LAND O’ LAKES — Gene DellaSala stood at his window late Monday afternoon.
Outside was somewhere DellaSala had not seen much of recently. Save for a few health-related excursions, he had confined himself to a small part of the house. Much of his family’s home, not to mention the outside world, was unsafe — not because of the danger somewhere out there, but because DellaSala thought he might still be the danger.
It had been more than five weeks since an acquaintance, fresh off a trip to China, stopped by DellaSala’s house to check out some speakers. It had been four weeks since the 46-year-old, battling what he thought might be flu or pneumonia, became the first person in Pasco County to test positive for the coronavirus. And it had been nearly two weeks since his cough and fever went away, leaving him with a question he was still trying to get answered: How will he know when he’s not contagious anymore?
Through the window, he saw a familiar shape come into frame: His 85-year-old mother. Before the virus, he often visited her home ten minutes away. When she needed help, he was the one to give it. Now he saw her, from a distance, for the first time in 35 days.
“It makes me feel guilty,” DellaSala said. "It makes me feel helpless. Am I being overly cautious, isolating like this?”
Even as the coronavirus claims lives, thousands of others are recovering from it, and consciously or not, they will all have to grapple with similar questions — when is it okay to go back to doing their own grocery shopping, rather than shelling out for delivery? To sit with the rest of their household for a family meal? To return to work at an essential job?
There is no definitive answer, doctors say. Early research has suggested that people are most contagious in the first few days after they’re infected. But research has also shown that viral shedding, an indicator of contagiousness, can continue even after a patient has seemingly recovered.
The Centers for Disease Control and Prevention have published guidelines suggesting that patients recovering at home emerge from isolation once they’ve gone three days without a fever and at least seven days since symptoms first appeared, as long as their respiratory symptoms have also improved. The guidelines for healthcare professionals who have gotten sick are similar.
Some doctors are telling patients to wait seven days since their last symptom, tech and science website The Verge reported. Manish Sagar, an infectious diseases doctor at Boston Medical Center, told the Tampa Bay Times that he’s been telling patients to self-isolate for two weeks after the onset of symptoms.
“Generally, for healthy people, after symptom onset, 14 days is probably beyond the point where they’re going to transmit the virus,” he said. “It’s very low likelihood that you would be infectious at that point.”
A few factors can upend that generalized advice, though. People in certain medical situations, such as cancer patients undergoing chemotherapy or organ transplant recipients taking medications that could suppress their immune systems, should be extra cautious, Sagar said. A weakened immune system could make it easier for the virus to live in the body longer.
People who fit those criteria may want to wait until they test negative for the virus, he said. But relying on follow-up tests could cause unnecessary confusion, said John Sinnott, chair of internal medicine at the University of South Florida’s Morsani College of Medicine.
The type of test most available in the U.S. shows a virus’s presence — Sinnott said he thinks of it as a fingerprint. But it doesn’t show whether someone is still contagious, and it’s possible for patients to continue to test positive even after they’ve seemingly recovered.
Because these tests don’t show contagiousness, Sinnott said he doesn’t think they should be used to determine when someone can end self-isolation. He worries that using them as such a benchmark could be psychologically damaging.
Repeated positive tests “are a source of immense emotional anguish,” he said. “People worry that they’re going to be carriers their whole life. But that’s not the case.”
DellaSala has remained in isolation for weeks after his symptoms passed because of repeated positive tests, he said. The Pasco County Health Department has continued to test him weekly, he said, and he tested positive as recently as last week.
Health officials and his doctor have told him that he should stay in isolation until he tests negative, he said. His doctor also prescribed him antibiotics, in case a secondary ailment is weakening his immune system and letting the virus hang around. His wife has a compromised immune system, making him even more reluctant to leave isolation until he tests negative.
What he wants most is a test that can give him a yes or no answer: Is he contagious or isn’t he? But he’s unlikely to get access to one.
Sinnott said the only tests that could answer that question involve biohazard labs, and developing and broadly distributing a test that doesn’t use those resources would be prohibitively expensive. Sagar also said a yes-no contagiousness test isn’t likely to come anytime soon.
Sagar did note that the U.S. may soon get an updated version of the widely available test, one that shows levels of the virus rather than just indicating its presence. Though it wouldn’t be definitive, it could show whether there’s a lot of the virus, meaning the carrier is probably contagious, or just a little, meaning the carrier probably isn’t.
For now, DellaSala stays in his room, the hours blurring around him. Time felt slow at first; now it feels oddly fast. He wakes up in the afternoon and goes to bed in the early morning. He can’t hug his family, can’t help his wife with cooking or cleaning. He’s lonely, even when his loved ones are in the next room, so he passes the time and grasps for connection by posting on the YouTube and Facebook pages of Audioholics, his long-running audio-visual industry publication.
He worries that the repeated positive tests will tag him with a scarlet letter for life.
“When I go to the gym, for example, people are going to recognize me from the news and YouTube,” said DellaSala, who has been outspoken about his diagnosis. “Are they going to welcome me with a warm reception or fear me like I have cooties?”
DellaSala’s last test was Tuesday. He hopes to get the results this weekend. He hopes they’re negative. Until they are, he’s alone.
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