9 Comments

Agree that isolating only when levels are “extremely high” avoids inconvenience, but in some circumstances isolating until levels are undetectable seems more appropriate. For example, IMO health care workers should not return to work (even if masked) if they have any detectable virus, unless they do not see “high-risk” patients.

Expand full comment
founding

I am in three groups of up to 10 seniors who each meet regularly every month and eat indoors, obviously unmasked, when outdoors is not possible. We decided that the best we can do is test before we meet and not attend if we test positive. We only test once, recognizing lack of access. Any suggestions on this would be more than welcome.

Expand full comment
founding

I should add that we need to be realistic about health literacy and the lack of adequate public health messaging. When boosters become available, for example, I share that with my groups and there are inevitably people who are not aware and immediately go out to get their boosters. One of our group members for today's meeting emailed yesterday that they did not have tests but just got the booster. Two people arrived without testing and tested on arrival (as we had tests available). One thought you only test positive with symptoms. These are intelligent, active, educated people who read the news (not just on FB).

Expand full comment

A family member who had a high risk exposure was negative on a nasal swap rapid test, but positive when they swabbed their throat--any comments? Their spouse was positive, very positive--and had a medical procedure the day before for which they were "screened"

Expand full comment
author

Hi Jan,

Interesting! In general, my understanding is that throat swabs have not added a ton of sensitivity...maybe a little though!

https://jamanetwork.com/journals/jama/fullarticle/2800526#:~:text=Combining%20a%20nasal%20swab%20with,recommend%20swabbing%20only%20the%20throat.”

That said, if you pick up a + result on throat swab, but not on nasal swab, it's possible that the viral load is actually still on the lower side and the person is less contagious so far. My bet is that anyone who is negative on nasal swab but positive on throat swab will be positive on BOTH within a few hours. And at that point, they're probably a fire hydrant of virus (!)

Expand full comment

Interesting. I think one of the issues is how do we evaluate when to stop masking after a prolonged period of positive testing.

As an example, I have tested positive on a rapid test (Flowflex) everyday since the 12th of September. It is a faint line, and it does not appear until the 14 minute mark, but it is still positive. Two physicians have told me that I can’t be contagious still and can drop the mask, but honestly that seems like it is missing the science behind how a rapid antigen test works. So, I will keep on masking until I get a negative test.

Note: I was fortunate to split a bulk order of Flowflex tests with friends so my cost is about $1/test and I have plenty on hand. It is not sustainable to test consistently at the usual price point. And because people ask: fully vaccinated and boosted all the way around.

Thanks again for always providing thoughtful analysis and insight.

Expand full comment

Very timely for me, as I am day 6 with Covid and finished my Paxlovid this morning.

On day 5, my BinaxNow test today lit up quickly and almost as dark as on day 1. Today, I had the merest whisper of a positive line that showed up about 7 minutes into the test. At 15 minutes, it was still the same super faint line. Because I have a lot of tests and love a science experiment, I also took Flowflex tests. The Flowflex tests yesterday and today were the same - faint line about 3 minutes in and by the end virtually the same medium color. Do you have any thoughts about why the results were a bit different?

Expand full comment
author

I hope you’re feeling okay. If you had a spreadsheet of your timeline (exposure, last negative test before you became positive, symptom log, Paxlovid dates, etc) and photos with the date and time

of each test, someone like me could probably construct a narrative of what’s going on. It wouldn’t be rigorous science, but it would sure be interesting and possibly informative!

Expand full comment

Fortunately, I'm feeling fine. Paxlovid is a wonderful drug. I could do all of the above.

Expand full comment