There is life beyond covid-19 for the great majority of people who have been infected by the coronavirus. But the escape from this pathogen is a journey fraught with uncertainties, starting with the most basic question: “Am I really over it?”
Such questions have vexed Ritchie Torres, 32, a New York City Council member from the Bronx. He has been through the full course of the disease, and his doctor has declared him recovered. He no longer has to self-quarantine and can assume he’s immune to further infection, his doctor said.
Yet Torres remained holed up in his apartment.
“When you’re possibly carrying a deadly virus, there’s no margin for error. So the safest thing to do is to assume the worst and stay home,” Torres said.
In the war against the coronavirus, recovery is an example of “the fog of war,” as Torres puts it. He’s not alone in feeling apprehensive and uncertain. Survivors don’t really know where they stand with the virus. Some may still be rattled, emotionally, psychologically, and can face stigmatization as they reenter what passes for society these days.
This is a new, still-enigmatic disease. Virologists have scrutinized the genome of the virus and found it sufficiently similar to the SARS coronavirus that caused a 2003 epidemic in China that they simply named it SARS-CoV-2. But this new virus behaves differently. For those who get infected, it’s less likely to result in death than its viral cousin. Yet it spreads far more efficiently, and often stealthily.
The incubation period lasts roughly five or six days on average, and a person can shed virus for a day or two before becoming symptomatic, epidemiologists believe. By the time an infected person feels sick and goes into isolation or treatment, the virus may have already laid hold of several other people.
The symptoms, which may include fever, fatigue, headaches, muscle aches, coughing and loss of smell, are caused by the body’s immune system trying to thwart the virus. Those symptoms don’t shut off automatically once the virus is largely obliterated. Whether and to what extent a person remains infectious after the symptoms are gone is unclear.
The Centers for Disease Control and Prevention has published guidelines for when a person who has been self-isolating at home with covid-19 can cease doing so. The guidelines feature two paths to recovery. One is when a person receives two negative covid-19 tests at least 24 hours apart. But as everyone knows by now, it has not always been easy to get even one test, much less two.
Thus, the CDC also embraces a second standard for discontinuing self-quarantine, which the agency dubs the “Time-since-illness-onset and time-since-recovery strategy”: A person can stop self-isolating if fever-free for three days without the use of fever-reducing medication, has seen “improvement” in respiratory symptoms such as cough and shortness of breath, and at least seven days have passed since the onset of symptoms.
The CDC guidelines include a footnote that reflects the uncertainties about the virus: “This recommendation will prevent most but may not prevent all instances of secondary spread. The risk of transmission after recovery, is likely substantially less than that during illness.”
The CDC has not published data for how it came up with its guidelines for patients, which echo the guidelines established for health-care workers who have contracted the virus and are needed back on the job.
The gold standard for determining if a patient is no longer infectious would be a cell culture, in which isolated virus would be placed in cells to see if it could still reproduce, said Andrew Noymer, an epidemiologist at the University of California at Irvine. But that’s highly labor-intensive and expensive, Noymer said.
“There is no way — zero way — we can do viral cell culture at wide scale,” he said.
That leaves, for now, polymerase chain reaction (PCR) tests, which are capable of detecting tiny traces of the coronavirus. They can be hair-trigger sensitive, however, Noymer notes. The presence of a minute scrap of coronavirus genetic material can register as a “positive” result even if the patient is no longer infectious. The presence of virus particles does not necessarily mean that the virus is still viable.
Amid these uncertainties, covid-19 patients may lack confidence they’ve left the coronavirus behind.
“People are sending mixed signals when you are allowed to leave quarantine,” said Noah, who tested positive for the coronavirus in early March. (Noah, who works in sales in New York City, spoke on the condition that his last name not be used because of stigma related to having the virus.)
When he came down with the illness, his chest tightened dramatically, forcing him to use his asthma inhaler for the first time in years. Early-morning chills were so severe he took hot showers at 4 a.m. Noah and his wife did not leave their apartment for 12 days.
Noah’s doctor said Noah could exit quarantine after 72 hours passed without symptoms. But the building managers where he lives requested that Noah receive additional tests to confirm he was virus-free. Noah has declined to ask for them, believing the limited supply of tests should go to other people.
“We’re basically inside for 23 hours a day,” he said. He leaves his apartment to exercise and complies with New York’s physical-distancing rules. He asked to donate his blood plasma at Mount Sinai Hospital but has not heard back. When he contacted medical professionals about opportunities to volunteer, their messages were clear, he said: “Just stay in my house.”
Julie Thaler, a 57-year-old kindergarten teacher, was part of the outbreak in New Rochelle, N.Y. Her illness started with a fever and chills March 7, and she did not feel better until March 20. She was taken to a hospital emergency room twice when she found herself gasping for air.
After being discharged, she was told by doctors to self-isolate for seven more days. On the eighth day, she put on a mask and gloves and went to the supermarket to buy food, intending to make dinner for her son. But then her son sent her an article about how some patients in China were still testing positive long after they had officially recovered. She abandoned the dinner plan and returned home.
Three days later, researchers called her to tell her she had antibodies to the coronavirus — but a nasal swab had come back positive for the virus. They told her she was probably still infectious.
“Every answer I get is: ‘This is all new and we’re still figuring it out.’ And that’s downright scary,” Thaler said.
Alison McGrath Howard, a D.C. clinical psychologist who tested positive for covid-19 in early March, no longer has a fever, and her respiratory symptoms have improved. The health department declared her recovered and said she no longer had to self-quarantine. But the management company where she lives has told her to disinfect everything she touches in the building if she leaves her apartment.
And she doesn’t feel 100 percent. She still has a bit of a cough and fatigue. Her doctor told her that her symptoms are probably post-viral and that she’s no longer contagious, but there’s no way to be completely sure.
“I don’t know whether I’m really not contagious, and I don’t know whether or not I’m immune,” she said.
SARS-CoV-2 could act like other coronaviruses that circulate in humans and cause colds. If so, a person who had the disease would probably be immune to catching it for a while. A year or two. One study of the original SARS coronavirus, which caused an epidemic when it emerged in China in 2003, showed that infected people had a full suite of antibodies to it for an average of two years but that afterward the antibodies declined.
That said, people who have had covid-19 might not experience as severe an illness the next time they get it, because of partial immunity. This remains conjectural. Science says: Stand by for further data.
Diana Berrent, a 45-year-old mother of two on Long Island, woke March 13 with a 102-degree fever and tremendous pressure on her chest. She tested positive for the coronavirus, but most of her symptoms cleared up after about three days, and she was never hospitalized. Her husband and kids ended up getting the virus, presumably from her, she says. They had milder cases.
Berrent said she has been given conflicting guidance on when it is safe to interact with others. One doctor told her he didn’t know. A county health worker told her 14 days from the date of her positive test, but then another person said she needed two negative tests at least 24 hours apart.
She asked how she could get those tests. She was told they weren’t available.
She saw that New York City had put out guidance that mimicked the CDC guidance. She decided the best course of action was to stay at home.
“I don’t feel comfortable being around anybody, to take a chance you could infect a single person,” Berrent said.
Last week, she started a group, called Survivor Corps, that she hopes can ease the burden on health-care workers.
“We could hold the hands of the dying without their loved ones, cheer on women in labor and, ultimately, we can go back to work,” she said.
Jadon Hartsuff, the rector at All Souls Episcopal Church in the District, is another recovered covid-19 patient who hopes to do something positive. After the terrorist attacks of Sept. 11, 2001, he quit his job and joined the Army, even though that required that he conceal his sexual orientation, he said. Now, he would like to volunteer for research studies, including the National COVID-19 Convalescent Plasma Project, but hasn’t gotten a response.
Hartsuff has a letter from the D.C. government affirming he has recovered from covid-19 and no longer has to self-isolate. Even after he got the letter, a health official called every day to “check in” and asked questions about his condition.
“I keep telling you the same thing over and over again! I’ve been asymptomatic for weeks!” Hartsuff would say. “Please use your time now for people who are sick!”
Eventually, they stopped calling.
Washington Post columnist David Von Drehle has written about his protracted battle with a covid-19-like illness (he was told by an emergency room doctor that he probably had it and to isolate himself but never got tested). Fully recovered, he was walking in his neighborhood one recent day when a woman in a car at an intersection, roughly 12 feet away, recognized him and engaged him in conversation. He took a step toward her. “Oh, don’t come any closer!” she said.
Says Von Drehle, “Once you get branded with the scarlet C, how do you ever get it off?”