When your spouse tests positive for COVID-19, the urgent question is whether you will get sick too. Living in the same home as someone infected with the virus places you in the highest-risk category for transmission. While it is not an absolute certainty that you will contract the infection, the probability is significantly higher than in any other setting. Understanding this risk and immediately implementing rigorous prevention steps is the most effective way to protect your health.
Understanding the Risk of Household Transmission
The household environment presents the greatest challenge for preventing the spread of the virus that causes COVID-19 due to the prolonged, close-contact nature of the exposure. Studies consistently show that spouses and partners face the highest likelihood of infection within a home. The secondary attack rate (SAR) often falls in the range of 30% to over 40%, a rate notably higher than for other household contacts, likely due to the intimate nature of the relationship and shared sleeping space.
The specific variant currently circulating plays a large role in the risk level, with newer variants, such as Omicron and its sublineages, demonstrating a higher household SAR compared to earlier strains. The infectiousness of the positive case is also a major factor, as symptomatic individuals tend to shed more virus than those who are asymptomatic. Your own protection is also shaped by your immune history, where being up-to-date on vaccination and booster doses reduces both your susceptibility to infection and the infectiousness of the person who is sick.
Immediate Steps to Prevent Spread Within the Home
The single most effective action you can take is to establish immediate, strict separation between the infected person and all other household members. Ideally, the individual who tested positive should isolate themselves in a designated “sick room” and, if possible, use a separate bathroom. If sharing a bathroom is unavoidable, the infected person should clean and disinfect surfaces after each use, focusing on high-touch areas like the toilet handle and faucet.
Airborne transmission is the primary route of spread, making ventilation paramount to reducing the viral load in shared air. Maximize air exchange by opening windows throughout the home to bring in fresh outdoor air, even if only slightly. Using a portable air cleaner with a High-Efficiency Particulate Air (HEPA) filter in the sick room and common areas can significantly reduce airborne viral particles. Look for a unit sized appropriately for the room to achieve the recommended standard of five air changes per hour (ACH).
When the infected spouse must leave their isolation room, they should wear a high-quality, well-fitting mask, such as an N95 or KN95, to act as a source control measure. The uninfected person should also wear an N95 mask when entering the sick room or when in proximity to the infected individual, as these masks can reduce the odds of personal infection by over 80%. Finally, avoid sharing any household items, including dishes, glasses, towels, bedding, and electronic devices.
When and How to Test After Exposure
The timing of your test is crucial because testing too early can result in a false negative result, giving you a misleading sense of security. If you remain asymptomatic following the exposure, wait a full five days after your last close contact with your spouse before taking a test. This waiting period allows the virus enough time to replicate to detectable levels, maximizing the accuracy of the result.
If you develop any symptoms, you should test immediately, regardless of when the exposure occurred. The molecular Polymerase Chain Reaction (PCR) test remains the gold standard, as it is highly sensitive and can detect lower levels of the virus. Rapid antigen tests (RATs) are convenient and faster, but they are generally less sensitive than PCR tests, particularly in asymptomatic individuals.
A positive result on a rapid test is highly reliable. If you receive a negative result on a rapid test but have been exposed or have symptoms, do not assume you are in the clear. Public health guidance recommends serial testing with rapid tests: test again 48 hours after the first negative result, and a third time 48 hours later, for a total of three tests over five days.
Current Isolation Guidelines for Contacts and Cases
The guidelines for the infected spouse depend on how they are feeling. The infected person should stay home and away from others until they have been fever-free for a full 24 hours without fever-reducing medication, and their symptoms are improving. This requirement is the primary trigger for ending the home isolation period, regardless of the number of days that have passed.
Once the initial isolation period is over, the infected spouse should continue to take extra precautions for five additional days. These precautions include wearing a high-quality mask when around other people, maintaining physical distance, and practicing good hand hygiene. If the positive spouse’s symptoms worsen or a fever returns, they should immediately restart the isolation period from day zero.
For the exposed but asymptomatic individual, strict monitoring and precautions are advised for ten full days after the last exposure. During this time, monitor yourself daily for the onset of symptoms. Wear a well-fitting, high-quality mask whenever you are around other people, especially your infected spouse. If symptoms develop, you must isolate immediately and get tested.