend or neighbor down the street). I’m not a dog owner, but I don’t know, pee pads exist? Or see if a friend would mind walking and/or watching your dog for a week or so. The good news is that dogs aren’t vectors for COVID-19, so you’re allowed to pet and play with your dog as much as you want in quarantine, just as long as it’s in your own space.

The only exception to leaving the house during quarantine is if you need to go to a healthcare setting, in the instance that you become ill, or want to get tested around day seven to put your roommates/yourself at ease. If you start displaying symptoms of COVID-19, get tested immediately and notify any contact tracing system your city/state has in place. If your test returns negative and you’re still experiencing respiratory symptoms, get re-tested, Chin-Hong said. False negatives can occur in the first few days of infection.

If you live alone, or have just traveled and are staying alone in a hotel or Airbnb at your destination, great! Quarantine is easiest for you. Stay in your living space for 14 days, or, if you aren’t under a state travel advisory, until you can get tested around day seven. If the test returns negative, Chin-Hong said it’s likely that it’s accurate—barring any symptoms—you can be nearly certain you don’t have COVID-19.

If you traveled with a partner, you’ve both been potentially exposed together, and may as well quarantine together. For those who can’t stay totally alone or in a separate residence/hotel, Chin-Hong offered a few guidelines on how to best quarantine in a family home or with roommates: Try staying in your own bedroom as much as possible, for starters, and anytime you’re in shared spaces, wear a mask. Others in the household don’t need to wear a mask, necessarily, but doing so can’t hurt. Wipe down high-touch surfaces, like faucets, doorknobs, and the flusher thing on the toilet, after you use them. Open windows, if you can, and give the bathroom and other shared spaces a few minutes to ventilate between visitors. Also use your own utensils and plates, and wash them yourself with hot water.

If you’re stressed about it, know that Chin-Hong said to just do your best, and try not to spiral with worry. This isn’t a zero-sum game.

“You’re just minimizing risk, basically,” he said. “You can’t lose sleep making sure your iPhone is clean every 10 seconds. Don’t be anxious, just do the best you can—you don’t even know [if you’re] positive yet.”

Fourteen days is the CDC-determined period of time for COVID-19 quarantine because it’s the long end of the average range of infection. Most infected people start displaying symptoms around day five, but the 14-day period is designed to “to capture the stragglers,” Chin-Hong said.

Like everything else about quarantine, though, there’s nuance; it really depends on where you’re coming from, where you’re going, how long you’ll be there, who you’re seeing, and how readily available testing is in your area.

If you’re traveling to a state with a travel advisory that mandates a 14-day quarantine for travelers from states with high infection rates—like from Texas to New York, for example, as I recently did—then yes, even if you test negative, you still have to complete a full, two-week quarantine to satisfy the state mandate. Failing to comply with state mandates like these is punishable by a fine. (I did the full 14 days of quarantine in New York before getting a test on day 15, but my contact tracer, who did call me, mentioned I could’ve gotten tested sooner. I didn’t know the rules. Now you do.)

But if you’re going the other direction—from a low-rate state to a high-rate state—quarantining for 14 days isn’t really useful, because you’re at much greater risk in your new location than in your previous one. Still, if you took public transportation to your new destination or otherwise may have exposed yourself to someone infected with COVID-19, undergoing a quarantine is reasonable and can help provide a little peace of mind (especially before visiting with elderly family members or anyone with comorbidities).

Fourteen days is best if you can swing it, but if you have access to testing, and if the 14 days isn’t a state mandate, you may be able to cut quarantine shorter by getting a negative test result.

Chin-Hong described the exposure to infection period as a continuous scale on which day zero is the day of possible exposure.

“You may return positive by day three at the earliest, because [the virus] takes three to four days to incubate,” he said. “The period of highest infectiousness is days four to seven, so if you test on day seven, you pretty much capture everybody who’s infected.”

“False positives aren’t a thing,” Chin-Hong said, then clarified that they’re extremely rare, and most commonly associated with rapid antigen tests like those used by the White House and the governor of Ohio. False negatives are more likely, especially when someone is tested too early on in their incubation period, or with less effective tests (like those used by the White House). By day seven, Chin-Hong said, 95 percent of those who have COVID-19 will test positive. Only those who Chin-Hong referred to as “the stragglers” will be positive but return a false negative at that point.

“If you can’t wait 14 days, seven days from exposure is the day on which the likelihood of a false negative is lowest,” he said. Or in other words, if you test negative one week after possible exposure or traveling, you can be almost completely certain that you aren’t infected, and feel better about leaving quarantine and safely interacting with housemates or family members.

If you’re traveling to visit family for just a week, Chin-Hong said you can get tested as soon as day three or four, with day four being the “biggest bang for your buck.”

But! None of this overrides state mandates (sorry). Per state travel advisories, getting a negative test doesn’t end your quarantine period early, on the small percentage chance that your test is a false negative or you get sick on day 10. It’s still a good idea to get tested around day seven anyway, especially if you have roommates. It gives you and your household a bit more peace of mind, and may mean you can stop wearing a mask around common spaces inside the home (if your roommates are cool with that).

Chin-Hong separated the available tests into two main buckets:

1. The more reliable polymerase chain reaction, or PCR, test. The PCR test can be performed using a nasal swab (the long one that pokes your brain and the mid-nose one) or a saliva sample, and takes a few days to come back.
2. The rapid, 15-minute result antigen test. The antigen test is also performed using a swab that reaches the back of the throat or the middle of the nose, just like the PCR.
1.

While these two types of tests are performed in the same way, they have different uses. Make sure you know which type you’re getting when you go to get swabbed. The main difference is that the rapid antigen tests are only cleared by the FDA for use within the first seven days that someone starts displaying symptoms. They’re best at identifying people who are at the peak of their infection, and are most infectious to others. So if you’re asymptomatic, this test won’t necessarily give an accurate result.

Basically yes, since there is no way of knowing whether everyone you came into contact with on the way to the airport, in the airport, on the plane, and on any public transit you take to your destination from the airport was infected. Airlines now require travelers to fill out a form stating they haven’t been exposed to COVID-19 in the past two weeks and aren’t displaying symptoms, but we’ve seen how well the honor system works.

Chin-Hong clarified that while most people concern themselves with the plane, transit to the airport and the airport itself are the more risky environments for infection because that’s where you’re in close quarters with others for longer amounts of time. (This is assuming you fly on an airline, like Delta, JetBlue, and Southwest, that’s still blocking middle seats.) If you take a Lyft, Uber, or cab to the airport, roll the windows down, wear a mask, and wash your hands before and after riding. If you take a bus, wear a mask, try to put distance between yourself and other riders, and prop your window open, if you can.

Same rules apply inside the airport: Keep your mask on, wash your hands often, and stay at least six feet away from others as best you can.

On the plane, Chin-Hong said a window seat is better than an aisle, and if you want to be extra cautious, turn your overhead air conditioner vent on and blast it toward you. “It disrupts the flow, so if somebody’s talking to you and they’re full of COVID or coughed at you, the air conditioner breaks the current,” he said. Or, in other words, it’s just extra ventilation.

Even if you don’t travel anywhere beyond your neighborhood for the foreseeable future, there is no way to completely eliminate your risk of becoming infected with COVID-19.When traveling, the best you can do is assess your own risk, and the risk you present to others around you, Chin-Hong said. “State guidelines and public health guidelines are made for a reason, just to keep things simple for people, and to capture the whole range of possibilities,” he said.

Barring breaking your state mandates and catching a fine, there’s room for personal interpretation. Don’t travel around willy-nilly, don’t get tested on day one since you know now how useless that is, and don’t assume a positive test is false, because it really never is. Exercise good judgment, make choices with an abundance of caution, and act as though anyone you might infect is your favorite grandma.

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