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 subvariant of Omicron is now the dominant strain of coronavirus nationwide.
Two years into the pandemic, many aren’t sure what to do after testing positive for Covid-19. Should they isolate, and if so, for how long? How important is it to see a doctor? What therapies 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 the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health” and the mother of two young children.
CNN: It seems like a lot of people are getting diagnosed with Covid-19 right now. I have friends who have been very careful throughout the pandemic who are now testing positive. Why is that?
Dr. Leana Wen: First and most importantly, we are dealing with an extremely 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 transmissible variant means that the activities we thought were relatively safe before are now higher risk. This doesn’t mean that we should avoid all activities, but rather that people who have been very careful before may be getting infected now because of how contagious this subvariant is. Also, people previously infected with Omicron have some degree of protection against this new subvariant; those not previously infected are now more susceptible. Fortunately, it does not appear that this variant causes more severe disease in most people, and the vaccine and first booster still provide good protection against hospitalization and death for those who are infected.
Another reason for the increased number of infections is that people are engaging with one another more, including indoors and without masks. Any time such interactions occur, there is risk of transmission. Again, this is not to say that people should never associate with one another, but rather, to be aware of the risk and to take precautions, especially for those with immunocompromise and others at higher risk for severe disease.
CNN: If someone gets diagnosed with Covid-19, what should they do? Is isolation still recommended?
Wen: Yes, it is, and in fact, that is the first thing that I recommend for people to do if they test positive for Covid-19. Whether they performed their own home test and have a positive result or received a positive result back from a PCR test, they should immediately isolate. If they are at home, go to a room away from others. If they are at work, put on an N95 mask to transit through public areas and head home, ideally in your own vehicle.
Isolation isn’t always easy, especially for those with young children and who live in multigenerational housing. If possible, identify another adult to care for young kids so that the infected person can isolate by themselves. If a child is the one who tested positive, assign one adult to care for that child. (We discussed more about the challenges of isolation with young children in this previous Q&A.)
CNN: How long should people isolate?
Wen: The day that you take your positive test is day zero. If you had symptoms before then, say the day before, that day is day zero—whichever is first. Day 1 is 24 hours after the positive test or appearance of symptoms. You need to be isolated from others for five days. That means not being in the same room at home with people you live with and not going to work in person. If you have to share, say, a bathroom, make sure to wear a well-fitting N95, KN95 or KF94 while in these common areas, minimize your time in them, and open the windows as much as possible.
The CDC says that after the fifth day of isolation, if you have no fever and your symptoms are improving, you can go into public spaces like grocery stores and to work and school, as long as you wear a well-fitting mask the entire time. A lot of workplaces and schools have their own policies that are more stringent than this and may require, for example, a full 10 days before you return.
In addition, I want to caution that the CDC is not saying that after day 5, you can freely associate with your family and people in your home. You could still be contagious. The CDC says that you should still be masking around others for days 6 through 10. That includes not dining with people you live with, indoors, during those days.
Many public health experts, including me, would recommend testing out of isolation as an additional level of precaution that also reduces inconvenience. This is not what the CDC says, but I think it’s reasonable to start testing with a home rapid test from day 5. If you test negative on day 5 and day 6, and you have no fever and improved symptoms, then you could exit isolation. That would make for a less onerous isolation period, especially for families who live in small spaces or have young children to care for.
CNN: What therapies should people take? Should everyone get them?
Wen: It’s important you call your medical provider and ask if you are eligible for therapeutics. I would call regardless of whether you have mild, severe or no symptoms, because you should know what your options are. There are three main types of therapies, all of which are meant to be taken before someone becomes severely ill, in order to prevent hospitalization. Generally, the sooner you start on the therapies, the more effective they are.
The three options are antiviral pills (paxlovid and molnupiravir are the two antivirals that have been granted authorization), monoclonal antibodies, and remdesivir. The pills are taken orally, while the other two require injections or infusions. They are meant for people who are at higher risk for progression to severe disease. Some of the therapies may not be easily available in your area. Others might have interactions with other medications or treatments you are on.
I highly recommend that people speak with their medical providers in advance of getting ill so that they have a plan. Someone who is in their 20s and healthy is probably not eligible for these therapies, but someone else who is in their 60s with some chronic medical conditions will be. Know in advance what you’d get if you test positive and how you would access the therapies, including after hours and on weekends. If you don’t already have this plan, call your provider immediately after you test positive and discuss the options.
For people who don’t have a regular medical provider, the federal government has a therapeutics locator, including a “test-to-treat” option where people can go to get tested, see an urgent care provider, and get the therapies all at the same location. Your local and state health departments will likely have additional information and resources, too.
CNN: How do you address skeptics who might ask what’s the point of getting vaccinated if vaccinated people can still become infected?
Wen: Let’s talk about the primary purpose of vaccination. The most important reason is reduce the likelihood of severe disease and to keep infected people from being hospitalized and dying. That’s why it’s so important to be up-to-date with vaccines, to get the initial vaccines and then the boosters, because people who are vaccinated and boosted are much less likely to become severely ill and to die compared with people who are unvaccinated.
Vaccination also reduces the chance of infection, but that risk still exists. For people who want to further reduce their risk of contracting Covid-19, other precautions remain important, including wearing an N95 or equivalent mask while in indoor public settings, and same-day testing before gatherings, especially if community Covid-19 levels are high.