COVID-19: Positive and close contacts: what to do when we don’t know what to do? | Science and Technology


Official COVID transmission figures are growing dramatically, matching (and will likely exceed in the coming weeks) those of previous waves.

Fortunately, the high vaccination figures achieved, especially in those over 60 years of age, make the situation of hospitalizations and deaths – at least for the moment – less serious than in previous waves.

However, our subjective perception of the situation tells us that the actual number of cases (contagions) is even higher. Relatives, friends or colleagues call us to congratulate us on the holidays and, incidentally, tell us that “I have come out positive”. Or in the best of cases “so and so has tested positive”, or “in my son’s class there has been a positive.” And they do it much more frequently than in other waves.

Fortunately, most of the time – though not always – these messages are accompanied by a “calm down, I’m fine.”

It is more than possible that there is much more transmission than we are capable of detecting. Many asymptomatic or paucisymptomatic cases do not seek medical attention. Many vaccinated, even symptomatic, attribute their symptoms to colds or other minor conditions and do not undergo diagnostic tests.

Others (positive in tests for antigens for sale to the public or close contacts) are unable to contact primary care services that, despite their efforts to respond, are overwhelmed between vaccinations, PCR, follow-up of positives, contact tracing and maintaining care for the most complex patients.

While hospitalizations saturate hospitals, infections – even if the majority are mild – overwhelm the response capacity of primary care. These cases do not exist for official statistics either.

In this article we try to give some ideas of how to act in these situations. In general, although not always, they coincide with the latest version of the document “Strategy for the early detection, surveillance and control of covid-19” of the Ministry of Health. And they are suitable in many general situations, but not for some specific situations (residences, schools, prisons, health centers or others with vulnerable people, etc.) that require specific management.

What to do if I have symptoms compatible with COVID-19?

Forget the idea that since you are vaccinated or have passed the covid it will be a cold or another viral picture. Act positive (isolation) until COVID is ruled out with a diagnostic test. If possible, contact your health center (they will usually give you the date and time for a PCR). If this is not possible, drugstore antigen tests (performed according to the manufacturer’s instructions) are very reliable in symptomatic people.

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The Conversation

Suspicious symptoms (more than one usually appears) may include fever or chills, cough, shortness of breath (“shortness of breath”), fatigue, headache, muscle pain, (recent) loss of smell or smell. Taste, sore throat, stuffy nose (“runny nose”), nausea or vomiting, and diarrhea.

Difficulty breathing is the most worrisome symptom and requires urgent medical consultation for evaluation. You should also seek urgent care if you have persistent chest pain or pressure, confusion, or a pale or bluish color to the skin, lips, or nail beds.

What to do if I am ‘positive’ on a drug store antigen test?

Initiate isolation. Wear an FFP2 mask. Contact your health center. They will probably call you for a PCR and give you instructions based on your symptoms.

The isolation should last a minimum of 10 days from the onset of symptoms (or the date of the test for asymptomatic patients), although if the symptoms persist, the isolation could be prolonged. Put aside those false ideas that those vaccinated, those who have passed the covid-19 or children do not infect or cannot be infected. Strictly adhere to isolation.

In most cases, the symptoms are mild and do not require intensive monitoring by primary care. But if you have difficulty breathing or any of the symptoms to seek urgent attention previously mentioned, contact a health service as soon as possible.

It is very likely that your partners have been infected. They are contacts, more than close, very close. Also those people with whom you have recently shared the air you breathe (especially in the last two days). Warn them. Even if they are vaccinated or have passed the covid-19.

Contagions can occur anywhere (not only in restaurants, nightlife or in crowds). Also at work, in sports, teaching, worship, etc. The possibility of contagion is higher if the encounter took place in closed, poorly ventilated spaces, without a mask, with proximity and was prolonged. Prepare a list with phone numbers of your contacts to help trackers.

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What to do if I am close contact?

Even if you have been infected, diagnostic tests, including PCR, will not give positive results until 3-5 days after contact with the person who infected you. If you are not vaccinated, you should isolate yourself and try to contact the health services to carry out a PCR (usually they will summon you around the 5th day of the date of contact with the person who potentially infected you).

Getting a test before (unless you had symptoms of covid-19) is of little value and the negative result does not allow you to lift the isolation. If the test on the 5th day is negative, the isolation can be lifted.

If you are vaccinated you should do exactly the same as if you are not vaccinated. Currently, the Ministry of Health does not require the isolation of vaccinated close contacts (although some Autonomous Community does) and only recommends reducing encounters and avoiding contact with elderly and vulnerable people. But this is a recommendation based on initial studies after vaccination. When the immunity provided by vaccines was recent, the predominant variant was not delta and omicron was not expanding.

This mismatch between the current situation and the recommendations of some health authorities may complicate obtaining sick leave due to isolation. Even with this complication, which will probably be resolved shortly, workers and employers should avoid exposing themselves to a – predictably more damaging – outbreak in their company.

Let us remember that the viral loads of the vaccinated infected are similar to those of the unvaccinated and that, as far as we know, omicron notably increases the risk of gap infections (in vaccinated) and reinfections (in people who have previously suffered covid-19 ).

What to do if I have no symptoms and I am not close or positive contact?

What should anyone do in such a high transmission situation? Basically, reduce as much as possible the risk of being a case or close contact of a case. This has two components: distrust the myths and legends that circulate everywhere and act while avoiding at least the most risky situations.

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In the first, neither the covid-19 has become a cold (although many people will only suffer mild symptoms), nor the vaccinated – or those who have passed the covid-19 – cannot catch it or spread it (although they probably do something less).

Currently, vaccination or having passed the COVID-19 (and, above all, both) maintain protection against the risk of developing severe COVID-19 (having to be hospitalized or dying). But not completely. And probably a little less the greater the distance from vaccination. And probably less so with the omicron expansion.

Much transmission will derive (it already does) in the overflow of primary care. And many patients – COVID-19 and, above all, not COVID-19 – will suffer the consequences. In addition, if the numbers of infections are high, they will also saturate the hospitals and make it difficult to care for the most serious cases (covid and non-covid).

And if we approach the limit at which we can no longer adequately attend to the most serious cases, harsh restrictions – as is now imposed by the Netherlands, with much higher hospitalization, ICU and death figures than in Spain – will be inevitable. And the restrictions will increase poverty and unhappiness for many people and, of course, social unrest, unrest for all.

These are festive times, but also the time to reduce our encounters. If you can avoid contacts, of any kind, avoid them. If you can’t, better outdoors. If it cannot be outdoors, better in well-ventilated places, and keeping a distance and a mask whenever possible. Whether you are vaccinated or not. Whether they require a covid-19 passport to enter, or not. Whether you’ve had antigen testing or not.

And when you can, and especially if you’re over 60, go for your third dose. Don’t put it off. It’s not the moment.

Salvador Peiró, Researcher, Health Services Research Area, FISABIO SALUD PÚBLICA, Fisabio

This article was originally published on The Conversation. Read the original.


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George Holan

George Holan is chief editor at Plainsmen Post and has articles published in many notable publications in the last decade.

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