The holidays are over, the kids are back in school and everybody, it seems, has COVID-19, from Whoopi Goldberg to late night TV hosts Jimmy Fallon and Seth Meyers to Minnesota Attorney General Keith Ellison to, likely, many of your friends, family members and acquaintances.
Thanks to the new and more transmissible omicron variant, Minnesota’s confirmed COVID-19 cases have risen dramatically in recent days, and Gov. Tim Walz said in an MPR interview earlier this week that this COVID-19 surge could peak in the third week of January, based on Mayo Clinic modeling.
That means a lot more people are going to be hearing that a close contact has tested positive for COVID-19. At the same time, many people are vaccinated against the virus, and the new omicron strain seems to, yes, move more quickly but also potentially cause less severe disease, particularly for vaccinated people.
Given all those dynamics, here’s a look at what to do if you learn you’ve been exposed to COVID-19.
Minnesota Department of Health Infectious Disease Director Kris Ehresmann said department estimates suggest omicron — first identified just over a month ago around the Thanksgiving holiday — makes up roughly 90 percent of cases in Minnesota now.
There’s a lot we still don’t know about the variant, but early studies suggest it may spread far more readily, come on more quickly and evade vaccines better than earlier strains. These factors likely explain the variant’s quick takeover as well as how so many people — many of them fully vaccinated and some even boosted — seem to be coming down with COVID-19 all at once. Google Trends suggests searches for “covid exposure” have skyrocketed in Minnesota in recent weeks.
So what, these days, is considered a COVID-19 exposure?
In general, the Centers for Disease Control defines an exposure as contact with a COVID-19-infected person that increases the likelihood of viral transmission. Typically, the CDC considers a high-risk exposure as one where someone comes into “close contact” with another person infected with COVID-19. For much of the pandemic, “close contact” has generally been defined as being within six feet of an infected person for at least 15 minutes over the course of 24 hours.
Given omicron’s ability to spread, you may want to consider revising what you think of as a close contact, said Dr. George Morris, the physician lead of CentraCare’s COVID-19 incident command. Because of its transmissibility, people may become infected with omicron in settings where they were less likely to get previous variants, like in the grocery store.
“It doesn’t take 15 minutes. It doesn’t take six feet. It takes closed space,” he said.
Taking precautions and testing
If you’ve had a risky exposure, how much you should curtail your regular activities — like going to the grocery store or work — depends your vaccination status.
Under CDC guidance, people who are not fully vaccinated (for adults, this now includes people who don’t have a booster if eligible) should stay home for at least five days, wear a well-fitting, high-quality mask, like a surgical mask, KN95 or N95, around others in the house and watch for symptoms. They should get tested at least five days post-exposure or if symptoms occur. If they are negative after five days, they should continue to wear a mask around others until 10 days after the exposure. More details can be found here.
For people who are fully vaccinated (for eligible kids, this means you’ve completed the primary series, and for adults, it means you’re boosted if eligible), it’s more a matter of being careful than staying home altogether. CDC guidelines say they should wear a good mask when they’re around others for 10 days following the exposure. They should get tested at least five days following the exposure, and isolate —meaning stay away from others — if symptoms occur or if they test positive. (One caveat: If you’ve had COVID-19 in the last 90 days, vaccinated or not, you don’t need to quarantine or get tested after a close contact but should wear a mask and monitor for symptoms.)
One thing you should not do if exposed is assume that a negative result from an at-home antigen test (this is what many of the over-the-counter tests you can buy at drug stores are) means you’re completely safe for others to be around.
For one thing, Ehresmann said, any test only measures one point in time. Omicron moves quickly and just because a person tests negative at one point doesn’t mean they’re not going to test positive.
But another concern with omicron is that positive antigen tests may be lagging behind molecular tests (or PCR tests, the kind that often require a deep nasal swab or spitting into a tube) in their ability to detect the virus, said Dr. Jill Foster, a pediatric infectious diseases physician with the University of Minnesota Medical School and M Health Fairview.
“If you started having a runny nose or a cough [the day after an antigen test], you shouldn’t say ‘Hey, I had the antigen test yesterday, this is probably something else,’” she said.
If you do get a positive on an antigen test, you probably don’t need a molecular test, Foster said: These tests sometimes produce false negatives, but rarely false positives.
“So if you have an antigen test that’s positive, you’re positive. You don’t really need a molecular test at this point,” she said.
It’s also not a bad idea to let any other people you were in close contact with know you may have become infected with COVID-19, Ehresmann said, especially given the fast spread of omicron.
“It just alerts people to be thoughtful if they develop symptoms,” she said. “It just makes everybody a little bit more thoughtful.”
How to handle a positive test
If your exposure results in a positive COVID-19 test, you should take further action to mitigate the virus’ spread around you.
That includes some do-it-yourself contact tracing. If you test positive and are given a code to notify people you were close to of a potential exposure through the COVIDAware app, you should do so. If you test positive on a home test, it’s a good idea to contact anybody you may have exposed, going back two days before the onset of symptoms or your positive test.
Under new CDC guidelines that shorten the isolation period, people who test positive for COVID-19 or have symptoms and are awaiting a test should stay home and isolate themselves from others for at least five days. After that point, they can end isolation if they’ve been fever-free for 24 hours without fever-reducing medication and have reduced symptoms, but should continue to wear a mask around others for five more days.
It’s tempting for some people to think that because we’re in a wave of omicron, which causes seemingly less severe disease, they don’t need to be as careful about exposures, particularly if they’re vaccinated.
But a certain percentage of people — particularly the unvaccinated — are still likely to end up in the hospital, and with more people sick from COVID-19 overall, a high number of hospitalizations, plus illness among health care workers, threaten to prolong the pressure on the state’s overtaxed hospital system.
At CentraCare, Morris said many patients are still in the hospital with delta infections. Meanwhile, Morris estimated up to twice as many health care workers are out sick or quarantined now compared to mid-November and December, which presents staffing challenges. Health care providers across the state face the same hurdles.
“We’ve had a long slow burn. If this one just comes through as a raging forest fire the hard part is it will still take more people with it. But it’ll be quick,” Morris said.