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Questions My Friends Ask | Part 3: I Have COVID. Now What?

It’s a smart question. The virus is constantly evolving, our level of immunity has increased, and public health guidelines have changed. Confused? We have answers.

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Kim Noble
friends asking questions

September 2022: This post has been updated to reflect changes to CDC guidelines.

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Omicron and its evolving, highly contagious variants have more of my friends hitting me up to say, “Hey, I just tested positive for COVID-19. What do I do now?” or some version of that.

This is the third in a series of articles Questions My Friends Ask. It seems we all want to know the same things, and those of us who spend our work days dealing with COVID-19 information might be the only ones with the time to keep up on it all!

This is not my first time with COVID. Is it the same drill as before?

Whether you count yourself among COVID-19’s many repeat victims or this is your first time, take a few minutes to do your homework. Public health recommendations change as the situation changes (here’s an overview of the most recent update in August 2022), so if you’re not testing positive today, check back again when you do.

Should I try and get the COVID medication? And if so, how do I get it?

For most of us, the answer is “no.” For people who are high risk though, medication will lower the risk of a case severe enough to require hospitalization (a risk that is already low for the rest of us). This high risk group includes people over 65 and those with certain health problems. If you’re over 65, you should definitely get treated as soon as possible, because age is the number-one risk factor for getting very sick.

Paxlovid is the primary medication to treat COVID-19. It’s taken as a pill and works best in people over age 65. Molnupiravir is another one, but it’s harder to find in the US. Monoclonal antibodies are a third option. They are given as a drip into the vein.

All of these medications must be taken within the first few days of developing symptoms, so if you qualify, act fast. You’ll need a prescription. If you don’t have a health care provider, you can bring your test results to a pharmacy that’s part of the Test to Treat program, and a pharmacist can prescribe medication for you. (Find a Test to Treat location here.)

I know I need to isolate. How long do I have to stay put?

You should isolate for at least 5 days. If you have to be around others during this time (for example, people in your household), wear a high-quality mask (i.e., N95, KN95 or KF94).

The day you test positive is Day 0. After Day 5 is over, you can stop isolating if:

  • You never had symptoms. (Lucky you!)

  • You had mild symptoms, those symptoms are improving, AND you’ve been fever-free for 24-hours without the help of medication.

(If you’re wondering about whether you should test before coming out of isolation, hang on — there’s a Q/A about that coming up.)

Those lucky enough to get a pass before Day 10 should wear a high-quality mask around others until Day 10. It’s best to stay away from people who are at high risk during this time, and don’t travel unless you can keep your mask on the entire time. But you can take your mask off a little early if you test negative two times, with a 48-hour break between tests. Once that happens, you can be fairly sure you’re not contagious any longer.

If you have shortness of breath or trouble breathing at any point during your COVID-19 infection, your case is more serious, and you need to isolate for a full 10 days after testing positive.

Once you’re out of isolation, you should keep an eye out for symptoms. If they come back or start to get worse, you’ll need to isolate again, starting the clock back at Day 0.

What do you mean, “if my symptoms come back or worsen”? Doesn’t that only happen if I take the medication?

You’ve probably heard someone mention “rebounding.” This happens when people start to feel better, but then their symptoms come back or get worse. While there have been notable cases of this happening in people who have taken Paxlovid, rebounding can also happen in up to a third of people who did not take anti-COVID medication. Some of those people may even start to test positive again, even after they were testing negative for a few days.

So we don’t have to take a test to get out of isolation anymore?

The current rules from the CDC attempt to make things as simple and straightforward as possible. They’re based on the way most cases of COVID-19 go.. But while taking a rapid test on Day 6 isn’t required, it’s still a good idea, because some people are still contagious at that point.

If you do test positive, you might want to think twice about leaving isolation, because you’re probably still contagious. (Make sure you’re using an antigen test, not a PCR test. PCR will continue to react to bits of virus in your system long after your infection is over.)

If you test negative, you should still follow guidance about masking around other people. If you take a second test 48 hours later though, and you test negative both times, you can stop wearing your mask a little early.

Did I answer the questions you had after testing positive? Do you have another? Email me at knoble@whentotest.org, and maybe you’ll see them turn up in a future installment of Questions My Friends Ask.

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