“The path trodden by wayfarers and pilgrims followed the railway and then turned into the fields. Here Lara stopped, closed her eyes and took a good breath of the air which carried all the smells of the huge countryside. It was dearer to her than her kin, better than a lover, wiser than a book. For a moment she rediscovered the meaning of her life. She was here on earth to make sense of its wild enchantment and to call each thing by its right name, or, if this were not within her power, then, out of love of life, to give birth to heirs who would do it in her place.” Doctor Zhivago by Boris Pasternak
This quote speaks to my physician brain. It has been ingrained in me to call each thing by its right name because a lack of precision can have dire and life-threatening consequences.
What’s in a word? Why are proper definitions important?
These are questions I have been pondering lately as I watch and hear so many friends and family struggle to put into action the word quarantine. To a great degree, I think well-meaning people are failing to quarantine because of a misconception of what the term means.
Call each thing by its right name.
From the start of the pandemic, I have heard people talk about being in quarantine. When businesses were closed, and people were only doing essential shopping, I heard our society described as being in quarantine.
I hate to tell you folks, but this is NOT QUARANTINE.
What we have been doing, generally, as a society is called social (or physical) distancing. Social (physical) distancing is when you shop, run errands, hang out, and work six feet (or more) apart with one or two other people either outside or inside while wearing masks. We are all physical distancing with anyone who is not in our “family bubble” if we are being conscientious about this pandemic. Physical distancing involves a lot of nuances and difficult social decisions.
The definition of quarantine is simple. It is defined as strict isolation to prevent the spread of disease or pestilence.
There are very few nuances to quarantine. There are no difficult decisions. In order to quarantine, you simply do not interact in person with any humans until the quarantine period is over.
There are two types of quarantine
1. An individual can quarantine from their household by staying in their own room with the door closed, having meals delivered to the door and dishes and garbage picked up at the door, and, ideally, if available, using their own bathroom, or, if a shared bath, thoroughly washing all surfaces with alcohol or soap and water, or dilute bleach after the quarantined individual has finished using the bathroom. This should be done until the quarantine period is over (typically 14 symptom-free days.)
If an individual is known to be positive for COVID-19, and is isolating from their (presumably uninfected) household, then the household should also be quarantining from society as in #2 below.
2. A household can quarantine from society by isolating themselves in their house (or, if they live in the country and can go outside without seeing another soul, that’s ok too). All groceries and necessities should be delivered to the doorstep by a volunteer, a friend, a neighbor, or a delivery service. All errands should be canceled. All appointments should be canceled. All sports practices should be canceled, and all work or school outside the home should be canceled. Cleaning people should be canceled, and childcare should be canceled.
The family should have no in-person interaction with ANYONE for anything other than a life or limb-threatening emergency. This should be done until the period of quarantine is over.
Who needs to quarantine?
In Vermont, all out of state visitors from counties where there are moderate to high active COVID cases (defined as >400 active cases/million) are required to quarantine for either 14 days symptom-free, or seven symptom-free days from last travel PLUS a negative test needs to be done at or after day 7. Any Vermonter who visits one of these counties is also required to quarantine upon return to VT.
You can access the map for the required quarantine here. The map is updated every Friday with up-to-date information.
In order for a test to be relatively accurate, it can not be performed before 7 days from last likely exposure. Tests done before the 7-day mark have a high false-negative rate, meaning you could have the infection, but still have a negative test result.
Anyone with a known or potential exposure to someone who has COVID who is awaiting test results needs to quarantine until the test results are back and negative (test is done no sooner than 7 days from the known exposure).
Anyone who is COVID negative but living in a household with a known COVID positive person needs to quarantine from that person AND the entire household should quarantine from society until the known positive case is done with quarantine, and the household members have tested negative as per #2 above.
Anyone who is sick with COVID symptoms or who has a known positive test needs to be completely isolated from all people (and have at least 10 days from known positive test and 72 hours symptom-free before they can leave isolation).
Isolation is to separate people we know are sick from people who are not sick.
Quarantine is to keep high-risk individuals or individuals with potential exposures separated from low-risk populations until we know they are not sick.
The concepts are similar (both require no face to face contact with other people) but the populations differ in their disease status.
Pretty simple right? So, let’s discuss some recent cases of people I know and their “quarantine” mistakes.
- Family with a second home in Vermont with parents from a moderate risk county (yellow on the COVID infections by population map, above), and kids who live with another parent in a low-risk county but visit the Vermont summer home (thus assuming the contagious risk of the parents from the moderate risk county) and invite their Vermont friends to come for an outdoor dinner or a socially distanced walk. THIS IS NOT QUARANTINING.
- A family goes to visit relatives in a moderate risk or high-risk place, then returns and doesn’t quarantine because “we stayed with them and they are quarantining, so we didn’t get any exposure.” Here’s the thing- families who have visitors, by definition, are NOT QUARANTINING.
- A family who returns from a beach vacation to a high-risk place and tells me they are quarantining. I ask what that looks like and they say that they are not shopping, are mostly eating out of the freezer, and are working from home. BUT their kids are playing with the neighbors and going to sports practice. THIS IS NOT QUARANTINING
- A person with a known exposure gets a test, but while awaiting the test results, continues shopping and going to work. THIS IS NOT QUARANTINING
- A mother travels to a high-risk state then returns home to her family. The mother quarantines from work, but not her family, and her kids go to camp. This whole family needed to quarantine, not just the mother, or the mother needed to strictly quarantine from the rest of the family. THIS IS NOT QUARANTINING
- A man who tests positive but is not isolating in his household sends his daughter to a friend’s house for a sleepover. THIS IS NOT QUARANTINING.
The bottom line is that in order for us to be able to safely open the economy and our lives a bit more, we all need to do our part in understanding what quarantine is, when quarantine is needed, and then be diligent about doing it. Sadly, we can’t control how our friends and extended family follow these rules. We can only control our own behavior. We have to make difficult choices to be the party pooper, and, in some cases be ok with being called a “fear monger.”
One sentiment I have heard repeatedly is, “Well, I guess everyone has to do what’s right for their family.”
The point is, however, that we should not only be doing what is right for our family, but also doing what is right for society and humanity. We must look outside of our self-centered (and often privileged) positions and save humanity with our individual actions which may well involve significant sacrifices on our part. It is OK to tell friends, family, and neighbors “no” and to explain yourself with science.
Additionally, we all need to be continuing to be diligent about wearing masks, hand washing, and physical distancing from others who are not in our immediate bubble.
