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Around the world, cases and deaths from COVID-19 continue to grow daily. Yet there are also more than 440,000 people around the world who have recovered to date.
For those who have had the disease, recovery can be a slow journey. And even after you feel better, there can be a period of uncertainty. After days or weeks of isolation, you may be impatient to see your family again and even enter the outside world. But how long is too early? And how do you know you are no longer contagious?
For answers, we turned to several experts, including two doctors who were both diagnosed with COVID-19 in mid-March and have since recovered. Rosny Daniel, 32, an emergency room doctor at the University of California at San Francisco, has returned to work and feels “completely back to normal.” And Darren Klugman, 45, a pediatric cardiologist, says he feels “100%” and is also back at work after isolating himself from his family.
Klugman says the news of the rising death toll from COVID-19 is heartbreaking and sobering. He says this highlights the critical need for pandemic planning. But he says it is almost as important to realize how many people are recovering. “The majority of people will have a mild to moderate flu illness like mine,” says Klugman.
He says it’s essential that everyone follows the guidelines on social estrangement and that if you think you may be sick – whether or not you tested positive – take steps to protect yourself and those around you. . “The most important thing is to recognize the symptoms early, isolate yourself and strictly follow the quarantine rules,” says Klugman.
Am I still fine? Watch out if you think you are recovering.
Daniel says that people who receive COVID-19 can have a wide range of symptoms and that the severity of the disease can vary greatly from person to person. “It is incredibly confusing, and there is a lot of unpredictability,” he said.
But keep an eye out if you think you’re feeling better after a few days, because you might get worse. Daniel says that during the first days of his illness, he had aches and chills. He developed a fever and a mild cough and felt overwhelmed, tired. “My muscles hurt my legs very much. I felt really bad, ”he says. ” [It was] painful to the point that they felt like tingling. ”
He started to feel better, but by the seventh day the symptoms returned and he also started to have trouble breathing.
He has mild asthma and type 1 diabetes, two underlying conditions linked to an increased risk of serious illness. He started using his inhalers to treat asthma. He also took an antibiotic to treat what could be a secondary bacterial infection in his lung. After several days, he felt much better.
Klugman says he felt sick for about 10 days. At first he had “intermittent chills and body aches”, then he developed a low fever and a “very strong cough”. Based on these symptoms, he quarantined himself away from his family for 14 days, even before obtaining the positive results from the COVID-19 test.
“On day 10, I felt that my energy level was close to normal,” said Klugman, but said that his cough persisted a little longer. Now, he says, he’s fully recovered and even starts running again.
As a doctor, Daniel says, he is really looking forward to seeing more tests and better data on COVID-19: “Right now, we seem to be fighting with a blindfold. We are trying to get as much information as possible. ”
What are the guidelines for when you can stop isolating yourself after being sick?
The Centers for Disease Control and Prevention have issued guidelines saying that people with COVID-19 can stop isolating themselves when they have had no fever for 72 hours, three days after the fever has ended. And note: this is without the use of fever medication. This should accompany an improvement in respiratory symptoms, such as coughing and shortness of breath, and should be at least seven days after the onset of the first symptoms.
The CDC says tests can also inform the decision. But the test-based strategy the CDC suggests involves getting negative results on two tests, with samples taken at least 24 hours apart. Given the difficulties associated with testing, this may not be realistic for most people at this time.
After self-isolation, recovered patients who return to work and to public spaces should always follow social distancing recommendations for everyone, such as avoiding groups and washing their hands. Currently, most people are subject to residence orders, so outside travel can be restricted anyway.
For health workers, some institutions have put in place additional guidance based on the CDC.
Daniel was absent from work for almost three weeks. His hospital used a specific process to send him back to work. “The guideline we use is 14 days after the first symptoms, plus 72 hours without symptoms,” said Daniel.
It should be noted that the CDC says that this is all based on limited information – so this advice may change as it learns more.
Since the symptoms of some people reappear on the seventh day, as Daniel says, there is reason to be careful. To be conservative, you may want to wait a few more days before leaving self-isolation, in case you regress.
What does science say about how long people can remain contagious after recovery?
It is not known how long an individual with COVID-19 is infectious. “A rough guide to other infections is that infectivity goes down when the fever goes down,” said Ben Cowling, professor of public health at the University of Hong Kong.
Aaron Carroll, professor of medicine at the University of Indiana, says there is still some uncertainty. “We still don’t have enough data to really know how long people are infectious,” he says.
And he says some doctors are concerned about the CDC’s guidelines. “I’ll tell you that I think a lot of the people I know are not comfortable with this advice. They think it may not be as conservative as necessary, “said Carroll.
Cowling says studies are underway to assess how long the body continues to clear the virus after someone starts to get better. But, he adds, there is no direct link between excretion and infectivity.
Meta-study of more than 100 cases found virus RNA in stool samples up to 33 days after onset of disease, even after patients tested negative using samples of their airways. But the researchers noted that they were unsure if it was only RNA fragments or active viral particles that could infect someone.
I feel good and have returned to normal – when can I see my older family members?
Many people who feel better would like to reconnect with family members – perhaps with elderly parents. But it’s not yet clear, says Sean Morrison, geriatrician and palliative care specialist at Mount Sinai Health System.
Seniors are more vulnerable to COVID-19, and 8 in 10 deaths reported in the United States occur in adults 65 years and older, according to the CDC.
“What I highly recommend is that in-person visits to older family members be made only when necessary and, if so, infrequent,” says Morrison. To provide things like groceries and medicine, some visits may be necessary, but they should be limited as much as possible. “Particularly for the elderly, the isolation and physical distance required is really difficult,” he adds. “And yet that is what will help us get through this. “
Will I be immune to reinfection after I have COVID-19, or can I get it again?
The CDC says the full immune response, including the duration of immunity, is not yet fully understood. So there is some uncertainty.
“I hope my antibodies are all raised and I’m protected from a new disease, but I’m not sure,” says Daniel. “So I treat him like I don’t have immunity, and I wear full protection at all times, according to our hospital guidelines, to make sure I always protect myself. “
So far, there is almost no data, and no long-term data, on the virus that causes COVID-19 (called SARS-CoV-2), so it is speculative to say how long l immunity may last after infection.
“Based on immunity from SARS [and] With MERS and seasonal coronaviruses, a reasonable expectation is that most, if not almost all, people who have been infected with SARS-CoV-2 will have immunity for a year or more, “says Marc Lipsitch , epidemiologist at Harvard TH Chan School of Public Health. This immunity will likely protect people “at least from serious illnesses and from the spread of many viruses that would make them highly contagious,” says Lipsitch.
He says this better guess is informed by what scientists have documented in the blood of people who have recovered from SARS and MERS, which are also caused by coronaviruses. Lipsitch Says These Studies Suggest Their Defenses Against Viruses Seemed To Last A Long Time, About Two Years For SARS and, for MERS, almost three years.
Lipsitch says more research is needed to determine how long people are protected after COVID-19. “We need to design studies in which individuals with known COVID-19 infection and without infection are followed over time to assess whether the first group is protected, or partially protected, from COVID-19 infection compared to to the second group, “says Lipsitch. He says these studies are difficult to design, but he and some colleagues are currently trying to do so.