Determining Day Zero

ihavealltheice · Jan 28, 2022

first day of the first symptom

k1p1ssk, BSN, RN · Jan 28, 2022

That's a great question... If I think back to conversations with our PH nurses, I imagine that if there was a consistent worsening of existing symptoms (I.e. headache and congestion that just keeps worsening or persisting), then I would count from the start of symptoms. But remember, isolation continues until symptoms resolve, so you are well within your boundaries to state that they must remain home beyond day 5.

If they started out with a headache and congestion, tested negative, but then got GI symptoms and a fever (or something like that) and tested positive 2-3 days later, I think I would count from the start of the new symptoms/positive test.

arlingtonnurse · Jan 28, 2022

4 minutes ago, ihavealltheice said:

rst day of the first symptom

4 minutes ago, ihavealltheice said:

first day of the first symptom

Yes, this is what my gut tells me and what the 'first day of symptoms or day of positive test' that I have taught would say. I guess I was thrown off by the negative tests. I had also been advised to be conservative and use the pos test date since it was later but I don't want to make up new rules just to keep kids out of school for longer.

NutmeggeRN, BSN · Jan 28, 2022

I also keep reminding people that not too long ago we were quarantining for 14 days...not everyone is done @ day 5, regardless of what the business and political industries have to say...

JenTheSchoolRN, BSN, RN · Jan 30, 2022

So, this can be tricky. No two situations are ever the same and I really look at it case by case.

Symptoms can the day 0, but for some folks a baseline for them is a daily headache/congestion (especially for chronic allergy sufferers, like myself!). When that is the case here, I just use the test as day 0.

Sometimes I have seen students develop a 102 degree fever AND test negative that day on a rapid test. Fever goes away 12-24 hours later (and often they have zero symptoms after) AND then they test positive. In that case, I use fever day as day 0.

I also ALWAYS tell folks, if you still pretty sick on day 5, do NOT release from isolation at day 6. Because some folks will need more time. I've had a few staff that needed all 10 days just to be well enough to be back at work. In my state, school nurses need to test negative to return to work after day 5. I had COVID in early January and did not test negative on an antigen test until my day 7, even though 90% of my symptoms resolved by day 4 (headache and fatigue lingered with me for a good two weeks after I went back to work). I can't require a negative test to re-enter, but if someone can rapid test day 5 and it is still positive, even with minimal symptoms, I've been advising isolation through day 7 at least (and can now hand out free rapid tests to the folks that need them to retest).

GoldenRN28, DNP, APRN · Feb 2, 2022

Technically first day of symptoms are day 0. For healthcare workers, many organizations use the first positive test as day 0. Rapid antigen testing is a good indicator of contagiousness/transmissibility but as we know also unreliable. Returning to work/school on day 6 vs day 10 is a change many providers are uncomfortable with, and because of that we usually use test day to push the isolation out a little longer. Studies have shown that 1 in 3 people are still contagious day 6 vs 1 in 10 on day 10. The new guidelines accept a risk of transmission so that we don’t completely close down with large amounts of cases. Not a fan of the day 6 guidelines. Also not a bad idea to do a rapid antigen before returning, it that’s organization specific. Because where do these day 6 returning staff or students eat lunch (since they are required to mask around others per CDC as they are known to still likely be contagious even if symptoms are improved)? Are they ensured they aren’t in contact with immunocompromised peers?