How long am I contagious?

How long am I contagious? A person is lying on their couch with their head under a blanket
More episodes in the Sounds Like Health Podcast

Whether a child or an adult, a registered nurse gives some basic guidelines on how to tell if you should stay home with a short-term, possibly contagious illness.

Episode Transcript

Mary Leigh Meyer: Howdy, everybody! Welcome to another episode of Sounds Like Health. My name is Mary Leigh Meyer.

Sam Craft: And I’m her co-host, Sam Craft.

Mary Leigh Meyer: And we are here today with the lovely Dr. Alison Pittman. She’s a registered nurse, and she’s here with us from the Texas A&M College of Nursing. Welcome!

Alison Pittman: Thank you for having me.

Mary Leigh Meyer: Yes, and so it’s back to school season, and so that comes with a lot of…

Sam Craft: And parents are like, “Yes!”.

Alison Pittman: I know. I was just going to say, ‘all the parents are screaming with joy’.

Mary Leigh Meyer: Until their kid picks up some bug from daycare or school.

Sam Craft: Kid germs are the worst. They’re like super mutant germs. I feel like they’re more potent than other germs.

Alison Pittman: Right. I teach the pediatric nursing course to our undergrads, and I just can’t tell you how many times I say in class, “kids are little Petri dishes of germs.” They’re good. If there’s something around, they’re going to pick it up. So, you do. You have to be careful.

Mary Leigh Meyer: And so that leads us to what we are talking about today. How long are we contagious? So, whether it’s a child or an adult, somewhat, the rules still generally apply to both.

Alison Pittman: Right.

Mary Leigh Meyer: So, let’s get started. What is one of the biggest contagious things kids pick up?

Sam Craft: Chicken pox.

Mary Leigh Meyer: Chicken pox? Fevers? Yeah. Stomach bugs.

Alison Pittman: Yeah. I mean, chicken pox is actually a little bit better than it used to be, because now we have a vaccine against it. But it used to be virulently contagious. Just very … When I was a kid, we used to have chicken pox parties. Parents would have … Yeah, I’m revealing my age here.

Sam Craft: No, no. I had it too. We had them too. It was like the whole purpose.

Alison Pittman: If someone had the chicken pox, especially when you were really young…

Sam Craft: Just get it over with.

Alison Pittman: Yep. Because once you had it, they thought you wouldn’t get it again. So, but now we have a vaccine for that. The varicella vaccine, it’s not quite so bad. But nowadays, really the most common thing you get are just viral illnesses. The common cold is a virus, sort of those gastroenteritis, vomiting, diarrhea viruses, they’re highly contagious. Those are probably the most common things, especially with kids that we see.

Mary Leigh Meyer: And those would be like the 24-hour or 48-hour bug?

Alison Pittman: Right.

Mary Leigh Meyer: That type of thing?

Alison Pittman: The good thing about the stomach bug is it’s over in usually 24 hours, but with the common cold or RSV, respiratory syncytial virus, is a really common viral illness that’s respiratory, and most of us have had it by the time we’re 3, 4 years old. But it can actually be really dangerous to kids, very young children, especially those who have heart or lung disease existing, like a heart defect, or maybe they were premature and have lung disease as a result of that.

When those kids get RSV, it can be very dangerous for them. So that’s why we are so vigilant about teaching kids and families about hand-washing, because that’s the number one way to prevent a lot of these illnesses.

Mary Leigh Meyer: Is there a bad way to wash your hands? Are there any best practices we can talk about?

Alison Pittman: Yeah. So, the way we teach kids, and that’s probably the simplest way to start, is whether you’re using soap or you’re using hand sanitizer, to apply it to the palm of your hand, and then sing Happy Birthday two times. That’s about how long it takes, and rubbing vigorously. So, rubbing your hands together, interlacing your fingers so you get in between your fingers, doing the front and the back. And we even teach kids that to get under your fingernails, you pretend like you’re scratching the palms of your hands, and that gets the soap under your fingernails. So as long as you sing Happy Birthday two times, and then if you’re using soap, rinse your hands, dry them off. And that’s … Even adults can sing Happy Birthday two times. So that’s…

Sam Craft: That reminds me, we did a Vital Minute piece, one of our little video snackables, with you about this subject. I remember that specific thing. But I have a four-year-old and we did the B-roll for that with him washing his hands, singing Happy Birthday.

Alison Pittman: Yeah, great. Super!

Sam Craft: Just reminded me of that so much.

Mary Leigh Meyer: Yep. Is that something he does now? Has he learned?

Sam Craft: Well, no. He’s four, so he’s like…

Alison Pittman: I mean, I have a nine-year-old and I still … I have…

Sam Craft: He just claps his hands.

Alison Pittman: I have a nine-year-old, and I still have the eagle ears. I don’t know if that’s a thing. But is that a thing?

Sam Craft: It’s totally a thing.

Alison Pittman: Whatever animal has super excellent hearing, moms have that. “Did you wash your hands?” So, yeah. But yeah, that really is the number one way to prevent so many. I mean, especially the common cold virus, and things like that, they shouldn’t live on non-human surfaces for more than 24 hours. But we have seen research that shows that some of those gastroenteritis viral illnesses, those can live on surfaces for up to two weeks without a human host. And so that’s why you see a lot of daycare centers. If there’s an outbreak of gastroenteritis, they will kind of shut the place down and really anti-bacterial, anti-viral, wipe everything down.

Sam Craft: Napalm everything pretty much.

Alison Pittman: Right. Because there are door knobs and light switches and things like that.

Sam Craft: Everything.

Mary Leigh Meyer: And kids touch everything.

Alison Pittman: They do. They do.

Sam Craft: We were in France last year, and my kid, he actually licked the subway pole as we were sitting there. And all I could think about all the horrifying things that just happened in life.

Mary Leigh Meyer: Oh no.

Sam Craft: I know. It was … Yeah, no, and it just continued to happen throughout the trip, and I was finally just like, “Whatever. Guess it’s just going to be what’s going to be.”

Alison Pittman: It’s good for his immune system.

Sam Craft: Sure. We’ll get some new things. So yeah, no, but…

Mary Leigh Meyer: Oh, my heart just stopped.

Sam Craft: I know, it’s terrifying. Believe me. I know, but at some point as a parent, stuff happens, and then you’re just kind of like, “All right, well we’ll see where this goes.” It’s going to make his immune system better or we’re going to get sick. So…

Mary Leigh Meyer: And everybody in the household will get sick.

Sam Craft: Yes.

Alison Pittman: And that’s especially true with the gastroenteritis. You can just see it rotating through the house and yeah. Yeah. It’s … But that’s what I’m saying, the good thing about those is they don’t last very long. Your body just has to work it out of your system and then usually you’re good. Every fall, winter, it goes around and hopefully you only get it once in a season. Once you get it, your body has really built up a natural immunity to it and you don’t get it again until the fall.

Mary Leigh Meyer: So, when can you go back to school after that? After gastroenteritis?

Alison Pittman: So, with the illnesses where you have vomiting and diarrhea, you really need to be symptom free for 24 hours. Sometimes you have a low-grade fever with those. But really the key … And always check with either your employer, if you’re worried about your job, or your child’s school. Check their policy. But usually it’s that you have not had any vomiting or diarrhea in 24 hours. That’s usually the key with those.

Sam Craft: What about viruses that incubate for a day or two? Are you contagious at that point? If it’s … I mean, I know you don’t know if it’s incubating, but I mean, is that contagious?

Alison Pittman: Yeah, we find with those GI viruses, like we’ve been talking about, you’re probably contagious for a full 24 hours before you show symptoms. With the flu, you’re contagious for a couple of days before you start to show symptoms. So, the only thing that we can do about that is be vigilant about hand washing. You may have been exposed to … Especially if you know you’ve been exposed to someone who’s sick, be very vigilant with everyone in your family about hand washing, covering your mouth when you cough and sneeze. Those are kind of the universal precautions we should all be taking that would help prevent if we were exposed before we get symptoms.

Mary Leigh Meyer: And do you need to stay home from school if you have a cold or the flu?

Alison Pittman: Yes. So, so again, check with your child’s school policy or your employers. But in general, if you have a fever, especially a fever over a 100.4, that’s the guideline, at least for our local school districts. You should be staying at home because that is indicative of contagious illness, whether it’s viral or bacterial.

Sam Craft: The one time I ever got the flu, I had a coworker who came to work with the flu and he was just … I just wanted to fight him.

Alison Pittman: I know and that’s really it.

Mary Leigh Meyer: In three weeks when he’s better.

Sam Craft: Yeah.

Alison Pittman: That’s the huge message that I really feel like we need to get out, is you’re not being Superman or Superwoman by coming to work sick. You’re first of all … You are going to wear yourself out. It’s not good for you. Your body’s telling you to rest, and you need to rest. Secondly, you’re exposing everyone else that you come in contact with that illness, and so don’t be a hero. Your employment supports you staying home when you’re sick, you’re not going to get in trouble.

Sam Craft: You have sick days. Use them.

Alison Pittman: You have sick days, use them. And same with kids. And I know that there are parents who they worry that if they have a sick child and they stay home with them, that they may lose their job. But you are supported by laws and policies about if you have a child that’s sick, you cannot lose your job by staying home with a sick child. You need to be supported with that.

Sam Craft: Well, I feel like most employers understand. They’re like, “Sure. Go home.”

Alison Pittman: Absolutely. Yeah.

Mary Leigh Meyer: But sometimes there’s just an unspoken pressure. You have all these projects and jobs to do, and sometimes leaving for the day just isn’t possible. Or even if you’re an hourly employee…

Sam Craft: I feel like this is when you change jobs.

Mary Leigh Meyer: And you’re just depending on…

Alison Pittman: Well, and I think it depends on your job. If you have the kind of job, for example, you are taking care of sick people, or you have the kind of job where you can’t just leave. You’re a firefighter or you’re a first responder, or something like that. And you have children, they’re going to get sick. And so, have some kind of a plan B in place, where you have a sitter, or a family member, or someone that can kind of be on call, and say, “Hey, my kiddo’s day care center just called, he’s throwing up. Can you please go pick him up and I’ll come get him as soon as I am off of work?” But a lot of those types of jobs do have things in place for that. They can call in someone who’s on call or whatever.

So, but I do think there’s some kind of a stigma or a pressure that, “if I go home from work, I am not as good of an employee.” And that’s not the case. You have a … Family comes first, and if you have a sick child, you should be allowed to go take care of them. Absolutely.

Sam Craft: I think you brought up a good point that I think about occasionally, because being in health care and this world of things. I think nurses, and doctors, and hospital workers … I mean they’re always around someone who I feel like is sick. So how does that work with them? I mean they know the risk. I guess they just precaution and hand wash. I know you walk in a hospital room, there’s always a hand wash dispenser.

Alison Pittman: Hand sanitizer.

Sam Craft: Hand sanitizer. There it is. So, what do you think about that? What are other precautions that they take or are they contagious? I can imagine how that could spread in the hospitals.

Mary Leigh Meyer: Even teachers. Teachers don’t get that many sick days, either.

Sam Craft: For sure.

Alison Pittman: Right. Yeah, and if you talk to people who are … Anyone who works in healthcare or teaching, whether it’s daycare all the way up to high school, they will tell you … I mean, at least for me, my first year as a bedside nurse, I was sick out just dozens of times. It’s kind of like that’s your trial by fire, so to speak. Where you’re going to be exposed to everything. And then after that, now I’ve been a nurse for over 20 years. I’m hardly ever sick. My immune … I have that super immune system, because my body’s built up immunity to all these different things, and I’m sure teachers are…

Mary Leigh Meyer: Well, not since you just jinxed it.

Alison Pittman: Perhaps. I’ll probably come down with the flu. Yeah, no, but I mean, I know I’ve talked to my child’s teachers, and his preschool teacher said, “Oh yeah, I used to be sick all the time, and now I’m not.”

So, there’s that. I mean, I think we really try to take every precaution, especially if you’re working in healthcare. If you’re taking care of a patient that you know has a certain illness, there are precautions that go with all of our known illnesses, and we may have to wear gowns, and gloves, and masks depending on what’s going on. We always wear gloves, we always wash our hands. But even then, especially in the beginning of your career, you’re exposed to a lot of things. I know there’s been times, especially in the beginning of my nursing career, where as soon as I got home, my scrubs went straight in the washing machine before I interacted with anybody in my family, and I’d shower. And so, it kind of depends on who you know you’ve come into contact with, but we do have isolation and hand washing precautions in place. Those universal precautions are supposed to protect us as long as we do them correctly. And that’s the key.

Mary Leigh Meyer: And what about those times … You said with a fever, it’s a 100.4, but you can take an over-the-counter medicine to fix the fever pretty much. Does that influence when you can go back?

Alison Pittman: Well that’s the … I’m sorry, I’m glad that you brought that up, because really the rule is to be fever free without any fever reducing medications. So, you can’t say, “Oh, my kid has a fever, I’ll give him some acetaminophen and send him to school.” That’s not how it works. Your child has to be fever free without any use of medications in order to go back to school.

Mary Leigh Meyer: Okay. And what about antibiotics?

Alison Pittman: So, antibiotics, if your child or you have a known bacterial illness and you’re on antibiotics, usually, and again you want to check with your employer or school, they need to be on those drugs for 24 to 48 hours before you can go back to school. Usually, you’re not contagious in terms of that bacterial illness if you’ve been on them for at least 24 hours.

Mary Leigh Meyer: Then what about if you take those antiviral flu medications?

Alison Pittman: So, the medications that … If you know you have the flu, and you’re given a medication that’s an antiviral like that, first of all, it’s very important that you get those within the first 24 to 48 hours of onset of symptoms, or they just don’t work. Those don’t necessarily affect … The only reason they factor into whether or not you can go back to school, is they make the symptoms go away faster. They’ve been shown, and it doesn’t work with everybody who gets them, but the fever will go away faster. The achiness goes away faster when you take those medications. So, it might benefit you to take them if you qualify early in the illness, because it will help you or your child to be able to go back to work or school faster.

Sam Craft: So, we’ve kind of breached some of the bigger things like flu and fever and that kind of stuff. What about the little things like head lice, or pink eye, or the little gross things that kids get? I call them gross. That’s exactly what they are. They’re gross.

Alison Pittman: We’re always kind of horrified when we find out someone in our family has that.

Sam Craft: Yeah. It’s not very, like I say, harmful, but more just kind of like, “Oh, you have this.”

Alison Pittman: Yes. So, let’s talk about head lice, because that’s always a big one. One important thing that I always try to point out when I talk about head lice is head lice cannot jump. They physically cannot jump. And people think, “Oh my gosh, it’s going to jump from this person’s head to my head.”

Sam Craft: It’s like fleas.

Alison Pittman: They’re not like that. Fleas can jump, no doubt. Head lice crawl, and so I always … It’s not possible for them to jump. Now if I touch my head, and then I touch a piece of paper, or a light switch, or a doorknob, and then someone else touches that, and then they touch their hair. Absolutely. Sharing towels, and clothing, and bedding, and all that, they can be spread that way because they crawl.

Sam Craft: How do head lice live?

Alison Pittman: So, an adult louse can live without a human host for only about 48 hours. Now on a human body, they can live for a long time, like a month. I think their lifespan is about a month. Now their eggs, they … The big thing about head lice is they lay eggs, and those eggs need about two weeks for their whole gestation to occur, for the louse to hatch from the egg. And if it’s without a human host, it’ll die within 24 to 48 hours. So, the way to treat head lice … And first of all, for most school districts, head lice is not a reason to stay home from school. It is not a…

Sam Craft: Really?

Alison Pittman: It is not a health risk. It is not a risk to your health. It’s just a nuisance.

Sam Craft: It was like a pandemic growing up.

Alison Pittman: I know, and it’s a nuisance, and people have always been so horrified about head lice, like, “Oh my gosh, you’re going to stay home forever, and you’re banned from school.”

Mary Leigh Meyer: Yeah, because you have to wash all clothes, all towels, all sheets, all blankets.

Alison Pittman: Yes. You do. You do. But it’s considered a nuisance infestation. And again, check with your local school district and your school nurse. But for a lot of school districts, it’s not a reason to send a child home from school. It does need to be treated.

Alison Pittman: So, you can get over the counter treatments that are shampoos, and you usually have to shampoo it into the head and scalp and leave it for a certain amount of time, and it will kill all of the adult lice and any eggs, nits, if you leave it on and follow the directions appropriately. Then it always comes with a little tiny comb, and the comb is used to remove all the dead nits, hopefully, from the shaft of the hair.

And whenever you’re checking to see if your child has lice, lice are pretty smart. They lay those eggs back right above the nape of the neck in the back. If you have long hair, lift up the back of the hair and look at the base of the hair shaft, at the base of your neck, because they’re not gonna lay eggs where everybody can see them. They’re going to hide them. And so, they’re pretty smart that way. So, then the key is if you missed any nits, they will hatch within two weeks. And so, it’s recommended that you do that shampoo treatment again in two weeks to get any that you missed.

You don’t need to shave all your child’s hair off. What you do need to do is any laundry, bedding, towels, clothing needs to be washed in as hot water as it can handle, and then dryer setting as hot as possible. And that will kill anything that’s on clothing.

Sam Craft: Napalm.

Alison Pittman: If there’s something like special pillows, stuffed animals that can’t be washed, they need to be sealed in a plastic bag for two weeks, and then that gives … If there were any nits or lice, that’s the whole life cycle from laying of the egg to the death of the hatched adult, and then those can be used again.

Sam Craft: That’s wild.

Alison Pittman: Yeah, and it is. We’re getting to where we’re noticing that there are lice that are becoming resistant to the typical…

Mary Leigh Meyer: No. Stop talking.

Alison Pittman: … Typical over-the-counter medications.

Sam Craft: It’s like cockroaches.

Alison Pittman: And so, if you see, despite all of those efforts, that they are still around, you might need to get a prescription grade anti-lice medication from a provider.

Sam Craft: That’s terrifying. Super lice.

Mary Leigh Meyer: I’m starting to itch. It’s starting to itch now.

Sam Craft: I know. Just like…

Alison Pittman: Oh, whenever I lecture on this in class, all my students start scratching their head. It’s so funny.

Sam Craft: Well, what about pink eye? I know that that’s a common one too.

Alison Pittman: Yeah. So pink eye is very contagious. It’s just spread by touch, contact. A lot of times it’s viral, so you just have to sort of wait it out. But again, check with your provider or your school district on their policy. It is commonly something that kids have to stay at home for until they resolve it. But sometimes that’s not their policy, because if we wash our hands and follow those universal precautions, we shouldn’t be spreading it. But if someone scratches … Of course, it itches, and burns, and so they touch their eye with conjunctivitis, and then they touch something, and it would be spreadable to someone else.

Sam Craft: What exactly is pink eye? Just while we’re here. I thought it was an infection of sorts, isn’t it?

Alison Pittman: Mm-hmm. So, the conjunctiva is the sort of the protective lining of your eye that covers sort of your eyeball. And then if you ever look at … Pull your lower eyelid down, that that shiny pink part, that’s your conjunctiva. And so, conjunctivitis just means it’s inflamed by something.

Sam Craft: Okay.

Alison Pittman: It could be a foreign body or a substance that’s irritating it, but a lot of times it’s a virus or it can be bacterial. So anytime you get pink eye or conjunctivitis, seek a provider for it just so they can check it out and see if … They may give you … Most of the time, conjunctivitis is viral, and so you just have to wait it out. And they can give you drops that reduce the redness, and the itchiness, and the burning. If that doesn’t help, then you may need an antibiotic drop.

Mary Leigh Meyer: And I know you have to throw away your eye makeup brushes.

Alison Pittman: Yeah.

Mary Leigh Meyer: And all that, which can get crazy expensive.

Alison Pittman: Yeah. If you do have conjunctivitis and use eye makeup, it’s recommended that you start with all fresh products. Yeah. Because it can be contaminated.

Mary Leigh Meyer: And what … Pinworms?

Alison Pittman: Oh yes. Pinworms. Pinworms live in your rectum and your anal opening, and they lay eggs there, and they come in and out at night. And so, the best way to know is when your child first wakes up in the morning, you put a piece of scotch tape … Wear gloves if you have some. Put a piece of scotch tape across their bottom, put it in a zip-lock bag and take it to your pediatrician or your provider. They can look under a microscope and see if the child has pinworms.

Sam Craft: Parenting is so hard.

Mary Leigh Meyer: And you say that it is crazy contagious too.

Alison Pittman: Yeah, it is. Just because it sort of what we call fecal contamination, where if a child scratches their bottom, and they do itch, and then they don’t wash their hands, whatever they touch, there could be contamination.

There’s actually an over the counter medication for pinworms that you can get at a pharmacy. And then you can always seek help from your provider as well.

Sam Craft: Where do pinworms come from? I mean, is it something you can eat, or is it … I mean, does it have to be transmitted via scratching?

Alison Pittman: It’s usually oral. So, you touched something that someone with pinworms has touched, and then you eat or you don’t wash your hands and it gets in your mouth. So, it’s kind of a fecal-oral contamination. Yeah. And again, they’re not a huge health hazard. They’re just a nuisance, and they’re yucky.

Sam Craft: That’s gross.

Alison Pittman: Yeah. Yeah. Yep.

Sam Craft: Always wash your hands after touching anything.

Alison Pittman: I hope no one’s eating while listening to this podcast, they might be grossed out.

Sam Craft: Well, that’s half our goal. Keep people informed, and gross them out.

Mary Leigh Meyer: What about ring worms?

Alison Pittman: So, ringworm is a fungal infection of the skin, and very common in children more than adults as well. There are lots of different types of fungal illnesses. Some of them are … You get a lot from kitty cats, and puppies, and stuff, and not washing your hands. But those are pretty easy to treat. If you notice any kind of a lesion on your skin or your child’s skin, and it’s a perfect little ring and it seems to grow, and develop, and get bigger, it might be ringworm. And so just seek help from your provider. But there are antifungal creams that take care of those pretty quickly. But we do see it a lot in kids, because they play outside, they play with pets, they don’t wash their hands. And so, if there’s any fungal illness present that causes ringworm…

Sam Craft: I’m never not going to wash my hands again. I going to wash them every time I touch something now. I am so freaked out.

Alison Pittman: I know. The more you learn, the more of a germaphobe you become. It’s true.

Sam Craft: Howie Mandel had it all right.

Mary Leigh Meyer: So, before we end, let’s recap. So, if you have a fever, it’s a 100.4…

Alison Pittman: Right.

Mary Leigh Meyer: …then 24 hours after that you can go.

Alison Pittman: Right, without use of fever reducing medications. And I know that’s a weird number. It corresponds to 38 degrees Celsius, is 100.4 Fahrenheit. And that’s a really … I know it’s an odd number, but that’s kind of the cutoff for where we say, “Okay, this is probably something contagious.”.

Mary Leigh Meyer: Okay. And then vomiting, diarrhea, did you say 24 hours?

Alison Pittman: 24 hours. Mm-hmm.

Mary Leigh Meyer: Lice?

Alison Pittman: Lice just needs to be treated. Check … Again, I think there are a lot of variation in policies on that, so make sure you check with your school or your employer on what is required. And it might be good to say if it’s a viral illness, you need to be fever free, vomiting/diarrhea free for 24 hours. If it’s a bacterial illness, a known bacterial illness, you need to be on antibiotics, either whether it’s topical or oral, for 24 to 48 hours before you return to school. But always check and make sure you’re following the policy of either your school or your employer.

Sam Craft: If there’s any question, be safe. Stay home.

Alison Pittman: Right. And one other thing is if you feel crummy, if you don’t feel like your child can function at school or you can’t function at work because you feel like you’ve been hit by a Mack truck, you’re achy, you’re tired, your body is telling you to rest. You don’t need to go to work. And so, that’s always something to think about as well.

Mary Leigh Meyer: Well, okay. I think that’s all we have time for today. Thank you for coming on the show and educating us all.

Sam Craft: Wonderful having you.

Alison Pittman: Thanks for having me.

Mary Leigh Meyer: Hopefully coworkers stop coming to work sick.

Sam Craft: Yes, stay home.

Alison Pittman: That’s right.

Mary Leigh Meyer: Thank you all for listening! This has been another episode of Sounds Like Health.