After two years of successfully avoiding contracting COVID-19, including a few brushes with close contacts, a couple of are-they-just-colds? scares and many negative tests: I recently tested positive.
It felt both inevitable and shocking. I somehow avoided testing positive during the wave of omicron that infected most of my friends this winter, so I figured either I was invincible or I was next. Staring at my at-home rapid antigen test, I had to admit that the long game of high-risk labels was finally over. Now it was “it”.
COVID-19 caught me when I least expected it. Cases are low where I live in Queens, NY AND riding the subway felt low risk thanks to the federal public transportation mask mandate. (A federal judge struck down the mandate on April 18, though the Biden administration announced on April 20 that it would appeal the ruling, and some places, including New York City, maintain mask requirements for now.) I had dined inside, but I still wearing my mask within public spaces (Serial Number: 03/25/22). So when I woke up with a sore throat on a Wednesday, I put it down to needing more sleep. Before taking the test on Friday night, I was still convinced it was just another cold.
Two thick lines on me Quick test said the opposite (Serial number: 12/17/21). OK, I thought, I definitely have COVID. Now what?
I had a pretty good idea of the first steps, which had been drilled into my head ad nauseam: isolate yourself immediately. Send text messages to close contacts in the 48 hours before the first symptoms. Stay away from other people and pets in the house.
It got blurrier from there. Since I tested at home, my COVID-19 test was not official. Surely I should report my positive test; after all, public health regulations are often based on case numbers. For example, Philadelphia reinstated its mask mandate on April 18 in reaction to COVID-19 cases rising 50 percent in two weeks. But it turns out that playing my role was much more difficult than I would have thought.
When it comes to reporting home testing, “there is no formal recommendation,” says Autumn Gertz, an epidemiologist at Boston Children’s Hospital who works on COVID-19 surveillance. Without a federal program to report home testing, states are left on their own and it’s confusing to know where to report, which means many people won’t.
That’s problematic: Now that home testing is free and easily accessible, home testing is becoming more common. Gertz and his colleagues are tracking home testing trends and say they’ve noticed. a gradual increase in its use to detect COVID-19. In the coming weeks, Gertz says they expect 50 percent of people who get COVID-19 to find out through an at-home test.
Unreported cases are nothing new. Even early on, asymptomatic, mild cases where the person was never tested would not count. But home testing will make underreporting even more prevalent. Data from the Institute for Health Metrics and Evaluation show that only 7 percent of all COVID-19 cases in the US are reported.Katelyn Jetelina, an epidemiologist at the University of Texas at Dallas who writes the newsletter Your Local Epidemiologist, reports April 13 in a post titled “Can we trust the case numbers?”
For my case to count, I put on two KN95 masks and walked to the COVID-19 testing booth down the street to take a PCR test that would be officially reported. (The official result of a PCR test may also be required for insurance coverage in cases requiring medical attention.) The downside is that I was contagious, so there was a risk of exposing others to the virus, even though I was masked to everything but the swab. An alternative, Gertz suggests, is to report your positive home test to a primary care provider. Some home test manufacturers also provide information on how to report the results of that test.
But until public health reports catch up with the rapid transition to home testing, we are flying blind. However, there are ways to find clues about what’s going on in your community.
To get started, familiarize yourself with your local public health department’s website, says epidemiologist Michael Mina, chief scientific officer of eMed, a company developing a system for reporting tests at home. Check if your community monitor sewagewhich is a better way to track the amount of SARS-CoV-2, the virus that causes COVID-19, in communities than case numbers or hospitalizations. buds near mea project Gertz works on, she also collects results from volunteers to help track COVID-19 trends down to the local level.
In general, “stay tuned and try to keep your eyes open for signs,” says Mina. That includes not ruling out anecdotes: “If you start hearing, like, ‘Hey, you know, I’ve had a bunch of friends test positive lately,’ that’s probably a pretty good indicator … that there are a lot of COVID cases. in our community right now.” And that it’s a good time to start taking extra precautions again.
Speaking of precautions, according to the isolation guidelines presented by the US Centers for Disease Control and Prevention, I could have returned to the world without a mask on the tenth day after my symptoms began. But I learned from Mina that you can remain contagious after 10 days. So how do I know if I can still infect others?
Turns out it’s a tricky question. There is no magic number of days when all people will stop being contagious. And you can still have symptoms and not be contagious, and vice versa. But rapid home tests are a great, albeit imperfect, indicator of current contagion. (That’s unlike PCR tests, which are extremely sensitive to any virus remaining in your system long after it stops killing it.)
How contagious a person is is roughly related to their viral load, or the number of virus particles in their body. Early research suggested that SARS-CoV-2 viral load is at its highest just before or when symptoms arise and then declines rapidly after symptom onset. Those data informed the CDC’s decision to lower its isolation recommendation from 10 days to five days.
But several recent studies suggest that people infected during the recent surge in COVID-19 are still contagious after five days. A preprint that studied omicron infections in NBA players found that, after five days of symptoms, about half of the players still had a significant viral load. In another preprint, Mina and researchers at the University of Chicago found that 43 percent of rapid tests of 260 vaccinated health workers still came back positive five to 10 days after your symptoms appeared. Both studies have not yet been peer-reviewed.
“This is not like a small fraction of people who are still positive and infectious at five days,” says Mina. One possible explanation for these observations is that people who are vaccinated or previously infected have a faster immune system response to the virus. So the initial symptoms are caused by your immune response, not a high viral load, which comes later. “I would highly, highly, strongly advise people not to listen to the five-day isolation recommendation to go out,” says Mina. “That was based on old data.”
Instead, experts say, the best way to determine if you’re contagious after day five is to take a rapid home test, which measures the amount of viral proteins in your system in real time. You can even get an idea of how infectious you are by the strength of the positive line on your test and the speed at which it develops. If your positive line appears quickly, you likely have an extremely high viral load. If you take most of the allotted testing time and the line is weak, there is likely less virus in your body.
But because it takes a large amount of virus for tests to come back positive, “you have to assume you’re infectious” if any lines appear, Mina says. Even after you’ve tested negative (twice, if possible), avoid high-risk activities, such as visiting an elderly relative.
By my 12th day, my symptoms were mostly gone, except for a persistent cough and a new propensity to nap. But I was still coming up positive on my rapid test, even though the line was much fainter than it used to be.
I wish there was an on/off switch. But, as with most things in this pandemic, it’s a soft gray area. Despite all public health recommendations, personal navigation of this virus comes down to everyday individual decisions. We have a lot of power and it often feels like, not enough knowledge to make such decisionsSerial number: 06/16/21).
“It’s okay to be confused about all of this,” says Mina. “I think a lot of people are feeling isolated right now and confused by this pandemic.” Even doctors have a hard time keeping up with nuances and changes, she adds.
As for me, I finally tested negative 14 days after my symptoms started. Considering Mina’s advice to test negative twice, I’ll still be careful, but now I feel a little safer.