I tested positive for COVID-19 right before the holidays.  What should I do?

TThe scary scenario has happened: if you test positive for COVID-19 at the worst time, with holiday trips, parties or family gatherings in just days. Does this mean your plans are doomed?

Even nearly three years after the pandemic began, the answer is surprisingly complex.

The US Centers for Disease Control and Prevention (CDC) says that most people with mild COVID-19 can end isolation five full days after a positive test or the onset of symptoms, as long as they have been fever-free for 24 hours and their other symptoms are improving. The CDC considers the day you tested positive or developed symptoms as day zero; your five-day isolation period begins the next day.

That said, there is a difference between end of isolation and fly to attend a large holiday gathering. Until day 10, the CDC recommends staying away from people at high risk for severe COVID-19, such as those who are elderly or immunocompromised. If you’re going to be around others, the agency says to wear a high-quality mask, such as N95 or KN95. You can forgo the mask before day 10 if you test negative on two separate antigen tests done within 48 hours, the CDC says.

This pair of negative results is not guaranteed, even after five days of isolation. In a recent JAMA Network Open study80% of people with symptomatic COVID-19 during the first Omicron surge are positive on rapid tests for more than five days.

In short: you can still test positive and potentially remain contagious after an initial five-day isolation. What does this mean for your holiday plans? We asked two experts – Dr. Peter Chin-Hong, a professor of medicine at the University of California, San Francisco, and Dr. Tara Bouton, an assistant professor at Boston University School of Medicine, who has investigated periods of isolation against COVID-19— to consider several scenarios.

If your plans fall within five days of a positive test

Stay home, cancel all trips and connect with loved ones virtually. This advice can be hard to hear, especially around the holidays, but it’s “universally agreed upon,” Chin-Hong says.

If more than five days have passed and you still have a positive test

If your symptoms haven’t improved after five days, the CDC says you should stay in isolation.

If you feel fine but still test positive after five days, there’s a chance you’re still contagious. “The clear guideline is that you should not be exposed around others,” Bouton says. If you’re set on attending a holiday gathering, the safest move is to wear a high-quality mask at all times.

This is especially important if you have to travel by plane, bus or train to get to the party. If you tested positive 10 days or less ago and have not received your pair of negative test results, The CDC says not to use public transportation unless you can’t remain masked at all times. When deciding whether to travel, Bouton recommends thinking not only about your plans, but also about everyone else who will be traveling with you. “Would you like your grandmother to sit by [a person testing positive] on a plane?” Bouton asks.

If more than five days have passed and your test is negative

Under CDC guidance, you need a pair of negative antigen test results obtained 48 hours apart to remove your mask around others before the 10th day. But is it okay to unmask beforehand if you test negative once?

It “depends on the company you keep,” Chin-Hong says. If you plan to spend the holidays with people at high risk of severe illness, it’s probably wise to either wait for a second negative test or keep your mask on until the 10th day.

But “if you’re only going to hang out with friends from college and you’re negative on day seven, I’ll feel good about being normal with them without wearing a mask,” Chin-Hong says. (However, it’s a good idea to inform everyone you plan to see ahead of time and gauge their risk tolerance before removing your mask.)

If you test negative but have lingering symptoms, it’s wise to be extra cautious around vulnerable people, adds Chin-Hong. “If you only have a persistent cough, that’s probably not enough to keep me from seeing Grandma,” he says. “I would wear a mask when I’m in close proximity, but I wouldn’t go crazy.”

If you had a Paxlovid rebound

The antiviral Paxlovid can dramatically reduce the chances of people at high risk of dying or being hospitalized if they catch COVID-19. But some people who take the drug experience what is known as “Paxlovid rebound“: they give a negative test, then positive again shortly after. It’s possible to be contagious during your recovery phase, Bouton says, so if you do, you should “consider extending your isolation period.”

If more than 10 days have passed and you still have a positive test

It is quite unusual for someone who is not immunocompromised to test positive on a home test for more than 10 days, but it does happen. (This scenario is more common with PCR tests, which can detect even small fragments of the virus.)

“I usually tell people, ‘Don’t even bother testing after day 10,'” says Chin-Hong. Unless you’re immunocompromised, you’re probably not contagious at this point, even if you test positive, Bouton agrees.

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Write to Jamie Ducharme c [email protected].

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