What to do if you get COVID-19 before the holidays

TThe scenario he feared has happened: you test positive for COVID-19 at the worst time, with holiday travel, parties or family gatherings just days away. Does this mean your plans are doomed?

Even after nearly three years of the pandemic, the answer is surprisingly complicated.

The US Centers for Disease Control and Prevention (CDC) says that most people with mild COVID-19 can stop self-isolating five full days after a positive test or the onset of symptoms, provided they have not had a fever for 24 hours and their other symptoms improve. The CDC considers the day you tested positive or developed symptoms to be day zero; your five-day isolation period begins the next day.

However, there is a difference between end of isolation and flies to a big holiday gathering. Until day 10, the CDC recommends staying away from people at high risk of severe illness from COVID-19, such as those who are elderly or immunocompromised. If you’re going to be around others, the agency says to wear a high-quality mask, like an N95 or KN95. You can discard the mask before day 10 if you test negative on two separate antigen tests within 48 hours, the CDC says.

That pair of negative results is not guaranteed, even after five days of isolation. In a recent JAMA Open Network study, 80% of people with symptomatic COVID-19 during the first Omicron surge were positive on rapid tests for more than five days.

In short: you can still test positive and potentially remain contagious after the initial five-day isolation. What does this mean for your vacation plans? We asked two experts—Dr. Peter Chin-Hong, professor of medicine at UC San Francisco, and Dr. Tara Bouton, assistant professor at Boston University School of Medicine, who have researched periods of isolation from COVID-19—to weigh several scenarios. .

If your plans fall within five days of testing positive

Stay home, cancel all trips and connect with loved ones virtually. This advice can be hard to hear, especially during the holidays, but it’s “universally accepted,” says Chin-Hong.

If it has been more than five days and you are still positive

If your symptoms don’t improve after five days, the CDC says you should remain in isolation.

If you feel well but are still positive after five days, there is a possibility that you are still contagious. “It’s a clear guideline that you shouldn’t be exposed around others,” says Bouton. If you’ve decided on a holiday gathering, the safest move is to wear a high-quality mask at all times.

This is especially important if you have to travel by plane, bus or train to get to the party. If you tested positive 10 days or less ago and haven’t received your pair of negative results, the CDC says not to use public transportation unless you can stay masked the entire time. When deciding whether to travel, Bouton recommends thinking not only about your own plans, but also about everyone else who will be traveling with you. “Would you like your grandmother to sit next to you?” [a person testing positive] on the plane?” Bouton asks.

If more than five days have passed and your test is negative

According to CDC guidelines, you need a pair of negative antigen test results, received within 48 hours of each other, to remove the mask around others before the 10th day. But is it ok to remove the mask before then if you have tested negative once?

It “depends on the company you have,” says Chin-Hong. If you plan to spend the holidays with people at high risk of serious illness, it’s probably wise to wait for a second negative test or keep the mask on until day 10.

But “if you’re only going to hang out with your college friends and you’re negative on the seventh day, it would be good for me to be normal with them, without wearing a mask,” says Chin-Hong. (It’s still a good idea to notify everyone you plan to see ahead of time and gauge their risk tolerance before removing the mask.)

If you test negative but have lingering symptoms, it’s wise to be extra careful around vulnerable people, adds Chin-Hong. “If you just cough for a long time, it’s probably not enough for me not to see grandma,” he says. “I would wear a mask when I’m in close proximity, but I wouldn’t go crazy.”

If you have experienced a Paxlovid rebound

The antiviral drug Paxlovid can drastically reduce the chances of high-risk people dying or being hospitalized if they contract COVID-19. But some people who take the drug experience what’s known as a “Paxlovide rebound”: they test negative, then test positive again soon after. It’s possible to be contagious during the recovery phase, says Bouton — so if that happens to you, you should “consider extending your isolation period.”

If it has been more than 10 days and you are still positive

It is quite unusual for someone who is not immunocompromised to test positive at home for more than 10 days, but it does happen. (This scenario is more common with PCR tests, which can detect even tiny fragments of the virus.)

“I usually tell people, ‘Don’t even bother testing after day 10,'” says Chin-Hong. Unless you’re immunocompromised, you’re probably not contagious at this point, even if you test positive, Bouton agrees.

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Write Jamie Ducharme at jamie.ducharme@time.com.