COVID rebound? Am I contagious still? again? or not?
August 23, 2024 7:37 AM Subscribe
I have COVID.
I tested positive 9 days ago (had cold symptoms for 5 days before the tests turned positive). Took Paxlovid for 5 days, finished on Sunday (5 days ago), felt much better and tested positive. Three days ago, developed stuffed nose, today tested positive again! (these are all antigen tests). Doctor says that even though I'm testing positive again I'm no longer contagious. What?? Am I really not contagious anymore? Did I ever stop being contagious? Is this a "rebound" or it never went away? Should I continue to stay home?
I tested positive 9 days ago (had cold symptoms for 5 days before the tests turned positive). Took Paxlovid for 5 days, finished on Sunday (5 days ago), felt much better and tested positive. Three days ago, developed stuffed nose, today tested positive again! (these are all antigen tests). Doctor says that even though I'm testing positive again I'm no longer contagious. What?? Am I really not contagious anymore? Did I ever stop being contagious? Is this a "rebound" or it never went away? Should I continue to stay home?
Best answer: That's classic Pax rebound.
If you're positive, you're contagious.
posted by entropone at 7:42 AM on August 23 [7 favorites]
If you're positive, you're contagious.
posted by entropone at 7:42 AM on August 23 [7 favorites]
You might be contagious but there is no evidence that this rebound is caused by Paxlovid. Both people who do and do not take Paxlovid get rebound Covid, just as with other viruses.
You can have a positive test after you're no longer contagious but it's impossible to know. That is why the current guidelines say to wear a mask for at least 5 days after your symptoms improve and your fever has resolved, whether or not you test positive. That means you do the same now, in your current state of having it.
This article in the NYT is from last month. https://www.nytimes.com/2024/07/18/well/covid-contagious-period.html
posted by Tim Bucktooth at 9:00 AM on August 23 [3 favorites]
You can have a positive test after you're no longer contagious but it's impossible to know. That is why the current guidelines say to wear a mask for at least 5 days after your symptoms improve and your fever has resolved, whether or not you test positive. That means you do the same now, in your current state of having it.
This article in the NYT is from last month. https://www.nytimes.com/2024/07/18/well/covid-contagious-period.html
posted by Tim Bucktooth at 9:00 AM on August 23 [3 favorites]
Response by poster: Thank you. I never thought it was a "Paxlovid" rebound. I just think that it got a lot better but then it got a little worse. I do wonder if, in the future, "they" might prescribe Paxlovid for a longer period than 5 days (I've been reading that 5 days just might not be enough for some people).
"You can have a positive test after you're no longer contagious" is the tricky part, of course, and the actual question I'm asking. I wonder if there is an actual value of antigen that equates to "contagious." I would imagine not.
then again, what does "symptoms improve" mean? That they disappear? that they are mild? that they are much milder than at the start of the illness?
Nobody knows ("but the Shadow" --- old radio reference)
Thank you!
posted by DMelanogaster at 9:47 AM on August 23 [1 favorite]
"You can have a positive test after you're no longer contagious" is the tricky part, of course, and the actual question I'm asking. I wonder if there is an actual value of antigen that equates to "contagious." I would imagine not.
then again, what does "symptoms improve" mean? That they disappear? that they are mild? that they are much milder than at the start of the illness?
Nobody knows ("but the Shadow" --- old radio reference)
Thank you!
posted by DMelanogaster at 9:47 AM on August 23 [1 favorite]
Best answer: THE SHADOW KNOWS
(what evil lurks in the heart of viruses making you feel crappy - feel better soon!)
posted by rrrrrrrrrt at 10:09 AM on August 23 [1 favorite]
(what evil lurks in the heart of viruses making you feel crappy - feel better soon!)
posted by rrrrrrrrrt at 10:09 AM on August 23 [1 favorite]
Nobody can really tell you for certain when you stop being contagious. A couple seemingly contradictory things are true: (1) tests may still display positive results even though the virus isn’t “replication competent”; (2) most people stop being contagious on or before the 10th day after exposure or symptom onset, but not all, and this paper notes that the end of contagiousness hasn’t adequately been studied. If you have a healthy immune system, you’ve been fever-free for 48 hours, and your symptoms are improving, the science says you’re probably not contagious. Probably. If you have a weakened immune system, you still have a fever, your symptoms aren’t improving, or you’re in the 5-10% of people at the very tail end of the curve, you may still be contagious. Maybe.
posted by fedward at 10:22 AM on August 23 [4 favorites]
posted by fedward at 10:22 AM on August 23 [4 favorites]
The CDC no longer has COVID-specific guidance, but they do have generic respiratory virus guidance, but they are pretty frustratingly vague. This is what they say about rebounds:
If you develop a fever or you start to feel worse after you have gone back to normal activities, stay home and away from others again until, for at least 24 hours, both are true: your symptoms are improving overall, and you have not had a fever (and are not using fever-reducing medication). Then take added precaution for the next 5 days.
The "added precautions" list includes testing, and, later, in the "how it works section," it goes on to say:
For COVID-19, taking an antigen test can help you know how likely you are to spread the virus. A positive test tends to mean it is more likely that you can spread the virus to others.
But there's nothing specific about testing positive again after negative tests.
My partner recently had COVID, I had symptoms but never tested positive, and it was frustrating wanting rules to follow and only getting a shrug, so I sympathize with you! I hope you feel better soon!
posted by amarynth at 10:43 AM on August 23 [1 favorite]
If you develop a fever or you start to feel worse after you have gone back to normal activities, stay home and away from others again until, for at least 24 hours, both are true: your symptoms are improving overall, and you have not had a fever (and are not using fever-reducing medication). Then take added precaution for the next 5 days.
The "added precautions" list includes testing, and, later, in the "how it works section," it goes on to say:
For COVID-19, taking an antigen test can help you know how likely you are to spread the virus. A positive test tends to mean it is more likely that you can spread the virus to others.
But there's nothing specific about testing positive again after negative tests.
My partner recently had COVID, I had symptoms but never tested positive, and it was frustrating wanting rules to follow and only getting a shrug, so I sympathize with you! I hope you feel better soon!
posted by amarynth at 10:43 AM on August 23 [1 favorite]
The CDC does have COVID-specific guidance, last updated June of this year (2024). While they don't have guidance on what to do if you have a rebound positive specifically, they do say: "A positive COVID-19 test means the virus was detected and you have or recently had an infection." Congruent with all of CDC's respiratory illness recommendations, you're contagious if you have symptoms and should treat yourself as contagious for five days after symptoms end. To the CDC, this translates to going back to your normal activities but to take added caution like prioritizing ventilation, masks, physical distancing, and repeat testing.
Basically, the CDC says that if you feel better you can go back to your normal activities, but you might still be able to give a respiratory illness to other people for up to five days after you feel better. So, since we often don't have control over the ventilation of indoor spaces we might be in, you should really wear a mask during this time, at minimum. Ideally, stay home if you can. "Keep in mind that you may still be able to spread the virus that made you sick, even if you are feeling better. You are likely to be less contagious at this time, depending on factors like how long you were sick or how sick you were."
If I tested positive, I would personally treat myself as if I were still contagious and would stay home. And then I would keep doing it for 5 days after testing negative two times in a row, as the FDA recommends serial testing for COVID with rapid antigen tests (as described on the CDC guidelines specific to covid page linked above). They recommend serial testing in part because the antigen tests are less effective at catching positives than they used to be.
posted by twelve cent archie at 1:53 PM on August 23 [7 favorites]
Basically, the CDC says that if you feel better you can go back to your normal activities, but you might still be able to give a respiratory illness to other people for up to five days after you feel better. So, since we often don't have control over the ventilation of indoor spaces we might be in, you should really wear a mask during this time, at minimum. Ideally, stay home if you can. "Keep in mind that you may still be able to spread the virus that made you sick, even if you are feeling better. You are likely to be less contagious at this time, depending on factors like how long you were sick or how sick you were."
If I tested positive, I would personally treat myself as if I were still contagious and would stay home. And then I would keep doing it for 5 days after testing negative two times in a row, as the FDA recommends serial testing for COVID with rapid antigen tests (as described on the CDC guidelines specific to covid page linked above). They recommend serial testing in part because the antigen tests are less effective at catching positives than they used to be.
posted by twelve cent archie at 1:53 PM on August 23 [7 favorites]
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posted by DMelanogaster at 7:38 AM on August 23