Covid-19 positive: What next? – With insights from The Wall Street Journal

South Africans are battling a resurgence of the Covid-19 virus. The current wave of infections is said to be driven by a new mutation of the virus, which spreads far more easily. With 1.4 million reported cases and 1.2 million recoveries, the peak of the second wave seems to have passed.  Dr Shabir Madhi, Professor of Vaccinology, predicts a third and possibly a fourth wave of infections before the most vulnerable South Africans are vaccinated. He says the failure to procure and roll out vaccines quickly will lead to many more infections, deaths and indeed recoveries in South Africa. Thanks to media campaigns- even popular bread brands are printing advice on their packaging about how to avoid contracting the virus- most are aware of precautionary measures. There is comparatively little advice about what to do if one becomes infected with Covid-19. Some patients are asymptomatic while others fall critically ill within days. Each case is different and the good news is, statistically most are likely to survive the virus. Sumathi Reddy of The Wall Street Journal asks medical doctors some of the questions you need answered and others you never thought to ask. – Melani Nathan 

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You Tested Positive for Covid-19. Now What?

Doctors answer questions about quarantining, getting the vaccine and resuming daily activities

By Sumathi Reddy of The Wall Street Journal

Jan. 25, 2021 8:00 am ET

We asked doctors for answers to questions about dealing with a positive Covid test.

How long will I be contagious?

The U.S. Centers for Disease Control and Prevention says anyone who tests positive for Covid-19 should isolate for 10 days starting at symptom onset. That means avoiding all contact with other people and not leaving home unless you need to go to a medical appointment. If you are asymptomatic and test positive and never develop symptoms, the isolation period should start on the day you took your diagnostic test. You are believed to no longer be contagious after 10 days if you have had no fever—and haven’t taken fever-reducing medication—for at least 24 hours and your symptoms are improving. The CDC recommends that immunocompromised patients and those with severe Covid-19 cases isolate for up to 20 days after symptoms appear.

Do I need to tell people I’ve been in contact with that I tested positive?

Anyone who lives with you should get a Covid-19 test and quarantine for 10 to 14 days from their last contact with you. In some cases quarantine can be shortened to seven days with a negative test. If you’ve spent a total of 15 minutes within 6 feet anyone else in the past two to four days, you should contact those people and let them know you tested positive. Some experts say if you are masked and outside there is significantly less risk and quarantine may not apply to those contacts, but it depends on the contact-tracing guidelines of your local health department.

“Public health authorities vary in advice,” says Graham Snyder, medical director of infection prevention and hospital epidemiology at the University of Pittsburgh Medical Center. “In our jurisdiction, if masked, we still consider yourself exposed if within 6 feet for 15 minutes. Obviously you’re less likely to be contagious or exposed if both people are masked and less likely to transmit virus if outdoors but there is a continuum where public health draws that line and it may vary.”

When I’m isolating, what can or can’t I do?

Isolation means avoiding all human contact as much as you can. Some cities and governments provide housing for people who need to isolate. If that’s not an option and you live with others, try to remain on your own floor or room with a private bathroom, if possible. Food and other essentials should be left outside your door. If someone enters your room or you need to venture out, make sure you are both masked. Some experts say walks aren’t allowed while in isolation. Others say as long as you are masked, feeling OK, and in an area where you can easily be very distant from others, it’s fine to go outside for fresh air.

Should I get another diagnostic test after my 10-day isolation period?

No. Many experts say that isn’t necessary and may result in unwarranted stress and anxiety should another test turn up positive. The PCR test commonly used to diagnose Covid-19 is very sensitive and can detect virus particles that are dead or not infectious weeks later, says Kristin Englund, an infectious disease physician at Cleveland Clinic. “So it’s not going to be an accurate diagnosis of whether somebody is still infectious or not,” she says.

The only instance where a repeat diagnostic test may be necessary is for severely ill and immunocompromised patients whose recommended isolation period is up to 20 days following symptom onset.

What about an antibody test?

Doctors don’t recommend getting an antibody test in most cases. “Routine antibody testing after a Covid diagnosis is not necessary,” says Michael Lin, an infectious disease physician at Rush University Medical Center in Chicago. “It’s expensive and it does not change what you do day in and day out.”

Dr. Lin says, “We still don’t know if having a positive antibody test result means that you’re automatically protected or the converse, if a negative result means you’re at risk.” Doctors say it is important to observe pandemic protections after having had Covid-19, including wearing a mask, social distancing and avoiding crowded, indoor spaces. A vaccine is still recommended so the results of an antibody test provide no useful information, they say.

The only reason someone might consider a test is if they were unable to get a diagnostic test but had Covid-19 symptoms and want to see retroactively if that is in fact what they had, Dr. Lin says.

What if I don’t feel completely better after 10 days? If I’m still coughing do I have to worry about being contagious?

The CDC’s 10-day isolation recommendation relates to being contagious only. “The duration of symptoms doesn’t correlate with contagiousness,” says Dr. Snyder, of the University of Pittsburgh Medical Center. Many patients may feel fully recovered after 10 days or two weeks. But others may not be able to return to work and their normal routines. If your symptoms are improving and you don’t have a fever, that’s normal, he says.

“I don’t think you need to wait until you’re completely asymptomatic to come out of quarantine and to consider going back to normal daily activities,” says Dr. Englund. A recovery time of up to 28 days is reasonable, she says. After that, you should contact your primary care doctor.

What is long Covid?

Long Covid is a term for Covid-19 patients who experience symptoms that can last for months after their initial acute Covid infection. Also called longhaulers, such patients often develop new and worsening symptoms even after recovering from their initial bout of Covid. Some patients were never hospitalized for acute Covid-19 and are young and healthy with no underlying medical conditions. A recent study out of the United Kingdom’s Office of National Statistics estimated that 20% of Covid patients have symptoms for five weeks or longer and 10% have symptoms for 12 weeks or longer.

Can I get the Covid-19 vaccine if I’ve had Covid and if so, how long do I have to wait?

Yes, you can and experts say you should get the vaccine as soon as you are eligible. Most people with Covid-19 are thought to have some natural immunity and will be protected from getting the virus again for at least three months. “Theoretically the vaccine might boost immunity that a person has from being infected naturally,” says David Wohl, a professor of medicine in the division of infectious diseases at the University of North Carolina, Chapel Hill. There is no reason to wait, he says, except for ensuring that you are both outside the 10-day infectious period and fully recovered, since the vaccine can cause side effects or symptoms in some people.

Should I get the vaccine if I wasn’t hospitalized but had a monoclonal antibody treatment?

More outpatients are being treated now with the two monoclonal antibody treatments authorized for patients at risk of being hospitalized. Those patients should wait at least three months before getting the vaccine, says Dr. Wohl, because it takes the body several months to eliminate the antibodies and theoretically those antibodies could latch onto the proteins the vaccine teaches the body to make and hide them from the immune system.

Any symptoms that are a red flag to seek medical care?

Dr. Lin says during your active, acute infection if you feel short of breath and can’t speak in full sentences that is a sign your lungs are severely infected and you should seek medical care. Other red flag symptoms include confusion or signs of stroke, such as a sudden weakness in one part of your body or a loss of sensation. Dr. Lin says if you can’t do your daily activities after recovering from acute Covid, consult a doctor.

When can I resume my normal exercise routine?

Experts say don’t jump right back into your fitness regimen if you were doing high-intensity exercise pre-Covid. “I would start back slowly,” says Dr. Wohl. “Listen to your body.” Even people who weren’t hospitalized may have inflammation in their lungs and not be exchanging oxygen the way they normally would, he says. Exercise as tolerated, Dr. Lin advises. “This particular virus has a propensity to infect the lungs,” he says. “So we do expect people to have potentially more trouble getting back to their normal exercise routine compared to other viruses.”

Any tests Covid-19 patients should get to check for organ damage, like chest scans or electrocardiograms?

Experts don’t routinely recommend getting tests or scans unless there is a particular symptom that is lasting a long time and not improving, like shortness of breath or a racing heart beat.

Can Covid-19 cause other dormant viruses, like the Epstein-Barr virus, which causes mononucleosis, or shingles to activate?

Yes. When the body is under stress, latent viruses can get reactivated. “In most cases those are transient increases in levels and don’t lead to any organ disease,” says Dr. Wohl. “We do know people when under stress or illness break out with other types of viruses, such as cold sores or even shingles.” Under such conditions, they can flare-up, he says.

Write to Sumathi Reddy at [email protected]

Appeared in the January 26, 2021, print edition as ‘You Have Covid. What’s Next?.’

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