The maskless man a few rows back coughed his head off. I had just boarded the train from DC to New York City a few weeks ago and along with several other passengers had my neck down to take a look at what was going on. This wasn’t the Reedy Dregs of a common cold. This was a deep, constant, full-bodied cough. Think garbage disposal with an inner fork.
Nobody said anything to the man (at least to my knowledge). However, if someone had, I imagine they would have responded with now-famous pandemic timing: “Don’t worry! It’s not Covid! Such reassurances can be perfectly fine (even polite), say, at the height of allergy season when you want to look worried that you know you’re not showering them with deadly virus. But the reassurances only go so far. How my colleague Katherine J. Wu recently wrote, a negative Covid test, especially in the early days of symptomatic illness, is no guarantee that you are not infected and contagious. And putting even that concern aside, quiet: Whatever it was that this maskless man hacking like a faulty kitchen utensil didn’t want that either, I didn’t want that either!
If you’re feeling sick just because you don’t have Covid doesn’t mean you rip your mask off and get on a plane alongside other people, the University of Chicago told me. “Maybe you’re ruining someone’s vacation… maybe they’ll see their mother at the hospice. Let’s not ruin other people’s lives and plans. “
For the past two years, the public has taken a crash course in preventing respiratory virus transmission. We’ve learned the importance of testing, masking and distancing and isolating and ventilating. These lessons, some better received than others, apply just as well to more familiar pathogens like influenza and common coronaviruses in relation to the novel that reshaped our lives. We understand better than ever how to be a good sick person. Now we will see if anyone uses this knowledge.
The first and most important rule of feeling sick is to stay at home. This, says Ryan Langlois, an immunologist at the University of Minnesota, is simultaneously the “easiest and most difficult” guideline. Easy because it’s so easy: stay in your house Do not go! No technical know-how required. Difficult because it actually involves important disruptions of daily life. For employees, the normalization of working from home has been far more convenient than it was (and has, one can only hope once and for all, the entire fiction of dragging oneself to work is an act of self-sacrification You strength; it’s not -it’s just ruthless). However, remote work is not an option for much of the workforce, and more than a fifth of American workers do not have paid sick leave. Among the country’s lowest earners – the people most likely to need it – only about a third do. (Every wealthy country in the world except the United States guarantees paid sick leave.)
The tricky part of isolating is knowing when to stop. No one-size-fits-all formula will spit out the right answer for every type of infection, Langlois told me. A person could be completely virus-free five days after symptom onset. Another could still be very contagious. Even for the most responsible among us, this ambiguity can lead to some awkward calculations. Can you afford to miss this work meeting? How about family dinners? It would be a real pain to cancel those travel plans – but?
After a few years of Covid management, we have better tools and practices, at least in theory, to help people manage these situations. Many of us have formed the habit of regularly testing and retesting for Covid and now is no time to stop. But Seema Lakdawala, an influenza transmission expert at the University of Pittsburgh, sees a world with widely available tests for a whole range of pathogens: influenza, RSV, adenovirus, rhinovirus, seasonal cold coronavirus and, of course, SARS, SARS, SARS, SARS , SARS-CoV-2. Locations on every street corner offer patients not only a diagnosis but also a prescription for the appropriate medication. People in rural areas could purchase tests at home from drug stores or order them online. Someone who has tested positive for just a seasonal coronavirus, which kills tens of thousands of people most years, would know they would take stricter precautions. Regardless of the situation, you would know you were clear when you would test negative for whatever you originally tested positive for.
For now, Lakdawala admits that a world of such universal, accessible testing remains a distant fantasy. She and the other experts I spoke to offered several more practical guides. Even when things get uncomfortable, it’s good practice to notify people who may have exposed you to a pathogen, just as we’ve been encouraged to do with Covid. If you have a fever, keep yourself as far away as possible for at least 24 hours after graduation. If you don’t have a fever, I should realize that once your symptoms resolve, you’ll re-enter society. For a cold, she said, that generally lasts three to five days; for flu five to seven. After that, certain symptoms can linger for weeks, but as long as you don’t feel gross, Landon said, you can responsibly break out. (Call it the “EW” test.) Isolation with a persistent cough is fine, Saskia Popescu, an epidemiologist at George Mason University, told me, “As long as it’s not that wet, nasty cough.” (If you’re really interested in the nitty-gritty, you can always consult the CDC’s 206-page doorstop on isolation precautions, but Popescu doesn’t recommend: “I wouldn’t subject anyone to that.”)
If you are still symptomatic after the recommended isolation period, or if you need to phase out before the end, whether for an essential visit or because your employer does not provide sick leave, you should wear a quality mask. Ditto for that ambiguous time when you’re feeling a little distant and just wondering if you’re on to something: if you’re not sure, mask. People tend to be more contagious at this stage and the worst that can happen is you take a little unnecessary precaution and wake up the next morning feeling fine. Yes, masks can be uncomfortable, and yes, it’s a tragedy that such a basic health intervention has been lumped into the culture war, but they remain one of the most effective and least disruptive tools for fighting all types of respiratory infections. An N95 or KN95 is best, but a surgical or cloth mask is better than nothing, Lakdawala said, particularly because many people cannot afford to constantly replenish a stock of premium disposables. Healthcare providers and employers could suggest offering free masks that would protect patients, workers and those around them.
Like widespread testing, a steady supply of free masks and universal paid sick leave are only a distant vision. Congress is currently struggling to shore up our most basic public health infrastructure during one Pandemicleaving Americans to figure out Covid for themselves. The same is probably true of all other known viruses that we use to restore ourselves. Whether the more modest behavioral changes we’ve adopted over the past two-plus years, the pandemic is anyone’s guess. In this time of perpetual flux, a constant has been the disconnect between what we know and what we end up actually doing.
Better to know than not, but personal experience hasn’t made me optimistic that the knowledge will reliably translate into action. On the train I collected after a few fruitless minutes from which to hold back a few rows and collected my bags and moved to another car. At first everything was quiet. then two People started coughing.