LOS ANGELES — Health officials recommend that anyone infected with the coronavirus isolate for at least five days. But for many, that timeline is becoming overly optimistic.
The isolation period, which the U.S. Centers for Disease Control and Prevention shortened in December from 10 days to five, is more a starting point than a hard-and-fast rule. According to the California Department of Public Health, exiting isolation after five days requires a negative result from a rapid test on or after the fifth day following the onset of symptoms or first positive test — a step not included in federal guidelines.
But many people don’t start testing negative that early.
“If your test turns out to be positive after five days, don’t be upset because the majority of people still test positive until at least Day 7, to Day 10 even,” Dr. Clayton Chau, director of the Orange County Health Care Agency, said during a briefing Thursday. “So that’s the majority. That’s the norm.”
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But even typical, longer isolation periods carry very real effects, such as keeping people away from family and friends and out of work. While it may be disruptive, isolating is intended to stymie the spread of the coronavirus.
Dr. Robert Kosnik, director of UC San Francisco’s occupational health program, said at a campus town hall in July that there’s an expectation people will test negative on Day 5 and can return to work the next day.
“Don’t get your hopes up,” Kosnik told his colleagues. “Don’t be disappointed if you’re one of the group that continues to test positive.”
In fact, some 60% to 70% of infected people still test positive on a rapid test five days after the onset of symptoms or their first positive test, meaning they should still stay in isolation, Kosnik said.
“It doesn’t significantly fall off until Day 8,” he said.
Shoppers, some wearing masks, are seen in Los Angeles on July 14, 2022.
A study published by the CDC in February found that 54% of patients had positive antigen tests between five and nine days after an initial diagnosis or the onset of symptoms, though “the proportion of positive results declined over time.”
People with symptomatic COVID-19 were more likely to continue testing positive five to nine days after symptoms first appeared. In the study, 64% of symptomatic patients still tested positive in this time frame.
“However,” the study noted, “a positive antigen test result does not necessarily mean that a person is infectious. Similarly, a negative test result does not necessarily mean that a person is not infectious. Nonetheless, a positive or negative antigen test might be a useful proxy for the risk for being infectious.”
The proportion of positive test results “was lower after asymptomatic than symptomatic infection,” researchers found.
In general, the study said, “lower prevalence of positive test results over time and after asymptomatic infections might reflect lower infectiousness.”
Here’s a summary on guidance for isolation from the California Department of Public Health:
Day 0: Start of COVID-19 symptoms or the day of your first positive coronavirus test, if you’re asymptomatic. Wear a highly protective mask around others if in the same room as others in your home.
Days 1-5: Remain in isolation.
Day 5: You can take a rapid test. If you test negative, don’t have a fever and your symptoms are improving, you can exit isolation on Day 6.
Days 6-10: You can end isolation if your rapid test result — taken on Day 5 or later — is negative, you’ve been fever-free for 24 hours without taking fever-reducing medicines and your symptoms are improving or you don’t have symptoms.
Day 11: You can generally end isolation without needing a negative rapid test result. But if you still have a fever, stay isolated until 24 hours after the fever ends. And if you are immunocompromised or have had severe COVID-19, you might need to isolate longer.
“If you do not have access to an antigen test, then we feel pretty comfortable that 10 days after your symptoms start, you are no longer infectious,” Orange County Deputy Health Officer Dr. Matthew Zahn said.
Explainer: How health care for vets became a fight in Congress
Intro
A bill that would enhance health care and disability benefits for millions of veterans exposed to toxic burn pits hit a snag in the Senate last week, angering advocates like comedian Jon Stewart who say help from the government is long overdue.
Lawmakers have been hearing increasingly from constituents with respiratory illnesses and cancers that they attribute to serving near burn pits in Iraq and Afghanistan. The military used the pits to dispose of such things as chemicals, cans, tires, plastics and medical and human waste.
Veterans groups say servicemembers who were exposed to the pits have waited long enough for enhanced health benefits, and lawmakers largely agree. The Senate is ultimately expected to send the measure to President Joe Biden’s desk. It’s just a question of when.
Where the issue stands:
How would the bill help Iraq and Afghanistan veterans?
First, veterans who served near burn pits will get 10 years of health care coverage through the Department of Veterans Affairs upon their separation from the military rather than five.
Second, the legislation directs the VA to presume that certain respiratory illnesses and cancers were related to burn pit exposure. This takes the burden of proof off the veteran, allowing them to obtain disability payments to compensate for their injury without having to show the illness was a result of their service.
Roughly 70% of disability claims related to burn pit exposure are denied by the VA due to lack of evidence, scientific data and information from the Defense Department.
Is there help for other veterans?
Yes. For example, hundreds of thousands of Vietnam War-era veterans and survivors also stand to benefit. The bill adds hypertension, or high blood pressure, as a presumptive disease associated with Agent Orange exposure. The Congressional Budget Office projected that about 600,000 of 1.6 million living Vietnam vets would be eligible for increased compensation, though only about half would have severe enough diagnoses to warrant receiving it.
Also, veterans who served in Thailand, Cambodia, Laos, Guam, American Samoa and Johnston Atoll will be presumed to have been exposed to Agent Orange. That’s another 50,000 veterans and survivors of deceased veterans who would get compensation for illnesses presumed to have been caused by their exposure to the herbicide, the CBO projected.
How much will the bill cost?
The bill is projected to increase federal deficits by about $277 billion over 10 years, the CBO said. Lawmakers did not include offsetting spending cuts or tax increases to help pay for the spending.
Where do things stand in Congress?
Both the House and the Senate have approved the bill overwhelmingly. The Senate did so in June, but the the bill contained a revenue-related provision that must originate in the House, requiring a do-over to make a technical fix.
The House approved the fixed bill by a vote of 342-88. So, now the measure is back before the Senate, where the previous iteration had passed by a vote of 84-14. Biden says he will sign it.
So why hasn’t the Senate approved it yet?
When the CBO scored the bill, it projected that nearly $400 billion slated to be spent on health services would move from discretionary spending to mandatory spending, which is mostly sheltered from the bruising battles that occur each year over where to spend money in appropriations bills.
The Committee for a Responsible Federal Budget, a nonpartisan fiscal watchdog, said a reclassification of nearly $400 billion from discretionary to mandatory would “both reduce the pressure to keep those costs under control and make it easier for appropriators to spend more elsewhere in the budget without offsets.”
Those dynamics also applied to the bill when the Senate approved it in June. Nevertheless, senators voted for the measure overwhelmingly.
But, last week more than two dozen Republicans who voted for the bill in June voted against advancing it this time. They sided with Republican Sen. Pat Toomey (pictured) of Pennsylvania, who is seeking a vote on an amendment that he says would not reduce spending on veterans but would prevent spending increases in other nondefense programs down the road.
Senate Majority Leader Chuck Schumer has offered to let the Senate vote on the Toomey amendment with 60 votes needed for passage, the same number that is needed to advance the bill itself.
It’s unclear how the delay will be resolved, though Senate GOP leader Mitch McConnell predicted Monday that the bill will pass this week.
Advocacy groups for veterans, a key voting bloc in the upcoming midterm elections, are furious and ramping up the political pressure on lawmakers to act. At a Capitol Hill news conference the day after last week’s procedural vote, speakers used terms such as “villains” and “reprehensible” to describe the Republican senators who voted against advancing the measure last week but voted for almost the exact same bill in June.
“Veterans are angry and confused at the sudden change from those they thought had their backs,” said Cory Titus of the group Military Officers Association of America.
“You just screwed veterans yesterday,” added Tom Porter of the group Iraq and Afghanistan Veterans of America. “Now, we’re going to hold them accountable.”
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