UW doctor’s advice for those with BA.5 testing positive for 10 days

If you were one of the many people to catch COVID in this summer’s BA.5 surge, you might have noticed the little positive sign on your antigen tests sticking around for a week or more — even if you were already feeling better.

Dr. Seth Cohen, medical director of Infection Prevention at UW Medicine, said it is not uncommon for people with subvariants of omicron to stay positive for a week-and-a-half or even longer.

“We know that about 50% of people will still be positive sometime between day five and day nine after infection,” he said. “And then there’s still [a portion of] people after day nine that will remain positive.”

For people who are symptomatic, days are counted after the onset of symptoms, with day zero being the day the first symptoms started to come on and day one being the first full day after symptoms began, regardless of when the person actually tested positive. In asymptomatic cases, day one is the first day the person tested positive.

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Those who are positive on day 10 or later are more likely to be unvaccinated people and those with severe symptoms, Cohen said, but this is not always the case.

If you are one of the unlucky ones still testing positive after nine days, Cohen cautioned that you should still assume you are contagious. Just because you might be feeling fine again does not mean you cannot infect someone else.

“Personally, I would be very concerned if I was still testing positive by day eight, day nine,” Cohen said. “So I would really want to limit contact, particularly around vulnerable people, older family members.”

The CDC’s latest guidance says symptomatic people with COVID-19 can come out of isolation after day five if they have not had a fever for at least 24 hours (without the use of fever-reducing medication) and if their symptoms are improving. However, Cohen said, if you are still positive after day five, you should try to stay in quarantine longer, if possible.

“While having a positive rapid test does not perfectly predict whether you’re infectious, I do think it makes sense to be very cautious if you still have a positive test, and probably take a few extra precautions — isolate, make sure you’re not transmitting to others,” he said.

The CDC’s guidance states that people coming out of isolation should still wear an N95-style mask between days five and 10, and should avoid being around people who are immuno-compromised or high-risk until at least day 11. In that time, if you test negative on two tests at least two days apart, the CDC says it is safe to remove your mask around others.

Cohen noted that contagiousness does tend to wane the longer the illness goes on.

“Most people are highly infectious early on in their infection, and that risk of infection really drops off after day six, day seven, day eight, day nine,” he said.

One silver lining to BA.5 is that it does appear to have a shorter incubation period — so even if it sticks around longer, it is likely to at least come on faster. This is crucial for stopping the spread of COVID, because if people know they are sick and potentially infectious sooner, then they know to quarantine.

“Particularly with BA.4 and BA.5, we are seeing a much shorter incubation period, which means that when someone is first exposed to the virus, it takes only a few days for them to turn positive,” Cohen said.

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