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When Covid Enters the House, What Should We Do? – The New York Times

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When someone in the family tests positive for the coronavirus, there are some guidelines to follow.

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.

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.

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 after taking 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.

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.

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.

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.

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.”

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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Long COVID: Half of patients hospitalised have at least one symptom two years on – Australian Hospital + Healthcare Bulletin

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Long COVID: Half of patients hospitalised have at least one symptom two years on

Two years on, half of a group of patients hospitalised with COVID-19 in Wuhan, China, still have at least one lingering symptom, according to a study published in The Lancet Respiratory Medicine. The study followed 1192 participants in Wuhan infected with SARS-CoV-2 during the first phase of the pandemic in 2020.

While physical and mental health generally improved over time, the study found that COVID-19 patients still tend to have poorer health and quality of life than the general population. This is especially the case for participants with long COVID, who typically still have at least one symptom including fatigue, shortness of breath and sleep difficulties two years after initially falling ill.1

The long-term health impacts of COVID-19 have remained largely unknown, as the longest follow-up studies to date have spanned around one year.2 The lack of pre-COVID-19 health status baselines and comparisons with the general population in most studies has also made it difficult to determine how well patients with COVID-19 have recovered.

Lead author Professor Bin Cao, of the China-Japan Friendship Hospital, China, said, “Our findings indicate that for a certain proportion of hospitalised COVID-19 survivors, while they may have cleared the initial infection, more than two years is needed to recover fully from COVID-19. Ongoing follow-up of COVID-19 survivors, particularly those with symptoms of long COVID, is essential to understand the longer course of the illness, as is further exploration of the benefits of rehabilitation programs for recovery. There is a clear need to provide continued support to a significant proportion of people who’ve had COVID-19, and to understand how vaccines, emerging treatments and variants affect long-term health outcomes.”3

The authors of the new study sought to analyse the long-term health outcomes of hospitalised COVID-19 survivors, as well as specific health impacts of long COVID. They evaluated the health of 1192 participants with acute COVID-19 treated at Jin Yin-tan Hospital in Wuhan, China, between 7 January and 29 May 2020, at six months, 12 months and two years.

Assessments involved a six-minute walking test, laboratory tests and questionnaires on symptoms, mental health, health-related quality of life, if they had returned to work and healthcare use after discharge. The negative effects of long COVID on quality of life, exercise capacity, mental health and healthcare use were determined by comparing participants with and without long COVID symptoms. Health outcomes at two years were determined using an age-, sex- and comorbidities-matched control group of people in the general population with no history of COVID-19 infection.

Two years after initially falling ill, patients with COVID-19 are generally in poorer health than the general population, with 31% reporting fatigue or muscle weakness and 31% reporting sleep difficulties. The proportion of non-COVID-19 participants reporting these symptoms was 5% and 14%, respectively.

COVID-19 patients were also more likely to report a number of other symptoms including joint pain, palpitations, dizziness and headaches. In quality of life questionnaires, COVID-19 patients also more often reported pain or discomfort (23%) and anxiety or depression (12%) than non-COVID-19 participants (5% and 5%, respectively).

Around half of study participants had symptoms of long COVID at two years, and reported lower quality of life than those without long COVID. In mental health questionnaires, 35% reported pain or discomfort and 19% reported anxiety or depression. The proportion of COVID-19 patients without long COVID reporting these symptoms was 10% and 4% at two years, respectively. Long COVID participants also more often reported problems with their mobility (5%) or activity levels (4%) than those without long COVID (1% and 2%, respectively).

The authors acknowledged limitations to their study, such as moderate response rate; slightly increased proportion of participants who received oxygen; it was a single centre study from early in the pandemic.

References:

1. – National Institute for Health and Care Excellence – Scottish Intercollegiate Guidelines Network – Royal College of General Practitioners. COVID-19 rapid guideline: managing the long-term effects of COVID-19. https://www.nice.org.uk/guidance/ng188
2. – Soriano – JB Murthy – S Marshall – JC Relan – P Diaz JV – on behalf of the WHO Clinical Case Definition Working Group on Post-COVID-19 Condition. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2021; 22: e102-e107
3. – Huang L – Yao Q – Gu X – et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet. 2021; 398: 747-758

Image credit: ©stock.adobe.com/au/ink drop

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2SLGBTQ+ lobby group head speaks on the trauma of conversion therapy

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Although conversion therapy has now been outlawed in Canada, many are still victims causing them to go through a lot of trauma in the process.

According to Jordan Sullivan, Project Coordinator of Conversion Therapy Survivors Support and Survivors of Sexual Orientation and Gender Identity and Expression Change Efforts (SOGIECE), survivors of conversion therapy identify the need for a variety of supports including education and increased awareness about SOGIECE and conversion practices.

Also needed is access to affirming therapists experienced with SOGIECE, trauma (including religious trauma), safe spaces and networks, and access to affirming healthcare practitioners who are aware of conversion therapy or SOGIECE and equipped to support survivors.

“In January of 2021 when I was asked to be the project coordinator, I was hesitant because I wasn’t sure that my experience could be classified as SOGIECE or conversion therapy. I never attended a formalized conversion therapy program or camp run by a religious organization. Healthcare practitioners misdiagnosed me or refused me access to care.

In reality, I spent 27 years internalizing conversion therapy practices through prayer, the study of religious texts, disassociation from my body, and suppression or denial of my sexual and gender identities. I spent six years in counselling and change attempts using conversion therapy practices. I came out as a lesbian at age 33, and as a Trans man at age 51. I am now 61 and Queerly Heterosexual, but I spent decades of my life hiding in shame and fear and struggled with suicidal ideation until my mid-30s.

At times I wanted to crawl away and hide, be distracted by anything that silenced the emptiness, the pain, the wounds deep inside. I realized that in some ways, I am still more comfortable in shame, silence, and disassociation, than in any other way of being and living, but I was also filled with wonderment at the resiliency and courage of every single one of the participants.

However, many of us did not survive, choosing to end the pain and shame through suicide. Many of us are still victims in one way or another, still silenced by the shame, still afraid of being seen as we are. Still, many of us are survivors, and while it has not been an easy road, many of us are thrivers too,” said Jordan.

In addition, Jordan said conversion practices and programs are not easily defined or identified, and often capture only a fragment of pressures and messages that could be considered SOGIECE.

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Some in B.C. cross U.S. border for their next COVID-19 vaccine – Global News

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Global News Hour at 6 BC

There is evidence of the lengths some British Columbians will go to get a second booster dose of the COVID-19 vaccine — crossing the border to Point Roberts, WA for a shot. The movement comes thanks to the different approach to the fourth shot south of the border. Catherine Urquhart reports.

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