55 Comments
User's avatar
matthewdavidhealy@gmail.com's avatar

Actually, while I have yet to test positive, if I do test positive then I will isolate until after two negative tests on different days.

Expand full comment
Jeremy Faust, MD's avatar

makes sense to me!

Expand full comment
JL's avatar

Ditto.

Expand full comment
CC's avatar

Like Matthew above, I have still never tested positive. We seem to belong to a shrinking “club”. By the way, I do test regularly due to year round allergies just to be sure I don’t miss it and risk infecting someone else. If I ever do test positive, my inclination would be to isolate until I both feel better and test negative.

Expand full comment
Jeremy Faust, MD's avatar

I have taken SO many tests over the last few years. (I was into rapid tests way before they were cool: https://www.cnn.com/2021/08/20/health/coronavirus-steps-to-coexist-gupta-wellness/index.html .

Still never had it, despite treating hundreds of patients with it (and two outbreaks in my house!). Masks, good air turnover, and a built out basement (during the two home outbreaks) have been effective!

But yes, I'll be using rapid tests to determine when I end isolation.

Expand full comment
Glenda Delenstarr's avatar

Biochemist here... used to develop antigen tests. I'm thrilled with the availability and I'm also in the shrinking club of never having Covid. Fully boosted. Masking. Avoiding many indoor gatherings

Expand full comment
Moveable Garden's avatar

Like others commenting here, I've never tested positive for Covid (and I test quite a bit, using antigen tests) but if I do I will wait until I have at least one negative test before ending isolating and will continue wearing my mask whenever indoors in public. My husband had Covid in Oct 2023 and we isolated from each other and I never had symptoms or tested positive. It took him about 2 weeks to test negative, quite a while after his symptoms were gone.

Expand full comment
Beth Gebhardt's avatar

Although I would prefer to isolate until a negative test, my employer (healthcare) says we should work once feeling up to it and wear an N95 mask until negative test. I have also seen this at the SNF my mother is in. Notices are posted as to the number of staff positive, number of patients positive.

Expand full comment
Jeremy Faust, MD's avatar

wow they post that information? Do they tell them who? That's puzzling. You'd like to know who might infect you!

Expand full comment
Beth Gebhardt's avatar

I was told that the numbers have to be posted. (New Hampshire) You can tell which patient is positive by the closed door and gear outside the room. The staff have to wear masks; most only wear surgical. Visitors are at their own risk. My mother, age 90, did get Covid at one facility and was hospitalized with multiple complications. Luckily she survived and is now at another facility. Same posting of numbers.

Expand full comment
matthewdavidhealy@gmail.com's avatar

My mother hasn't tested positive yet despite MANY people around her getting it. I've overheard her kvetch to others about how annoying it can be to have a Virologist son, but she does what I say and it seems to have worked.

Expand full comment
Nurse Jenny's avatar

So crazy your employer wants you to work if you are still testing positive!

Expand full comment
Lyn Horan's avatar

Knock on wood, I have not had COVID yet like above folks. But that is the protocol we would follow, isolation till negative test. Because I was highly immune compromised even before COVID my husband and I unfortunately still live a pretty isolated life. Now am diagnosed with return of breast cancer in addition. A bit of an extreme individual case due to lack of immunity. We can no longer rely on others to follow even common sense precautions and because many go out knowingly sick and don't mask, protections fall on us. Pretty shocking to me that even in cancer centers here in Western MA, nobody wears masks. Thanks for continuing to address these issues, Dr. Faust.

Expand full comment
Jeremy Faust, MD's avatar

Lyn, I am sorry you are having to navigate your health problems in this time. I hope you have good n95 masks. I personally use the 3M Aura N95. They are extremely good masks and super comfortable. (And I am not on their payroll lol!)

Expand full comment
Nurse Jenny's avatar

I also use the 3M Aura N95. Being around the sick little ones who always test positive for covid19, this mask has always protected me.

Expand full comment
matthewdavidhealy@gmail.com's avatar

I've tried many products; on my face it's difficult to keep 3M Aura in position because when I talk the bottom moves up and then the top moves away from my nose. For me the 3M AFFM stays in position better. Of course no two faces are identical.

Expand full comment
Thea's avatar

I use those, too. But my favorite for long term use, like long plane flights, is the ULINE S-19252.

For a while my husband was working on developing a 3-D printer which used an acrylate in the process, to which many people are highly allergic, so the company bought these masks. When they moved on to working on developing another printer he brought the leftover masks home for me. I highly recommend them.

Expand full comment
JL's avatar

Re masks: I use Kimtech N95 Pouch Respirator (53358), aka "duckbill" - fits well, keeps the surface away from my mouth, but the straps are a bit stretchy after the first use, so I'm going to try your 3M Aura. As to Lyn's comment - alas, too true (I'm also in western Mass). What's it like at BWH emergency? (and in the hospital generally) Do the staff wear masks, and if so do they use N95s? Around here, the hospital system provides masks in boxes as you walk in the door, but they are the flimsy blue kind, and staff are mostly unmasked. Even at Dana Farber (in December), most staff were unmasked.

Expand full comment
Jan's avatar

Interesting post—I’d written to Michael Osterholm about my concerns with the new California isolation guidelines and he addressed it on his podcast— he said it was created after focus groups with teachers and as people don’t test or isolate it’s an attempt to get them to do something. I understand that without free testing and paid sick leave and the “it’s over” the behavior has changed, but should policy reflect that? I’m in your echo chamber— avoiding Twitter and would isolate until a negative test.

Expand full comment
Jeremy Faust, MD's avatar

The focus group explanation is credible. I guess I just think that science is not subject to a vote, lol. But in this case, their argument is that behavioral science (i.e., what people will actually do) is more important than what the actual science says. Which is something to consider.

Expand full comment
Jan's avatar

They focused on schools--and I do agree that policy by focus group is not what I'd want: in your previous post DAR suggested that the ideal should be stated, and then the caveats.

Expand full comment
matthewdavidhealy@gmail.com's avatar

I just wish AIR FILTERS (either HEPA or Corsi-Rosenthal) were given vastly higher priority. As for the "behavioral science" argument, what if the guidelines said in so many words "masks are optional IF the building provides evidence that filters and ventilation deliver at least 6 air changes per hour in all spaces normally occupied by more than 5 people." Give a behavioral incentive to improve air quality!

Expand full comment
Laurie's avatar

My husband caught Covid from choir rehearsals and a performance of Handel’s Messiah in December. He brought it home to me. We are seniors and were able to get paxlovid. We felt better soon but continued to coughs and runny noses. It was 3 full weeks before we both tested negative twice 48 hrs apart. Our last days of testing included negatives followed by my husband again testing positive and then both of us negative. The last 4 days were confusing as we tested and retested unclear if we had faulty tests or not. One of my tests got no result at all with the control line absent. We did not end isolation until we were absolutely sure.

Thank you for sharing your expertise.

Expand full comment
Jeremy Faust, MD's avatar

Glad you’re ok! It is interesting to think about choruses. People really panicked about choruses early on because of a superspreader in that Seattle chorus early on. But I’ve always maintained that this must’ve been somewhat of a freak situation because by that time, Covid was quite prevalent in this country but we just weren’t quite aware of it. That means that thousands of choruses were having rehearsal that same week, but no super spreader events occurred elsewhere that we heard about. It led me to realize that the stars have to really align for such a bad outcome: very confined space with poor ventilation, an asymptomatic singer, (otherwise they wouldn’t be there) who happens to be at the peak of their shedding. So I think that chorus is are certainly a possible set up for super spreader events, but it likely happens a lot less than we might have assumed early on.

Expand full comment
Thea's avatar

Speaking hypothetically, since I’ve never gotten Covid, I would isolate until I had 2 negative tests at least 24 hours apart. I would mask anytime I was indoors or in crowded outdoor areas, because that’s what I do all the time anyway, which might be why I’ve never had Covid?

Expand full comment
Laurie's avatar

My husband caught Covid from choir rehearsals and a performance of Handel’s Messiah in December. He brought it home to me. We are seniors and were able to get paxlovid. We felt better soon but continued to coughs and runny noses. It was 3 full weeks before we both tested negative twice 48 hrs apart. Our last days of testing included negatives followed by my husband again testing positive and then both of us negative. The last 4 days were confusing as we tested and retested unclear if we had faulty tests or not. One of my tests got no result at all with the control line absent. We did not end isolation until we were absolutely sure.

Thank you for sharing your expertise.

Expand full comment
Susan DeLaurentis's avatar

I tested positive for the first time on January 3rd, took Paxlovid and did not test negative until 10 days later. I isolated until my negative test. The Paxlovid didn’t seem to have an effect. I was nauseous, had the awful taste in my mouth and felt awful. Having said that, I have a lot of underlying issues and did not end up in the hospital. My husband had the same symptoms but did not test positive for Covid. He tested positive for another Coronavirus - OC43. We didn’t do much isolation from each other either. I don’t know how to explain that…

Expand full comment
Jeremy Faust, MD's avatar

It's interesting that you note no effect of Paxlovid. I think that's more common than most people realize. People tend to get the drug right near the peak of symptoms anyway. So when they start getting better, they give Pax the credit. But the studies have not really shown us any great proof that this happens in large numbers of people.

Interesting that you both got coronas of various types at the same moment. Can happen, if a little flukey!

Expand full comment
Kirsten L. Held's avatar

As a few others have said, both my husband and myself have never had COVID. We still wear masks every time we go into an indoor environment and work from home. We are participants in the RECOVER study since we are becoming a very rare control group. We test whenever we think there's the slightest chance that we might have been exposed and are completely up to date with our vaccines. If we ever do test positive, we will test every couple of days and monitor our temperatures accordingly.

Expand full comment
Joan Edelstein's avatar

I love seeing the number of people in the never had COVID group. Same here and I'm also part of the dwindling group of controls in the RECOVER study. I would use a combination of 5-10 days and negative tests. I mask indoors, except I occasionally eat indoors at not crowded well ventilated restaurants (my local one upgraded to medical quality ventilation). Everyone in my social groups tests before we meet indoors for meals together.

I do something different with masks. By August 2020 when it became clear this was going to last a long time, I wanted to set myself up for masking. Long story short, I incorporated masks into my wardrobe as an accessory, like scarves. I have many very well fitting masks made of two layers of tightly woven cotton and strong nose wire with a pocket for polypropylene filters. The masks can be washed and filters replaced. The poly propylene is not charged so I hope the double layer of cloth helps make up for that. They're duck shaped so room between my mouth and mask and the mask doesn't slide down when talking. I've even had strangers on the street compliment me on my mask and outfit. In any case, it's kept me masking all this time.

Expand full comment
Nurse Jenny's avatar

I also have color coordinated masks that I will wear over my N95. :)

Expand full comment
Carol Belding's avatar

Not to complicate things, but I see more familiar physician voices on Bluesky.

Expand full comment
Jeremy Faust, MD's avatar

I just can't lol

Expand full comment
Nurse Jenny's avatar

This is the first I am hearing of bluesky.

Expand full comment
Carol Belding's avatar

Seth Trueger and Ryan Radecki* are on Bluesky, and not on Threads. I've seen more docs on Bluesky that I followed on Twitter, there, as well. I didn't want to do it, either, but I've enjoyed it. We enjoy Sam Ghali presenting a case (and doing imitations of him) (great voice!) he is still only on Twitter.

*I enjoyed Ryan back in the SDN days when my son was applying to programs. (Non-trad EM to Palliative Care in the ED) Husband is an old Hopkins/Harvard shrink, specialized in poor LSD outcomes. I spent my working life with docs in different settings.

Expand full comment
Jeremy Faust, MD's avatar

This is like a hit parade of people I've known for eons :) Seth is good friend and he remains active on Twitter. Ryan I've also known for a long time (and used to be his editor at ACEP Now!), and he also remains somewhat on Twitter. Sam (another person I've known for a long time) is so great on Twitter. Funny thing...his voice in real life is so different. He's always channeling Scott Weingart's voice in his videos (https://www.youtube.com/watch?v=_6hVopnHOSU for an example). Imitation being the highest form of flattery, and Scott and Sam are really great educators.

All to say, who is on Bluesky that I can't get elsewhere?

Expand full comment
Carol Belding's avatar

I'll keep my eye out on who is where. Weingart's voice!!! I would bug Seth about not putting a sweater on his dachshund, and felt so bad when he got his cancer diagnosis. I told him I wouldn't have bugged him about the dachshund. (We have had too many.) He sent a photo of the dog in a sweater.

Expand full comment
Jeremy Faust, MD's avatar

Amirite re Weingart?!?

Expand full comment
Carol Belding's avatar

Absolutely! Very funny.

Expand full comment
Jill Knapp (DE / NJ)'s avatar

It's so funny-- I'm a "I just can't lol" with Threads. I can act all proud and say "Oh, it's because Meta is really reckless with user data," but I still lurk on Twitter, so I can't really explain it. :-D

It breaks my heart at what a dumpster fire Twitter has become. It used to be a really useful, important tool, and now it's just bots bots bots and nazibots.

Expand full comment
Jeremy Faust, MD's avatar

I should mention that my distaste for Elon is not the only reason I have decreased by Twitter use by 90%. One can't avoid bad actors. Meta too has its problems (though they were genuinely wonderful to me when I wrote for Bulletin, and took great care of the work; and a good friend of mine works on misinformation there, so I am sympathetic to the challenge they face and know that they at least *mean well* at fairly high up levels, for whatever that may be worth). And of course Substack has made news as of late for its troubles dealing with content moderation, sigh.

I've concluded that the world is a place with good and bad people, and these platforms reflect that. If purity were possible, I'd go for it. Instead, I make compromises in all of these places because I believe the mission of spreading this information (and learning from others doing the same) is worth it.

Expand full comment
Jill Knapp (DE / NJ)'s avatar

I love me some BlueSky!

Expand full comment
Nurse Jenny's avatar

Hi Laurie,

Did you and your husband test everyday for 3 weeks before having a negative rapid test?

Expand full comment
PamelaSPM's avatar

Dr. Faust, I'm still masking and doing everything within reason to not catch Covid, but if I should, do you have any recommendations on a 5 day vs 10 day course of Paxlovid? And, if you know, which rapid tests are most accurate? Are Cue and Lucia more sensitive tests? Thanks! Pamela

Expand full comment
Jeremy Faust, MD's avatar

Hi Pamela, I don’t have an opinion about different brands of rapid test. My sense is that cue and lucera are likely to pick up a positive case *sooner*. But I’ve seen cases where they didn’t. I think that a daily rapid test for several days gives you the information that you need. But if you really want to catch a case earlier, those other options might give you a slight head start. But $$$.

Regarding five verses 10 days of Paxlovid…there really is not data on this yet. However, I have heard rumors about it decreasing rebound and it kind of made sense to me so, for some high risk people, I have occasionally prescribed 10 day courses. But I am very careful to make a distinction between something I’m doing that is data driven and something that is not. While I have prescribed 10 day courses for some people, I’ll admit to you that I’m going to feel pretty bad about myself If it turns out that we learn that this is actually a bad idea (ie. backfires) from actual data. I’m eagerly awaiting some updates on this. I’ll let you know as soon as I know anything.

Expand full comment
PamelaSPM's avatar

I've looked but haven't found much on the safety profile of Paxlovid from days 6-10. I asked because I've had several family members "rebound," feel awful and test positive again after finishing the 5 day course. Thank you for replying and for the test info, too.

Expand full comment
Sue Lander's avatar

I have not had covid but I think that if I felt OK without a fever, I'd just wear an excellent mask and keep my distance from others. I would not take my mask off out of the house, at all, unless outside.

Expand full comment
Sue Lander's avatar

the thing with waiting for the negative test is that some folks test positive for frigging ever which I don't think is an accurate representation of where they might be in terms of the risk of infecting others.

Expand full comment
PamelaSPM's avatar

I'm still isolating from catching Covid!

Expand full comment