If you test positive for COVID and isolate, what should you do if you continue testing positive even after your isolation period has ended?
While there is currently no requirement to test out of isolation after having COVID, Chicago's top doctor has warned that the new BA.5 omicron subvariant is making people test positive longer.
Questions surfaced after news first broke that President Joe Biden tested negative, then positive again days later following his initial COVID diagnosis.
While it may not be required to test out, Biden's experience, Arwady said, is a reason to stay masked following isolation.
"So just a reminder if you catch COVID, regardless of your vaccination status, you need to stay home for five days," Chicago Department of Public Health Commissioner Dr. Allison Arwady said. "If your symptoms are resolving, are gone by day five, you can leave your house, but you must continue to mask while around others for days six to 10. We're seeing some examples, especially with the BA.4 and [BA.5] of people testing positive for longer, occasionally testing negative and then positive again later. We actually saw that with President Biden, for example. You've got to wear that mask for days six through 10."
Here's the guidance for quarantine and isolation.
If you come into close contact with someone with COVID-19, you should quarantine if you are not up-to-date on COVID-19 vaccines or are unvaccinated. For these individuals, the CDC and IDPH recommend you:
Those who are close contacts of someone with COVID but are up-to-date on their vaccinations or have had a confirmed case of COVID-19 within the last 90 days do not need to quarantine, but the CDC does recommend they wear a well-fitting mask around others for 10 days after their most recent exposure and get tested after at least five days.
According to the CDC, people who are positive for COVID should stay home until it's safe for them to be around others, including even other members of their home.
Health officials recommend a "sick room" or area for those who are infected and a separate bathroom, if possible.
But isolation may not just be for those who test positive. The CDC also recommends those who have symptoms of COVID-19 and are awaiting test results or have not yet been tested isolate, "even if they do not know if they have been in close contact with someone with COVID-19."
How do you end isolation?
So how do you calculate your isolation period?
According to the CDC, "day 0 is your first day of symptoms." That means that Day 1 is the first full day after your symptoms developed.
For those who test positive for COVID but have no symptoms, day 0 is the day of the positive test. Those who develop symptoms after testing positive must start their calculations over, however, with day 0 then becoming the first day of symptoms.
Under the CDC guidance, those in isolation should:
The CDC notes that tests "are best used early in the course of illness to diagnose COVID-19 and are not authorized by the U.S. Food and Drug Administration to evaluate duration of infectiousness."
Some health experts are warning that reinfection can occur even faster with the latest variants, particularly BA.4 and BA.5. That can make it challenging to determine if you are among the rare rebound infections or if you have been reinfected.
"We don't know know exactly how soon, but people have been recorded to get the infection as soon as four weeks after having a previous infection," said Dr. Sharon Welbel, director of hospital epidemiology and infection control at Cook County Health, adding that as early as two weeks can't be ruled out.
Dr. Monica Gandhi, an infectious disease specialist at the University of California, San Francisco, previously told CNBC she’d “feel really comfortable” with a symptom-free person emerging after five days of isolation, even if they’re still testing positive for COVID-19.
“Follow CDC guidance and wear a mask for the following five days,” she said.
Still, Arwady noted that some may take at-home tests as they prepare to end their isolation.
"If it is negative, that's another piece of information that suggests you're very unlikely to be contagious at that point. So, you know, no test is 100% just like no vaccine is 100%, but those tests are pretty good," she said.
Some doctors assert the safest course of action is to remain in isolation until you test negative. However, Dr. Stephen Kissler, a postdoctoral fellow at the Harvard T.H. Chan School of Public Health, said it's not unreasonable to gradually leave isolation — even if you’re still testing positive using a rapid test.
That's especially the case if you're fully vaccinated, symptoms have resolved and you continue to practice masking.
“You might be able to begin slowly sort of reintegrating while still being mindful of your contact," Kissler said.
The CDC recommends antigen testing for those looking to test before leaving isolation.
Chicago Department of Public Health Commissioner Dr. Allison Arwady agreed.
"If it is a PCR test - one that you get at the doctor's office, one that you get at a testing center - that is not telling me anything except that you had COVID not that long ago," Arwady said during a Facebook Live, adding that a PCR test "can stay positive for weeks sometimes after you've had COVID because it's so sensitive it can pick up even dead virus." "If it is a home test, we can't 100% know, but if it's been, I mean, I don't know, a few weeks ago, it would be unlikely that you would still be testing positive in a way that you would be contagious, sort of at that point. I'm going to tell you that if you are in doubt, please wear a mask and please don't have close contact with folks who are immunocompromised."
According to the CDC, the incubation period for COVID is between two and 14 days, though the newest guidance from the agency suggests a quarantine of five days for those who are not boosted, but eligible or unvaccinated. Those looking to get tested after exposure should do so five days after the exposure or if they begin experiencing, the CDC recommends.
If you continue to test positive after the 10-day period, should you remain in isolation? The CDC hasn't provided specific guidance for what to do in this situation, but experts widely assert that as long as your symptoms are gone, you likely don't need to isolate any longer.
Dr. Monica Gandhi, an infectious disease specialist at the University of California, San Francisco, previously told CNBC she’d “feel really comfortable” with a symptom-free person emerging after five days of isolation, even if they’re still testing positive for COVID-19.
“Follow CDC guidance and wear a mask for the following five days,” she said.
The CDC previously said people can possibly test positive for up to three months after contracting an infection.
If you continue to test positive, is it possible you're still infectious?
A Boston University study revealed that just 17% of people were likely still contagious six days after their first positive tests.
If you're concerned about how long you've been testing positive, check in with a health care provider for their guidance on your situation, the doctor said.
The CDC states that anyone who may have been exposed to someone with COVID should test five days after their exposure, or as soon as symptoms occur.
"If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19," the guidance states.
Illinois Department of Public Health Director Dr. Ngozi Ezike said that incubation times could be changing, but those who test early should continue testing even if they get negative results.
"We might be learning that the time of incubation might be a little shorter. So maybe you'd be testing at two days," Ezike said. "Obviously if you're symptomatic, you test right away. But you know, if you want to test at two days, but that negative test... the two days should not make you think, 'Oh good, I'm clear,' you know? You might want to test again and of course symptoms you cannot ignore - scratchy throat, headaches, all kinds of symptoms - anything new can be a symptom of this new illness."
According to earlier CDC guidance, COVID symptoms can appear anywhere from two to 14 days after someone is exposed to the virus.
Anyone exhibiting symptoms should get tested for COVID-19.
Some people may never experience symptoms, though they can still spread the virus.
A person is also considered contagious before symptoms appear.
The CDC says that its guidelines were updated to reflect growing evidence that suggests transmission of COVID-19 often occurs one to two days before the onset of symptoms and during the two to three days afterward.
"This has to do with data from the CDC that really showed after seven days there's virtually no risk of transmission at this point," Arwady said. "And in that five-to-seven-day window, you know, there's some depending on whether people have been vaccinated, underlying conditions, etc., but the risk drops a lot and the feeling is that in the general population, combined with masking, etc. the risk really is very low."
For those without symptoms, CDC guidance states they are considered contagious at least two days before their positive test.