September 18, 2023 – Americans may have different opinions on hot-button issues, but they seem to be focused on at least one line: wishes COVID-19 really stood behind us once and for all.
But four months after the CDC announced that the COVID public health emergency was officially over, hospitalizations are up nearly 9% and deaths are up nearly 5% from the week before, according to the latest Numbers. CDC data.
Like it or not, the recent resurgence of COVID could mean a return to testing, isolation and masking. So what are the recommendations again? The CDC’s guidance on COVID hasn’t changed much: if you test positive, isolate from everyone for 5 days and then depending on whether symptoms improve or if you still have a fever, you may need to continue isolating.
But now that the pandemic is over, are these guidelines still the most effective and reasonable? WebMD reached out to an emergency room doctor, a primary care physician, and an infectious disease expert for a refresher course.
Q: What should you do if you are sick and think you may have COVID? Do you still have to isolate until you get test results?
A: Leana Wen, MD, emergency medicine physician and professor of health policy at George Washington University in Washington, DC: Everyone should have a supply of at-home rapid antigen tests on hand so they can take a test as soon as they develop symptoms. This is especially important if they live with individuals who are more vulnerable to serious illness. If so, they should isolate from those individuals while they are symptomatic, regardless of test results.
A: Dana Hawkinson, MD, infectious disease physician and medical director of infection prevention and control, University of Kansas Health System in Kansas City, KS: It is always best to have a plan if you become symptomatic and/or are diagnosed with COVID-19. Yet it is very important to test early if you have complaints. Look for free testing sites that may be available through state or county agencies, ask your doctor’s office or local hospital if they perform testing, or perform testing at home. However, at-home testing may require testing on several different days, 24 to 48 hours apart. And yes, if you are symptomatic, try to stay home and isolate and wear a mask when you are around others.
Q: How long should you isolate if you get a positive test result or diagnosis? Should you stay home from work and isolate yourself from your family?
A: Wen: There are some misunderstandings about the CDC guidelines. The agency recommends anyone with mild symptoms isolate until after day 5, with “day zero” being the day of their positive test. That person should stay away from others in the same household and sleep and eat in a separate room if possible.
But after day 5, things get a bit complicated. The CDC guidelines technically state that people should continue to isolate, but they can be in the same room while wearing a mask. That recommendation was made more so that individuals can return to work if they are essential workers, or take public transportation if they need to get to work. The misunderstanding arises because some people think that after day five they can go back to dinner with their elderly grandparents.
A: Hawkinson: It is best to always stay at home when you are sick. You can end your isolation when five days have passed since the onset of symptoms, you have been fever-free for 24 hours and your symptoms improve if you have or have had a mild illness. Wear a mask and, if possible, try to avoid others through day 10. For moderate illness, such as shortness of breath or breathing difficulties, isolation for 10 days after the onset of symptoms is recommended.
Q: What should you do if you continue to test positive or experience symptoms for an extended period of time? How should you handle life activities such as going to the office or a place of worship, taking the kids to practice, etc.?
A: Tochi Iroku-Malize, MD, MPH, president of the American Academy of Family Physicians and a family physician in Long Island, NY: Anyone who has been infected with COVID-19 can develop long-term COVID-19, which is considered a possibility when someone does not return to their normal state of health after an acute COVID-19 illness. Long COVID conditions may also include the development of new or recurring symptoms after symptoms of acute COVID-19 illness have resolved, including brain fog, muscle fatigue, shortness of breath, and prolonged loss of taste and smell. Experts are still working to understand more about who experiences long-term COVID and the long-term effects.
A: Hawkinson: The symptoms can last for weeks. The most important thing is to determine whether symptoms are improving from when they were at their worst. The CDC only addresses testing by saying that you can consider testing with an antigen test if you want to remove your mask before 10 days after the onset of symptoms. In this case, you will want two negative antigen tests at least 48 hours apart.
Q: What if you are back to normal, but don’t know how to protect children or other family members? Do you have to supervise children, take weeks off from work, etc.?
A: Iroku-Malize: It can be stressful to manage family, business and social obligations while COVID-19 is still spreading. If you do get sick, your doctor can help you create a health plan that works best for you and your family members.
A: Hawkinson: We know that attack rates from household contacts can be quite high. It is best to continue to monitor others around you for symptoms, in your personal or family setting, who may have been exposed. If exposure occurs, masking and monitoring for symptoms is recommended for the next ten days. Testing is recommended five full days after exposure, provided they have not experienced any symptoms.
Q: How useful are at-home COVID tests right now?
A: Iroku-Malize: Self-tests for COVID-19 at home are still useful and effective. I tell my patients that testing can be helpful even if you have no symptoms or have recently been exposed to COVID-19, such as before an event or when visiting someone, to ensure you don’t accidentally expose others.
The most important thing you can do to protect yourself, your loved ones and your community is to get vaccinated against COVID-19. Every ounce of prevention helps create a community of immunity.
Visit this CDC COVID data tracker site for the latest news on COVID, including hospitalizations and deaths, and information to keep you and your loved ones safe.