You Have Covid. It’s Mild, Now What?

It’s hard to know what precautions to take with Covid these days—if you’re taking any at all. Image: Pixabay
It’s hard to know what precautions to take with Covid these days—if you’re taking any at all. Image: Pixabay

Summary

A reasonable person’s decision-making guide for Covid precautions in 2024.

If you have Covid, should you stay home? Wear a mask at work? For how long?

It’s hard to know what precautions to take with Covid these days—if you’re taking any at all.

Guidelines are in flux and can be confusing. The Centers for Disease Control and Prevention has discussed easing its recommendation to isolate for five days if you test positive. Many schools and workplaces aren’t enforcing the existing advice. Meanwhile, states such as Oregon and California have already relaxed their guidance. And all this is if people even bother testing when they have symptoms.

“In reality, most people do not isolate and they actually do not get tested," says Dr. Julia Adamian, section chief of general internal medicine and clinical innovation at NYU Langone Tisch Hospital in Manhattan.

So what should you do? Many doctors say that at this point, common sense should guide you. If you feel sick, stay home. When you’re feeling well enough to go out but still have some symptoms, it’s a good idea to wear a mask indoors to protect others. Be more cautious if you’re going to be around more vulnerable people, such as those who are immunocompromised or elderly.

Even if you’re not worried about health risks, there’s still the disruption of getting sick. So if you have a big trip coming up, an important job deadline looming, or just don’t want to juggle work and a sniffily kid, adjust your precautions to fit your tolerance level.

Just like the flu?

The crux of the conundrum is whether we should treat Covid like most other respiratory viruses such as the flu, or as something more dangerous.

When Covid first appeared, it was far more dangerous than flu, says Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston and public health researcher. Today, the difference has narrowed and is less clear-cut, he notes.

He doesn’t think it’s a good idea to treat Covid the same way we treat flu—because we don’t do a great job of controlling the flu, either.

For someone who has never been vaccinated or infected with Covid, it remains more of a threat than seasonal flu, says Faust. But most people have some degree of immunity to both diseases by now, and which one poses a bigger threat may vary by person, depending in part on age and health conditions.

Public health experts and physicians note that Covid is still a disease that is cited as a cause of death in more than 1,000 people a week, according to CDC data. And long Covid, with symptoms that can linger months and even years, hasn’t gone away.

In terms of case fatality rates, Covid is starting to look more like flu, says Dr. Marcel Curlin, medical director of Oregon Health & Science University Occupational Health and an infectious-disease specialist. But there are a few big caveats, he notes. Covid spreads more easily than the flu, it’s not strictly seasonal so it’s harder to predict, and it can affect the whole body, whereas flu mainly hits the respiratory system. “It’s a mistake to actually just consider them the same virus," he says.

What your symptoms mean

Assessing your symptoms isn’t a foolproof way to tell how contagious you are.

In general, asymptomatic people are less likely to spread the virus, but it is possible to spread it without having symptoms, says Deepta Bhattacharya, a professor of immunobiology at the University of Arizona College of Medicine in Tucson.

When you’re coughing and sneezing a lot, you tend to be more infectious, because you’re emitting lots of viral particles into the air. But you can still spread it simply by breathing, without coughing or sneezing.

Covid in general doesn’t usually cause a lot of fever, says Dr. Julie Parsonnet, a professor of medicine and infectious-disease doctor at Stanford. So the absence of fever isn’t a dependable sign that you’re Covid-free, or that you’re not contagious.

At-home rapid tests aren’t always reliable, either. So if you test negative but you still have symptoms, you should test again in a few days.

The bottom line, says Parsonnet, is that you should try to protect your family, friends and colleagues when you’re sick, no matter what you have. Stay home if you feel ill. If you have a runny nose and cough, test yourself and wear a mask, she says.

When to go out

Doctors have different views on how long you should isolate, especially as the CDC considers changing its advice to isolate for five days.

Dr. Peter Chin-Hong, an infectious-disease specialist at the University of California San Francisco, says it’s reasonable to follow California guidelines, which say that people can stop isolating when they are fever-free for at least 24 hours and have improving symptoms, though they should still mask up in public for up to 10 days.

Now that so many of us have been infected and reinfected, and gotten vaccinated at least once, our immune defenses against the virus are stronger, he notes. And we have more tools to fight it if we do get sick, including anti-viral medications.

Other doctors and public health experts are more cautious.

Dr. Sabrina A. Assoumou, an associate professor of medicine at Boston University Chobanian and Avedisian School of Medicine, says she recommends to patients and family members and friends that they isolate for five days and then mask for an additional five days.

How often to vaccinate

Most people should get a Covid vaccine once a year, likely in the fall around the same time as you get your flu shot, to bolster your immune defenses for the winter when cases rise.

Older people should get vaccinated more often. The CDC this week urged people 65 years and older to get a spring booster at least four months after their last dose. About 60% of seniors aren’t up-to-date on their Covid-19 shots.

People with compromised immune systems should be allowed to get a Covid shot whenever their doctors advise, spaced two months apart, the CDC recommends.

Write to Sumathi Reddy at Sumathi.Reddy@wsj.com

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