Dr. Toshi Is In! "Why do some people have to be quarantined for 14 days after a vacation?" Good question!

Dear Dr. Toshi, Why do some people have to be quarantined for 14 days after a vacation away from home if they're feeling fine and have no fever?

Good question!

It's been really confusing because 1) some unfamiliar words and phrases are used, 2) guidelines and rules seem to change a lot, 3) recommendations and guidelines from the CDC (Centers for Disease Control and Prevention, which is a U.S. federal agency) don't always match recommendations and guidelines from state or local governments, and 4) there's a lot of conflicting information out there in the world of the internet!

I'll discuss "conflicting information on the internet" in another article, but today I'd like to go over the other confusing parts.

• 1) Yes, the rules do change quite often.This is because scientists are learning more every day about the novel coronavirus (SARS-CoV-2) and the disease it can cause, COVID-19. home. By the time this article is published, it's very possible that there could be even more updates!
• 2) Guidelines, recommendations, and ordinances are set by each state and local government, so if you're traveling outside of your own state or community, it's important for you to find out what is recommended or even legally required in your destination state or community.

Going back to the question, some people need to quarantine themselves for 14 days after a trip, even if they don't have symptoms. So, you might be wondering, who are those people? Why 14 days? Why do they have to quarantine themselves even though they don't have symptoms?

First of all, let's clarify the difference between "quarantine" and "isolation." "Quarantine" is for people who don't have symptoms but were exposed to the virus or traveled internationally recently. It's important to remember that these people don't have symptoms yet, but they might still have the virus. Quarantine is for 14 days after your last known exposure to COVID-19 or after your return to the US from another country. And during those 14 days, it's really important for you to monitor yourself. It's important to check your temperature twice a day. And don't forget to write it down somewhere safe every time! You should also pay attention to whether you start to have any symptoms of COVID-19. Some symptoms you might get if you have COVID-19 are a cough, fever, chills, shortness of breath, fatigue, body aches, headache, loss of taste or smell, a sore throat, nausea or vomiting, diarrhea, or a stuffy nose. You might get one or more of these. It's also possible to get a symptom that's not on this list! That's why it's so important to keep track of how you feel by writing it down somewhere safe every day. If you don't have any symptoms after 14 days, it's okay for you to go back to your normal routine. If you start to feel sick or have any of the symptoms of sickness, or if you're not sure if your symptom is on the list or not, it's important to talk to your doctor or other medical provider.Also, to make sure the people around you are safe, it's important to remember to call your doctor before you go in to see them!

Why 14 days? Because of COVID-19's incubation period. Pretend you got infected by the virus, SARS-CoV-2, and a few days later, you started to cough. That period, between the time when you first got infected by the virus and when you started coughing or having other symptoms, is the incubation period. It's the number of days the virus needs to be in your body before you have symptoms. The average incubation period for COVID-19 is 5 days, but the incubation period can be anywhere between 2-14 days.That's right. The incubation period can be up to 14 days! That means that some people who have been infected by the virus might not develop symptoms for two weeks. And while they don't have any symptoms, they can still infect other people and make them sick, sometimes fatally sick. Data shows that people can spread the virus 2-3 days before symptoms start, and that they're most contagious 1-2 days before they even start to feel sick. That's why experts are sticklers for the "14 days of quarantine" all over the world.The fact that this virus can spread when infected people aren't feeling sick or aren't having any symptoms is one of many reasons why COVID-19 has been very difficult to control.

"Isolation" is for people who are already sick and symptomatic from the virus. Isolation is "for a minimum of 10 days from the beginning of symptoms and 24 hours after your fever is gone without the use of fever-reducing medicine and other symptoms have significantly improved," according to the North Dakota State website. This was just updated based on the CDC recommendations.

If you want to be up-to-date about North Dakota, you can go to the North Dakota State website.You can find the most updated recommendations and guidelines at https://www.nd.gov or call 1-866-207-2880.

Although North Dakota's risk is in the "low risk" level according to the www.health.nd.gov, it's all relative. Remember that now COVID-19 has been found in all counties in North Dakota, and it's still spreading.

So, it's important to remember: "Do not travel if you are sick or if you have been around someone with COVID-19 in the past 14 days. Do not travel with someone who is sick." (CDC) And, let's continue to use masks and practice hand hygiene and social distancing (6 feet).

Dr. Toshiko (Toshi) Luckow, MD is a Family Medicine physician at the West River Health Services hospital and clinics.