How do we de-Covid after Covid?
January 21, 2022 11:41 AM   Subscribe

So, I have covid. Symptomatic last Thursday; tested positive on Monday. The days in between have not been fun at all, but I seem to be coming out the other side of it now. What do I need to do (once I'm fully recovered and out of isolation) to make my isolation space, and my home, safe for myself and others?

I live with two other people. Two of us are sick, one of us is still healthy and testing negative. All of us are totally vaxxed and boosted.

We're pretty sure that my other sick housemate picked Omicron up at work and delivered it back to me; my healthy housemate and I work from home and stay tucked in tight most of the time. I seem to be a few days behind my fellow-sufferer, in symptoms and in testing positive. We're isolating at home separately, while our healthy housemate leaves us food at our doors (thank god for her, seriously. she's keeping us alive.)

We're breakthrough cases, and both of us seem to be in the "mild" category. (FWIW, fellow vaccinated people, "mild" basically means "extremely unpleasant but likely survivable" - this has been and still is pretty miserable. I'm so tired I feel like I could keel over from that alone, even without the other fun symptoms. I can't imagine how bad it could have been if I hadn't been thoroughly vaccinated).

I'm looking for any and all advice you may have on making sure my space is clean enough and safe enough that - once we are out of isolation - a healthy person could walk in and grab my phone charger for me and walk out again without getting infected. I'm not going to be entertaining or anything; I just don't want casual visitors getting infected (or to reinfect myself -- is that even a thing that can happen?)

I'm capable of being pretty nutty when it comes to germs. On a scale of 1 to 10, where 1 is "wipe everything down and do your laundry" and 10 is "throw out everything you've ever touched and replace with new stuff", where should my efforts fall? IS there anything I should literally throw out and replace (like bed clothes, toothbrushes? stuff like that) or is cleaning + time enough? How much time is enough time? What kind of cleaning is best?

I feel like I had a handle on this kind of thing until Omicron came along; it's so much more contagious I'm not sure where to draw the line between "paranoid" and "careful". (Healthy Housemate keeps saying "fomites are not a thing!" because that's what they told us early on - but is that still true with Omicron? I feel like maybe the landscape has changed enough that some of what I'm finding on web searches is out of date.)
posted by invincible summer to Health & Fitness (14 answers total) 8 users marked this as a favorite
Best answer: The key thing is to keep expelling the virusy-air while you're getting better. Open windows, blow fans out the windows. Try to get fresh air blowing through every room to replace the virusy air.

I think the research still supports your housemate that fomites aren't a thing, but since it's easy and cheap to do, personally I would wipe down anything wipe-able that you touched while sick - doorknobs, light switches, taps, flush levers, fridge handle, water filter, kettle, or juice jug handle, remote controls, electrical cord plugs, computer keyboard, headphones, celphone, etc.
Make sure to wipe the part your fingers actually touch- for instance, I often see people wiping the outer-facing surface of a door handle, but not the back of it - the part where their fingers actually wrap around apply pressure to open the door.

And I'd want to wash my sick clothing and bedding, in hot water if possible.

For things to trash and re-purchase, I would NOT spend a lot of time or money.
I'd get a new toothbrush for sure, since it's so cheap and easy. And maybe a new pillow if you can afford it. I'd probably wash any garbage cans or mop floors or surfaces that had mucusy used tissues touching them, but not even bother if you use bags in all your garbage cans.

I would definitely throw out all masks you and the housemates wore, unless it's a fabric mask you really love for some reason, and then I might boil it. Masks get icky.

If you ran air filters while sick and can afford to replace the filters, maybe do that for psychological reasons, but I don't think it's really necessary as the virus should be stuck in the filters and die there.

But like, personally, I'd spend one to two hours on "project smite-fomite", total, and it's mostly for psychological reasons - I definitely don't think the research says you need to be Lady MacBeth about it. Doctors and nurses don't throw away the curtains in a covid room. On a scale of 1-10? I would personally be like a 2-3.

Glad you're feeling better!
posted by nouvelle-personne at 11:57 AM on January 21, 2022 [6 favorites]

Best answer: Also I know fully well that this is nonsense, but I would wipe my cat with damp paper towels every day for a few days, especially on her head/ears/neck where she can't lick, or parts of her that I pet a lot, like her back. I pet her a lot when I'm sick. Of course this is nonsense. But I would do it, lol. Just in case she could get or host covid from licking my fomites off her fur. Again, easy, cheap, no hardship, so even if the benefit is small or none, why not.
posted by nouvelle-personne at 12:04 PM on January 21, 2022 [4 favorites]

Best answer: All discussion I've seen indicates you don't need to do anything. By the time you and your sick roommate are clear, the apartment will be clear. Sure, air the place out. Clean up. But I don't think you need to do anything more, especially for the scenario where someone is just stopping by to pick up a USB charger.
posted by Winnie the Proust at 12:20 PM on January 21, 2022 [31 favorites]

I had it too, before Christmas. From what I understand, as long as your temperature remains down after the first ~2 days, you are not contagious. (The CDC was right to reduce the number of isolation days from 10 to 5.) You will still have symptoms and you will still test positive, but you will not be contagious after the incubation period.
posted by Melismata at 12:23 PM on January 21, 2022

Best answer: I just had it - started getting symptoms Jan. 3rd. The first week is the worst. I'm glad you are feeling better.

We are both double vaxxed and boosted and really cautious, but I got a breakthrough case anyway (I suspect from the shared laundry room, since I'm one of the few who masks in there, sigh.) I aired things out and washed and dried bedding and towels I used, and my underwear and nightgown, in hot. I tossed my masks - I was using disposable KN95s anyway. Trash cans are lined anyway so did not worry about that. Did a thorough cleaning of the bathroom I used with a cleaner that includes bleach, both during and after, and included the door handles and light switches in the bathroom. Tossed the toothbrush. Did not do anything beyond that. It's a small apartment and my husband tested negative the whole time. I wore a mask around our cat when he wanted to cuddle, because he has cancer; he has been fine, fingers crossed.
posted by gudrun at 12:24 PM on January 21, 2022 [1 favorite]

If you just wait like 3 days any virus on a surface etc is pretty much deactivated. If you do some normal cleaning and washing, so much the better. Source:

When accounting for both surface survival data and real-world transmission factors, the risk of fomite transmission after a person with COVID-19 has been in an indoor space is minor after 3 days (72 hours), regardless of when it was last cleaned.

Fomites aren't "a thing" in the sense that fomite transmission represents a very small percentage of total transmission. Whether that is 10% or 1% or maybe even just 0.1% is hard to say. It's somewhere in that general range, however. There is some chance, but it is quite small. Regardless, just waiting 3 days after the last infectious virus was at your location will remove all danger from fomite transmission.

The main danger, however, is the infected people and their breathing/speaking/singing etc. If you want to be really safe, don't wait just the CDC-recommended 5 days but more like 10 days or even (to be super-safe) 14 days before having someone over. And even then, wear masks, air the place out really well etc.

Also, to be super-safe you have to consider not only 10-12 days from the time you and roommate were infected, but also that 3rd (non-ill) roommate might have been infected early on but also just might contract a case after 5 days or even up to 14 days. That does happen with a percentage of cases of people living together - thus the rule early on that people who were sick had to isolate 14 days but then their family/roommates had to quarantine another 14 days after that.

Again, all that is on the very far side of being very, very careful - but that is the question you asked! And FWIW after 5 days, 40% of patients are still at an infectious level (I recently saw research showing that - I'll see if I can dig up the reference). So waiting 12-14 days might be a bit excessive but waiting 8-10 days rather than just 5 is not really unreasonable at all.

(What happens is the percentages of infectious people drop each day - so at 5 days it's say 40%, after 8 days 15%, after 10 days 5%, after 14 days less than 1%. Those aren't the exact figures, but illustrative. But it illustrates why there is not simply one length of time that is the clear cutoff. Do you want to be 60% sure, 80%, 95%, 99%, 99.999%? Each of those will require a different waiting period. And then it becomes of tradeoff of practicality vs getting that least decimal place of "safety" - a risk/reward calculation where ending earlier and ending later both have risks and rewards associated with them. Also, on average vaccinated people are going to be infected for a shorter period than unvaccinated.)

Finally, omicron's superpower is that it is much better at infecting people who have previously had covid or are vaccinated. In short, it is better at evading those initial immune defenses than other strains. That explains most and perhaps all of its fitness advantage over other strains and the reason it is displacing Delta.

Point is, omicron doesn't jump further feet across the air than previous strains, doesn't lurk for longer on surfaces than previous strains, doesn't linger in the air longer than previous strains, etc. For purposes of cleaning, ventilation, air filtering etc you can use the same guidance that has been learned from previous strains.

Where you might exercise more caution with omicron than previous strains is in your interactions with others who have been vaccinated or previously infected with covid. If you want to avoid spreading omicron you must be just as careful around those people as unvaccinated people.

Fortunately the vaccinated/previously infected are more likely (in comparison with a similar unvaccinated person) to have no noticeable symptoms or very mild symptoms or the bad-cold type symptoms you describe than a serious case ending with a hospital stay or, deity forbid, death. But if you're trying to be careful and spare your friends/visitors even a "bad cold" type illness that means you're going to assume that every visitor is completely unvaccinated and act accordingly (both mask up, good ventilation, meet outside rather than inside when possible, etc etc etc).
posted by flug at 12:46 PM on January 21, 2022 [7 favorites]

Best answer: It hasn't been peer-reviewed and I'm cautious about accepting it as gospel, but there's a recent study from the University of Bristol’s Aerosol Research Centre that found that about 90% of infectivity is lost within 20 minutes of a respiratory particle being exhaled. (link to paper) (link to Guardian coverage) This lines up pretty well with what we already knew about covid transmission.

The speed at which the virus degrades is related to the speed at which the particles lose water; dryer air inactivates the virus faster and humid air keeps it infectious longer.

The study didn't test the Omicron variant specifically, though there's no reason to think it works any differently, either.

Masks are considered decontaminated after 3 or 4 days of non-use, though usually the recommendation is to cycle through seven masks, one per day of the week, just because it's easier to figure out what day of the week it is than to remember where you are in a 4-day cycle, and because 7 days is marginally safer than 4.

We think a person can continue to create infectious particles even after they're no longer testing positive or having symptoms, though not as many, and they disintegrate just as quickly; I haven't seen anything that suggests that people who test negative after being ill are responsible for many new infections. It's more of a well, it's not literally impossible thing.

I'd say the healthy housemate should probably be masked when leaving food, and should stay in their own space for 30 minutes(-ish) after the doors are opened to bring in the food (with similar rules for bathroom use), and should be doing home tests as often as is practical. It could help if you and sick roommate wore masks for half an hour or so before healthy roommate leaves food, and also while you're using the bathroom. Air filters or Corsi-Rosenthal boxes would be useful because they remove some of the particles from the air before they can degrade or infect anyone, but by the time you get one, most of the danger will probably be gone, so I wouldn't worry about it unless you know someone who builds CR boxes as a hobby and could bring one over immediately.

I haven't seen anything that suggests that the fomite rules are any different for Omicron than they were for any of the others.

Even if there's no infectivity-related reason to want to clean everything, there might be psychological benefit, especially since you already say you have issues with germs anyway, but on your 1-10 scale, I think somewhere in the 0.5 (clean the things you would ordinarily clean, plus maybe a little extra laundry if you have the energy) to 2 (basically what nouvelle-personne suggested: wipe down the stuff you touch a lot and replace stuff that you should be replacing more often anyway, like toothbrushes) range should be fine.

It is possible to be reinfected with Omicron (this has apparently happened a few times in South Africa, though I can't cite, I just know I read it recently from a credible source on Twitter), but you probably can't reinfect yourself. (If you could, nobody would ever recover.) I would wait to have anyone sharing your air until you're both past the isolation period and testing negative on home tests, but once those both apply, I don't think there's significant danger anymore, and you're probably actually clear some time before that.

You should still wear masks and distance after recovery, as much to stay in the habit of doing it as to prevent infection.

Isolation period should probably still be 10 days, despite the CDC; epidemiology Twitter was (and still is) VERY upset with the CDC for changing the guidance to 5 days, though there is computer modeling indicating that 5 days and 10 days are pretty similar in terms of transmitting covid. (Like, the CDC didn't make it up just because they want everybody back to work sooner, but . . . they were also strongly motivated to find ways to get everybody back to work sooner, so.)

Dogs, cats, and other mammalian pets (including at least hamsters) can get covid; as far as we know, they get it the same way people do: via respiratory droplets that are transmitted through the air. So if there are pets, they shouldn't be sharing air with you or sick roommate.

tl;dr: worry about sharing air with another person. A 20-30 minute elapsed time still counts as sharing air, especially if it's humid. Clean things if you feel like cleaning them. Beware of living mammals.
posted by Spathe Cadet at 12:52 PM on January 21, 2022 [8 favorites]

Some sources related to my comments above:

* Infectious viral load in unvaccinated and vaccinated patients infected with SARS-CoV-2 WT, Delta and Omicron. This paper measures infectious viral load of patients and also compares that with PCR testing results. PCR is commonly used in studies as a proxy for "amount of infectious material" but in fact PCR detects the amount of RNA present - some of which may be infectious virus and some just deactivated RNA particles. One of their main findings is that PCR results correlate only very weakly with actual infectious virus present - meaning that it is quite possible, and in fact common, to have a high PCR test result while having no or very low infectious virus levels. This is commonly seen among, say, vaccinated people or people who had onset of symptoms more than 5-10 days ago. They still have RNA fragments floating around their system but that represents virus that has been deactivated by their immune system and such, rather than infectious virus. PCR, unfortunately, cannot discriminate between the two.

Related to my comments above, this testing found:

- Infectious virus was found in 53.6% of subjects at 5 days post onset of symptoms

- Vaccinated individuals who contract covid have lower viral titres and also clear the viral load faster

Note that this paper is a pre-print. However it is the first/only research I know of that looks at actual infectious virus numbers rather than PCR test results (which, as noted above, correlate only very weakly with infectious virus numbers).

* SARS-CoV-2 Omicron VOC Transmission in Danish Households This demonstrates rather convincingly that "the rapid spread of the Omicron VOC primarily can be ascribed to the immune evasiveness rather than an inherent increase in the basic transmissibility" - at least among the Danish households studied. Note that this paper, too, is a pre-print.
posted by flug at 1:09 PM on January 21, 2022 [3 favorites]

On a scale of 1 to 10, where 1 is "wipe everything down and do your laundry" and 10 is "throw out everything you've ever touched and replace with new stuff", where should my efforts fall?

Like, less than 1. 0.5. Or 0.1. COVID-19 is an airborne illness and all evidence we have suggests that even things like hand washing are not that important for limiting spread.
posted by Betelgeuse at 1:12 PM on January 21, 2022 [7 favorites]

Your housemate, who is the most at risk from getting sick here, clearly has no interest in you giving the whole house a once-over with clorox wipes, let alone a full Velveteen Rabbit bonfire. Like do whatever makes you feel comfortable but I would be more afraid of a random Acme anvil falling on my head than giving a plumber covid next month because I didn't wash my sheets on a hot enough setting
posted by katiec at 1:24 PM on January 21, 2022 [8 favorites]

I would also say less than 1 on your scale. But I like to give my house and linens a good clean anyway after I'm sick with anything just to feel like I've refreshed my life bc everything just feels gross after you've been laying around in your pjs or whatever for days on end.
posted by greta simone at 1:56 PM on January 21, 2022 [5 favorites]

The covid virus does not live long on surfaces. Increasing fresh air exchange is an attempt to keep the remaining roommate from getting ill. I think you'll simply feel better if you wipe down surfaces using whatever mild cleaning product you have in plenty of water, and washing clothing and bedding when you have enough energy. I hope you are better soon.
posted by theora55 at 2:46 PM on January 21, 2022 [1 favorite]

Response by poster: This is a great range of the super-careful to the super-casual and it'll be very helpful in choosing where to land. I'm leaning toward the "light spring cleaning" end of things right now, with a lot of laundry done and surfaces wiped down, but not a biohazard level 4 effort. I will order replacement toothbrushes and toothpaste, because I'm just weird that way (and anyway it's probably time to do it in the normal course of such things.) I probably won't Clorox the cat. ;) That's about where I'm at.

We intend to be really careful with re-integrating the household; thanks for thoughts on how to handle that, too! We're definitely on the mend in terms of symptoms, but won't let cabin fever drive us out until all three of us (very careful people) feel safe.
posted by invincible summer at 7:35 PM on January 21, 2022 [3 favorites]

When I had COVID a few weeks ago, I threw out all my lip balms, FWIW. Not sure of the science but I have in the past gotten symptomatic/sick with other respiratory viruses from using old lip balm.
posted by Schielisque at 8:22 AM on January 22, 2022

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