Many people who get sick with COVID-19 may still test positive five days—and sometimes up to 10 days—after their symptoms begin, according to a new study published in JAMA Network Open. The research only fuels the ongoing discussion about how long people should isolate after they contract the virus, experts say.
For the study, researchers looked at data from more than 63,000 people who visited a community testing site in San Francisco from January 2021 to January 2022. The data spanned the pre-delta, delta, and omicron BA.1 periods. (BA.1 was the original omicron variant, first identified in November 2021.) The researchers found that, during the BA.1 surge, 80% of people (!!) had continued to test positive (via a rapid antigen test) five days after their symptoms had started.
And that’s a bit concerning. Currently, the Centers for Disease Control and Prevention (CDC) recommends isolating at home for “at least” five days if you test positive for COVID, even if you don’t have any symptoms. (FYI: The first day is technically the day after you test positive). At the five-day mark, you can end isolation if you test negative, if you don’t have symptoms, or if your symptoms are improving and you haven’t had a fever (without the use of fever-reducing meds) in 24 hours.
So…does that mean all those COVID-positive people in the study were also still contagious at the five-day mark? Unfortunately, there’s no way to know for sure, Thomas Russo, MD, an infectious disease expert at the University of Buffalo Jacobs School of Medicine and Biomedical Sciences, who was not involved with the new study, tells SELF. Remember, the coronavirus that causes COVID-19 is still considered to be relatively new—meaning there’s a lot that experts don’t know or totally understand about it yet. A positive test at the five-day mark confirms the presence of the virus, yes—but that doesn’t totally tell doctors how likely a person is to spread COVID at that point in time. “[Doctors are asking:] Is that just parts of dead virus, or are you truly infectious?” Dr. Russo posits.
That said, we shouldn’t rule out the possibility that some people will potentially be infectious five days after they test positive for COVID, William Schaffner, MD, professor of medicine in the division of infectious diseases at Vanderbilt University Medical Center, who was not involved with the new study, tells SELF. “Positive tests don’t tell us that a virus is live, but we think a substantial number of those people have live virus,” Dr. Schaffner says. “It’s likely that a lot of those people are still able to spread the virus.”
In fact, the authors of the JAMA study note that some existing data suggest a person’s infectiousness may last for an average of eight days; sometimes, a person may remain contagious beyond 10 days, but that’s thought to be “less common.”
This, Dr. Schaffner explains, is why it may not be totally safe to give everyone the all-clear after they isolate for just five days at home: “If you were going to visit your grandparents or a relative who had diabetes or heart disease and you had COVID, I would wait longer before I visited those high-risk people.”
So how long should you isolate after a positive COVID test?
It’s frustrating, but many people probably won’t isolate longer than five days after getting sick with COVID—if they even bother to wait that long, Dr. Schaffner says. Pandemic fatigue is real, and many people are eager to return to their pre-COVID lives, he adds. Of course, some people simply don’t have the option to stay home from work that long.
Beyond the CDC’s five-day recommendation—which was shortened from 10 days in December 2021—experts say there’s no magic number to point to right now, since the duration of COVID symptoms varies from person to person.
However, Dr. Schaffner recommends waiting until you have a negative COVID test before comingling again. This may be a better rule of thumb for most people who have the option to isolate longer, he says; in fact, the authors of the new study wrote that their research supports “guidelines requiring a negative test to inform the length of the isolation period.”
If anything, it’s definitely worth avoiding in-person visits with high-risk colleagues, friends, or family members until your symptoms have gone away, if you can, Dr. Schaffner adds. (Usually, people with mild COVID illness fully recover in one to two weeks.) That said, the signature COVID cough can last for months for some people, Waleed Javaid, MD, hospital epidemiologist and Director of Infection Prevention and Control at Mount Sinai Downtown in New York City, who was not involved with the new study, tells SELF.
So instead of just monitoring your cough if you have one, it’s also important to consider how well you’re doing overall and what measures you’re taking to protect others: Has your fever gone away? Are you still sneezing every three seconds? If you are still coughing, are you wearing a high-quality face mask in public or crowded spaces when you need to be out? When in doubt, it doesn’t hurt to touch base with a doctor so you have an expert opinion to lean on too.
This may also be a good time to talk to your boss or manager about what your options are if you get sick with COVID. If you have their blessing to work remotely, and you’re still symptomatic and/or testing positive after five days, you definitely should stay home until you test negative, Dr. Russo explains.
Of course, working from home is a huge privilege that isn’t an option for many people, such as service workers, health care professionals, and other people who need to physically be at work to do their jobs. For those who need to head back to work after five days, the research only highlights the importance of wearing a mask indoors, especially when case counts are high in your community, Dr. Schaffner says. Ideally, you should stock up on N95s or KN95s ahead of cold and flu season, he says. “A well-fitting mask is better than the simple surgical mask that we used to wear, which was very loose,” he explains.
While you’re at the pharmacy, consider making an appointment to get the updated COVID booster, if you haven’t already—and help loved ones make appointments to get theirs too—before a plethora of viruses start circulating more rapidly, Dr. Javaid says. “This is a beautiful time to get vaccinated,” he says. After all, it’s one of the best tools you have to protect yourself and your community, especially ahead of the holiday season.
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