Covid-19 infections are on the rise, with most US states reporting an increase in cases. According to the US Centers for Disease Control and Prevention, the highly contagious BA.2.1.21 variant of Omicron is now the dominant strain of coronavirus across the country.
Two years into the pandemic, many weren’t sure what to do after they tested positive for Covid-19. Should they be isolated, and if so, for how long? What is the importance of seeing a doctor? What treatments are available and who is eligible?
To help answer these and other questions, I spoke with CNN medical analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at George Washington University’s Milken Institute of Public Health. She is also the author of Lifelines: A Doctor in the Fight for Public Health and a mother of two young children.
CNN: It looks like a lot of people are being diagnosed with Covid-19 right now. I have friends who have been very cautious throughout the pandemic and who have now tested positive. why is that?
Dr. Lina Wen: First and most importantly, we are dealing with a highly contagious sub-material. The original Omicron variant was already more contagious than Delta and previous variants. Then we had BA.2, the variant of Omicron that was more contagious than Omicron, and now we have a branch of BA.2, called BA.2.1.21, that appears to be more transmissible.
A more portable alternative means that activities that we once thought were relatively safe are now much more dangerous. This does not mean that we should avoid all activities, it means that people who were very careful before may now become infected due to how contagious this variant is. Also, people previously infected with Omicron have a certain degree of protection against this new variant; Those who were not previously infected are now more likely to be infected. Fortunately, this alternative does not appear to cause more severe disease in most people, and the first vaccine and booster still provide good protection against hospitalization and death for those infected.
Another reason for the increase in the number of infections is that people are interacting with each other more, including indoors and without masks. Anytime such reactions occur, there is a risk of transmission. Again, this does not mean that people should never bond with each other, but rather that they should be aware of the risks and take precautions, especially for those who are immunocompromised and others at greater risk of developing serious illness.
CNN: If someone is diagnosed with Covid-19, what should they do? Is solitude still recommended?
Wen: Yes, it is, and in fact, this is the first thing I would recommend to people if they test positive for Covid-19. Whether they take their home test and get a positive result or get a positive result back from a PCR test, they should be isolated immediately. If they are at home, move to a room away from others. If they are at work, put an N95 mask on to cross through public areas and back home, ideally in your private car.
Isolation is not always easy, especially for those who have young children and live in multigenerational dwellings. If possible, designate another adult to care for young children so that the infected person can self-isolate. If the child is the one who tests positive, assign an adult to care for that child. (We discussed more about the challenges of isolation with young children in these past questions and answers.)
CNN: How long do people have to isolate?
wen: The day you take your positive test is day zero. If you had symptoms before then, let’s say the day before, that day is day zero – whichever comes first. The first day is 24 hours after a positive test or symptom onset. You need to isolate from others for five days. This means not being in the same room at home with the people you live with and not going to work in person. If you have to share a bathroom, for example, make sure you wear a well-fitting N95, KN95 or KF94 while in these common areas, reduce the time you spend in them and open windows as much as possible.
The CDC says that after the fifth day of isolation, if you don’t have a fever and your symptoms have improved, you can go to public places like the grocery store, work, and school, as long as you wear a proper mask at all times. Many workplaces and schools have their own policies that are much stricter than this and may require, for example, a full 10 days before returning.
In addition, I would caution that the CDC does not say that after the fifth day, you can communicate freely with your family and individuals in your home. You could still be contagious. The Centers for Disease Control and Prevention (CDC) says you should still hide others from 6 to 10 days. This includes not eating with the people you live with, indoors, during those days.
Many public health experts, including myself, recommend testing isolation as an additional level of precaution that also reduces inconvenience. That’s not what the CDC says, but I think it’s reasonable to start testing with a home quick test from day five. If the test result is negative on the fifth and sixth day, and you do not have a fever and the symptoms have improved, you can go out of isolation. This would make the isolation period less difficult, especially for families who live in small spaces or have young children to look after.
CNN: What treatments should people take? Should everyone have it?
Wen: It is important that you contact your medical provider and ask if you qualify for treatment. I would call you regardless of whether you have mild, severe or no symptoms, because you must know what your options are. There are three main types of treatments, all of which are meant to be taken before a person becomes severely ill, to prevent hospitalization. In general, the earlier you start treatment, the more effective it will be.
The three options are antiviral pills (paxlovid and molnupiravir are the two antivirals that have been given a license), monoclonal antibodies and remdesivir. The pills are taken orally, while the other two require injections or injections. They are intended for people at higher risk of developing acute illness. Some treatments may not be readily available in your area. Others may interact with other medications or treatments you’re taking.
I highly recommend that people talk with their medical providers before getting sick so they have a plan. A person in their twenties in good health would likely not be eligible for these treatments, but someone in their sixties with some chronic medical condition would. Know in advance what you will get if you test positive and how you can access treatments, including after hours and on weekends. If you don’t already have this plan, contact your provider immediately after you test positive and discuss options.
For people who don’t have a regular medical provider, the federal government has a treatment locator, including a “test to treatment” option where people can go for testing, see an urgent care provider, and get treatments all in the same location. Your local and state health departments will likely have additional information and resources as well.
CNN: How do you deal with skeptics who might ask what is the point of vaccination if people who have been vaccinated are still infected?
Wen: Let’s talk about the primary purpose of vaccination. The most important reason is to reduce the possibility of serious illness and prevent the injured from hospitalization and death. That’s why it’s so important to be up to date on vaccinations, to get the initial vaccinations and then the boosters, because people who are vaccinated and boosted are less likely to have serious illness and death than unvaccinated people.
Vaccination also reduces the chance of infection, but this risk remains. For people who want to reduce their risk of contracting Covid-19, other precautions remain important, including wearing an N95 mask or equivalent while in indoor public spaces, and testing the same day before gatherings, especially if community Covid-19 levels are high. .