Two years into the pandemic, many are unsure what to do after testing positive for Covid-19. Should they isolate themselves, and if so, for how long? How important is a doctor’s visit? What therapies are there and who is eligible?
To help answer these and other questions, I spoke to CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at George Washington University’s Milken Institute School of Public Health. She is also the author of Lifelines: A Doctor’s Journey in the Fight for Public Health and a mother of two young children.
CNN: It seems like a lot of people are being diagnosed with Covid-19 right now. I have friends who have been very cautious during the pandemic and are now testing positive. Why is that?
dr Leana Wen: First and foremost, we’re dealing with a highly contagious subvariant. The original Omicron variant was already more contagious than Delta and previous variants. Then we had BA.2, a subvariant of Omicron that was more contagious than Omicron, and now we have an offshoot of BA.2 called BA.2.1.21 that appears to be even more transmissible.
A more transferrable flavor means that activities that we previously thought were relatively safe are now more risky. This does not mean that we should avoid all activities, but that people who were previously very cautious can now become infected because this sub-variant is so contagious. Also, individuals previously infected with Omicron have some protection against this new subvariant; those not previously infected are now more susceptible. Fortunately, this variant does not appear to cause more serious illness in most people, and the vaccine and initial booster still offer good protection against hospitalization and death for those infected.
Another reason for the increased number of infections is that people are more involved with each other, including indoors and without masks. Any time such interactions occur, there is a risk of transmission. Again, this doesn’t mean that people should never come into contact with each other, but rather to be aware of the risk and to take precautions, especially for those with immunodeficiency and others at higher risk of serious illnesses.
CNN: If someone is diagnosed with Covid-19, what should they do? Is isolation still recommended?
Whom: Yes it is, and in fact that is the first thing I recommend people do when they test positive for Covid-19. Whether they have run their own home test and have a positive result or have received a positive result back from a PCR test, they should isolate immediately. If you are at home, go to a room away from others. When at work, put on an N95 mask to walk through public areas and drive home, ideally in your own vehicle.
CNN: How long should people isolate?
Whom: The day you get your positive test is day zero. If you had symptoms before, say the day before, that day is day zero, whichever comes first. Day 1 is 24 hours after testing positive or showing symptoms. They must be isolated from others for five days. That means staying at home away from being in the same room with your roommates and not going to work in person. For example, if you have to share a bathroom, be sure to wear a well-fitting N95, KN95 or KF94 in these common areas, minimize your time in them and open the windows as much as possible.
Additionally, I want to caution that the CDC does not say that you can freely connect with your family and the people in your home after Day 5. You could still be contagious. The CDC says you should still mask around others on days 6 through 10. This includes not eating with people you live with indoors on these days.
Many public health experts, including myself, would recommend testing outside of isolation as an extra precaution that also reduces discomfort. This isn’t what the CDC says, but I think it’s reasonable to start testing with a rapid home test from day 5. If you test negative on day 5 and day 6 and have no fever and improved symptoms, you can exit isolation. This would mean a less stressful isolation period, especially for families living in close quarters or with young children to care for.
CNN: What therapies should people take? Should everyone get them?
Whom: It’s important to call your doctor and ask if you’re eligible for therapeutics. I would call whether you have mild, severe, or no symptoms because you should know your options. There are three main types of therapy, all designed to be done before someone becomes seriously ill to prevent hospitalization. In general, the earlier you start therapies, the more effective they are.
The three options are antiviral pills (Paxlovid and molnupiravir are the two approved antivirals), monoclonal antibodies, and remdesivir. The pills are taken orally while the other two require injections or infusions. They are intended for people who are at higher risk of developing a serious illness. Some of the therapies may not be readily available in your area. Others may interact with other medications or treatments you are taking.
I highly recommend that people talk to their doctor before they get sick so they have a plan. Someone who is in their 20s and healthy is unlikely to qualify for these therapies, but someone else in their 60s with some chronic medical conditions will be. Find out in advance what you would receive if you tested positive and how you would access the therapies, including after hours and weekends. If you don’t already have this plan, call your provider immediately after you test positive and discuss options.
CNN: How do you address skeptics who might ask, what’s the point of getting vaccinated if vaccinated people can still get it?
Whom: Let’s talk about the main purpose of vaccination. The most important reason is to reduce the likelihood of serious illness and prevent infected people from being hospitalized and dying. This is why staying up to date on vaccinations, getting the first vaccines and then the booster shots is so important because people who are vaccinated and boosted are much less likely to become seriously ill and die compared to people who are not vaccinated .
Vaccination also reduces the risk of infection, but that risk still exists. For people looking to further reduce their risk of contracting Covid-19, other precautions remain important, including wearing an N95 or equivalent mask in indoor public spaces and same-day testing before gatherings, particularly when the Covid-19 19 values in the community are high.