Sept. 18, 2023 – Americans may have a range of opinions on hot-button issues, but they seem to align on at least one: Wishing COVID-19 was truly behind us once and for all.
But 4 months after the CDC announced the COVID public health emergency was officially over, hospitalizations have increased almost 9% and deaths have risen almost 5% from the previous week, according to the most recent CDC data.
Like it or not, the recent COVID uptick could mean a return to testing, isolation, and masking. So what are the recommendations again? The CDC’s guidance around COVID hasn’t changed much: If you test positive, isolate from everyone for 5 days and then, depending on whether symptoms are improving or if you still have a fever, you may need to continue to isolate.
But more than 3 years into the pandemic, with the public emergency over, are those guidelines still the most effective and reasonable? WebMD reached out to an emergency room doctor, a family doctor, and an infectious disease expert for a refresher.
Q: What should you do if you are sick and think you might have COVID? Should you still isolate until you have test results?
A: Leana Wen, MD, emergency medicine doctor and health policy professor at George Washington University in Washington, D.C.: Everybody should keep a supply of rapid home antigen tests on hand so they can take a test as soon as they develop symptoms. This is particularly important if they live with individuals who are more vulnerable to severe illness. If that is the case, they should isolate from those individuals while they are symptomatic regardless of test results.
A: Dana Hawkinson, MD, infectious disease doctor 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 diagnosed with COVID-19. It still is very important to test early if you have symptoms. Look for free testing sites that may be available through state or county agencies, ask your doctor's office or local hospital if they have testing, or perform at-home testing. However, for at-home testing you may need to test on a couple of different days 24-48 hours apart. And yes, if you are symptomatic, try to stay home and isolate and wear a mask when 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 from family?
A: Wen: There is some misunderstanding about CDC guidelines. The agency recommends someone 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, sleeping and eating in a separate room if possible.
But after day 5, it becomes a bit complicated. The CDC guidelines technically state people should continue isolating, but they can be in the same space if they wear a mask. That recommendation was made more so that individuals can go back to work if they're essential workers or take public transportation if they have to get to work. The misunderstanding comes because some individuals believe that after day 5, they're able to go back to having meals with their elderly grandparents.
A: Hawkinson: The best practice is to always stay home if you are ill. You may end your isolation if 5 days have passed since symptoms started, you are fever-free for 24 hours, and your symptoms are improving if you have or had mild illness. Wear a mask and try to avoid others, if possible, through day 10. With moderate illness, such as shortness of breath or difficulty breathing, isolation through 10 days after symptom onset is recommended.
Q: What should you do if you continue to test positive or experience symptoms over an extended period of time? How should you proceed with life activities like going to the office or place of worship, taking the kids to practice, etc.?
A: Tochi Iroku-Malize, MD, MPH, president of the American Academy of Family Physicians and family doctor in Long Island, NY: Anyone who has been infected with COVID-19 can develop long COVID, which is considered as a possibility when someone does not return to their normal state of health following acute COVID-19 illness. Long COVID conditions might also include development of new or recurrent symptoms after the symptoms of acute COVID-19 illness have resolved, including brain fog, muscle fatigue, shortness of breath, and extended loss of taste and smell. Experts are still working to understand more about who experiences long COVID and the long-term effects.
A: Hawkinson: Symptoms may linger for weeks. The important thing is to determine if the symptoms are improving from a time when they were the worst. The CDC addresses testing only in saying that you may consider testing with an antigen test when you would like to remove your mask prior to 10 days after symptoms onset. In this case you would want two negative antigen tests at least 48 hours apart.
Q: What if you’re back to normal but confused on how to protect children or other family members? Should you monitor children, take off work for weeks at a time, etc.?
A: Iroku-Malize: It can be stressful managing family, business, and social obligations while COVID-19 is still at large. If you do get sick, your family physician can help you make a health plan that works best for you and your family members.
A: Hawkinson: We know attack rates of household contacts can be fairly high. It is best to continue to monitor others around you for symptoms, in your personal or family sphere, who may have been exposed. If it is felt there was exposure, the recommendation is to mask and monitor for symptoms for the next 10 days, with testing recommended 5 full days after the exposure, provided they have not experienced symptoms.
Q: How useful are at-home COVID tests at this point?
A: Iroku-Malize: At-home self-tests for COVID-19 are still useful and effective. I tell my patients that testing can be helpful even when you don’t have symptoms or a recent exposure to COVID-19, such as before an event or visiting someone, to ensure you’re not inadvertently exposing 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 on COVID, including rates of hospitalizations and deaths, and information to help keep you and your loved ones safe.