Residents of San Mateo County who have tested positive for COVID-19 have been ordered not to leave their homes except to get necessary medical care or in an emergency that requires evacuation, according to a new mandate issued April 6 by county's top health officer, Dr. Scott Morrow.
As of Monday, April 6, the San Mateo County health department reported there were 579 COVID-19 cases confirmed countywide and 13 deaths related to the disease.
That data, the department stated, comes with a big caveat: "Because of limited testing capacity, the number of cases detected through testing represents only a small portion of the total number of likely cases in the county." In other words, there are probably a lot more cases out there that haven't been tested or even detected yet.
The mandate comes on the heels of new recommendations for people to wear face coverings when they leave their homes, and falls in step with a growing body of information suggesting that people who don't show symptoms may still have the coronavirus and be spreading it. Last week, Dr. Robert Redfield, the director of the U.S. Centers for Disease Control and Prevention, said that as many as 25% of infected individuals do not show symptoms, and that people probably shed the virus 48 hours before they start to show symptoms.
The county's new official orders lay out legally enforceable protocols for people who have tested positive for COVID-19 and for those who are in close contact with them.
Violating those orders is considered a misdemeanor and may be punishable by fine, imprisonment or both, according to the order.
Morrow has issued two sets of orders: isolation orders for people who have confirmed cases of COVID-19, and quarantine orders for people who are or have been in close contact with someone who has a confirmed case of COVID-19.
If you have been diagnosed with COVID-19
People who have a positive COVID-19 diagnosis should not leave their homes except to receive needed medical care or during an emergency, according to the county health department. They should stay in a room away from other household members. If possible, they should use a separate bathroom.
Shared areas like kitchens or bathrooms, as well as frequently touched household objects like doorknobs and fixtures, should be cleaned regularly. And people with COVID-19 should not share items like dishes, eating utensils, towels, bedding or drinking glasses without washing them.
They should use delivery services like Amazon or Instacart, or call 211 for help to obtain food or other necessities.
They should also should get medical help immediately if their illness worsens, especially if they have trouble breathing. If it's an emergency, they should call 911 and notify the operator that they have COVID-19.
Before they seek care, they should call their doctor and let the doctor know that they have COVID-19.
Before they leave the house to see a doctor, they should put on a face mask. If they don't have one, they should send someone into the doctor's office to inform the doctor when they arrive.
People without symptoms should isolate for seven days from the time they receive a positive test. People with symptoms can end their isolation under two conditions: after they have been fever-free for 72 hours without fever-reducing medicines and their cough and shortness of breath symptoms are improving, or after waiting seven days from the time their symptoms started – whichever is longer.
If you are in contact with someone who has been diagnosed with COVID-19
People who are in close contact with someone who has been diagnosed with COVID-19 also need to stay home, the order says.
What counts as a close contact? In this context, that would be someone who lives in, or has stayed overnight at that individual's home; someone who is a sexual partner; or someone who provides or has provided care to the individual without wearing a mask, gown and gloves, according to the county health department.
They need to abide by the regional shelter in place order, maintain social distancing and wash their hands frequently. In addition, Morrow advises, they should not go to work, "even if they work for an essential business, perform essential government functions, or operate or maintain essential infrastructure."
To the extent possible, they should also use delivery services to avoid entering businesses like grocery stores, pharmacies and hardware stores.
They should also monitor themselves closely for symptoms. The most common symptoms are fever, cough and shortness of breath. If symptoms develop, they should contact their health care provider and say that they have been exposed to COVID-19.
If they work at, volunteer in or visit areas where people are particularly vulnerable to infection – such as a skilled nursing facility, a nursing home, a correctional or detention facility, shelter, group home, dialysis center or healthcare facility – or are a first responder, they should let those facilities or organizations know that they are in quarantine.
The quarantine period may end only under certain circumstances.
If the exposed person lives in the same household as the person who has a COVID-19 positive diagnosis, he or she needs to wait 14 days until the person with the COVID-19 diagnosis does not need to be isolated.
If the exposed person doesn't live in the same household as the confirmed case, he or she needs to remain in quarantine for 14 days, so long as he or she is not also diagnosed with COVID-19.
The order offers an exception for health care workers, first responders and caregivers who may have a household member with a confirmed COVID-19 diagnosis. Such workers are mandated to let their employers know about the situation, and may only work if they are asymptomatic and their employers say they have to work based on staffing needs.
"This mass order provides the tools—and the necessary information—for keeping those sick with COVID-19 separated from others and for preventing those exposed to the illness from spreading it," said Morrow in a press statement. "People with no or mild symptoms may have COVID-19 and not know it."