COVID-19

COVID-19

Have a question about COVID-19? We will ask the experts.

Send questions to tribdem@tribdem.com.

Note: Due to the volume of questions submitted, we will not be able to answer them all. Any questions of an urgent nature should be directed immediately to your primary care physician.

Readers of The Tribune-Democrat asked the following questions:

“If I tested positive for COVID-19, can I retest later and test negative? I get different answers from different medical professionals. It seems like no one knows what they are talking about. A nurse this morning said that they have never had a second COVID test come back negative if the first test was positive – even if the first test was week ago. Does anyone know what they are talking about?”

The answer:

If you swab test (molecular Polymerase Chain Reaction – PCR) positive for COVID-19, can you retest negative later? The answer is yes.

However, sometimes the virus is persistent in detectable levels up to 12 weeks after infection, but likely isn’t infectious. For this reason, people previously diagnosed with symptomatic COVID-19 who have no symptoms after recovery shouldn’t undergo virus testing within three months after the date of symptom onset for the initial infection.

The cause of this persistence of detectable virus has yet to be determined, and one possibility is shedding non-infectious or dead virus particles.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I am 17 years old, and am being tested for COVID-19. If my test comes back positive, I will have no way to self-quarantine. 

“I live with my 60-year-old grandfather, who has had heart attacks and suffers from obesity, and my 62-year-old grandmother, who has asthma and COPD. I could go back to my mother’s, but my dad has high blood pressure, and my 5-year-old brother lives there. I considered going to one of my aunt’s, but aunt No. 1’s husband has a lot of medical complications, and aunt No. 2 lives in Arkansas, with a 2-year-old son and a husband who is recovering from cancer. My uncle is not an option as he is in Tennessee, and constantly moving. He is currently living in our RV for work reasons, and there is no way to quarantine myself from him there. 

“Are there places that people who test positive for COVID-19 can be sent? What if I’m a minor? Can my guardian give consent? How do I quarantine from my family in places where there is no way to quarantine?”

The answer:

I’m unaware of any designated COVID-19 quarantine facilities, and I recommend you contact the local health department for assistance and instructions. If you are a minor, I assume consent is required, but the health department would be able to answer that as well.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“On July 25, I was with friends at their home for a bonfire. On July 27, I woke up at home with a tickle in my throat. By July 28, I had a severe sore throat and nasal congestion, and by the 29th, I was very ill adding to my symptoms a persistent cough, body aches and fatigue.

“One of the friends I was with on the 25th called to tell me they tested positive with milder symptoms than I had. On the 29th, I got tested and by the 30th, my test came back negative. I have never experienced an illness like this before. Is it possible I had a false negative? Messaging with my doctor, he said it was possible, but not to bother getting retested because there’s no treatment for COVID-19. He said even though I tested negative, I should quarantine because I was in contact with someone who was positive. My symptoms aren’t as bad as they were, but I would like another opinion on getting retested.”

The answer:

A false negative is possible, or the incubation period was short. The mean incubation period for SARS-CoV-2 (COVID-19) is estimated to be five days, and you tested four days after exposure. Currently, a close contact is defined as being within 6 feet for 15 minutes or more, or being directly exposed to respiratory secretions (cough or sneeze). Close contacts of patients diagnosed with COVID-19 should be instructed to self-quarantine for 14 days from the date of their last contact with the patient.

I do not recommend a repeat swab test (molecular Polymerase Chain Reaction – PCR). I would consider a blood test for SARS-CoV-2 IgG in one to two weeks. If the blood test is positive, that means you were previously infected.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I have had COVID since July 4 and have had three positive test results, my last on July 30. I received my results Aug. 1 – positive. When can I go back to work? Am I still contagious?”

The answer:

In the updated coronavirus guidelines, the Centers for Disease Control and Prevention (CDC) and the Pennsylvania Department of Health made a shift to a symptom-based strategy, rather than a test-based strategy, in deciding when to stop isolation and resume normal activities. The updates are intended to prevent unnecessarily long isolation and excessive use of lab tests.

Sometimes the virus is persistent in detectable levels up to 12 weeks after infection, but likely isn’t infectious. The cause of this persistence of detectable virus has yet to be determined, and one possibility is shedding non-infectious or dead virus particles. For this reason, people previously diagnosed with symptomatic COVID-19 who don’t have symptoms after recovery shouldn’t undergo virus testing within three months after the date of symptom onset for the initial infection.

Most people can stop isolation 10 days after COVID-19 symptom onset and after a break in fever for at least 24 hours without the use of fever-reducing medications, and symptoms have improved. If you satisfy these criteria, you may return back to work in my opinion. I suggest you discuss the above with your employer’s human resources department. I also advise you to wear a mask and continue good hand washing hygiene.

 – Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My niece tested positive for COVID-19 and quarantined for two weeks. Her second test just came back positive. Her results came back in four days. Can you go to work if the second test is positive? I am arguing with her mother that she should quarantine for another two weeks. Will she give others the disease?”

The answer:

The latest recommendations from the CDC is:

A test-based strategy is no longer recommended to determine when to discontinue home isolation, except in certain circumstances.

Symptom-based criteria were modified as follows:

• Changed from “at least 72 hours” to “at least 24 hours” have passed since last fever without the use of fever-reducing medications.

• Changed from “improvement in respiratory symptoms” to “improvement in symptoms” to address expanding list of symptoms associated with COVID-19.

• For patients with severe illness, duration of isolation for up to 20 days after symptom onset may be warranted. Consider consultation with infection control experts.

• For persons who never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA.

You may want to check with your employer to determine if they are using the latest recommendations for returning to work. 

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My friend’s 12-year-old granddaughter tested positive for COVID. Her mother tested negative, but she was in contact with my daughter, who is 46 years old, who was in contact with my wife, who is 67. I am 72. What risk is there for my wife and me?”

The answer:

It is unlikely that you or your wife were exposed to SARS-CoV-2. From your question, you describe that the positive individual’s mother tested negative. If the positive individual is quarantining and the individuals in that home are practicing good hand washing, cleaning of high-touch surfaces, and wearing masks when in contact with others, then your daughter did not likely receive an infectious dose (adding to this that the mother was negative).

It is important to remind everyone that wearing a 3-ply cotton mask will protect you at about 65% effectivity. If the person you are interacting with wears a mask, they are also protected at about 65% effectivity. The combined effect is 85% protection. Mask wearing is truly our best defense against the spread of SARS-CoV-2, the virus that causes COVID-19.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I tested positive on July 16. Very mild case. Minor congestion in sinuses and chest with loss of smell. No fever. No other symptoms. I am one day out of quarantine and seem to be developing a cough. Should I see a doctor? Could I still be contagious?”

The answer:

It is always best to consult with a physician if you are concerned.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I tested positive yesterday for COVID after testing negative 11 days ago. I am asymptomatic so far. Is there any way to know how long ago I was exposed? How long would it take for a positive test to show up after exposure?”

The answer:

It is possible that you are in the pre-symptomatic phase of the infection based on your positive test result. If this is the case, you were likely exposed three or four days ago. 

Most adults who are infected will have a period of five to seven days where they are infectious but have no symptoms.

Within this time period, individuals are more likely to spread the infection in the 48 hours prior to symptoms starting. The virus will likely be detectable between three to seven days (three days after exposure to seven days after exposure). If you test too early, it may result in a false negative.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My kids’ father was exposed to the coronavirus. He was tested on June 23 and was confirmed positive from their he was quarantined and has been since the first of August. 

“He has been tested a second time due to not having any symptoms – through the nose with a swab – and the test still shows positive. His primary care provider said he is not infected anymore nor is he contagious. His doctor stated that since he was positive that he will show up positive for at least three to four months. I was wondering if this information is accurate, because I don’t want to expose our three children to him if there’s a chance he can infect them.”

The answer:

Once symptoms begin (dry cough, fever, loss of taste and smell, shortness of breath), most individuals will continue to have symptoms for 15 days. Studies show that the amount of virus in the body takes on a bell-shaped curve, with the highest amount of virus being, on average, seven days after symptoms begin. After that, the virus in the body begins to decrease. Most adults will be free of the virus, test negative by the genome test, by the 24th day. Some individuals will continue to shed non-infectious virus for weeks.

This is why the self-isolation is suggested to be 14 days. If you are exposed but do not develop symptoms within two weeks of exposure, you did not receive an infectious dose. 

Your body was able to handle to amount of virus you were exposed to. This is also why you are asked to remain in your home for 14 days after symptoms start. Most adults are not producing infectious virus after the 22nd day of the infection cycle. If this individual is still shedding virus, testing positive via the genome test, it is likely that he is non-infectious. However, if you are concerned, consult with your child’s pediatrician.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I was sick on July 4 and got tested July 16 and was positive for COVID-19. I got tested again Aug. 1 and I’m still positive but I have symptoms. How long would it take for me to test negative?”

The answer:

Some individuals will remain positive via the genome (PCR nasal swab) test for weeks after symptoms resolve. The CDC recommends that if it has been 10 days since symptoms started, you have been fever free for at least 24 hours, and your symptoms have improved, then you are likely not infectious.

I would recommend that you wear a mask and physically distance yourself from others when in public.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • • 

“I tested positive. I have been out of work for two weeks, but I still don’t feel good. My boss wants me to go back and she doesn’t want me to get tested. I think because she knows I’m still positive. She said she’s going to fire me if I don’t go back, but I can’t physically do it. I feel so sick and weak.”

The answer:

Repeat COVID-19 testing is not the answer for you.

I recommend you follow up with your primary care physician as soon as possible to determine why you’re feeling so sick and weak after two weeks. Additional diagnostic testing may be indicated.

I also advise you to discuss with your employer’s Human Resources Department if you qualify for a medical leave of absence under the Family and Medical Leave Act (FMLA).

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My daughter flew to Missouri from western Kansas for a teammate’s wedding. She was there from Thursday through Sunday. She stayed at another teammate’s house with her fiancé. Monday came and the teammate called – she had a fever, diarrhea and shortness of breathe. Her and her fiancé both got tested. The results came back and the fiancé tested positive, but a pregnant teammate tested negative. Long story short, my 25-year-old daughter went to the wedding. She came home and we live together – mother and daughter. Mother works at a 40-bed nursing home. Does mother quarantine?”

The answer:

Given that your daughter was likely exposed, she should self-isolate for 14 days. 

Have her use a separate bedroom and bathroom and you both should wear masks when in common areas of your home.

If your daughter develops symptoms, you should self-isolate as well. I also suggest that you speak to your workplace. 

Since you work at a nursing home, they may want to be abundantly cautious and have you self-isolate.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I tested positive for COVID-19 on July 9. I retested on the 26th and 29th of July. Both test results came out positive. Is this normal? How long before my body flushes COVID-19 out my system and I can test again and see negative test results? Although I’m 100% symptom-free, this is bothersome and worries me. My paid sick time from my employer is only good for 80 hours. I’m beyond that now. I won’t get paid.”

The answer:

The latest recommendations from the CDC is:

A test-based strategy is no longer recommended to determine when to discontinue home isolation, except in certain circumstances.

• Symptom-based criteria were modified as follows: Changed from “at least 72 hours” to “at least 24 hours” have passed since last fever without the use of fever-reducing medications; Changed from “improvement in respiratory symptoms” to “improvement in symptoms” to address expanding list of symptoms associated with COVID-19.

• For patients with severe illness, duration of isolation for up to 20 days after symptom onset may be warranted. Consider consultation with infection control experts.

• For persons who never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA.

You may want to check with your employer to determine if they are using the latest recommendations for returning to work.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I’m 67 years old. Should I be in contact with someone that tested positive three times in six weeks? She was tested every 14 days and still tested positive on the third test. Is she still contagious?”

The answer:

Recent changes in the quarantining procedures for individuals with COVID-19 from the CDC suggest that it may be OK to visit with your friend after 14 days if these conditions are met:

• The individual has been fever free from at least 24 hours without the use of fever-reducing medications and symptoms of COVID-19 have improved.

• If the individual had a severe case of COVID-19, it is reasonable to wait 20 days after symptom onset to visit.

• If the individual is symptomatic, actively coughing and has a fever, it is not recommended to visit with that person. 

If this is the case, they should be quarantining.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I got back from India on July 16 after going through five airports and being on four different planes. I have been on self-quarantined for 21 days. Do I need to get tested for COVID before I ask my husband to join me? My husband is 78 years old, highly diabetic and has heart disease. I want to make sure there is no risk for him.”

The answer:

The recent change in guidelines suggests that you can discontinue self-isolation. It has been 21 days since you may have been exposed. Given this time period, it is unlikely that you were infected with SARS-CoV-2. 

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I drove through to pick up my food. 

“Usually I wear a mask in doing so, but realized I forgot to stock back up in my car (disposal face masks). Well, when I pulled up, the girl had her mask under her chin. 

“It wasn’t covering anything. And she kept talking and talking as she was handing me my food. I quickly brushed her off, but now am worried – am I at risk of catching COVID if she’s an asymptotic carrier?”

The answer:

Just because you are exposed does not mean you will be infected. You must be exposed to more virus than your body can destroy, this is called an infectious dose. 

Infectious doses are likely to occur if you have been in close contact for greater than 15 minutes with a pre-symptomatic individual or a symptomatic individual.

Two variables need to be considered for your question.

1. Was the individual you interacted with pre-symptomatic?

2. Were you in contact, without a mask, long enough to get an infectious dose?

I applaud you for wearing your mask and respecting the virus. I suggest that you continue to do so. It is unlikely that you were in contact with this person long enough to get an infection dose.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My husband and I (age 73) live with our son and granddaughter. She was exposed to someone who tested positive for coronavirus. What should we do? She is 13 and showing no symptoms.”

The answer:

Your granddaughter should self-isolate, if possible, in the home. You can wear a mask when in common areas with her, wash your hands regularly and clean high touch surfaces.

After 14 days of self-isolation, if no symptoms have developed, your granddaughter can resume normal activities.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My family and I got exposed to the virus. My mom first started with symptoms on July 13, and then I was the last to get infected on July 20. Mom’s results came out positive that same day. For the first few days I had body aches and headaches, and a sore throat up to the eighth day. On July 30, I tested positive but my symptoms had been gone for six days. We have all been quarantine for about 20 days now. 

“I’m on my 15th day with five days of no symptoms. Am I still contagious?”

The answer:

If you feel that you had severe symptoms of COVID-19, it is recommended that you wait 20 days after symptoms begin to resume normal activities. Please wear a mask when in public after this quarantine.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“It’s been 22 days since my girlfriend tested positive and 28 days since the first symptoms. She tested positive again on the next two follow up tests. She has no symptoms for three weeks – only loss of smell is still present. Is she still contagious? Would kissing transmit COVID-19 to me?”

The answer:

Recent guideline changes suggest that if an individual is fever free for at least 24 hours and symptoms have improved, then they can resume normal activities. However, if your girlfriend is still feverish and symptomatic, then kissing would transmit the virus.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I tested positive on July 16. Very mild case. Minor congestion in sinuses and chest with loss of smell. No fever. No other symptoms. I am one day out of quarantine and seem to be developing a cough. Should I see a doctor? Could I still be contagious?”

The answer:

It is always best to consult with a physician if you are concerned.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“The governor and the good doctor seem to mention only “new” (as in additional, not current) cases. Considering the four-plus months since all this started, are the numbers really alarming? 

“Doesn’t the flu affect more people more often? The inconsistent data from state to state, and even within Pennsylvania, makes it all hard to understand.”

The answer:

According to Stedman’s Medical Dictionary, statistics is the science and art of collecting, summarizing and analyzing data that are subject to random variation. 

Interpretation involves drawing inferences and formulating or bringing out the meaning of the collected data. Interpretations and opinions change over time based on new information and data that were not previously known. That is certainly true about new diseases and in particular, the novel coronavirus, SARS-CoV-2 (COVID-19). My own opinion has changed from January, when there were only five cases of the new coronavirus confirmed in the United States, and the new virus was linked to 106 deaths in Wuhan, China. 

Little was known then about the new coronavirus SARS-CoV-2.

At that same time Influenza (the “flu”) had already caused about 8,200 deaths and 140,000 hospitalizations according to the Centers for Disease Control and Prevention (CDC).

Since January, a COVID-19 pandemic was declared. According to the latest surveillance data posted on the CDC website on Aug. 1, there were 4,542,579 total cases in the U.S. (68,605 new cases since July 31) and 152,870 total deaths (1,371 new deaths since July 31). The above statistics are only six months into the pandemic, and the deaths are expected to rise.

Preliminary CDC estimates (cdc flu statistics) of the 2019-2020 U.S. Flu Season from Oct. 1 through April 4, there have been:

• 39,000,000 – 56,000,000 flu illnesses;

• 410,000 – 740,000 flu hospitalizations; and

• 24,000 – 62,000 flu deaths.

The week of April 4 was the last week in-season Influenza estimates will be provided for the 2019-20 season. Because influenza surveillance does not capture all cases of flu that occur in the U.S., the CDC provides these estimated ranges to better reflect the larger burden of influenza.

In my opinion, the numbers are alarming for both COVID-19 and Influenza. In six months, COVID-19 has caused significantly more deaths than the flu in the United States – and more than anyone predicted.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • • 

“My granddaughter is 14 and spent a week in Florida with her sports team. How long should she quarantine coming home?”

The answer:

The recommended time for self-isolation after traveling to a COVID-19 “hot spot” is 14 days. If symptoms are present during that time, monitor them for severity and seek medical treatment if needed.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I work in a mental health hospital. My first test was in May and they could not find my results. I was assured my test was negative because they said no one had positive results from our institution. 

I had another mandatory test July 15. I never received a call positive or negative. 

On July 23, I had a fever of 101.5 and they sent me home from work. I had a bit of an upset stomach. Felt fine and went to work on July 27. I had no fever and they let me work. After being there for six hours, I was told I have to leave. My doctor will not give me a test because I have no symptoms. The state does not want to waste a test on me either. Trying desperately to find a testing site so I can return to work, I finally called for the test results myself from the July test – all of my testing was done by the National Guard. 

“The person I spoke with said they can not find any record of me being tested in July. They did find my May results, which were negative. I do not have a fever or symptoms. I feel fine. I am being kept home. My question is, does my husband need to disclose any of this information to his employer?”

The answer:

A difficult question.

You do not have a confirmed positive test result, but you had an unexplained fever of 101.5 on July 23. Health care personnel with community exposures should be excluded from work and self-quarantine for 14 days following the last date of exposure. I recommend you contact the medical director at the mental health hospital where you are employed for instructions regarding when you may return back to work. The medical director will decide whether to notify the Department of Health.

In my opinion, the most responsible action for your husband is to inform his employer even though you do not have a confirmed positive test result. That would be good citizenship.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber. 

• • • • •

“We are a mature couple, getting married on Sept. 6. The wedding will be virtual, except our children will be in attendance. The wedding will take place in New York. There are seven in our family who will be at the wedding – two live together in Pennsylvania and social distance and wear masks; two live in Colorado, social distance as best as possible (one goes to work, one works from home) wear masks in public as well; one is in “our” cohort of three, and the two others live in different apartments and also adhere to social distancing and wear masks. Everyone has agreed to step up the social distancing, stay home more for the two weeks prior to the wedding.

“My daughter and son-in-law will be traveling from Colorado. So far, there is no quarantine requirement from Colorado to New York. We have a few scenarios that we are exploring to safely get the couple to New York and have them tested (we are all getting tested) to make sure that none of us has the virus so we can safely take photos and not be afraid of each other on wedding day. All of these scenarios depend on the time of possible exposure to the time of testing.

“If the kids fly on a plane, and there is someone traveling on the same flight who has the virus, how many days should we wait before a swab to determine if they picked anything up? (We will assume exposure and test them.) If the kids are social distancing in Colorado, test the day before they leave, then drive to New York state, and we test them when they arrive, and they have not been exposed to anyone who is positive, and their tests are both negative, will they still need to quarantine? If they drive to New York two weeks before the wedding, test before they leave Colorado, test again when they arrive in New York, and both tests are negative, will we still need to worry about being together at the wedding?

“Since my son-in-law works and cannot be socially distant and take off the two weeks, he may not come, but if we know that we can test, and get a turnaround results within a few days, then that would alleviate some of the anxiety around logistics and allow us to be together as a loving family.

“What do you recommend we do without the luxury of total quarantine/isolation?”

The answer:

There are a few things that can help you decide on your safety plan for the wedding.

Just because you are exposed does not mean you will be infected. You must be exposed to more virus than your body can destroy, this is called an infectious dose. 

Infectious doses are likely to occur if you have been in close contact for greater than 15 minutes with a pre-symptomatic individual or a symptomatic individual (such as on a plane). Wearing a triple-ply cotton mask is going to protect you from about 65% of the virus. If the other individual is wearing a triple-ply cotton mask protecting them at 65%, the combined protection of both masks is about 85%. 

This is the best method we have to reduce spread of SARS-CoV-2, the virus that causes COVID-19

To your question about testing, most adults who are infected will have a period of five to seven days where they are infectious but have no symptoms. Within this time period, individuals are more likely to spread the infection in the 48 hours prior to symptoms starting. If you feel you have been exposed to SARS-CoV-2, it is best to get tested around day 3 after exposure. 

The virus will likely be detectable between the third and seventh day. If you test too early, it may result in a false negative. Some individuals will be in this phase for 14 days.

If they drive to New York two weeks before the wedding, self-isolate, and show no symptoms, then it is highly likely that they do not have COVID-19.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My husband was in jail, had a fever for about two days and lost his sense of smell and taste. He got out on July 17. I took him to get tested that day, and he came out positive. His sense of smell and taste came back the following week and he has had no symptoms since then. I took him July 27 to test again, and he came back positive again. I tested July 24, and I was negative. Is he still contagious? Could he not have the virus and still test positive?”

The answer:

A test-based strategy is no longer recommended (except for rare situations) because, in the majority of cases, it results in prolonged isolation of patients who continue to shed detectable SARS-CoV-2 RNA (sometimes up to 12 weeks after infection) but are no longer infectious.

The CDC updated coronavirus guidelines for discontinuing isolation include at least 10 days have passed since symptoms first appeared and at least 24 hours have passed since last fever without the use of fever-reducing medications, and symptoms have improved.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“Can a person test positive for COVID-19 for the rest of their life?”

The answer:

Antibodies that are produced by the adaptive immune response can last for years. These levels can be tested in what is called a titer check.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • • 

“My 23-year-old daughter tested positive for coronavirus two weeks ago. My husband’s employer sent him home from work and says he cannot return to work until he provides two negative test results for my daughter and then one negative for my husband, myself and my 24-year-old son. My question is, are they able to require all of us to test and send our medical records? Also, are we required to pay for all five tests, or should they pay for them?

The answer:

You didn’t mention if your daughter and son live with you and are household contacts.

In the updated coronavirus guidelines, the Centers for Disease Control and Prevention (CDC) made a shift to a symptom-based strategy, rather than a test-based strategy, in deciding when to stop isolation and resume normal activities. The updates are intended to prevent unnecessarily long isolation and excessive use of lab tests. Most people can stop isolation 10 days after COVID-19 symptoms onset and at least 24 hours have passed since last fever without the use of fever-reducing medications, and symptoms have improved. I suggest you discuss the updated CDC guidelines with your husband’s employer.

Persons who test positive are considered infectious 48 hours before the onset of symptoms. Close contacts of patients diagnosed with COVID-19 should be instructed to self-quarantine for 14 days from the date of their last contact with the patient. For household contacts, this will be 14 days from the date the person with COVID-19 is released from isolation.

Regarding protection and release of your medical information, I refer you to Health Information Privacy | HHS.gov (The Health Insurance Portability and Accountability Act – HIPPA)

Concerning payment for COVID-19 testing, I recommend you contact your insurance company.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My company requested me to have a test for COVID-19 without symptoms and I got a positive result, but my doctor told me you can go back to work after 10 days and gave me a note to show to my company, but my company doesn’t accept it. 

“What should I do?”

The answer:

The CDC’s new recommendations on returning to work are:

• A test-based strategy is no longer recommended to determine when to discontinue home isolation, except in certain circumstances.

• Symptom-based criteria were modified as follows: Changed from “at least 72 hours” to “at least 24 hours” have passed since last fever without the use of fever-reducing medications; changed from “improvement in respiratory symptoms” to “improvement in symptoms” to address expanding list of symptoms associated with COVID-19.

• For patients with severe illness, duration of isolation for up to 20 days after symptom onset may be warranted. Consider consultation with infection control experts.

• For persons who never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA.

I would recommend that you reach out to your employer and see if they are aware of these changes. They were made on July 20.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I tested positive for COVID-19 with no symptoms. Everyone in my family who has been around me tested negative; we all got tested at the same time. I’m positive and they’re all negative. How?”

The answer:

SARS-CoV-2 is highly infectious, however some individuals do not shed as much virus. Shedding is related to the symptoms a person has. If you are experiencing severe respiratory symptoms, it is likely that you will shed more virus. If you have milder symptoms and are practice the recommended guidelines, then you reduce your risk of spread the virus to your family.

Since you were positive, I suggest that you self-isolate and follow the recommended guidelines (face mask, hand hygiene, separate bedroom and bathroom).

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My son had the virus but has now fully recovered. It’s been almost a month, yet he still keeps testing positive – four times already. How long is this going to go on? When will he finally test negative and when can we see him again? He is 28 years old. This is very frightening and heart rending.

“Also would like to know if there will be any permanent side effects after he recovers. I’ve been hearing horror stories about bad side effects that can kill you even after you recover, or shorten your life. I’m scared for him.”

The answer:

You report that your son is now fully recovered, and I suspect his prognosis will be good. Sometimes the virus is persistent in detectable levels up to 12 weeks after infection, but likely isn’t infectious. 

For this reason, people previously diagnosed with symptomatic COVID-19 who are asymptomatic after recovery shouldn’t undergo virus testing within three months after the date of symptom onset for the initial infection.

In the updated coronavirus guidelines, the CDC made a shift to a symptom-based strategy, rather than a test-based, in deciding when to stop isolation and resume normal activities. The updates are intended to prevent unnecessarily long isolation and excessive use of lab tests. 

Most people can stop isolation 10 days after COVID-19 symptom onset.

It’s been almost a month for your son. If he has no fever, you may see him. I recommend you and your son wear a face mask and follow other routine safety precautions including good hand washing hygiene.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My daughter’s boyfriend just tested positive for COVID-19. He is asymptomatic. I have had no direct contact with him, but my daughter lives in an apartment with my wife and I and our youngest daughter. Do I need to quarantine for 14 days? Or can I go to work?”

The answer:

Your daughter should self-isolate for 14 days and monitor her health for symptoms of COVID-19. If possible, she needs to use a separate bedroom and bathroom in your home. All should wear face coverings in your home while in common spaces.

If your daughter develops symptoms of COVID-19, you will need to self-isolate for 14 days and follow the recommended guidelines for quarantine.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My brother-in-law is traveling from the hard-hit state of Texas. He has continued working and interacting with people all over, without a mask on and with no social distancing. He is going to be staying in our home (I live with my parents and sister), despite my numerous objections that it is not safe. He is not going to be here long enough to self-isolate to ensure he is not infected. How can I protect myself? Do I just leave and go stay in a hotel for the next month?”

The answer:

Conversations with family regarding COVID-19 can be difficult. When talking with a family member who is not following safety guidance, you can try to appeal to the personal aspect of the situation. Talking statistics and scientific research is likely not going to help in this situation.

In your case, you could speak to your brother-in-law about your concern for your aging parents. Try your best to remain calm. Sharing your fears and concerns may help him see that he doesn’t have to follow guidance for him, but for them. Keep in mind that you may not be able to change his mind and know when to quit.

If the caviler attitude toward the virus continues, you can:

• wear a mask when in common spaces

• physically distance yourself

• wash your hands regularly

• disinfect high-touch surfaces

If he shows signs and symptoms of COVID-19, have him quarantine away from the family.

Good luck, I know from personal experience these conversations are difficult.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“Is it possible for two persons who sleep together and use the same utensils to get positive and negative results for COVID-19? My cousin and I live together. We already quarantined for 14 days, and after we got swab tests, the results were different. I’m positive (always stay inside of our house) while my cousin is negative (she was exposed outside). And I also don’t feel any symptoms.”

The answer:

Many things are factored into the answer to this question, arguably the most important factor in this answer is human behavior. If your cousin followed public health guidelines of frequent hand-washing, wearing a mask when in common areas, and frequent disinfection of high-touch surfaces, this could explain why your cousin did not contract the virus.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I have an acquaintance who recently tested positive for COVID-19. He is saying that he doesn’t believe he really has COVID-19 because of a high number of false positive test results. I am not sure what type of test he had done. I am also not sure if he is referencing local testing or concerns from another region.

Others have stated that they know of local hospital staff who are also expressing concerns about the number of false positives. Can you please comment on this? I would hate to think that people who test positive aren’t taking appropriate precautions due to a concern about false positive test results. Nor would I like to think that the number of reported COVID-19 cases are erroneously inflated, especially since so many decisions are based on the rates of COVID-19 in a particular area and/or state.

The answer:

I don’t know which test, what area or region, and which local hospital staff he is referencing. In my experience and in this region, a positive swab test (molecular Polymerase Chain Reaction – PCR) and a positive blood antibody test (SARS-CoV-2 IgG) are both highly accurate.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I went to my first test June 20. The test came back positive for COVID-19. I took a retest July 7, came back still positive; took another test July 17, still positive. Is it possible to test positive that long, or is there a chance I could have a messed up test?”

The answer:

This is why a test-based strategy is no longer recommended, because in the majority of cases, it results in prolonged isolation of patients who continue to shed detectable SARS-CoV-2 RNA (sometimes up to 12 weeks after infection) but are no longer infectious. Therefore, a symptom-based strategy is recommended for discontinuing isolation precautions. The CDC updated guidelines on coronavirus isolation and testing are intended to prevent unnecessarily long isolation and excessive use of lab tests.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My husband and I both recently tested positive for COVID-19, but our children (11 and 9) tested negative. While we are trying to keep our distance from each other, it is difficult to do while living in the same house. What is the CDC’s advice for this with regard to quarantine duration and retesting for all of us?”

The answer:

The CDC recently updated coronavirus guidelines on isolation and testing. Most people can stop isolation 10 days after COVID-19 symptom onset, and at least 24 hours have passed since the last fever without the use of fever-reducing medications, and symptoms have improved.

The updates are intended to prevent unnecessarily long isolation and excessive use of lab tests. A test-based strategy is no longer recommended, because in the majority of cases, it results in prolonged isolation of patients who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My daughter was on a road trip and away from home for 11 days. On her way home, she found out someone she was in contact with tested positive. My daughter got tested and was also positive. She has no symptoms. She lives at home with us but we have had no contact with her since she got home. She has stayed in the basement in her own room and her own bathroom. So we haven’t been within 6 feet from her since she got home. I leave her food outside her door always with a mask on and she is eating off of paper products. Does the rest of the family living at home need to self-isolate for 14 days?”

The answer:

Yes, 14 days of quarantine is recommended. For household contacts, this will be 14 days from the date the person with COVID-19 is released from isolation.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“If someone tests positive twice and then the third test is negative are they no longer contagious at that point?”

The answer:

It is recommended that any individual who has tested positive remain isolated for two weeks or until

10 days since symptoms began, you have been fever free without the use of medication for 24 hours, and symptoms have improved.

If you are concerned about your ability to infect others, please wear a mask in public, wash your hands frequently, and consult with your primary care provider.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“On June 2, tested positive. On June 16, did drive-through testing site where you do self-swab. Test results back on July 22 saying negative. Also on June 16, directly after leaving drive-up testing site, I went to federal site where they do swab and got positive test result back on June 18. Then had to go to ER on morning of June 18 for shortness of breath, burning sensation on back. Another COVID test was done. Was admitted to hospital on this day due to blood clot being found in lower lobe of right lung and test results came back as negative on July 19. On July 20, upon discharge from hospital, was given another COVID test, which on July 21 came back positive. What is going on?”

The answer:

While molecular swab testing (Polymerase Chain Reaction – PCR) detects whether someone has the virus, blood antibody testing is an important next step to tell if someone has been previously infected. Therefore, I would consider a blood antibody test for SARS-CoV-2 IgG, and if positive, identifies that the person has had the novel coronavirus (COVID-19).

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“Because a coworker came back with COVID 19, I did a test and came back positive on June 24. I hadn’t had any symptoms. On July 10, I did a retest and came back positive. I did another retest on July 25 and it still is positive. I am feeling great, during all these 31 days, I didn’t develop any symptoms. Do I need to see my doctor for future tests?”

The answer:

Recent guidelines from the CDC state that if it has been 10 days since symptoms began, you have been fever-free for at least 24 hours, and there is improvement in your symptoms (you say you feel great), then you can return to work.

Given that you are still testing positive, I strongly recommend that you wear a mask when around others. SARS-CoV-2 affects individuals differently and some can continue to shed infectious virus for 21 days or more after symptoms resolve.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I am 39 and my wife is 27. I got a mild fever on July 22 and tested COVID positive on July 25. I am in isolation from the date of getting a fever. My wife got a fever on July 25. We have beautiful 3-year-old baby girl and she is with her mother in a separate room. Now, could we start to stay together or better to stay isolated? Please advise us. We are in great dilemma. I have no fever or other symptoms of coronavirus since July 23.”

The answer:

For you:

The updated symptom-based strategy for discontinuing isolation include at least 10 days have passed since symptoms first appeared and at least 24 hours have passed since last fever without the use of fever-reducing medications, and symptoms have improved.

Your wife and daughter:

Close contacts of patients diagnosed with COVID-19 should be instructed to self-quarantine for 14 days. For household contacts, this will be 14 days from the date the person with COVID-19 is released from isolation. If a close contact develops symptoms during those 14 days, they could be swab tested (molecular Polymerase Chain Reaction – PCR) for COVID-19, or they may be advised to self-isolate at home. For further instructions regarding your daughter, please consult her pediatrician.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I tested for COVID on June 30, and results came out positive on July 2. I did have mild symptoms and self-isolated for 14 days. I retested on July 21, and came out positive again on July 25 and I have no symptoms. How does that happen? And am I contagious around my 1-year-old son, who is negative?”

The answer:

Some research is showing individuals can be contagious (shedding infectious virus) for 21 days. Recent guidelines from the CDC suggest that if it has been 10 days since your symptoms started and you have not had a fever within 24 hours, you may not be contagious.

In some case, individuals will shed noninfectious virus for weeks after symptoms resolve.

If you are questioning whether or not to be around your family, consult with your pediatrician and discuss any possible underlying conditions your son may have.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My husband tested negative. My results came back positive. Do I need to continue testing? Why did he not catch the virus?”

The answer:

SARS-CoV-2 affects each of us differently. Some individuals have mild cases and other have severe cases. It is possible that you are shedding low amounts of virus.

Since you have a positive test result it is suggested that you self-isolate, remain physically distance, wash your hands regularly, use a separate bathroom and bedroom, and wear a mask when in common areas.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My girlfriend was tested on July 2 and I tested on July 3 and we both were positive. We had symptoms for about a week then we were OK. I went to get tested again on July 15 and the results came back negative. My girlfriend tested again on July 23 and her test came back positive. She’s showed no symptoms at all for two weeks. How can her test come back positive and mine came back negative? We’re around each other all day. What do we do going forward?”

The answer:

Most people can stop isolation at least 10 days after COVID-19 symptom onset and at least 24 hours have passed since last fever with-out the use of fever-reducing medications, and symptoms have improved.

A test-based strategy is no longer recommended (except for rare situations) because, in the majority of cases, it results in prolonged isolation of patients who continue to shed detectable SARS-CoV-2 (COVID-19) RNA, sometimes up to 12 weeks after infection, but are no longer infectious.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My niece, whom we are supposed to go on vacation with, along with her family, were all tested with a molecular test last Monday. Five days later, results were negative for everyone but positive for her. She went to a clinic for a rapid (antigen) test Friday, and that came back negative. Also negative from another rapid test. She is 16, has no symptoms, nor does the rest of her family. How likely is it that the PCR test was a false positive? Please answer soon, our vacation will either be canceled or we will all be exposed.”

The answer:

The PCR tests are highly specific and are less likely to have false positive results. The rapid antigen tests have about 80% reliability (they are more likely to give false negative results). If your family member is symptom free for 10 days before the vacation, it is less likely that she will spread the virus to you.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My husband has been in Indiana for three weeks. He is driving back here to Oregon. Does he need to self-quarantine? He is 70 years old. I am 68. He did not have contact with anyone with COVID, as best he knows, and was mask wearing and social distancing while in Indiana though he says not everyone else was doing so.

The answer:

If your husband does not have any symptoms, I do not recommend he self-quarantine.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My child is with her dad for the summer in another state. He tested positive for COVID-19. He first had symptoms on July 7 and just now found out he had it. My daughter was to come back home this weekend. If she tests negative, does she still need to quarantine for 14 days with her dad? What should I do when she comes home? Should I self-quarantine her for another two weeks?”

The answer:

While science is still learning about COVID-19 disease and SARS-CoV-2 in children, it seems (from the research thus far) that children ages 5-13 are the least likely to have severe disease.

Those same research papers suggest that children in this age group develop symptoms earlier (as early as twp days in some cases). However, since your daughter was exposed and tested negative, she could do one of the following:

Non-testing option:

• At least 10 days have passed since symptoms first appeared, and

• At least 24 hours have passed since last fever without the use of fever-reducing medications, and

• Symptoms (e.g., cough, shortness of breath) have improved.

Testing option:

• Two negative tests greater than 24 hours apart.

Some states are requesting a 14 day self-isolation upon returning from travel to certain areas. If your daughter is returning from a “hot spot,” she may need to self-isolate anyway.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I started having mild symptoms seven to 10 days ago – mostly headache and sore throat initially, then developed slight fever – 99.6 was my high for one to two days. Developed mild cough with small mucus production. Tested positive yesterday. Currently, no fever. I am a caregiver for elderly parents who live with us and my husband works. No one else is sick. Should they also be tested and should my husband quarantine himself also? Does it make sense to quarantine myself from my parents since I have been exposed to them for so long already?”

The answer:

Close contacts of patients diagnosed with COVID-19 should be instructed to self-quarantine for 14 days. For household contacts, this will be 14 days from the date the person with COVID-19 is released from isolation.

If a close contact develops symptoms during those 14 days, they could be swab tested for COVID-19 (molecular Polymerase Chain Reaction – PCR), or they may be advised to self-isolate at home.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“If a fitness instructor has tested positive for COVID-19, are they obligated to tell members or merely stay quarantined for two weeks until they return?”

The answer:

Contact tracing is occurring at the state level. No one is legally obligated to tell another person about their health status. If you feel that you were exposed to a COVID-19 positive individual, I urge you to self-isolate and monitor yourself for symptoms.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“A 5-year-old child came out positive for COVID-19. Does the child need to be checked again after the 14 days?”

The answer:

Repeat testing is not recommended.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My pregnant wife and I have come in contact with someone who tested positive for COVID-19. She was tested two weeks ago, but the test came back positive. We were with her 14 days after her test. Should we be concerned? Do we need to be tested? Should we now quarantine for 14 days?

The answer:

Since your contact with the COVID-19 person was 14 days after her test, the COVID-19 person likely wasn’t infectious then. If you, your wife and the COVID-19 person were all wearing masks, and if you and your wife have no symptoms or fever, then I do not advise testing, and I do not advise quarantine. I do recommend that your pregnant wife inform her obstetrician of the exposure.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I been positive with COVID-19. I lost my sense of taste and smell and had a light sore throat. I’ve had 14 days of quarantine. My employer said since I’m fever free, I can now go back to work after quarantine, because I’m no longer contagious even though I’m still positive. Is this right? Should I wait for my sense of smell and taste before I go back? I just want to be safe for myself and everybody.”

The answer:

According to CDC updates, most people can stop isolation 10 days after COVID-19 symptoms onset, and at least 24 hours have passed since last fever without the use of fever-reducing medications and symptoms have improved. The updated guidelines don’t say, “until all symptoms have resolved.”

A test-based strategy is no longer recommended because, in the majority of cases, it results in prolonged isolation of patients who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious.

A study involving COVID-19 patients with alteration in smell and taste symptoms reported that nearly half had complete resolution of these symptoms by four weeks, while 40% noted improvement in symptom severity. However, 10% described symptoms that were unchanged or worse.

In my opinion, you may resume normal activities and return back to work. I do recommend that you continue to wear a face mask and follow CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“Today, I had a co-worker who coughed directly at me. I don’t know if it was intentionally. She has had a dry cough for months and coughs with her mouth wide open. I did have a mask on while she did not. We were not 6 feet apart. Should I be worried? My employer says it’s mandatory to wear a mask, but some employees still don’t.”

The answer:

You were wearing a mask. Since your co-worker has had a dry cough for months, it’s unlikely that she’s contagious. However, she should be wearing a face mask.

If you don’t develop any symptoms, I do not recommend testing. You should inform your employer that not all the employees are following the face mask mandate.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I was sick with COVID-19 symptoms and fell in the shower. I went to the hospital July 14 and stayed in the hospital for a day and they tested for COVID. I received a positive result on July 18. My husband tested July 15 and got a positive result on July 25. When can I go back to work? Have not had symptoms for more than two weeks. Employer just says stay out 14 days from date of your test. So I don’t need to retest and be negative before returning? I had some very bad symptoms and still feel foggy headed and tired.”

The answer:

If you are still symptomatic you should be self-isolating. Symptomatic individuals are able to pass the virus onto other individuals as it is spread by airborne droplets.

There are two strategies in place for returning to work. The first is that it has been 10 days since symptoms have begun, you are fever free without the use of fever-reducing medications, and your symptoms have significantly improved.

The other is that you have had two negative tests greater than 24 hours apart. It seems from your question that you are still symptomatic. I urge you to consult with your primary care provider and to self-isolate until your symptoms improve.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I have a patient whose boyfriend had his last COVID fever on July 15. She was with him one week after his last fever symptom. She came into my office today – July 29. Can she be contagious?”

The answer:

If she was with him 10 days after his COVID-19 symptom onset, she likely isn’t infectious. She and you should have been wearing face masks on July 29.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“After visiting my uncle in Missouri, we found out nine days after we left that he possibly could have COVID-19. We have not seen him in 12 days now and he said symptoms started a few days ago. Should I quarantine? I am the director of a child-care center and I have been at work since our trip. I and the people I traveled with do not have any symptoms. The test has not come back for him yet.”

The answer:

Individuals are able to transmit SARS-CoV-2, the virus that causes COVID-19, in the 48 hours prior to symptoms beginning throughout the time they are symptomatic. Some scientific research also states that individuals can shed infectious virus that is able to make someone sick, up to two weeks after symptoms resolve.

From your question it is difficult to determine a timeline for your uncle.

However, it is likely that if you were exposed and became infected your symptoms would have presented within 14 days of exposure.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I might have been exposed to someone with coronavirus last night. I was going to get tested today until I found out I could have been exposed last night. So now I’m waiting for symptoms. But my question is: I live with my grandfather, and what can I do to make sure he doesn’t get COVID?”

The answer:

If you feel you have been exposed to SARS-CoV-2 (the virus that causes COVID-19) or if you develop symptoms of COVID-19, it is important that you self-isolate.

If possible, use a separate bathroom and bedroom. Wear a mask when in common spaces and have your family members wear a mask also.

Clean frequently touched surfaces, such as door knobs and light switches. Do your best to remain physically distant from the other person.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

 

“Both of my sons got tested on July 20, one got a negative result back and the other has still not gotten results. They were tested at the same time at their pediatrician’s office and then tests were sent to a lab. Should I be concerned?

The answer:

Some sites are experiencing testing delays. If you had your children tested because they were exposed, it is prudent to continue with the self-isolation until at least 10 days with no symptoms or a negative test result is returned.

Some research is showing children ages 5-13 develop symptoms within two days, other children take 10 days for symptoms to show. Follow up with your son’s pediatrician if your child is symptomatic or you have other questions.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I just got exposed to a person who was positive for COVID-19. If I go get tested today, will the result show or is it too early to know the result?”

The answer:

Persons who test positive are considered infectious 48 hours before the onset of symptoms. 

Persons testing positive, but who do not have symptoms, are considered infectious starting two days before the test date. The median incubation time is approximately five days.

If you were in close contact, and if you and the person who tested positive were not wearing a mask, I recommend you get a swab test (molecular Polymerase Chain Reaction – PCR). I also advise you to self-isolate at home pending test results and follow CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I tested positive along with my seven family members seven days ago. After completing the eighth day, we don’t have any symptoms and we are home quarantined. Are we safe now?”

The answer:

Recent guidance from the CDC regarding when you can be around others after COVID-19 suggests that if:

• you have been fever free for 24 hours without the use of a fever reducing medication,

• your symptoms have improved,

• or it has been 10 days since your symptoms have begun,

• or you have had two negatives tests greater than 24 hours apart.

Keep in mind that someone with symptoms, even mild ones, can spread the virus.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My friend is going to Florida for a week and we live in Kansas. When he gets back does he need to quarantine for two weeks?”

The answer:

The Pennsylvania Department of Health posted on July 2:

If you travel to the following states, you will need to quarantine for 14 days upon return: Alabama, Arizona, Arkansas, California, Florida, Georgia, Idaho, Louisiana, Mississippi, Nevada, North Carolina, South Carolina, Tennessee, Texas and Utah.

More information: https://bit.ly/2YQNLvg

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I just found out that a young man who is a friend of my son tested positive. We were together on the 10th of the month. I have not seen him since. Tomorrow is 14 days. Should I isolate myself? I am getting tested (nasal).”

The answer:

CDC guidance states that if you have had contact with an individual with COVID-19 you should self-isolate for 14 days.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I tested positive for COVID on July 17, but symptoms started July 13. My daughter is having a baby soon. My symptoms have greatly improved and I never had a fever or cough – only loss of taste and smell with congestion. Will I be safe to see my grandbaby?”

The answer:

COVID-19 can present itself differently in each infected individual. Some may experience a mild illness and some may experience a severe illness (and anything in between).

Scientific studies show that SARS-CoV-2 is more severe in the very young, the elderly and those with underlying conditions.

It is strongly recommended that anyone with symptoms of COVID-19 (even minor ones) quarantine until 14 days after symptoms resolve.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I am 71 years old and have asthma. My son asked me to drive him to be tested for COVID. Is it safe for me to do so?”

The answer:

Asthma is considered a risk factor for developing severe COVID-19 disease. Being in close contact with someone for 15 minutes or more even while wearing a mask increases your risk of exposure.

It may be prudent for your son to ask someone else to take him.

If that isn’t possible, seek guidance from your physician.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My husband tested positive for COVID-19. He was hospitalized for a week and was discharged to home quarantine and had to be isolated after two weeks. He got retested on swab, which came back negative – but his blood antibody came back positive. So is he still contagious or does he still have the virus?”

The answer:

Your husband is not contagious, and the positive antibody test means that your husband was previously infected.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My 13-year-old daughter tested positive for COVID-19 on June 24. She was asymptomatic and nobody around had the virus, so we have no idea how she could have been exposed. She continued to be asymptomatic and on July 14. We retested for COVID and also for antibodies. Both of those tests came out negative. Is it possible that her first COVID test was a false positive? Was the antibody test a false negative?”

The answer:

Based on the history you provided and assuming that the antibody test was SARS-CoV-2 IgG, there are two possibilities. Either the first test was a “false” positive, or the antibody test is a “false” negative. What’s not clear to me is why your daughter was tested on June 24 when she had no symptoms, and she wasn’t exposed to anyone with the virus?

Your daughter could be retested with a blood antibody for SARS-CoV-2 IgG in two weeks, but is probably not necessary. If a repeat blood SARS-CoV-2 IgG antibody test is positive, that is consistent with previous infection.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I took a shingles vaccination four days before a SARS-CoV-2, PCR test resulting in a positive for the virus. Could the shingles shot, which caused severe shoulder discomfort for several days, cause a false positive COVID-19 test? I am 79 and in good health with current temperatures in the 96-97.5 range – normal for me. I have no other symptoms. I take blood pressure and cholesterol meds daily and GERD Rx as needed. Would appreciate some advice as to the validity of the positive test, considering that I am asymptomatic.”

The answer:

Studies have suggested that 40% to 45% of individuals infected with SARS-CoV-2 (COVID-19) may have no symptoms at the time of testing, and they may transmit the virus for 14 days or longer.

In my opinion, the shingles shot (I assume you’re referring to the Shingrix vaccine) did not cause a false positive COVID test. The swab PCR test (molecular Polymerase Chain Reaction) detects SARS-CoV-2 viral RNA for COVID-19. The Shingrix vaccine induces antibody formation for varicella (“chicken pox”) – zoster virus.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“A friend tested positive but had no symptoms. I haven’t seen her in over a year. She is planning on coming to visit. How long does she have before she will transfer the COVID to me?”

The answer:

You may find this timeline helpful to assess whether or not it is safe to visit with your friend.

Exposure and infection occur (Day 1): Just because you are exposed does not mean you will be infected. You must be exposed to more virus than your body can destroy, this is called an infectious dose.

• Infectious doses are likely to occur if you have been in close contact for greater than 15 minutes with a pre-symptomatic individual or a symptomatic individual;

• Wearing a triple-ply cotton mask is going to protect you from abut 65% of the virus. If the other individual is wearing a triple ply cotton mask protecting them at 65%, the combined protection of both masks is about 85%. This is the best method we have to reduce spread of SARS-CoV-2, the virus that causes COVID-19.

Pre-symptomatic phase (up to Day 7 on average): Most adults who are infected will have a period of five to seven days where they are infectious but have no symptoms. Within this time period, individuals are more likely to spread the infection in the 48 hours prior to symptoms starting.

• If you feel you have been exposed to SARS-CoV-2, it is best to get tested around the third day after exposure. The virus will likely be detectable between three to seven days. If you test too early, it may result in a false negative.

• Some individuals will be in this phase for 14 days. This will make all other phases shift by seven days.

Symptomatic phase (Days 7-22): Once symptoms begin (dry cough, fever, loss of taste and smell, shortness of breath), most individuals will continue to have symptoms for 15 days.

• Studies show that the amount of virus in the body takes on a bell-shaped curve, with the highest amount of virus being, on average, on the 14th day of the infection cycle. After that, the virus in the body begins to decrease.

Symptom relief phase (Days 22-25): Most adults will be free of the virus, test negative by the genome test, by the 24th day.

This is why the self-isolation is suggested to be 14 days. If you are exposed but do not develop symptoms within two weeks of exposure, you did not receive an infectious dose. Your body was able to handle the amount of virus you were exposed to. This is also why you are asked to remain in your home for 14 days after symptoms start. Most adults are not producing infectious virus after the 22nd day of the infection cycle.

I would suggest that you talk to your friend and find out a bit more information about how she is feeling and if she is symptomatic or not. If she is in the pre-symptomatic phase, I would suggest that you delay her visit until she is sure she is not infected.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I have a friend whose husband died from COVID-19. She tested positive and had a mild reaction. After the two-week quarantine, she tested positive again. This has happened four times now. Is there a length of time that a person is safe to be around, even though they are still testing positive for COVID-19?”

The answer:

COVID-19 can present differently in individuals. Some will experience severe symptoms and need hospitalization and some will have mild illnesses.

If someone has been fever-free for 24 hours with no medication, it has been 10 days since symptoms has started, and the symptoms have improved (this is the important one), then it should be safe to interact with that individual. Have the patient reach out to their health care provider for specific case by case guidance.

Keep in mind that if someone is symptomatic they can spread the virus.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I’m a 22-year-old student. My repeat swabs have been tested positive two times; totally, three swabs have been taken. It’s been 15 days in isolation, still with no symptoms. What am I supposed to do?”

The answer:

If you have been fever-free with no fever-reducing medication for 24 hours and your symptoms have improved, you may be able to be around others. 

I suggest that you follow up with your health care provider to seek out specific guidance based on your health history.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My boyfriend tested positive for COVID-19 around a month and a half ago while I tested negative. The test we took was a rapid swab test that did not go all the way into our nostrils and was therefore only 80% accurate. For this reason, the nurse assumed my result had been a false negative and advised that we quarantine together in my apartment (my boyfriend’s roommate has asthma so it seemed like the most responsible choice) which we did for two weeks plus the one week waiting for the new results. This time around, we did the regular swab test that is supposed to be 99% accurate. I got my results first and tested negative, so we thought he would as well, but he again tested positive. I started to think maybe I had gotten the virus before, since I was in Europe in January and had therefore developed antibodies, which would explain why I tested negative twice. However, my antibody test came out negative! 

“So now, I am even more confused. How is it that I have been as exposed as possible to this virus 24/7 for almost a month and a half, and I keep testing negative without having the antibodies? Is there something wrong with the tests administered in Florida? Does my immune system have something that should be looked into for COVID-19 research?”

The answer:

How is it possible that you were in daily close contact with a symptomatic COVID-19 patient and I didn’t contract the virus? This is a great question.

Many things are factored into the answer to this question. Arguably the most important factor in this answer is human behavior. If you followed public health guidelines of frequent hand washing, wearing a mask when in common areas and frequent disinfection of high-touch surfaces, this could explain why you did not contract the virus.

Other explanations for your lack of illness are:

Your boyfriend had a mild case and was not shedding large amounts of virus. If your daily exposure to SARS-CoV-2 was low (due to a low level of shedding from your boyfriend), your innate immune response, the one encoded in all of our DNA, may have been able to handle the exposure. We are exposed to microbes daily, you are being exposed as you read this, and we don’t get sick daily.

SARS-CoV-2 affects each individual slightly differently based on a number of cellular factors. Recent research shows that receptor density at the cellular level of ACE2 is related to disease severity.

Some recent research suggests that a recent MMR (measles, mumps and rubella) vaccine may be protective. Did you have a recent series of vaccinations due to your travel to Europe?

I am glad to hear that you did not become infected. Remember to keep practicing good hand hygiene, wear a mask in public and maintain physical distance to keep your risk low.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“We are a family of three. I tested positive on July 7. Symptoms started on July 1. I quarantined for over 14 days. I tested again still waiting on results. I do not have insurance. My fiancé tested positive on July 8 with hardly any symptoms other than headaches, sweating and feeling crummy. And then on July 23 he tested positive again. My 11-year-old daughter had symptoms but they went away. She still tested positive on July 21. Do you think we are still contagious? Why would my fiancé test positive 16 days later? I’m just so nervous about all of this. We are still quarantined.”

The answer:

Sometimes the virus is persistent in detectable levels up to 12 weeks after infection, but likely isn’t infectious. Most people can stop isolation 10 days after COVID-19 symptom onset, and after a break in fever for at least 24 hours without the use of fever-reducing medications, and if symptoms have improved.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I have re-tested positive but quarantined for 21 days. What does that mean? Should I go for quarantine again since I’m positive for the second time?”

The answer:

A test-based strategy is no longer recommended (except for rare situations) because, in the majority of cases, it results in prolonged isolation of patients who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious.

CDC and Pennsylvania Department of Health updated guidelines for a symptom-based strategy for discontinuing isolation for patients with mild to moderate illness who are not severely immunocompromised include:

• At least 10 days have passed since symptoms first appeared and

• At least 24 hours have passed since last fever without the use of fever-reducing medications and

• Symptoms have improved.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My co-worker tested positive and was out of work for nearly a month. She received a negative test result before returning, but is still experiencing symptoms. Could she be spreading the virus?”

The answer:

In my opinion, no.

The Centers for Disease Control and Prevention (CDC) and the Pennsylvania Department of Health updated symptom-based strategy guidelines for discontinuing isolation include most people can stop isolation 10 days after COVID-19 symptom onset, and at least 24 hours have passed since last fever without the use of fever-reducing medications, and “symptoms have improved.” It does not say “symptoms have completely resolved.”

In the updated coronavirus guidelines, the CDC made a shift to a symptom-based strategy in deciding when to stop isolation and resume normal activities. The updates are intended to prevent unnecessarily long isolation and excessive use of lab tests.

Your co-worker retested negative before returning to work. You and your co-worker should continue to follow safety precautions, including wearing a face mask.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My daughter was at her friends house on July 15. Her dad was not home. On July 20, her dad developed symptoms and tested. He got his test back and it was positive. This was 10 days ago. None of us have symptoms. Do we need to quarantine?

The answer:

Based on what you reported, I do not recommend you quarantine.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“Today, I’ve found out that three people in my building have the virus. Thank God there was a nurse outside coming from her apartment and she said to be very careful in our building, which has 12 apartments. We all enter and leave at the same entrance. Do I need to be worried or to quarantine and/or get tested?”

The answer:

I recommend you follow CDC safety precautions including wearing a face mask, good hand-washing hygiene, frequent sanitation and cleaning of common surfaces, etc.

If you develop any symptoms, then get tested and self-isolate in your apartment pending test results.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I tested positive through nasal swab three weeks ago. I was sick for two days. I quarantined for 14 days. 

“I have not had symptoms in over a week. I want to travel to England to stay with my son and his family. Is it safe for them if I have already had COVID?

The answer:

According to CDC updates on coronavirus guidelines on isolation, most people can stop isolation 10 days after COVID-19 symptom onset. In the six months since the virus emerged, the CDC said “there have been no confirmed cases of SARS-CoV-2 (COVID-19) reinfection.”

Sometimes the virus is persistent in detectable levels up to 12 weeks after infection, but likely isn’t infectious.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“If I have two COVID-19 rapid tests done more than 24 hours apart and both are negative, do I still have to isolate for 14 days? I am a close contact of someone who tested positive (my boyfriend). I have no symptoms and took the first rapid test a few days after I was exposed. I want to take another test on the sixth or seventh day of my isolation. And if it also is negative, then can I assume regular activities?”

The answer:

If you are not continually exposed to the symptomatic individual and you have two negative tests, you are not positive and do not have to self-isolate.

I would suggest that you remain physically distant from the symptomatic individual until 14 days after their symptoms have resolved. Otherwise, you may be exposed again.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I took the test yesterday in preparation to drive back to visit my ailing mother. She is in hospice at home with COPD, on oxygen and having heart failure. I want to be sure I am not bringing back the virus. Should I quarantine after I’ve tested? I have no symptoms however I do work daily with essential employees. I was instructed not to stay with my other grown children but to go directly to her house and shower, mask up and social distance, wearing gloves.”

The answer:

You are following safety precautions, and self-quarantine is an extra layer of protection for your ailing mother.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I have classic COVID-19 symptoms; however, my two tests have come back negative. Can my employer require two more negative tests before I can return to work? It has been 18 days since my first symptom and almost a week since my last fever.”

The answer:

The latest Pennsylvania Department of Health update issued on July 18 for symptom-based strategies for discontinuing transmission-based precautions include patients with mild to moderate illness who are not severely immunocompromised:

• At least 10 days have passed since symptoms first appeared and

• At least 24 hours have passed since the last fever without the use of fever-reducing medications and

• Symptoms have improved.

There are other updated guidelines for patients with severe to critical illness and for severely immunocompromised patients, which I assume you are not.

A test-based strategy is no longer recommended (except for rare situations) because, in the majority of cases, it results in prolonged isolation of patients who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious. I suggest you discuss the above with your employer.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“We learned that my daughter was exposed to someone with COVID last week. We tested and just received positive results. She doesn’t have any symptoms, but needs to have a documented negative test before she can go to a camp. What is the likelihood that the test will be negative in two weeks?”

The answer:

Symptoms of COVID-19 can take up to 14 days to present themselves. I would monitor your daughter and seek medical treatment if her symptoms become severe.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My daughter tested positive for the coronavirus 17 days ago. It was a nasal swab. She had no fever or cough and only had a heaviness in her chest. She has had no symptoms at all for a week. She is still testing positive with a nasal swab. Is she still contagious? If she uses a saline solution nose spray would it help get rid of the virus in her nose.”

The answer:

Some individuals are contagious for up to 21 days after symptoms resolve (though the average is 14 days). It is possible that your daughter is shedding non-infectious virus. I would suggest that she wears a mask while in contact with others.

Using saline spray in the nose is a good way to aid in removal of many types of infections.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I was first tested on June 18, and it came back positive. I did the self isolation for 14 days and retested on July 2. It came back positive again so I self-isolated again for 14 days. Went and took the test again on July 18, and it came back non-detected. Went and took it on July 21 because I needed two negative results to go back to work. Came back positive. What do I do now? I have to go back to work or lose my job.”

The answer:

I can understand your confusion. I urge you to check with your employer and determine which return-to-work strategy is in place. If the “two negative tests that are greater than 24 hours apart” plan is in place, you may need to be tested two more times. If the “at least 10 days symptom free” plan is in place, you may want to discuss with your employer the option for returning to work.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My husband just tested positive today and took the test yesterday. He had a runny nose but he always has one due to allergies. Myself and our toddler have an appointment tomorrow to get tested. My son has had a runny nose all week and we thought it was simply his allergies. Should we be alarmed? My husband didn’t really have symptoms.”

The answer:

You and your son are close household contacts of your husband who is diagnosed with COVID-19. You and your son should self-quarantine for 14 days. For household contacts, this will be 14 days from the date the person with COVID-19 (your husband) is released from isolation.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My grandmother was experiencing severe symptoms and we went as a family to test. I would share a bed with her because she was unable to do anything. I’m negative and everyone in the house is positive. My uncle, whom we live with, will be the only one in quarantine. Is there a way to find out if I had the virus or if I’m going to get it?”

The answer:

Having a nasal swab test will allow you to determine if you have an active infection, even if you are asymptomatic or pre-symptomatic. An antibody test will allow you to determine if you were infected previously and have recovered.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I was exposed to COVID-19 the week of June 21 by a coworker who tested positive June 25. I got tested and got my positive test July 20, nearly a month later. Never did I develop symptoms or any of my immediate family members in the house. What are the chances of a false positive?”

The answer:

Most of the nasal swab tests for SARS-CoV-2, the virus that causes COVID-19, are highly specific. This means that they are very reliable at detecting the virus if it is present.

There are factors that come into play when looking at false positives or false negatives. If an individual tests too early, like on the day of exposure, the test will likely be negative. It is best, if you suspect that you were exposed, to get tested 72-96 hours after exposure. This is the window that is often before symptoms start but the virus is at levels of detection.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My husband and I are 65 years old. We made plans to see our daughter, son-in-law and grandkids for three days. In preparation, we have been self-isolating and so have they. 

“The plan was to self-isolate for 14 days and then get together. A week into the isolation, our 2-year-old granddaughter had to visit the clinic for a suspected urinary tract infection, which caused her mother to go to the pharmacy. They were within six feet of the nurse for about a minute and my daughter was in the pharmacy for about 15 minutes. Everyone was wearing masks throughout the visit. Do we have to wait another 14 days to visit them or is 12 days sufficient? I want to be able to hug everyone when we go.”

The answer:

I commend your for self-isolating prior to a visit.

From what you describe, the risk of exposure was minimal. 

Wearing a mask has been shown to be the most effective way to prevent spread of the virus. Adding to that, most young children seem to develop the infection within two days of exposure while adults develop the infection (on average) within five to seven days.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“A person living next door to my family got tested for COVID-19 because she got exposed to a coworker who is positive for the virus, and she’s not showing any symptoms. My question is, how long does it take to get results back? She’s also living with her father, that’s my friend, whom I always talk to without any masks. Is it possible that I got it? And I’m having second thoughts on getting inside the house because I might bring it to them.”

The answer:

It is best to maintain physical distance and wear a mask when interacting with others during this pandemic. By implementing these minor changes to your behavior, you can significantly reduce your risk of exposure to SARS-CoV-2.

Testing is delayed in may parts of the country. It may take anywhere from two days to 10 days to get results back. If you feel that you were exposed, it is best to self-isolate for 14 days and monitor your health for symptoms of COVID-19.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“Is it safe to use a laundromat during the coronavirus?”

The answer:

Practicing physical distance and wearing a mask has been shown to be highly effective at reducing the spread of SARS-CoV-2.

If you choose to patronize a laundromat, I would recommend washing your hands regularly while in the laundromat (due to the buttons on the washer and dryer) and keeping physical distance while wearing a mask. 

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My daughter tested positive today for COVID. My husband and I and saw her 11 days ago. Should we quarantine?”

The answer:

If you do not have symptoms, it is likely that you do not have COVID-19. Average time to onset of symptoms is five to seven days. Since you saw her 11 days ago, it is doubtful that she was contagious then.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My 22-year-old son, who lives at home, is not able to taste or smell. He went on Saturday to get tested. We will not have results for 3-10 days. Should the rest of the family self quarantine as well? He’s been in his room since getting tested.”

The answer:

Yes.

Symptom-based strategy for discontinuing transmission-based precautions pending test results for patients with mild illness who are not severely immunocompromised:

• At least 10 days have passed since symptoms first appeared.

• At least 24 hours have passed since last fever without the use of fever-reducing medications.

• Symptoms have improved.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • • 

“On June 27, I had a low-grade fever of 100.2, then I went for the test, and on Monday the 29th, my results came out positive. My wife slept next to me on the 28th. On July 9, after 72 hours without symptoms, I went for my second test with my wife and my 19- and 13-year-old daughters. My wife had symptoms – chills and little chest pressure, no fever at all. On

July 10, she started losing her smell and taste. On July 17, my wife’s test came back positive and mine, too – but my girls came out negative. Are we still contagious?”

The answer:

It is suggested that 10 days at the least and 14 days to be abundantly cautious without symptoms is sufficient to be considered non-infectious. It is possible that you and your wife are shedding non-infectious virus.

However, some studies show that individuals can remain infectious for 21 days after symptoms resolve. I would suggest that you wear your mask when around others to be abundantly cautious. If you have more questions, please follow up with your physician.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • • 

“In November 2020, I was very sick; three weeks before I was also very sick. When I asked the doctor why I was so sick again, his reply to me was age and put me on antibiotics again. I was worried because he put me on antibiotics three weeks before this. This month, both my son and his wife became sick (I live with them) and both tested positive for COVID. I never became sick. I’m almost 52 and have had asthma all my life. Why didn’t I get the virus, or did I just live through it?”

The answer:

Based on your history, you were a close contact with household exposures. I cannot exclude a recent or previous coronavirus infection (COVID-19). Therefore, I recommend you be tested with a swab test (molecular Polymerase Chain Reaction – PCR) and a blood antibody test for SARS-CoV-2 IgG.

I also advise you to follow CDC safety precautions including wearing a face mask, good hand washing hygiene, and self-isolate at home in a private room and use a private bathroom if possible pending your swab (PCR) test results.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • • 

“My son’s wife works for a testing lab. She says if a person tests positive, they count the whole family as positive. And if both husband and wife test positive, they count family twice. If both husband and wife test positive, the count is 10 for a family of five. She works for a lab that does testing in Texas and Michigan.

The answer:

Positive results are counted based on the individual. Some states do count based on the person and some states count based on testing only (if one person is tested four times, it is counted four times).

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • • 

“My son and daughters had an outside conversation with an uncle for about 15 minutes. Two days later, the uncle came down with symptoms and tested positive. Should they all be in quarantine or is their risk minimal?”

The answer:

According to your history, your son and daughters were in close contact (defined as being within six feet for a period of 15 minutes or more) with the uncle from the period 48 hours before symptom onset. Persons who test positive are considered infectious 48 hours before the onset of symptoms. Also, their risk was increased if they were not wearing a mask.

I recommend your son and daughter be tested with a swab test (molecular Polymerase Chain Reaction – PCR). While awaiting pending test results, they should self-isolate at home in a private room and use a private bathroom if possible. Wear a mask when entering general living areas and interacting with others. Monitor for symptoms and follow other CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • • 

“A husband of 47 years had positive antibodies for COVID and the wife’s test for antibodies came back negative. How is that possible?”

The answer:

If both test results are correct (not a “false” positive and not a “false” negative), then the husband was previously infected, and the wife was not.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My daughter just tested negative for the virus. She wants to come up to see us. My wife is in a delicate way. What should we do?”

The answer:

If your daughter was tested via the nasal swab test and has been maintaining self-isolation and/or practices that will reduce her risk of exposure, then she is likely to remain negative until arrival.

Depending on where she is coming from, it is recommended that she self-isolate for 14 days upon arrival.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I just tested positive for the COVID antibodies. I was not tested for the virus, but believe my exposure was in March while I was overseas. However, I’m not positive. Do my family members need to be tested for the antibodies as well?”

The answer:

If your positive antibody blood test was SARS-CoV-2 IgG, that means you were previously infected with the novel coronavirus (COVID-19), but the exact date is unknown. Therefore, I recommend your family members also get a blood test for SARS-CoV-2 IgG antibodies.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

 • • • • •

“I work in a physical therapy clinic and I saw a patient on a Tuesday and a week later we were informed that this patient tested positive for COVID, but we were told that they were informing anyone who was in contact with him Wednesday or Thursday. I was told “You saw him Tuesday” – so does that mean I don’t have to worry? Is there an amount of time from the time you spend with someone and they test positive that you don’t need to be concerned with contracting the virus?”

The answer:

A close contact is defined as being within six feet for a period of 15 minutes or more. Persons who test positive are considered infectious 48 hours before the onset of symptoms. Persons testing positive, but who do not have symptoms, are considered infectious two days after exposure (if known) or starting two days before test date (if exposure is unknown). If you were wearing a mask, your risk is lower.

If you were a close contact as described above, I recommend that you be tested with a swab test (molecular Polymerase Chain Reaction – PCR).

Close contacts who are Healthcare Personnel (HCP) should be instructed to notify occupational health immediately for additional instruction. Close contacts who are HCP with community or household exposures should be excluded from work and self-quarantine for 14 days following the last date of exposure.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I have a bad case of osteoporosis and fractures in most of my bones. I fell last night and have a new fracture. I was tested for COVID-19. The nurse said they don’t test everyone who comes to the ER. Why did they test me? I won’t get the results until next week. Please help me. I am very scared.”

The answer:

There are several possibilities. One is that you had a slight fever in the ER (which may have been related to your fracture). Other possibilities include, the ER staff was considering admitting you to the hospital, and/or was considering surgery for your fracture. Some hospitals routinely test patients that are admitted and for all patients before surgery. This is done for patient care and to protect healthcare personnel.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I tested positive for COVID on June 17. I was sick and fought it. On July 8,I got retested and it still came back positive. I have been feeling good, just a little coughing here and there not much and a little short of breath. So it’s still showing positive after three weeks. What should I do?”

The answer:

Some clinical research has showed that individuals are no longer contagious by 10 days after symptom resolution. Out of an abundance of caution, most experts are recommending 14 of isolation after symptoms end. By the sounds of it you, still have symptoms (shortness of breath and coughing). To protect others I recommend self-isolation until at least 10 days after your symptoms resolve.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My 15-year old son arrived from Florida on a packed airplane yesterday with suspicions of COVID-19 infected passengers aboard. He had a PCR test done today and is now self-quarantined. He has no symptoms. The test result will be delivered to us tomorrow.

“Assuming the test turns out negative, can we have full confidence in that result ? Or was the test done too soon after he came into contact with someone positive for COVID-19 ? In which case should he be tested again in a few days time, or after 14 days, for us to be sure ?

“In other words, does the PCR test reliably show positivity or negativity when done immediately after a person is infected, or only after a period of time?”

The answer:

Great question. I appreciate your respect for the virus and the self-isolation practices that are recommended when risk of exposure is high. Thank you.

Most individuals will begin to see symptoms within 5-7 days of exposure and infection. The test may come back negative because it was given quickly after exposure. If infection from an exposure occurred, time is required by the virus to replicate to detectable levels. Given that he was on an airplane and cabin air is recirculated every 5 minutes or so, it is likely that if someone was infected on the plane he was exposed.

I would recommend that he continues to self-isolate, using a separate bedroom and bathroom if possible at home and that he monitors himself for symptoms for 14 days. If you would rather take the testing option, I would recommend that you retest 48 hours after the initial test (since it was given so quickly after exposure). This would be around 3 after exposure and if infected, the virus will be detectable.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“So my husband started feeling bad with a fever. The next morning he still had a fever and headache. He got tested and was negative, then went back to the doctor and was told to test again. He’s finally fever free four days later. So my question is: should he go take it again if now he doesn’t have symptoms and how long should we wait for him to join the family again?”

The answer:

Does he have a cold or is it COVID-19?

COVID-19 often causes symptoms similar to those a person with a bad cold or the flu would experience (fever, shortness of breath, loss of taste and smell, coughing). It is more likely to suspect coronavirus if you have respiratory symptoms (like mentioned above) and you have been exposed to someone suspected of having COVID-19, or there has been community spread of the virus that causes COVID-19 in your area.

Since your husband’s physician recommended a test again, I would heed that advice. Out of an abundance of caution you could have your husband wait 10 days before returning to family life. Some clinical research has showed that individuals are no longer contagious by 10 days after symptom resolution. If you wish to be more cautious, you could have him wait 14 days.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • • 

“I am a 69-year-old female. My friend who has O-positive blood had COVID in March. I stayed with him five weeks after he came home from the hospital because he also had developed blood clots in his lungs. I participated in a University of Louisville study in June. I tested negative for COVID, but my body had developed antibodies. I never got sick, but obviously had encountered the virus at some point. I have O-negative blood. Is it medically possible to share my antibodies with my brother who has A positive blood? He is petrified of this virus.”

The answer:

Multiple studies have reported on the use of convalescent plasma to treat severely or critically ill COVID-19 patients without unexpected or serious adverse events. Many patients improved clinically and cleared the virus, however the role of convalescent plasma in these patients is unclear, because all patients received at least one additional therapy, including antivirals and corticosteroids.

Multiple ongoing clinical trials are investigating the use of convalescent plasma in patients with less severe infections, or prophylactically in highly susceptible individuals, such as exposed health-care workers or family caregivers of COVID-19 patients.

Lastly, there are a number of FDA-approved multi-centered clinical trials ongoing, focused on a variety of study subjects, including high-risk individuals for prophylaxis, patients with mild disease, those with serious, but not critical disease, ICU patients or children.

Based on what you reported, I doubt that your brother will qualify. For additional information, see:

FDA guidance and summary options for obtaining convalescent plasma.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I work in HR, hiring nurses for staffing facilities. I had a caregiver sitting at my desk about two feet from me (small space) and she did have a mask on for all but 30 minutes (for oral drug test, etc.) of the two hours she was there. I also handled and processed all paperwork of hers. We require a COVID-19 negative test before we can hire someone and him/her put into the facility. When I asked her, ‘You have not had a COVID test yet?’ And she said, ‘Yes I had one last week.’ I replied, ‘Oh, perfect, we can use that then.’ She said, ‘Well no, because it was positive.’ I was shocked. She said she tested positive at end of June and then again July 4. She never said anything and now I’m worried since I was in such close proximity to her. Should I be tested? Quarantine? How should my employer be handling this? Oh, and I live in South West Florida. So I’m worried even more with our steady increasing numbers.”

The answer:

You are a close contact of a documented and confirmed positive case. Yes, you should be tested with a swab test (molecular Polymerase Chain Reaction – PCR), and you should quarantine/self-isolate at home pending test results. You didn’t mention if you were wearing a face mask. If you were, your risk is lower.

Regarding the caregiver who tested positive. Persons who test positive are considered infectious 48 hours before the onset of symptoms. Persons testing positive but who do not have symptoms are considered infectious two days after exposure (if known), or starting two days before test date (if exposure is unknown).

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I haven’t had smell or taste for more than a month. Do you think that could be the virus? I don’t have any other symptoms. What do you think is best for me to do?”

The answer:

I recommend that you be tested for coronavirus disease with both a swab test (molecular Polymerase Chain Reaction – PCR) and a blood test for SARS-CoV-2 IgG antibodies. If both tests are negative, then I advise you to follow-up with your primary care physician for further evaluation and diagnostic testing.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My colleague and I were in isolation for 14 days. Then we both went to test for COVID-19. After the test, we enjoyed a nice breakfast together, and from there to my home to pick up my car to take her home. The next morning, we received our results that I’m negative and she is positive. My questions is: Should I go back into self-isolation and do a second test?”

The answer:

Yes. From your question you were exposed to your friend who is positive in a close setting for more than 15 minutes.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I was exposed to my brother, who has COVID. I did not know he had it. I was in a mask the whole time but he didn’t wear one. I drove him around for at least an hour, and after dropping him off, I still wore my mask until I got home and disinfected my car as soon as I pulled in just as I do with anyone in my car. What are my chances of catching it? He was not coughing or sneezing in my vehicle.

The answer:

SARS-CoV-2 is highly contagious. It appears that you were in close contact with a known positive patient for greater than 15 minutes. I recommend that you self-isolate for 14 days and monitor yourself for symptoms. If you experience symptoms, contact your physician.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I have had three consecutive positive tests for COVID-19. Recovered at home and currently asymptomatic. Am I able to spread the virus to others?”

The answer:

One possibility is that you are shedding non-infectious or dead virus particles. I recommend that you continue to follow CDC safety precautions, including wearing a face mask.

The decision to discontinue home isolation should be made in the context of local circumstances. Options include a symptom-based or a test based strategy. These are fully described at https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My daughter was exposed to the coronavirus at her best friend’s house. The mom and the daughters have tested positive. My daughter and I tested on Friday – same day as her friend. She received her results on Monday, which was positive, and we received ours today which is Tuesday and they are negative. All of the sudden my daughter checks her temperature and it says 100.1. Should we be worried? Did we test too soon?”

The answer:

Individuals who are positive for SARS-CoV-2 are reportedly most contagious 48 hours prior to symptoms starting and in the early stages of the when they are coughing and sneezing. Most individuals who are infected will see symptoms between days 5-7.

Viruses such as SARS-CoV-2, due to the nature of their replication, can take 48-72 hours to replicate to the level of detection. Hence the 48 hours prior to symptoms being the most likely time to expose other people.

You may have tested a bit early. Without knowing more details, it is hard to determine your specific situation. I would suggest that you self-isolate and monitor your daughter’s symptoms. If they become more severe, contact your physician. Seeking out another test is also an option.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • • 

“My husband started feeling bad and got a 102-degree fever on the night of June 29. We both went for a test the next day. His result came back positive while mine came back negative. Our daughter started running a fever on July 1 and also tested positive, as well as our nanny, who started showing symptoms on July 2. I did not isolate from them as I thought being in close proximity with them will for sure mean I was contagious as well. We were all in self-isolation for two weeks. I have had only really mild symptoms – tiredness and headaches. My daughter, my husband and the nanny are fine now and are not having any symptoms. I went for an antibody test this week and it came back negative. Does that mean I have not had the virus at all? But how could I be hugging and kissing my family and not get it? Should I be retested and if so which test do I need to get?”

The answer:

I recommend a blood test for SARS-CoV-2 IgG antibodies in one to two weeks. IgG antibodies are detected in most patients 10 to 21 days (median 14 days) after symptoms of COVID-19. If the test is positive, that means you were previously infected with the novel coronavirus (COVID-19).

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“How long do we quarantine if a household member began having symptoms July 1, got tested July 2 and was positive July 7? Another family member in the home began to feel sick and was tested July 11 and was positive. So does this mean our quarantine should start all over again from then?

The answer:

It is recommended that the sick are quarantined until two negative tests occur that are greater than 24 hours apart or until at least 10 days after symptoms resolve (14 days to be abundantly cautious as some people are contagious for 14 days after symptoms cease).

For those of you who are not sick but in the home, it is important that you are using separate bathrooms and bedrooms when possible, washing your hands regularly, cleaning high-touch surfaces daily and monitoring yourselves for symptoms.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“After two weeks of quarantine, I still tested positive. Am I still contagious and need to quarantine longer? I have never had any symptoms and can’t return to work until I get two negative test results.”

The answer:

Studies have suggested that 40% to 45% of individuals infected with SARS-CoV-2 (COVID-19) may have no symptoms at the time of testing, and they may transmit the virus for 14 days or longer.

The Pennsylvania Department of Health issued an update on July 18, Discontinuation of Transmission-Based Precautions for Patients with COVID-19. A test-based strategy is no longer recommended (except for rare situations) because, in the majority of cases, it results in prolonged isolation of patients who continue to shed detectable SARS-CoV-2 RNA but are no longer infectious.

I advise you to discuss the above with your employer’s Human Resources Department.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I went to dinner with two friends on July 4. The one friend texted us that she started with a cough and congestion on Thursday. She got tested for coronavirus and won’t know the results for 10-14 days. 

“Should I go get tested or should I self-isolate? We sat in a booth across from each other.”

The answer:

Recent scientific research shows the individuals may spread SARS-CoV-2 as early as 48 hours before symptoms start and some are contagious for 14 days after symptoms resolve.

You were interacting with a friend within the six-foot recommended physical distance. Since you were having dinner, I assume you were not wearing a mask. 

Your friend’s symptoms started on July 9, by your account. She may have been contagious as early as July 7. Given that you were with her four days prior to that, it is less likely that you were exposed from her.

I would recommend wearing a mask in public, maintaining physical distance and washing your hands regularly. Monitor yourself for symptoms and if any develop self-isolate for 14 days or until two weeks after symptoms resolve.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My dad, who is 84 years old, is having major surgery to remove cancer. I work at a health care facility where an employee has tested positive for COVID-19. Although I have not been around that employee, I have been exposed to the same patients and those patients are in quarantine. Should I not visit my dad at home before surgery due to those circumstances?”

The answer:

As difficult as it may be, I recommend you not visit your dad for his protection and safety.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

A reader of The Tribune-Democrat asked:

“Can a person who has already had COVID-19 come in contact with someone who currently has COVID-19 and bring home the virus and infect family members? My daughter had COVID-19 and has been over it since May (she lived in NYC) and she is coming to live with us here.

If she goes out to see friends and then comes back to our house, can she infect us?”

The answer:

Scientific evidence suggests that the antibodies produced by the immune system during infection with SARS-CoV-2 will provide protection for 3-6 months. Due to the nature of the virus that causes COVID-19 (it being an RNA virus) mutations in the genetic make up of the virus are likely. These mutations result in small changes in the virus.

These changes confuse the immune response into thinking it is a new (or different) virus.

Think of it like this, as humans grow we change our physical appearance. We are still the same person, but we wear different clothes or change our hair or are taller. This causes others, who may have not seen us lately, to not recognize us.

Given the change that is occurring with the virus, it is prudent that your daughter still practice the social distancing, mask wearing and hand washing recommendations when in public.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My boss tested positive for COVID three weeks ago with no symptoms. His wife tested positive and is symptomatic. He retested and is still positive but no symptoms. He was told by his doctor to go back to work, but his wife still has symptoms. Is it safe for him to come back to work and treat patients? Should he tell patients?”

The answer:

He and his wife should follow CDC safety precautions. He has no symptoms now, and his physician released him back to work. I don’t know all the details involved in that decision-making. One possible explanation for his repeat positive test is that he is shedding non-infectious or dead virus particles.

Should he tell patients? When someone tests positive, the test site is required to notify the Department of Health, and the DOH contacts the person and instructs them what to do. Healthcare Personnel (HCP) who are diagnosed with COVID-19 should follow the return to work for HCP with confirmed or suspected COVID-19 as described in PAHAN501

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“If someone comes to work and his wife is COVID-19 positive, is there a chance I can catch it from him at work even if I didn’t get close to him?”

The answer:

I understand your concern regarding exposure; it seems to be on everyone’s mind of late.

The practice of social distancing and wearing a mask has been shown to be effective in reducing the risk of infection.

Without knowing the specifics of your workplace, it is difficult to determine your exposure level. Current guidelines recommended that any exposure be considered significant if individuals in the workplace were involved in activities that could increase aerosols in the air.

If you feel that you were exposed, I suggest that you wear a mask, monitor yourself for symptoms and isolate yourself as much as possible.

– Jill D. Henning, UPJ associate professor of biology.

• • • • •

“A neighbor of ours was tested for COVID-19 on July 3, which was the first day she experienced symptoms. Her results came back positive July 6 and she has been self isolating since the onset of symptoms. We are supposed to go on vacation with her and her family July 21. If she meets the criteria for ending self isolation prior to going could she still be spreading the virus. We need to decide if we are going to go and this is a huge factor. Coincidentally, my son and I helped them move furniture six days before she started experiencing symptoms and it has now been 14 days since helping them and neither of us have shown and symptoms so I’m guessing we weren’t exposed or she wasn’t carrying the virus on that date?”

The answer:

Persons who test positive are considered infectious 48 hours before the onset of symptoms.

If she meets CDC criteria for ending self-isolation, she should be clear.

The decision to go on vacation is a personal one, and should definitely consider the vacation site destination.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I tested positive on July 27, then quarantined myself for 14 days and retested on July 10. I received my results on July 12, which came out positive again. I have no fever – still no smell or taste, with a headache. Should I quarantine again away from everyone for the same time period?”

The answer:

Most individuals who are infected with SARS-CoV-2 will experience symptoms within 5-7 days, but some may take up to 14 days to become symptomatic as a general rule.

An important thing to consider regarding general rules is that this virus behaves differently in individuals. Some are contagious 48 hours before symptoms some are contagious for 14 days after symptoms cease. That’s why everyone needs to wear a mask and keep a physical distance of at least 6 feet.

With the current data on SARS-CoV-2, it is believed that individuals are most contagious within 48 hours of developing symptoms and when they are beginning to experience symptoms (coughing and sneezing). There is evidence that individuals with no symptoms can also spread the virus to others if they are not maintaining physical distance and wearing a mask. Recent studies show that individuals who are asymptomatic or presymptomatic are more likely to spread the virus to others as they are not or are less likely to be physically distancing themselves from others.

Some clinical research has showed that individuals are no longer contagious by 10 days after symptom resolution. Out of an abundance of caution, most experts are recommending 14 of isolation after symptoms end. Since you are still experiencing symptoms, you should maintain isolation until 14 days after symptoms resolve.

– Jill D. Henning, UPJ associate professor of biology.

• • • • •

“My friend is currently in isolation due to COVID-19 and her family is in quarantine awaiting tests results (nasal swab). She’s been sick for about 12 days, and up until now no one in her family has had symptoms or felt sick at all. I offered to drop something off for her outside her home, however upon getting there her dad was outside disposing of the trash and I (without thinking) handed him what I was dropping off. I didn’t come closer than 6 feet, was wearing my mask and the interaction was about 1 minute or less. I didn’t realize I shouldn’t have done that until I got back in my car. Should I be worried?”

The answer:

A close contact is defined as being within 6 feet for a period of 15 minutes or more. According to your description, it’s doubtful that you were a close contact. And you were wearing a mask which is good.

I wouldn’t worry, and thank you for helping this family in need.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My son was exposed by someone who tested positive for COVID on June 14, and he’s been in self-quarantine ever since. We got him tested on June 24 but no results as of yet and he has no symptoms. What can he do now that its been this long with no symptoms? Does he have to still be quarantined? Such a scary time right now.”

The answer:

Thank you for having your son follow self-isolation guidelines.

Most individuals who are infected with SARS-CoV-2 will experience symptoms within 5-7 days, but some may take unto 14 days to become symptomatic. If you are maintaining a physical distance and your son is isolating in the home (using a separate bathroom and bedroom), you are reducing your risk of exposure as a general rule.

An important thing to consider regarding general rules is that this virus behaves differently in individuals. Some are contagious 48 hours before symptoms some are contagious for 14 days after symptoms cease. That’s why everyone needs to wear a mask and keep a physical distance of at least 6 feet.

With the current data on SARS-CoV-2, it is believed that individuals are most contagious within 48 hours of developing symptoms and when they are beginning to experience symptoms (coughing and sneezing). There is evidence that individuals with no symptoms can also spread the virus to others if they are not maintaining physical distance and wearing a mask. Recent studies show that individuals who are asymptomatic or presymptomatic are more likely to spread the virus to others as they are not or are less likely to be physically distancing themselves from others.

Some clinical research has showed that individuals are no longer contagious by 10 days after symptom resolution. Out of an abundance of caution, most experts are recommending 14 of isolation after symptoms end.

It is likely that your son is negative for SARS-CoV-2 given the timeline you presented. If you are concerned he may be infected, you could be abundantly cautious and get a nasal swab test or saliva test. If it is negative, you can consider him to be non-infectious.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I tested positive for COVID-19 on June 19, and on July 12 was told I’m still positive. What should I do now to keep others around me safe? Should I continue to quarantine?”

The answer:

You didn’t mention if you have any symptoms or fever now. One possible explanation is that you are shedding non-infectious or dead virus particles.

A study from the Korean Centers for Disease Control and Prevention studied 285 COVID-19 survivors who had tested positive for the coronavirus after their illness had apparently resolved. The virus samples collected from them could not be grown in culture. So once you recover and have no symptoms of infection or fever, you should be safe. I do recommend that you continue to follow CDC safety precautions including wearing a face mask and good hand washing hygiene.

The decision to discontinue home isolation should be made in the context of local circumstances. Options include a symptom-based or a test-based strategy. These are fully described at https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html

I also advise that you follow-up with your primary care physician.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I was with a friend one week ago who was with someone days before who has tested positive for COVID-19. No one has symptoms. Should I self-quarantine? For how long? Do I tell people I was with to quarantine?”

The answer:

Most individuals who are infected with SARS-CoV-2 will experience symptoms within 5-7 days, but some may take up to 14 days to become symptomatic as a general rule.

An important thing to consider regarding general rules is that this virus behaves differently in individuals. Some are contagious 48 hours before symptoms some are contagious for 14 days after symptoms cease. That’s why everyone needs to wear a mask and keep a physical distance of at least 6 feet.

With the current data on SARS-CoV-2, it is believed that individuals are most contagious within 48 hours of developing symptoms and when they are beginning to experience symptoms (coughing and sneezing). There is evidence that individuals with no symptoms can also spread the virus to others if they are not maintaining physical distance and wearing a mask. Recent studies show that individuals who are asymptomatic or presymptomatic are more likely to spread the virus to others if they are not or are less likely to be physically distancing themselves from others.

So how does this apply to your situation? I’ve been explaining the spread of the virus and choices individuals make like they are ripples in a pond. Someone who is infected and maintains isolation, physical distance and wears a mask is going to have a tight ripple. If that individual removes the isolation but wears a mask the ripple is a bit bigger. If they don’t isolate and don’t wear a mask the ripple is 3x bigger. If they remove all three precautions, the ripple is 4x bigger. The larger the ripple the more people are put at risk. (you can also use this “visualization” to factor in your exposure, which ripple did you fit in)

This is simplistic, I know. It does not take into consideration the stage of infection an individual is in and other factors are left out. It is designed to aid ones understand of risk.

We all need to understand that to reduce the spread of the virus we must enter into the social contract that I will make choices that protect me and you and you will do the same. We should be wearing masks in public, physically distancing ourselves, and washing our hands regularly.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“So I tested positive for COVID-19, but it has been 14 days since my onset of symptoms and 12 days since I had fever or respiratory symptoms. Am I still contagious just because I tested positive again?”

The answer:

With the current data on SARS-CoV-2, it is believed that individuals are most contagious within 48 hours of developing symptoms and when they are beginning to experience symptoms (coughing and sneezing). There is evidence that individuals with no symptoms can also spread the virus to others if they are not maintaining physical distance and wearing a mask. Recent studies show that individuals who are asymptomatic or presymptomatic are more likely to spread the virus to others as they are not or are less likely to be physically distancing themselves from others.

Some clinical research has showed that individuals are no longer contagious by 10 days after symptom resolution. Out of an abundance of caution, most experts are recommending 14 of isolation after symptoms end.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My family and my neighbors were all tested and all came back negative. Is it OK to socialize normally now – hugs, handshakes, etc.?”

The answer:

All of us want to return to hugging and interacting without the restrictions in place due to SARS-CoV-2.

Testing gives us a snapshot of what is occurring. Human behavior is key to reducing the spread of the virus. Take this hypothetical: Yes, you tested negative on Monday, but then on Thursday you went to the beach and weren’t physically distant and didn’t wear a mask. Someone there was presymptomatic and you were exposed. You come back and interact with your neighbor on Saturday. You were in the presymptomatic stage yourself and didn’t know it. Wearing a mask would protect your neighbor in this case.

I understand the desire to interact with others in ways in which we used to (before COVID-19), but we need to be vigilant in our mask wearing and physical distancing. Our choices will help protect our neighbors, family and friends.

The best way to get back to normal is to remain physically distant and wear a mask.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

A reader of The Tribune-Democrat asked:

“I have an employee who said his daughter (she lives with him) was exposed to COVID-19 from someone she was caring for over the weekend. His daughter works at the local hospital and when telling her employer, she was told to return to work unless she develops symptoms. I would like to send both his daughter and our employee (her father) for testing before I have him return to work. Does this make sense?”

The answer:

With the current data on SARS-CoV-2, it is believed that individuals are most contagious within 48 hours of developing symptoms and when they are beginning to experience symptoms (coughing and sneezing). There is evidence that individuals with no symptoms can also spread the virus to others if they are not maintaining physical distance and wearing a mask. Recent studies show that individuals who are asymptomatic or presymptomatic are more likely to spread the virus to others as they are not or are less likely to be physically distancing themselves from others.

Some clinical research has showed that individuals are no longer contagious by 10 days after symptom resolution. Out of an abundance of caution, most experts are recommending 14 of isolation after symptoms end.

In this situation, I would ask the daughter what precautions she was taking at work to reduce her exposure. If she was wearing a mask, what kind? How long was she in the room with the infected individual, was it greater than 15 minutes at 6 feet of physical distance or less? If the answers are, a homemade mask, for 15 minutes or greater inside at 6 feet or less, she should self-isolate.

If you are concerned he or she may be infected, you could be abundantly cautious and get two nasal swab test or saliva test 24 hours apart. If both tests are negative, you can consider them to be non-infectious.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“I am a stylist and have a customer who has had a severe case of COVID and is wanting a haircut. What questions should I be asking him before he comes in? I don’t want to be exposed.”

The answer:

Recommendations for returning to work can apply to this situation. You can ask your client how long it has been since his/her symptoms have ceased. In order to protect yourself and any other customers in your salon, all clients should follow these guidelines:

• No appointments until at least three days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,

• At least 10 days have passed since symptoms first appeared (reference CDC website July 8).

Of course, all clients and employees should be wearing a mask while in the salon. This link can provide more detailed information regarding safety in a salon or barber shop during this pandemic. https://www.mass.gov/doc/sector-specific-workplace-safety-standards-phase-i-for-hair-salons-and-barbershops-to-address/download

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

A reader of The Tribune-Democrat asked:

“I tested positive in March for COVID-19. Had mild symptoms didn’t require hospitalization. Small cough, headaches, body aches, low fever daily, small cough, tightness in chest, pink eye, and I am itchy at times on my body all different areas on and off. It is now July and I still have low fever for part of the day, headaches, sometimes itchy and very tired. I tested negative twice in the past two months. Also tested negative for antibodies. Had full blood panels done. Only found low vitamin D level. CT and X-ray of chest performed in late March or early April showed interstitial inflammation but I only ever had very little shortness of breath and some tightness in the chest. Family and friends don’t want to come near me. If I feel well one day, the next day knocks me down. I am on average feeling a little better each day lately. Question is: Can I still be contagious? And why do I still have this low fever?”

The answer:

I doubt you are contagious. However I am concerned that you have persistent symptoms after four months, which is unusual. I’m glad that you are feeling better. I recommend that you follow up with your physician. Further evaluation and testing may be necessary.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

A reader of The Tribune-Democrat asked:

“My daughter lives with her 5-year-old daughter and they both sleep in the same bed. My daughter started feeling ill and started wearing her mask and wearing gloves, then tested positive two days later. My granddaughter negative a day after that. My daughter is self-isolating and my granddaughter is staying with me. Should I be worried about my granddaughter?”

The answer:

Your granddaughter is a close contact of your daughter who tested positive. Close contacts of patients diagnosed with COVID-19 should be instructed to self-quarantine for 14 days from the date of their last contact with the patient.

If your granddaughter develops symptoms during those 14 days, I recommend she be re-tested. Contact your granddaughter’s pediatrician for further instructions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

A reader of The Tribune-Democrat asked:

“My sister in-law tested positive for COVID-19. My children and I were in close contact with her on June 28 and she got tested June 30. We’re close to other family members. We have not had any symptoms so far, but can our family members get COVID if they haven’t been in contact with her?”

The answer:

Onset of symptoms of COVID-19 can take up to 14 days (the length of the incubation period) with typical occurrence between 5-7 days after exposure. It has been more than 10 days since your exposure. If you do not develop symptoms in the next few days, it is unlikely that your family members will develop COVID-19 from this exposure.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

A reader of The Tribune-Democrat asked:

“We are a family of three, and we all tested positive for COVID-19. Should we isolate from each other?”

The answer:

In my opinion, yes and follow CDC safety precautions.

The decision to discontinue home isolation for persons with confirmed COVID-19 should be made in the context of local circumstances. Options include a symptom-based (time since illness onset and time since recovery strategy) or a test-based strategy. These are fully described at https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“If someone comes to work and his/her wife has a COVID positive, is there a chance I can catch it from him at work even if I didn’t get close to him?”

The answer:

I understand your concern regarding exposure; it seems to be on everyone’s mind of late.

The practice of social distancing and wearing a mask has been shown to be effective in reducing the risk of infection.

Without knowing the specifics of your workplace, it is difficult to determine your exposure level. Current guidelines recommended that any exposure be considered significant if individuals in the workplace were involved in activities the could increase aerosols in the air.

If you feel that you were exposed, I suggest that you wear a mask, monitor yourself for symptoms and isolate yourself as much as possible.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“If I had exposure 10 days ago with someone who tested positive and I was tested 1 day after that exposure can my test results still come back negative?”

The answer:

Yes the test may be negative. There are many variable in this question. The average time from exposure to onset of symptoms is 5-7 days with an incubation period of 14 days total. You could have tested too early. I would recommend monitoring yourself for symptoms and if you are concerned getting a retest on the 10th day after exposure.

In the meantime, since you were exposed, you should be self-isolating until the 14-day incubation period is over.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My cousin and his wife visited my 85-year-old aunt twice this past week and they exchanged hugs. A day or so after their last visit, both the cousin and his wife tested positive and are now exhibiting symptoms. My aunt has mesenteric artery bypass in early February. She’s diabetic, has congestive heart failure and a slew of other health issues. Should she be tested? Also, she has a gastroenterologist appointment in a couple of days, to which I will have to take her. What are my risks and what should we do to protect one another?”

The answer:

I recommend your aunt get a swab test (molecular Polymerase Chain Reaction - PCR). She is a presumed close contact of two confirmed COVID-19 positive patients. If her appointment with the gastroenterologist is routine and not urgent, I would cancel that appointment. You should notify her gastroenterologist that she is a presumed close contact and is awaiting test results.

She should self-isolate at home pending her results. If she lives with others, self-isolate in a private room and use a private bathroom if possible. Wear a mask when entering general living areas and interacting with others. Continue good hand washing hygiene and follow other CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My neighbor’s father has tested positive for coronavirus. She had contact with him. She and her kids are self -quarantining, but I was in her home two weeks ago. I am 71 and pretty healthy. I have no symptoms but I am concerned I might give the virus to someone else. Should I be worried?”

The answer:

I appreciate your concern for others.

Since you were in contact with them two weeks ago and you have no symptoms, you have passed the incubation period for SARS-CoV-2. It is unlikely that you have the virus.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My mother is very ill in the hospital ICU with positive COVID-19 test. They have given her plasma with the COVID-19 antibodies. What kind of results can we expect from those antibodies?”

The answer:

I am sorry to hear that your mother is ill.

The human immune system is truly amazing. When someone becomes infected with a pathogen, the body is able to make antibodies against one or more of the components of the pathogen.

SARS-CoV-2 is an enveloped RNA virus. This means that it has a protective layer of lipids that surround the RNA genome. This protective layer has spikes embedded in it that allow the virus to attach to human cells.

The virus then enters human cells and makes more copies of itself by replicating the RNA, producing proteins associated with the virus (spikes in the protective coating), and other parts of the virus. This allows the virus to then leave infected cells and infect more cells of the host body.

Our immune system can respond to any part of the virus, but it is most likely to respond to the spikes on the protective coating of the virus. The cells of the immune system will recognize those spikes as foreign and make antibodies to them.

There are two main types of antibodies that are produced: neutralizing antibodies and binding antibodies.

Neutralizing antibodies will bind to the spikes before the spikes can bind to human cells. This prevents the virus from entering cells and beginning the replication cycle. So, it makes the virus ineffective (naturalized).

Binding antibodies can bind to the spikes or any other part of the virus.

Binding antibodies often tag the infection for removal. The cells of the immune system recognize the part of the antibody not bound to the virus and attach to that to clear the virus away. (Think of garbage disposal by tagging the garbage bags)

Since both types of antibodies can be present in the serum of someone who has recovered from COVID-19, it is likely that your mother will begin to see improvement in symptoms.

The addition of antibodies to the ones already being made by her immune system equates to more “fire power” in the fight against the virus. 

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“We are a family of three, and we all tested positive for COVID-19. Should we isolate from each other?”

The answer:

In my opinion, yes and follow CDC safety precautions.

The decision to discontinue home isolation for persons with confirmed COVID-19 should be made in the context of local circumstances. Options include a symptom-based (time since illness onset and time since recovery strategy) or a test-based strategy. These are fully described at https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“If my mom tests positive and is in quarantine and I test negative, do I still have to quarantine or would it be safer to go stay with my sister who tested negative, too?”

The answer:

Most individuals who are infected with SARS-CoV-2 will experience symptoms within five to seven days, but some may take unto 14 days to become symptomatic. If you are maintaining a physical distance and your mother is isolating herself in the home (using a separate bathroom and bedroom), you are reducing your risk of exposure as a general rule.

An important thing to consider regarding general rules is that this virus behaves differently in individuals. Some are contagious 48 hours before symptoms; some are contagious for 14 days after symptoms cease. That’s why everyone needs to wear a mask and keep a physical distance of at least 6 feet.

If you are concerned about the risk you pose to your sister, you could be abundantly cautious and get a nasal swab test or saliva test 24 hours apart. If both are negative, you can consider yourself to be non-infectious.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • • 

“A friend tested negative for a nose swab, but positive for antibodies. I was in brief contact with him (3 minutes) two days before he got his results. Both of us were wearing masks. He delivered some food to me in a plastic bag which my husband and I ate. What are our risks? Should we get tested?”

The answer:

The PCR test (nasal swab) tests for active infection. It is looking for viral replication that occurs when an individual is infected. The antibody test often is looking for past infection.

I would say that your risk is little to none, given the situation described. From this encounter, it is not necessary to be tested. I appreciate your continued respect of the virus and that you are wearing masks when encountering others. Keep up the good work.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I am 47 and live with and take care of my 73-year-old mother. I have perennial rhinitis and a few other chronic health issues. My mother has COPD and a few health issues. I am only out for essentials and doctor appointments or to take my mother to her appointments. I wear a mask everywhere I go. My mother’s chronic health issues have some of the same symptoms as COVID. How can I tell the difference? Should we be tested?”

The answer:

I doubt either of you have active coronavirus disease at this time.

However, I cannot exclude previous infection or exposure. Also, studies have shown that 40% to 45% of individuals infected with SARS-CoV-2 (COVID-19) may have no symptoms.

Therefore, it is not unreasonable to get tested. I recommend both a swab test (molecular Polymerase Chain Reaction – PCR) and a blood test for SARS-CoV-2 IgG antibodies for both you and your mother.

I also advise that both of you continue to follow CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“If a person drove a car and found out he was positive with the virus, can the person picking up the parked car get infected from driving it?”

The answer:

Evidence suggests that SARS-CoV-2 can remain on surfaces for two to three days, but the primary route of transmission is respiratory droplets.

If you practiced good hygiene and wiped down the commonly touch surfaces of the vehicle, it is unlikely that the virus would be transmitted.

Of course, there are many variables to this equation. Here is one to consider. How long after drop off was the car picked up? Scientific research suggest that respiratory droplets can remain in the air for 20 minutes. Assuming the car did not have the windows down, the droplets could have remained airborne for that amount of time.

All in all, good use of common sense likely make your exposure nil.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“Two and a half weeks ago, my husband was positive for COVID-19. My employer put me in quarantine since I was exposed. I tested negative three days after I was exposed to him. About a week later, I started having symptoms as well, so when I retested at about six days after symptoms started for me, I was positive. My husband has recovered and is doing very well. My question is, should he be now worried and quarantined because of me testing positive? They want him back at his job, but is he at risk?”

The answer:

Your first test was negative because you tested early. The median incubation period for SARS-CoV-2 (also known as the COVID-19 virus) is five to seven days. Your second test was positive. Your husband has recovered and is doing very well.

The immune response to COVID-19 is not fully understood at this time, and definitive data on post infection immunity is lacking. I recommend both of you continue to follow CDC safety precautions.

The decision to discontinue home isolation should be made in the context of local circumstances. Options include a symptom-based (time since illness onset and time since recovery strategies) or a test-based strategy.

These are fully explained at https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html

I also advise your husband to contact his employer’s Human Resources Department regarding back to work instructions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I recently had heart surgery. My good friend went to a bar tonight. Should I wait two weeks before I am in her company again?”

The answer:

It is a good idea to reduce your risk by waiting the 14 days before seeing your friend.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My cousin and his wife visited my 85-year-old aunt twice this past week and they exchanged hugs. A day or so after their last visit, both the cousin and his wife tested positive and are now exhibiting symptoms. My aunt has mesenteric artery bypass in early February. She’s diabetic, has congestive heart failure and a slew of other health issues. Should she be tested? Also, she has a gastroenterologist appointment in a couple of days, to which I will have to take her. What are my risks and what should we do to protect one another?”

The answer:

I recommend your aunt get a swab test (molecular Polymerase Chain Reaction - PCR). She is a presumed close contact of two confirmed COVID-19 positive patients. If her appointment with the gastroenterologist is routine and not urgent, I would cancel that appointment. You should notify her gastroenterologist that she is a presumed close contact and is awaiting test results.

She should self-isolate at home pending her results. If she lives with others, self-isolate in a private room and use a private bathroom if possible. Wear a mask when entering general living areas and interacting with others. Continue good hand washing hygiene and follow other CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My sister in-law tested positive for COVID-19. My children and I were in close contact with her on June 28 and she got tested June 30. We’re close to other family members. We have not had any symptoms so far, but can our family members get COVID if they haven’t been in contact with her?”

The answer:

Onset of symptoms of COVID-19 can take up to 14 days (the length of the incubation period) with typical occurrence between 5-7 days after exposure. It has been more than 10 days since your exposure. If you do not develop symptoms in the next few days, it is unlikely that your family members will develop COVID-19 from this exposure.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“We are a family of three, and we all tested positive for COVID-19. Should we isolate from each other?”

The answer:

In my opinion, yes and follow CDC safety precautions.

The decision to discontinue home isolation for persons with confirmed COVID-19 should be made in the context of local circumstances. Options include a symptom-based (time since illness onset and time since recovery strategy) or a test-based strategy. These are fully described at https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“If someone comes to work and his/her wife has a COVID positive, is there a chance I can catch it from him at work even if I didn’t get close to him?”

The answer:

I understand your concern regarding exposure; it seems to be on everyone’s mind of late.

The practice of social distancing and wearing a mask has been shown to be effective in reducing the risk of infection.

Without knowing the specifics of your workplace, it is difficult to determine your exposure level. Current guidelines recommended that any exposure be considered significant if individuals in the workplace were involved in activities the could increase aerosols in the air.

If you feel that you were exposed, I suggest that you wear a mask, monitor yourself for symptoms and isolate yourself as much as possible.

– Jill D. Henning, UPJ associate professor of biology.

• • • • •

“If I had exposure 10 days ago with someone who tested positive and I was tested 1 day after that exposure can my test results still come back negative?”

The answer:

Yes the test may be negative. There are many variable in this question. The average time from exposure to onset of symptoms is 5-7 days with an incubation period of 14 days total. You could have tested too early. I would recommend monitoring yourself for symptoms and if you are concerned getting a retest on the tenth day after exposure.

In the meantime, since you were exposed, you should be self-isolating until the 14-day incubation period is over.

– Jill D. Henning, UPJ associate professor of biology.

• • • • •

“My neighbor’s father has tested positive for coronavirus. She had contact with him. She and her kids are self-quarantining, but I was in her home two weeks ago. I am 71 and pretty healthy. I have no symptoms but I am concerned I might give the virus to someone else. Should I be worried?”

The answer:

I appreciate your concern for others.

Since you were in contact with them two weeks ago and you have no symptoms, you have passed the incubation period for SARS-CoV-2. It is unlikely that you have the virus.

– Jill D. Henning, UPJ associate professor of biology.

• • • • •

“My cousin and his wife visited my 85-year-old aunt twice this past week and they exchanged hugs. A day or so after their last visit, both the cousin and his wife tested positive and are now exhibiting symptoms. My aunt had mesenteric artery bypass in early February. She’s diabetic, has congestive heart failure and a slew of other health issues. Should she be tested? Also, she has a gastroenterologist appointment in a couple of days, to which I will have to take her. What are my risks and what should we do to protect one another?”

The answer:

I recommend your aunt get a swab test (molecular Polymerase Chain Reaction - PCR). She is a presumed close contact of 2 confirmed COVID-19 positive patients. If her appointment with the gastroenterologist is routine and not urgent, I would cancel that appointment. You should notify her gastroenterologist that she is a presumed close contact and is awaiting test results.

She should self-isolate at home pending her results. If she lives with others, self-isolate in a private room and use a private bathroom if possible. Wear a mask when entering general living areas and interacting with others. Continue good hand washing hygiene and follow other CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

"I tested positive in March for COVID-19. Had mild symptoms didn’t require hospitalization. Small cough, headaches, body aches, low fever daily, small cough, tightness in chest, pink eye, and I am itchy at times on my body all different areas on and off. It is now July and I still have low fever for part of the day, headaches, sometimes itchy and very tired. I tested negative twice in the past two months. Also tested negative for antibodies. Had full blood panels done. Only found low vitamin D level. CT and X-ray of chest performed in late March or early April showed interstitial inflammation but I only ever had very little shortness of breath and some tightness in the chest. Family and friends don’t want to come near me. If I feel well one day, the next day knocks me down. I am on average feeling little better each day lately. Question is: Can I still be contagious? And why do I still have this low fever?"

The answer:

I doubt you are contagious. However I am concerned that you have persistent symptoms after four months, which is unusual. I’m glad that you are feeling better. I recommend that you follow up with your physician. Further evaluation and testing may be necessary.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

"I am a stylist and have a customer who has had a severe case of COVID and is wanting a haircut. What questions should I be asking him before him comes in? I don't want to be exposed."

The answer:

Recommendations for returning to work can apply to this situation. You can ask your client how long it has been since his/her symptoms have ceased. In order to protect yourself and any other customers in your salon, all clients should follow these guidelines:

• No appointments until at least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,

• At least 10 days have passed since symptoms first appeared (reference CDC website July 8).

Of course, all clients and employees should be wearing a mask while in the salon. This link can provide more detailed information regarding safety in a salon or barber shop during this pandemic. https://www.mass.gov/doc/sector-specific-workplace-safety-standards-phase-i-for-hair-salons-and-barbershops-to-address/download

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

"My daughter lives with her 5-year-old daughter and they both sleep in the same bed. My daughter started feeling ill and started wearing her mask and wearing gloves, then tested positive two days later. My granddaughter negative a day after that. My daughter is self-isolating and my granddaughter is staying with me. Should I be worried about my granddaughter?"

The answer:

Your granddaughter is a close contact of your daughter who tested positive. Close contacts of patients diagnosed with COVID-19 should be instructed to self-quarantine for 14 days from the date of their last contact with the patient.

If your granddaughter develops symptoms during those 14 days, I recommend she be re-tested. Contact your granddaughter’s pediatrician for further instructions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I tested positive for COVID-19 and the rest of my family members tested negative. Should I retested to be sure it wasn’t a false positive? We all did the viral swabs test.”

The answer:

It is possible that you were exposed to a person with COVID-19 that your family members did not come in contact with. I would suggest that you self-isolate. If possible use a separate bathroom and bedroom from the rest of your family. If you begin to show symptoms, monitor them for severity and seek treatment if they become severe.

In the meantime, have your family wear masks when they are interacting with you in common areas of the home, and be sure to disinfect common areas and high touch surfaces.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My best friend was with her boyfriend on June 30 for a long time. He has to get tested for COVID every two weeks in order to work at a restaurant. He was tested on July 1 and it came back as positive on July 5. I saw my friend on July 3 for her birthday and we spent most of the day together. I am going to get tested, but should I worry about other people I have been around since me seeing her on July 3 and what are the chances I could have it from this kind of interaction?”

The answer:

“Your best friend was a close contact of a documented positive case (her boyfriend). Your risk is dependent upon whether your best friend tests positive, and if you were wearing a mask. If you test positive, then your contacts are at risk, and their risk is increased if they were not wearing a mask.”

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My daughter was home June 18-23. On the 20th, she developed respiratory signs we thought were normal allergies/sinus infection. She decided to get tested for peace of mind and had a nasal swab on June 25. On June 26, I developed a headache and sore throat. By the 27th, headache was worse and throat was on fire and I had a mild cough. Our daughter learned on the 27th that she was positive for COVID. My husband and I were tested on the afternoon of the 28th. I had a runny nose that day and still had headache. He had a headache and sinus congestion.

“Within 12 hours of testing, I was vomiting, having chills, and running a fever and very weak. I was in bed for two days extremely fatigued and running a fever of 100.4 to 101. We were called the evening of June 30 and told that I was negative and my husband was positive. We asked if they could have mixed our tests up.

“We convinced the doctor to retest me the next morning. During the night, I awoke drenched in sweat and my fever was gone. Throughout all of this, I continued to have a headache.

“Now, I developed a consistent cough. When I went back to be retested they insisted on chest X-rays, which were normal.

“Neither my husband or daughter have had any fever. We have all had fatigue, muscle aches, and a headache. We were certain my second test would be positive but once again it was negative.

“I am going to continue my quarantine to protect my staff, but how is it possible that I am the most symptomatic and yet negative twice? I had been on Enbrel for a year and a half and just started Humira on the 25th if that could be a factor.”

The answer:

I recommend you get a blood test next week for SARS-CoV-2 IgG antibody. If your blood test is positive, that means you were previously infected with the novel coronavirus (COVID-19).

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

My husband was sitting with a co-worker recently in a shared office (neither were wearing masks and unfortunately did not have 6 feet between them). The coworker received a message the next day that someone he played basketball with three days before had tested positive for the virus. Should my husband be tested? Or should he wait for the coworker to get results? What are the chances that my husband was infected?

The answer:

COVID-19 is spread mainly from person to person. Spread occurs between people who are in close contact (within about 6 feet) with one another through respiratory droplets, that come from the mouth or nose when an infected person coughs, sneezes or speaks. Playing basketball is close contact and comes with a moderately high risk of infection.

Since COVID-19 can be spread by people who are not showing symptoms or before their symptoms start and your husband was in an office with no mask on, he may have been exposed. Since his exposure would be once removed from the person testing positive, I would suggest that he self-isolate for 14 days (stay home) from his last exposure to his coworker and monitor his health. If he begins to show symptoms of COVID-19 and they become severe, he should seek medical treatment.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“After my wife got her test results that she is positive, the following day I went to test with my two children and the results were positive for them but negative for me. What do I do? Can I go to work?”

The answer:

Persons with positive tests results and close contacts of patients diagnosed with COVID-19 should be instructed to self-quarantine for 14 days. Currently, close contact is defined as being within 6 feet for

15 minutes or more, or being directly exposed to respiratory secretions (cough or sneeze). Self-isolate in a private room at home, and use a private bathroom if possible. Wear a mask when entering general living areas and interacting with others.

Continue good hand washing hygiene and follow other CDC safety precautions. Monitor symptoms and notify your health care provider if symptoms worsen.

The decision to discontinue home isolation for persons with confirmed COVID-19 should be made in the context of local circumstances. Options include a symptom based (time since illness onset and time since recovery strategy) or a test based strategy and are fully described at https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html and PAHAN 504

Regarding back to work, I also recommend that you contact your employer’s Human Resources Department.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I have been waiting all day for my COVID-19 results to come in and I am very nervous I received a test at my doctor’s yesterday at about 2 p.m. Should the results have already come in if it was negative or should I be worried thinking maybe that it’s positive and they’re trying to find out what I’m positive for?”

The answer:

Depending on the test you received, it can take up to 48-72 hours for test results to come back. If you are concerned, contact your physician’s office and see what help they can provide. In the meantime, monitor yourself for symptoms and if they develop to severity, seek out medical attention.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“How do I prepare my dad’s home for his return from the hospital after testing positive for the coronavirus? He is currently on ventilator and in ICU. Once he gets better and comes home, how do we as a family ensure his home, and specifically his bed, are safe to come home to? We are considering just buying him a new bed. Is that the best action to take?”

The answer:

I do not advise buying a new bed at this time. I recommend waiting until he improves and is transferred out of the ICU. Closer to discharge, Social Services will meet with you to discuss and arrange for all home care needs including possibly a hospital bed and home oxygen therapy if medically indicated. Home care needs may be covered by insurance depending upon his coverage.

My best wishes for your Dad’s quick and full recovery. 

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My stepdaughter and her three kids all tested negative using the nasal swab. I got tested as well and am negative. They are planning a visit here (they live two hours away), with an overnight stay. My grandkids want to hug me. What do you think?”

The answer:

It appears that you are all negative as of last week. If you have maintained social distance and have been practicing good hygiene, I’d suggest a hug.

Please keep an eye on the cases in your area and your stepdaughter’s area. If they have had spikes, it is important that all involved are following the social distancing recommendations.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My husband and I became sick June 14. We both were tested June 15. Three days later, swab-testing showed he was positive and I was negative. But he only had fever and body aches as symptoms. I, on the other hand, had experienced every symptom – shortness of breath, loss of taste and smell, body aches, fever, headaches and stomach pain. Yet I was negative. We waited 11 days and retested. He is still positive and I am again negative. Could you maybe explain what in this crazy world is going on?”

The answer:

You didn’t mention if you and your husband still have symptoms and/or fever.

Your husband was infected with the SARS-CoV-2 virus (also known as COVID-19). If he has no symptoms or fever now, he is likely recovered.

One possible explanation for your husband’s repeat positive swab test is that he is shedding non-infectious or dead virus particles.

Since you had 2 negative swab tests 11 days apart, I believe you are not infected now with the COVID-19 virus. For you, I recommend a blood IgG antibody test for SARS-CoV-2 (COVID-19). If your IgG antibody test is positive, that would tell you were previously infected.

Finally, I also advise both of you to continue CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I recently spent nine days in Florida and practiced self-distancing as well as wearing a mask. I did have two airline flights, from Illinois to Florida and back, wearing a mask at all times. Upon my return, I was tested (nasal swab) and the results were negative. I’m in my eight day since returning. Am I still at risk of getting COVID-19 from my trip to Florida even if I tested negative the day after my return?’

The answer:

Florida is a hot spot for infection with SARS-CoV-2. COVID-19 cases in Florida for the week that you were there totaled 54,456.

Authorities there are confirming community spread. Since you were on an airplane, which is considered moderately high risk of exposure, and you were in a known COVID-19 hot spot, you should continue your self-isolation for 14 days.

Most cases of COVID-19 develop in days 5-7, but some people will develop symptoms as late as 21 days after exposure. If you develop symptoms, seek medical treatment.

The CDC recommends that further travel to areas of the country where COVID-19 cases are high should be on an as-needed basis only.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I am a 65-year-old female. I was going to take swim lessons at the lake from an instructor who just told me her daughter works in radiology at a hospital and has had no symptoms. Neither she nor her daughter has been tested since March. Should I still take lessons?”

The answer:

Determining the level of risk associated with any activity has become forefront in our minds of late. When we are working to determine the level of risk that is associated with each activity, it is important to consider these things:

How close will you be to others? Six feet of personal space is best.

Will you be outside or inside? Outside is better to reduce your risk.

How many people will be involved in the activity? The less the numbers the better.

• Lower risk activities include: getting restaurant take-out; opening your mail; going camping; playing tennis.

• Moderately low risk activities include: grocery shopping while wearing a mask; going for a walk/run with a small group of people; waiting in a doctor’s office waiting room.

• Moderate risk activities include: going to a beach; shopping at a mall; swimming in a public pool; going to a backyard barbecue.

• Moderately high risk activities include: eating in a restaurant; playing basketball; playing football; traveling in a plane.

• High risk activities include: working out in a gym; going to a large event (music, sports, movie); going to a bar.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My sister just found out she has the virus. She is coughing, and can’t eat more than a couple of bites. What can she do to make herself comfortable?”

The answer:

She needs to contact her primary care physician as soon as possible for evaluation of her symptoms and further instructions. If she is getting worse and has shortness of breath, then take her to a hospital emergency department. It is important to remain hydrated and to avoid dehydration. She may also have pneumonia.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My son tested positive for COVID-19 six weeks ago. He no longer has symptoms, but his test has been positive every week after. Is this the pattern of all positive individuals? How many weeks are most people taking to get a negative result?”

The answer:

If your son had a genome (PCR) test for SARS-CoV-2 and it was positive, then he is still actively shedding the virus and should maintain his self-isolation. If your son had an antibody test, he could be positive for a few months.

Since he is still positive, I would recommend that he continues self-isolation. If you have further questions, please follow up with your primary care physician.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“Both my husband and I tested positive for COVID-19. Our boys did not, and they play baseball. Can the boys play this weekend if someone without COVID takes them? They have had no symptoms and have been isolated for seven days now.”

The answer:

Since you and your husband are in the same household as your boys, it is better that they also self-isolate.

SARS-CoV-2 is highly contagious and your sons could be in the incubation period now. 

This is the time when they have no symptoms but are still contagious. I would recommend that they remain isolated for 14 days and that you retest them once your symptoms have subsided.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • • 

“If you’ve taken the COVID-19 swab test and it was negative and you have no symptoms, do you still have to quarantine?”

The answer:

Many states have implemented rules for travel into their borders from places where COVID-19 cases are high. You may have to self-isolate for 14 days. I suggest you check local rules for where you are.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“I wanted to ask about my child who tested positive today for COVID-19. He is 10 and has shown no symptoms at all, but we were told that his friends he was hanging around with had tested positive so we went ahead and got him tested – as well as my wife and I. My wife and I both tested negative. How is it that this virus has been deemed very contagious but yet the two people that are around him all day that hug and kiss him, test negative? Is it possible we didn’t wait long enough to get tested?”

The answer:

I can understand your concern and confusion regarding your son’s positive test and your negative test. Without knowing which test you were given, I can only give you generalities. It is possible that your son is farther along in his infection than you and your wife.

SARS-CoV-2 is highly contagious. Even though you have tested negative, a member of your household has tested positive. I would recommend that you have your son use a separate bathroom and bedroom, that you wear a mask when interacting with your son, and that you monitor yourself and your family for symptoms or worsening conditions.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • • 

“I had given a friend a ride home and both where wearing masks. But I just found out they tested positive for COVID, but they just told me they had been feeling sick for over a week. Could I be infected now?”

The answer:

You were in close contact, but you were wearing a mask. If you don’t have any symptoms or fever, I doubt that you are infected. However since you were in close contact of a confirmed COVID-19 case, I do recommend that you get a swab test (molecular Polymerase Chain Reaction - PCR) now. I also advise you to continue CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber. 

• • • • • 

“I have to go for an operation, so the doctor told me to get a COVID-19 test because they will need them at the hospital, so I did a swab test and am still waiting for results. My employer told me not to come to work if you tested for COVID-19. I don’t have symptoms, and I only did the test because I have the operation. What should I do?”

The answer:

It is standard procedure for hospitals to require a COVID-19 test before surgery. I would suggest that you speak to your employer and see what the policy is through the Human Resources department. It may be that you are not to come to work if you are positive.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • • 

“I just had a nephew pass away and doctors say all his symptoms point to COVID-19. He was tested, I believe, three times at the hospital and they were all negative results. So after he passed away the hospital transferred him to the medical examiner’s office to help determine if anything else could have caused his death as he was only 29 years old with no underlying condition that we knew of, plus he was very active in sports and took his health seriously. So my question is: Is it possible to be tested for COVID-19 multiple times with negative results and still have the virus?”

The answer:

I’m sorry to read of your young nephew’s passing. In my opinion, it is unlikely that an individual who recently tested negative three times in the hospital before his death was infected with SARS-CoV-2 (COVID-19 virus).

I believe the autopsy will probably give the answer.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My parents were both positive for COVID-19. My dad has been hospitalized after a month. My mom recently tested negative after a 14-day quarantine. I would like to go there and help my mom but I’m concerned about whether I could catch it due to the fact nothing has been sanitized inside the home. My mother has COPD, so she has not used any Lysol spray or wipes to clean anything she or my dad have touched. I want to go there but I have underlying conditions and have concerns?”

The answer:

I understand your concern. 

Studies have shown that SARS-CoV-2 can remain on surfaces for days. From your question it seems that your father is hospitalized and your mother has been at home for 14 days with no symptoms and a negative test. This would make your risk of contracting SARS-CoV-2 in their home low.

There are a few precautions you can take. You can wear a mask while in their home, and while cleaning you can wear gloves. Be sure to clean high-touch surfaces well and let the cleaning products dry on their own – don’t wipe them dry. Also, remember to wash your hands regularly.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I just found out my granddaughter has COVID-19 and I was around her 11 days ago. What do I do? I have chronic lymphocytic leukemia.”

The answer:

I definitely recommend that you get tested now with a swab test (molecular Polymerase Chain Reaction – PCR). The incubation period for the SARS-CoV-2 virus (also know as COVID-19) is estimated to be between two and 14 days, with a median of five to seven days. So now is a good time to be tested. If you don’t have any symptoms or fever, you’re probably not infected, however I can’t exclude it in view of your underlying chronic lymphocytic leukemia.

While you wait for your results, you should self-isolate to your home in a private room and use a private bathroom if possible. I also recommend that you continue good hand washing hygiene, wearing a mask and following other CDC precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber. 

• • • • • 

“My husband was tested for COVID-19 at a free testing site in Beeville, Texas. He has no symptoms. He had to be tested because a person from his work tested positive. It’s been a week and a day and they still have not called or texted his results to him. That was how they told him he would get his results. They also told him it would be 24-48 hours to hear from them. So what do we do now?”

The answer:

It can be so worrisome to wait for test results. Many testing sites are experiencing delays in testing. I would follow up with your primary care physician to see if that office can get your results.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“My sister tested positive for COVID-19 via nasal swab on May 31. She had mild symptoms for less than 14 days and was retested via nasal swab on Day 17, and that test came back negative. She has had no more symptoms, except a small cough. Her job requested her to be retested to return to work and when she tested after Day 20 via swab, she was positive. Why would that happen?”

The answer:

There are several possible explanations.

The second nasal swab test (molecular Polymerase Chain Reaction – PCR) done on Day 17 was possibly a “false negative” due to an inadequate specimen.

The third swab (PCR) test done after Day 20 was positive. A study from the Korean Centers for Disease Control and Prevention studied 285 COVID-19 survivors who had tested positive for the coronavirus after their illness had apparently resolved. The virus samples collected from them could not be grown in culture. One possible explanation is that the patients were shedding non-infectious or dead virus particles.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“If a family member was in contact with someone that had the virus and the family member's test was negative, does the family need to quarantine?”

The answer:

No.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“A coworker of mine tested positive for COVID-19. The person had been attending work for two weeks prior to the test, and had been feeling unwell, but did not tell anyone. After having mild symptoms myself for about four to five days, I got tested. My result came back as undetected. Since then, I have developed more symptoms, and have been feeling worse. 

“It has still only been about 10 days since the onset of my symptoms. My question is: What does an undetected result mean, since it was not negative or positive? Also, should I get retested, and if so how long should I wait before testing again?”

The answer:

I assume your test was a swab (molecular Polymerase Chain Reaction – PCR). The swab PCR test results that I receive are reported as POSITIVE for the SARS-CoV-2 virus (COVID-19), or NON-DETECTED (which is negative). Therefore, I believe your test result was negative.

The incubation period is the time between exposure to the virus and the onset of symptoms. The incubation period for the SARS-CoV-2 virus (also known as COVID-19) is estimated to be between two and 14 days, with a median of five to seven days.

It has been more than 10 days since the onset of your symptoms. Therefore, I recommend you get retested with a swab (PCR) now.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“One of my tenants tested positive for COVID twice, then 15 days later, had moved out of the house. What should I do?”

The answer:

 Clean and disinfect the house using CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“Suppose someone tested positive, recovered, and later tests showed the antibodies in their system but no further COVID-19.

“If that same person is later exposed to droplets or aerosols containing the virus, can that person inhale and then transmit the virus to someone else before their antibodies have a chance to kill the virus?”

The answer:

This is a good question.

Viruses need to be inside our cells in order to make copies of themselves. We inhale the virus, it attaches to our cells and then enters them by penetrating the cell membrane. Once inside, the virus will proceed to redirect the cell’s metabolic processes to make copies of the virus. This essentially makes the cell a virus factory.

If someone has been infected with SARS-CoV-2 and has recovered, then they have antibodies to the virus. Those antibodies will bind to the virus before it can enter the cell and prevent infection. It is nearly impossible for someone to inhale respiratory droplets and then transmit them to someone else. 

We have many levels of defense that prevent that from happening, mucus in our respiratory tract, histamine release (which causes sneezing and coughing), and the antibodies someone makes to a virus can be secreted into our nasal passages to stop the virus before it breeches our skin.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I live in New Jersey but will be traveling to North Carolina. New Jersey is currently requiring a 14-day quarantine for residents after they return from certain states, including North Carolina. If I get tested on the day I return, and the test is negative, is a full 14-day quarantine still necessary?”

The answer: 

Yes. You could have been exposed on your last day in North Carolina. On average symptoms present themselves five to seven days after exposure. However, some individuals are seeing symptoms as late as 19 days. I strongly recommend that you self-isolate for 14 days after travel.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My wife and I were exposed to my son two days before he manifested COVID-19 symptoms and tested positive. Eight days after the exposure, my wife tested and was negative, but I still didn’t get tested, although we live, eat and sleep together, is it possible that I might be positive while she is negative in eight days?”

The answer:

Yes it is possible that you are positive even if she is negative. It is best to self-isolate for 14 days from the time of exposure. If no symptoms present themselves, then you are likely not infected.

 – Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My cousin that we are supposed to be going on vacation with in two weeks tested positive for COVID. The only symptom he had was lack of taste that began more than two weeks ago. He has a retest five days before we are supposed to be leaving. If it is negative, is it OK to be around him? We will be staying in a house together, my wife is pregnant and we have a 2-year-old.” 

The answer:

If someone has tested positive for SARS-CoV-2 via PCR (genome) test, that person is considered to be actively infected and is likely shedding the virus.

Even though his symptoms are mild, he can still be shedding the virus. Until a PCR test is negative, it is wise to have him self-isolate (even with mild symptoms), because he is likely spreading the virus to others he comes in contact with.

His family should also be self-isolating to reduce the spread of the virus to the community, family and friends.

It is your choice as to whether you go on vacation with them, the risk assumption is high if he is PCR positive for SARS-CoV-2.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I tested negative for the COVID-19 antibodies, but my daughter who lives with me just informed me that someone she works with tested positive for coronavirus. Should I get a COVID-19 test?”

The answer:

If your daughter was a close contact (defined as being within six feet for a period of 10 minutes or longer) with an employee who tested positive, then I recommend both you and your daughter be tested (molecular Polymerase Chain Reaction – PCR swab test).

Your daughter’s exposure risk was higher if she was not wearing a mask. If you or your daughter develops any symptoms or fever, notify your primary care physician for instructions.

I also recommend that you both continue good hand washing hygiene, wear masks and following other CDC precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber. 

• • • • • 

“I am staying with my daughter and son-in-law. We took the COVID test. He tested positive and my daughter and I tested negative. He is self-isolating in part of the house. For how long do my daughter and I quarantine? When will I be able to get on a plane and fly back home?”

The answer:

Great job self-isolating after exposure.

Avoid interactions with the infected individual. 

Don’t share the same bathroom. Wear a mask in common areas of the home. Open the windows in the house, to avoid continual exposure.

The least amount of time you should spend in self-isolation is 14 days. Since you are in the same home, you could be exposed during your isolation. 

The safest course of action is to wait until your son-in-law has tested negative twice by PCR for SARS-CoV-2.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • • 

“How effective is a mask when the nose is not covered? It seems many prefer to wear their masks in this manner.”

The answer:

Masks are only effective if you cover both the nose and mouth. 

Wearing them in any other manner is ineffective.

By covering your mouth and nose, you are placing a barrier in between the world and any respiratory droplets that you are expelling via breathing.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“My daughter works in a dental office. Her manager tested positive for COVID. I saw my daughter last night, hugged her and talked to her for about 15 minutes. Am I now exposed as well?”

The answer:

Close contacts are people who have been within six feet for a period of 10 minutes or longer.

There are significant unknowns. I don’t know which test (Polymerase Chain Reaction – PCR swab or blood antibody) the manager had; if the manager was previously quarantined; if the manager had symptoms, fever or recovered; if the manager was contagious; and if your daughter was wearing a mask.

I recommend you and your daughter discuss screening for COVID-19 (PCR swab test) with your primary-care physician. I also advise continuing CDC safety precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“I tested positive on April 14 and 29, and indeterminate on May 14, and negative on May 26 and 30 and June 6. Now it’s June 29 and I’ve tested positive again. So am I still shedding the virus? Is that the reason I’m testing positive again?

The answer:

If the test you received was the PCR genome test, then you are shedding the virus. Please self-isolate for 14 days. If you are still symptomatic, I urge you to monitor your symptoms and seek medical treatment if your symptoms become severe.”

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

•  •  •  •  •

“Upon her return from Florida, my daughter tested positive for COVID on June 23. She has been quarantined since her return. When should my wife and I get tested for COVID? We would like to go Thursday. Should we wait until July 9?”

The answer:

I am assuming your daughter lives with you or that she visited you before she knew she was COVID-19 positive.

First, she should contact anyone she was in contact with and if she was on an airline, she should contact the carrier to inform them of her status. 

Contact tracing is incredibly important to prevent major community spread of the virus.

If you were exposed to her and have not developed symptoms, you may not need to be tested. You can self-quarantine for 14 days (avoid neighbors, crowds, etc.) and only get tested if you become symptomatic. If you feel that you want a test, I urge you to contact your physician.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“Is it possible to expose another person to coronavirus if you were positive but are now negative but a family member now has it? I tested negative after 43 days, plus had antibodies test done and I was positive for having antibodies.”

The answer:

An interesting question.

If you don’t have any symptoms or fever now, then I believe you are recovered and not contagious.

Your repeat swab test (molecular Polymerase Chain Reaction – PCR) was negative. You tested positive for antibodies (SARS-CoV-2 IgG) which is what I would expect because a positive SARS-CoV-2 IgG antibodies test tells if someone has been previously infected. IgG antibodies are detected in most patients 10 to 21 days (median 14 days) after symptoms of COVID-19.

I recommend that you continue good hand washing hygiene, wearing a mask and following other CDC precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber. 

• • • • •

“If I test positive for COVID-19, would subsequent follow-up tests that are also positive be included in the daily report of new positive cases?”

The answer:

Each state is counting positive tests differently. If the state is counting cases, they are counting each person once.

In Pennsylvania, cases are counted as confirmed cases, probable cases, negative tests and deaths. 

New cases, however, can be antibody positive or genome positive.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“I am going to have surgery and I got tested for COVID-19. I have no symptoms other than a sinus infection that I’ve been dealing with for a while and postnasal drip. No chest congestion, very minimal cough. The test came back positive. Does not having any symptoms mean that I’m in the last stage of the virus, or is there a way to know in what phase of the disease I’m in – not because I felt sick, but because of the planned surgery?”

The answer:

I’m assuming that your positive test was a Polymerase Chain Reaction (PCR) swab test.

According to recent studies, approximately 40% to 45% of individuals infected with SARS-CoV-2 (COVID-19) may have no symptoms at the time of testing, and they may transmit the virus for 14 days or longer.

Therefore, inform your close contacts and advise them to quarantine at home for 14 days. 

This includes family members. Self-isolate in your home until these conditions are met:

1. It has been at least seven days since your symptoms first appeared.

2. It has been at least three days since you have not had a fever (without using fever reducing medications) and your respiratory symptoms are improving.

If your symptoms get worse, notify your primary care physician immediately. I also recommend continuing good hand washing hygiene, wearing a face mask and following other CDC recommendations.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My colleague tested negative but lives with his mother, who tested positive. I spent about an hour working with him. Are there any precautions I should take or am I OK to continue on?”

The answer:

If you and your colleague both have no symptoms or fever, I don’t have any specific instructions. However, I do recommend continuing good hand washing hygiene, wearing a face mask and following other CDC precautions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My employer had me take a COVID-19 test on Monday. We were scheduled to return to work on Friday. I got a phone call Wednesday from my HR department telling me that the laboratory that conducted my test needed more time on my test or had to re-do my test and can’t determine my results at this time. She told me I wouldn’t be put on the schedule until they hear back from them. She told me I can also go somewhere else that offers free testing if I wished, but I didn’t have to. She told me not to be nervous. I was told that they didn’t need me to give another sample and that they had enough. I am unsure why it came back abnormal or that it came back inconclusive. I am surprised because I have no symptoms. Why would the test come back this way?”

The answer: 

You didn’t mention whether your test was a Polymerase Chain Reaction (PCR) swab test, or a blood antibody test. It is important to know which test was done.

It’s possible that your test result was a “false positive.” 

However, recent studies suggested 40% to 45% of individuals infected with SARS-CoV-2 (COVID-19) may have no symptoms at the time of testing, and they may transmit the virus for 14 days or longer.

Therefore, I recommend that you discuss repeat testing and further instructions with your primary care physician.  

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I have allergies, and I usually have a rough couple of weeks at the start of the yellow pollen season. I take my meds, but almost every year I end up with sinus infection which leads to fever, sneezing, sore throat and coughing, also aches and chills. I try to see my doctor ASAP to keep it from going full bloom. Well, I knew it was coming on, so I called the office to go in for the usual shots, antibiotics and zpak. I was told I couldn’t come to the office until I was tested for COVID-19. Why? I am 63, and I have worked in a hospital lab as a phlebotomist for more than 20 years. I know how to prevent contamination. I lived through SARS, several flu outbreaks, c-diff (C. Difficile Colitis), Mrsa.”

The answer:

First, thank you for your long service as a hospital phlebotomist. I’m sure you’re following appropriate hospital infectious disease precautions, as well as, department of health and CDC recommendations.

I recommend that you ask your physician this question. I don’t know what your physician’s office policies are for treating patients with respiratory symptoms during the COVID-19 pandemic.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“I was tested for the antibodies for COVID-19 and was negative. Are my chances of getting COVID-19 higher than if I had tested positive?”

The answer:

An excellent question without an answer at this time.

Since the pandemic is only months old, there’s no data on long-term immune response. The immune response to COVID-19 is not fully understood, and definitive data on post infection immunity is lacking. It is not known for certain whether individuals infected with SARS-CoV-2 (COVID-19) who subsequently recover will be protected either fully or partially from future infection with SARS-CoV-2 or how long protective immunity may last.

Further research and the collection of patient data are needed. It remains to be determined whether a robust IgG response corresponds with immunity.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“My wife had COVID-19 as far back, we believe, as February with loss of taste, no smell and headaches. These symptoms were not known at that time and she was coughing a lot. We thought nothing of it, but maybe allergies or a cold. She then developed a fever in April, after the other symptoms subsided – fever for one week of 100 degrees-plus. 

“On May 4, she tested positive for the coronavirus. I had shown no symptoms through these four months and I tested negative for the coronavirus on May 4 as well. 

“We both had antibodies done on June 23, hers was positive and mine was negative. Should I be worried about catching the coronavirus? Should I get re-tested for the coronavirus?”

The answer:

If the question you are asking is if you should be concerned about your wife infecting you with SARS-CoV-2, the answer is no. It appears, from the information you have given, that your wife has recovered from COVID-19.

That does not mean that you are not at risk of acquiring SARS-CoV-2 from other sources. To add to this, research is showing that antibody protection is lasting three to six months. We do not know yet if reinfection is possible.

If you begin to show symptoms of COVID-19, monitor them and seek medical treatment if they become severe.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“I’ve been watching all the reports of new cases of COVID-19 in the U.S. with over a half-million tests being done daily now and about 25,000 positive results every day from these tests. My question is: Do these results mean that they are all sick or do the results mean in some or most cases that at one point they had it and have no symptoms and are not infectious to anyone anymore? Are we seeing higher numbers but only because they were previously infected or are these going to be active cases?”

The answer:

There are approximately 300,000 tests daily for COVID-19. 

Many public health officials are calling for 500,000 (on the low end) to tens of millions (on the higher end). The more we test, the better we will be able to respond to this pandemic. Testing allows science to determine how bad the problem is and how best to respond to it.

Testing is being done differently across the United States. Each state has put in place policies for how testing is being done there.

These tests come in two forms: viral genome tests (for active infections) and antibody tests (to look for an immune response to the virus and see if you previously had the infection). Depending on which test a person has gotten, they may be in an active infection (genome test) or they may have recovered from the infection (antibody).

Some important things to remember when looking at the testing data:

1. These data are assembled from many sources – private labs, state-run labs, hospitals.

2. Not all states are reporting at the same level. Some states are only reporting positive cases. 

This can lead to a skewed view of the results by not showing a comprehensive picture of the total testing being done. Some states are blending the testing data reporting genome positive tests with antibody positive tests, this is combining active infections (genome tests) with those that are recovered (IgG tests) and those in the early stages of recovery (IgM). Some states, particularly where meat packing industries are found, have set a threshold for reporting. They will not report cases unless 10% of the population from that plant has tested positive.

3. Positive tests in a state may not be indicative of total cases in that state, as some individuals are tested more than once.

4. Not all tests are being reported to the CDC. It can be difficult to determine the accurate picture of what is occurring with infections in the U.S. due to the lack of coordinated response in reporting. I would suggest looking at your state’s reporting and determine if officials there are reporting the type of positive case (genome vs antibody) along with the number of negative cases. This is the best way to see who is active, recovered and virus free.

This was a great question.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •  

“If you have been tested at your work place on a daily basis with temperature check and all the questions, and have been healthy, can you refuse to be swab-tested if health department demands it to be done?”

The answer:

I don’t know your place of employment.

However, the Wolf administration has issued a universal coronavirus testing order for nursing homes in Pennsylvania. 

The order requires all nursing homes to complete initial baseline testing no later than July 24. 

The Department of Health also issued updated testing guidance to all long-term care facilities, with a renewed focus on keeping COVID-19 out of the facility by testing all staff members and residents.

Your local health authorities have the latest information about COVID-19 testing in your area.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • • 

“My co-worker came to work with a fever. I wasn’t in the office when the person came in and was promptly sent home. My co-workers and I are currently divided into two teams – one team works one week and the other team works the other week. Should I be worried?”

The answer:

Fever can be a sign of many types of illnesses. If other symptoms were present – shortness of breath, coughing and loss of taste and smell – this would be more of an indication of COVID-19.

I would ask your workplace what the cleaning procedures are. If they are deep cleaning the area daily and your co-workers are practicing good hygiene, then you can better assess your risk.

It is important to remember that many illnesses cause fever, but the best way to prevent most infectious diseases is with good hygiene and proper hand washing.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“My buddy’s ex-wife tested positive for COVID but refuses to quarantine. She is constantly over at my friend’s house and won’t leave him and their son alone. She even barges up in my friend’s house uninvited, knowing she’s positive. My friend told me that his son got his test results back and he’s negative and my friend already had a test done last week that came back negative. They don’t live in the same household, but she’s constantly driving by his house or stops by and just won’t leave him and his son alone and go home and self-quarantine. 

“She tested after him, so now he’s gotta go get retested because of her. But when they were leaving, she bent into the passenger window and gave their son a long hug – knowing that he just tested negative and knowing that she’s positive. Is there anything at all he can do to make her stop without getting a restraining order?”

The answer:

I would suggest that your friend and his former spouse work together to make a safety plan for COVID-19. It is always best to start with a dialogue about the problem.

If this is not possible or has been tried with no results, he can contact a lawyer and see what (if any) legal rights are afforded. 

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“Can my job require my dad’s negative test results for me to return to work? He does not work there but we live together.”

The answer:

Most employers have policies in place that cover what is required to return to work. I suggest that you contact your Human Resource Office and determine what their policy is.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“My daughter’s son was exposed to someone with COVID and we have been around all of her family. He had the test but it’s not back yet. How long does it take to get it once he was exposed? My husband has no immune system. He is 89.”

The answer:

The incubation period is the time between exposure to the virus and the onset of symptoms. The incubation period for SARS-CoV-2 (also known as the COVID-19 virus) is estimated to be between two and 14 days, with a median of five to seven days (possibly longer in children).

According to recent studies, roughly 40% to 45% of individuals infected with SARS-CoV-2 may have no symptoms at the time of testing, and they can transmit the virus for 14 days or longer.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • • 

“I was COVID-19 positive after my quarantine of 14 days. I tested negative, but I’m confused what precautions I need to follow and am I free to move around my house and cook for myself. Do I need to repeat my test and after how many days?”

The answer:

Your history is that you were COVID-19 positive, then quarantined 14 days, and after which you tested negative.

You should self-isolate in your home until each of the following conditions are met:

1. It has been at least seven days since your symptoms first appeared and

2. It has been at least three days since you have not had a fever (without using fever-reducing medications) and your respiratory symptoms (cough, shortness of breath) are improving.

So after the above, and you have no symptoms of infection or fever, you should be safe. I do recommend continuing good hand washing hygiene, wearing a face mask and following other CDC recommendations. In my opinion, there is no need to repeat a Polymerase Chain Reaction (PCR) swab test.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I would like to know if a person has a spouse who tests positive but he or she tests negative, can the person testing negative still transmit the virus unintentionally through contact by touching of contaminated surfaces? Can that person then bring that into the work place?”

The answer:

If a person in your home has tested positive for SARS-CoV-2 (COVID-19), that individual should self-isolate and monitor his/her symptoms. If possible, have them use a separate bathroom and bedroom. If symptoms become severe, seek medical treatment. 

Others in your home should also stay home and wear masks when you enter common living areas.

While transmission is possible via fomites, inanimate object that can transmit disease (such as door knobs and tissues), that is not the main route of transmission. The best way to reduce the risk of this type of transmission is frequent cleaning of the high-contact surfaces and good hygiene practices.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I am having surgery in a few days and have to have the swab test done. I think I had the virus in February and am wondering if I can pass the test. I am well and have no symptoms. Also, my dad had coronavirus this winter. Is it safe for me to travel out of town and see him this close to surgery? He is perfectly well now.”

The answer:

Chan Soon-Shiong Medical Center at Windber also requires pre-operative Polymerase Chain Reaction (PCR) swab testing for patient care and safety of operating room personnel. I suspect your PCR swab test will be negative since you feel well and have no symptoms. A blood test for COVID-19 IgG antibodies will be helpful to determine if you were infected with the SARS-CoV-2 (COVID-19) virus in February 2020.

I do not recommend traveling out of town this close to surgery because of the exposure risk. I do recommend continuing good hand washing hygiene, wearing a mask and following other CDC recommendations.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

 •  •  •  •  •

“My sister and her husband had developed symptoms on May 23. They were symptom-free as of June 19. They tested three times PCR. The first two times the results were borderline, the third time for my brother-in-law the result was positive and my sister was borderline. They don’t have any symptoms except they didn’t restore the sense of smell and taste completely. So what does that mean? To be positive while you are recovered and also are they infectious?”

The answer:

The nucleic acid amplification test is designed to look for active infections. It is possible that they are still infectious since symptoms are still present (loss of sense of smell and taste). If they want to rule out active infections, they can request an antibody test. In the meantime, please have them self-isolate to avoid spreading the virus.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

 •  •  •  •  •

“I had a COVID antibody test done just for the heck of it because I was already getting other blood drawn. The IgG was negative, but the IgM was positive. My doc deemed the whole test negative. Well, after I looked at my chart and discovered that the IgM was positive, I started researching online. I learned from your site (www.tribdem.com) and another site that if you test positive for the IgM one, then that means you are either currently infected or recently recovered from it. I called my doctor’s office and after informing them of the differences between the two antibody tests, they agreed to order a COVID-19 swab test. I won’t hear back for 24 to 48 hours. So, in the meantime I’m of course anxious about it. If I have it, I wonder if my husband and two kids do as well, and of course worry about every little symptom I may develop. So basically I guess my question is: If I had my blood drawn on a Tuesday and the test that I just got back last night shows I’m IgM positive but IgG negative, where would I most likely be at in the sickness phase? My only symptoms are a slightly stuffed up head and a little phlegm in my nose and in the back of my throat that I have had for the past few days. Just tonight I started getting a low-grade fever of 99.6. Would the worst be over or yet to come?”

The answer:

SARS-CoV-2 (COVID-19) antibodies include IgM and IgG. IgM is usually the first antibody produced by the immune system when a virus attacks. A positive IgM test indicates that you may have been infected and that your immune system has started responding to the virus. IgM detection with COVID-19 is a median five days (range three to six days). I agree with a Polymerase Chain Reaction (PCR) swab test. While you wait for your PCR result, you should:

• Quarantine and self-isolate to your home in a private room and use a private bathroom if possible.

• Whoever else lives in your home should also stay at home.

• Wear a mask when you enter general living areas. Interact with others as little as possible.

• All family members should wash hands regularly with soap and water.

• If you develop additional symptoms, or if your symptoms get worse, notify your physician.

Further instructions will depend on whether the PCR swab test is positive or negative.

Finally, I also recommend repeating the IgG blood antibody test in two to three weeks. IgG antibodies are detected in most patients 10 to 21 days (median 14 days) after symptoms of COVID-19 begin. IgG antibodies remain in the blood after the infection has passed.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

A reader of The Tribune-Democrat asked:

“I have been throwing my mask in the dryer on high heat for two or three minutes. Shouldn’t the heat kill any virus?”

The answer:

It is best to wash the masks in warm, soapy water, but if that isn’t possible the dryer on high heat for 10-15 minutes will suffice.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“My question is: A person who tested positive and had coronavirus, can they still infect other people even after the 14 days and testing negative for the second test after they quarantined? I’m very concerned about that. Do scientists know if it could still be spread after the positive then negative test results? I have two small babies and I’m very worried. I’d appreciate an answer to this as I cannot find this on the internet anywhere.”

The answer:

We are unsure at this time about reinfection with SARS-CoV-2. A positive test after symptoms have ceased does not mean that the person is shedding virus that can be or is infectious.

Recent studies out of South Korea show that it is unlikely that persons who are testing positive for the virus via the genome test are not infectious. What the study suggests is that these patients have dead or non-infectious virus and that is what is being detected. Of course, more research is needed.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“Can a person who has tested negative still be carrying the virus and infect someone else?”

The answer:

There are two different types of tests for SARS-CoV-2, the virus that causes COVID-19. The genome test looks for viral RNA from a swab of the tested individual. The other type of test is an antibody test. This tests for an immune response to the virus in the form of antibodies being made by the body.

Tests are measured on two criteria, sensitivity (can the test detect small amounts of the viral genome or antibodies to the virus) and specificity (does the test detect only the virus and no other pathogen indicating there is no cross reactivity).

The FDA recently released determinations on how the tests are performing. These determinations had to make some assumptions due to the unknown prevalence of infection in the USA. They assumed a 95% confidence interval, meaning they are about 95% sure the tests will fall within the ranges they have set for detection. The results of these determinations show that the majority of the test available (14/16) are able to detect positive patients 90% of the time or greater (they are sensitive and specific).

No test is going to capture all positive individuals (false negatives happen) and tests also return false positives (individuals who are negative but test positive). As more testing is done, more data is gathered and the testing specificities and sensitivities can be adjusted accordingly.

If you’d like to see the FDA report, this website will give you the results of the determinations done thus far at https://www.fda.gov/medical-devices/emergency-situations-medical-devices/eua-authorized-serology-test-performance

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

• • • • •

“Will students have to wear masks to school this fall semester because of the coronavirus?”

The answer:

The Pennsylvania Department of Health along with the Centers for Disease Control and Prevention have given a list of preliminary guidelines that include health and safety plan considerations. Among those guidelines is the use of masks in Pre-K through 12th grades.

Each school will have to design its own health and safety plan and have it approved by the board of directors. Once that plan is approved by the directors, it must be sent to the Pennsylvania Department of Education and posted on the school’s website.

For more information on what Pennsylvania is recommending to the school districts, please navigate to this link: https://www.education.pa.gov/Schools/safeschools/emergencyplanning/COVID-19/SchoolReopeningGuidance/K12/Pages/default.aspx

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

A reader of The Tribune-Democrat asked:

“I’m an RN. Thankfully, the pediatric population I care for is isolated. I only go to work and home. My husband gets groceries and other necessities and is diligent with wearing a face mask, wiping down all areas of the cart, etc. My daughter and granddaughter do not leave our home.

“One week ago my temperature was 99.9 and I was chilled to the bone, then a cough developed. Tested negative on May 30. Had virtual visit with my care providers on June 2 for increasingly productive cough, intermittent wheezing, increased fatigue. Was started on Albuterol inhaler, doxycycline and bromfed.

“My cough is very persistent, no relief to my chest heaviness.  Whenever I eat, drink, talk or move, coughing is triggered.

“Should I get tested again?”

The answer:

First, I thank you for your nursing care.

Regarding your question, your symptoms may or may not be related to coronavirus disease or other illness. I would repeat a molecular Polymerase Chain Reaction (PCR) swab test, and I also suggest a blood test for SARS-CoV-2 IgG antibodies to evaluate your immune response.

I’m concerned about your persistent cough and chest heaviness. Therefore, I also strongly recommend you contact your treating physician as soon as possible for further evaluation and treatment. You must continue good hand-washing hygiene and wearing a face mask.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

A reader of The Tribune-Democrat asked:

“I have heard that results of a COVID-19 test can also tell which day and which time exactly it enters the infected body. Is that true?”

The answer:

False. I’m not aware of such a test.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • • 

A reader of The Tribune-Democrat asked:

“My daughter, who is a nurse, tested positive for COVID-19 on May 10. She stayed home from May 6 to May 23. She returned to work May 26. Is it safe for me, her 62-year-old mom, to take care of her baby?”

The answer:

An interesting question with unknowns.

First, I assume you and the baby have no symptoms or fever. 

Second, were you exposed to your daughter when she was sick and before or when she was quarantined?

I recommend you get a blood test for SARS-CoV-2 (COVID-19) IgG antibodies. In my opinion, it is probably safe for you to care for the baby. However I would wait for your antibody test result, and I recommend you ask the baby’s pediatrician if it is safe.

I also advise you to follow precautions including wearing a mask and good hand washing hygiene.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

A reader of The Tribune-Democrat asked:

“If you have been around someone with COVID-19 antibodies, do you have to quarantine?”

The answer:

SARS-CoV-2 (COVID-19) antibodies include IgM and IgG. IgM is usually the first antibody produced by the immune system when a virus attacks. A positive IgM test indicates that you may have been infected and that your immune system has started responding to the virus.

IgM detection with COVID-19 is a median five days (range three to six days). IgG antibodies are detected in most patients 10 to 21 days (median 14 days) after symptoms of COVID-19 begin. IgG antibodies remain in the blood after the infection has passed.

IgG antibodies also indicate that you may have had COVID-19 in the past, and these antibodies may protect you from future infection. It is unknown at this time how much protection antibodies might provide against reinfection.

If the individual had a positive IgM antibody test, I recommend a molecular Polymerase Chain Reaction (PCR) swab test and quarantine until the PCR test result is available.

If the individual had a positive IgG antibody test and symptoms – such as fever, cough and/or shortness of breath – 10 to 21 days ago, I also recommend a PCR swab test and quarantine until the PCR result is available.

If the individual has positive IgG antibodies, no recent symptoms and no fever, then no further testing is indicated and quarantine is not necessary.

In summary, it depends on which antibody was detected and if the individual had recent COVID-19 symptoms and/or fever.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“If two relatives had coronavirus and are now negative, am I safe to be with them if I have not?”

The answer:

A recent study from the Korean Centers for Disease Control and Prevention tracked 285 COVID-19 survivors who had tested positive for the coronavirus after their illness had apparently resolved, as indicated by a previous negative test result. The virus samples collected from them couldn’t be grown in culture, indicating the patients were shedding non-infectious or dead virus particles.

So once you recover, and you have no symptoms or fever, it’s safe to go out in public. However, I would recommend continuing to follow CDC precautions, including social distancing, good hand-washing hygiene, and wearing a face mask.

Since the pandemic was just recently declared on March 11, there is no data on long-term immune response.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“After much concentration with social distancing and staying at home I inadvertently drank from a soda my granddaughter had been drinking from. She is from a family of four with no apparent symptoms. I am 70 years old with Type 2 diabetes. Is there testing we should have done following this incident or any additional measures? I’m nervous that after all my efforts the past 2 1/2 months that I will contract the virus.”

The answer:

I congratulate you on all your efforts and safe practices. In my opinion, no testing is indicated unless you develop any symptoms or fever, and no additional measures are needed.

I believe your risk is very low concerning the one incident which you described, and I would not worry. I do recommend that you continue social distancing, good hand washing hygiene, and wearing a face mask. You’re doing a great job!

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My employer has required me to have two negative tests before returning to work. How long do I have to wait after my first negative test before I can get my second test?”

The answer:

The CDC has placed guidelines concerning returning to work after recovery from COVID-19. 

These guidelines state that an individual should have two consecutive negative results of an FDA-approved COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive respiratory specimens collected greater than 24 hours apart.

Therefore, the least amount of time between testing that can occur is 25 hours.

It is important to point out that an individual must have two consecutive negative tests, and results for these tests can take several days to be returned to the individual.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“I am a personal trainer who has had an 89-year-old client request that I come to her home to train her. Besides being a trainer, I also have a part-time job at a regional airport near my home where I handle bags and check in passengers, as well as cleaning the plane. I am very careful when I work about wearing a mask, gloves, using social distancing and washing my hands. Is it safe for my client if I train her?”

The answer:

I’m glad that you are using personal protective equipment (PPE) and practicing good hand-washing hygiene. The question of risk exposure for an 89-year-old individual is not insignificant, even though you are taking appropriate precautions.

In the United States, the highest incidence of severe outcomes with COVID-19 were in patients older than 85. Therefore, visitors – other than caregivers – are not recommended.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“I am 75 and have Post Polio Syndrome, chronic bronchitis and shingles. My husband is going back to work at an auto glass manufacturer. How can I isolate in my home? We also have three dogs. Could they carry the virus to me if he gets sick?”

The answer:

Self-isolate in a private room and use a private bathroom, if possible. Wear a mask when you enter general living areas. Follow other Pennsylvania Department of Health and CDC recommendations and precautions including good hand-washing hygiene and frequently clean with a sanitizer common surfaces you may both touch.

CDC is aware of a small number of pets worldwide, including cats and dogs, reported to be infected with the virus that causes COVID-19, mostly after close contact with people with COVID-19. Based on the limited information available to date, the risk of animals spreading COVID-19 to people is considered to be low.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“I have symptoms of COVID-19 and am scheduled to do my test this morning. It will take two days to get results. Is it safe to use my inhaler and nasal spray? And if my test is positive, is it safe to use my inhaler and nasal spray?”

The answer:

“I’m not aware of any inhaler and/or nasal spray contraindications with SARS-CoV-2 (COVID-19). I recommend that you follow-up with your primary care physician.”

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“If the virus has a very short life in/on non-living environments, why is it so important to deep clean spaces that have been vacated for several months? 

Wouldn’t routine cleaning suffice before the space is occupied again?”

The answer:

Cleaning spaces that have been vacant for several months with a deep cleaning is a good idea in general. Many microbes could be present on these surfaces (Staphyloccous and Streptococcus species for example).

There have been news stories circulating that the CDC has changed their guidelines on how SARS CoV-2 spreads. This is untrue. The CDC merely placed the contaminated surfaces under a subcategory stating that the virus does not easily spread via contaminated surfaces. Both the old and new versions of the recommendations state that it is known that the virus can survive on contaminated surfaces for hours to days depending on the surface.

The best way to reduce risk of infection is to wash your hands regularly and clean surfaces with soap and water followed by a disinfectant.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My husband had COVID-19 symptoms, a sore throat, and because he is 63 years old, we wanted to check to see if he is OK. His results came back positive and he is on a 14-day quarantine. We have now all been tested in the family. So far my youngest daughter’s results came back negative. Should she move out to be safe?”

The answer:

I am assuming the test that all of you received was the genome test. If your husband was positive for the genome, that is indicative of an active infection. This means he is contagious. He needs to quarantine himself and limit the exposure to other family members. It is recommended that high-touch surfaces be cleaned multiple times a day as well.

It is prudent for your daughter (and any other family member who tested negative) to self-isolate in a separate part of the home. Since she is currently living in your home and your husband tested positive, there may have been exposure to SARS CoV-2 since the testing. Testing gives us a snapshot of what is occurring, and since you are all in the same household, there could have been exposure after testing.

If she has a place to go to for 14 days where she is not risking exposure to others, you may want to consider having her go there.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • • 

“If I pick up the virus from someone at noon, how soon do I start infecting others?”

The answer:

A small number of studies suggest that some people can be contagious during the incubation period, the time between exposure to the virus and the onset of symptoms. The incubation period for SARS-CoV-2 (also known as the COVID-19 virus) is estimated to be between two and 14 days, with a median of five to seven days (possibly longer in children). Greater than 95% of patients develop symptoms within 10-12 days of infection.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My ex and I have shared custody. She just called to say she’s in quarantine – waiting for COVID-19 test results. I have the children now, but she had them last week before her quarantine. 

Do we need to quarantine now until we hear her results? From a concerned father.”

The answer:

Yes, self-isolate to your home while you wait for her results. Whoever else lives in your home should also stay at home. Close contacts are people who have been within six feet of you for a period of 10 minutes or more. If you or the children develop symptoms, notify your health-care provider for instructions and testing. 

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“How can I keep COVID-19 from spreading in my home once I turn on my whole-house air conditioning? My husband works and I am doing my best to isolate him in his room and a bathroom across the hall.”

The answer:

There have been two studies that show the airborne droplets containing SARS-CoV2 can spread farther than six feet when the airflow in a room is increased (either from an air conditioner or a heating system). These systems often draw air in from a room and cool it, sending the cool air throughout the home and the heat outside. This type of system has the potential to circulate the virus in a home if someone is infected.

A study out of the University of Oregon together with the University of California-Davis says the best way to reduce the spread of the virus and still ventilate a room is to open a window. Opening a window in the home will reduce the possible virus concentration by increasing the concentration of air from the outside.

If you can’t open the window (allergies, asthma, 95-degree heat) and there is concern that someone in the home is infected (showing symptoms, asymptomatic or exposed), you could block the intake vent in the room(s) that individual is isolating in. 

Duct tape can cover the vent and help to reduce the spread of the virus through the home.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“Is there a COVID-19 test my 3-year-old grandson can take that would allow him to stay with us for a day or two if he tests negative? I am 71, and would do anything to see him again.”

The answer:

Molecular (Polymerase Chain Reaction – PCR) swab test detects RNA from SARS-CoV-2, also known as the COVID-19 virus. If the PCR is positive, the patient is considered infected with the COVID-19 virus and presumed to be contagious.

You mention testing your grandson, but also consider testing the grandparents as well. However, it is important to emphasize that a negative PCR does not exclude COVID-19. 

Also, realize that the mean incubation period for COVID-19 is five days, and the range can be two to 14 days. This means that a negative result does not rule out infection.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“If a person’s antibody IgG and IgM came back positive, are they able to spread the virus because of the IGM result?”

The answer:

Testing shows us a snapshot of what is happening with a person and his/her course of disease. The two types of antibody tests are looking for a particular type of immune response.

When we are exposed to a pathogenic microbe, our immune system has two ways to defeat it.

The first is called the innate response. This response is encoded in our DNA as a human. 

It is nearly the same for all of us (with minor differences). This response causes inflammation. It is non-specific and only reacts to each pathogen based on its particular type. 

For example, all bacteria are treated the same. It cannot distinguish Streptococcus pyogenes from Staphylococcus aureus. It doesn’t distinguish an adenovirus from the Ebola virus.

Most of the time, this innate response kills the invading microbe. When it doesn’t, that is when we see symptoms of a disease. 

When the innate response can’t destroy all of the microbes, then we see the adaptive response.

The adaptive response is specific. This response is different in every individual. 

We have a complex immune genetic system to take gene segments and piece them together to create an entirely new gene. It’s called somatic recombination. Our germline DNA is pieced together to give us a new never before seen gene to fight a specific pathogen. 

That gene is then turned into a protein and made into an antibody for the specific pathogen.

The first antibody made when fighting that response is IgM. If this is found in a test, it indicates the person is in the early stages of the specific response to the virus. IgG is made later, about 14 days into the infection, in the specific response – and is often the antibody that allows our immune response to remember the infection (it is made for a few months to years after an infection).

If a person tests positive for IgG, that would suggest the individual was infected sometime in the past. If he or she is symptomatic, the person would still be able to transmit the SARS CoV-2 to others, but in most cases the IgG test would be positive after the disease has run its course.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“If a person had COVID-19 in the past, let’s say in February, and takes the test again in May, is the test going to show negative? In other words you could have had coronavirus in the past and it would test negative now? 

“So, the only way to find out if you had it in the past would be the antibody test, correct?”

The answer:

Great questions, and it all comes back to testing and more frequent testing. There’s some very recent positive data out of South Korea which I’ll discuss below.

Your questions refer to the different types of tests. One test is the molecular swab (Polymerase Chain Reaction – PCR), which detects genetic RNA from SARS-CoV-2, also known as the COVID-19 virus. The other test is a blood IgG antibody, which determines if someone was previously infected, or was recently exposed to the virus 10-21 days ago.

If you had COVID-19 infection in February, the PCR swab test would probably be negative now, and the blood IgG antibody test would probably be positive (indicating prior infection). Recent data out of South Korea suggest that if the repeat PCR swab test is positive, that may be detecting dead virus, rather than indicating reinfection. And the positive IgG antibodies may provide some protection.

Because the pandemic is only a few months old, there is no data on long-term immune response.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“When older adults fly, can they get tested upon arrival so they don’t need to be secluded for 14 days?”

The answer:

The tests that are available on the market are antibody tests and SARS CoV-2 genome tests.

The antibody tests show if a person is having an adaptive or specific response to the virus; the genome test is indicative of an active infection, as viral RNA is present. These tests, particularly the genome test, give a snapshot of what is happening on that day.

Individuals who are exposed to SARS CoV-2 won’t show symptoms for five to seven days, on average. A test upon landing would not be sufficient to say that the individual is not in the incubation period of COVID-19.

The person could have been exposed to the virus on the plane. This is why the 14-day quarantine is recommended.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My husband and I tested positive in March, then after two weeks, we had no symptoms. We got retested last week and are both positive. Why would this happen?”

The answer:

An excellent question that has relevant implications.

I assume the tests were molecular PCR (Polymerase Chain Reaction), which detects genetic RNA from the COVID-19 virus. If you and your husband don’t have any symptoms or fever, this implies both are now asymptomatic carriers. It is not known how long you will remain a carrier without symptoms, and that may depend in part how long protective immunity will last.

I recommend you and your husband consider blood tests for IgG antibodies to SARS-CoV-2. 

It is unknown if both are still contagious, and that’s why it’s important to wear face masks in public and continue social distancing. While the evidence on reinfection is evolving, current data and experience from previous viruses without substantial seasonal mutation do not support this hypothesis.

Because the COVID-19 pandemic is only a few months old, there is no data on long-term immune response. It is also controversial when asymptomatic carriers may return back to work. I recommend both of you follow up with your primary care physician, and if necessary, consult an infectious disease specialist.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I have read that scientists are working on testing community spread by testing water from the sewer. 

Would it be possible to develop individual urine tests (akin to pregnancy testing) that could inform a person positive or negative for the virus on a daily basis?”

The answer:

To my knowledge, there are only two kinds of tests for SARS CoV 2, a genomic RNA test and an antibody test. The RNA test is looking for viral genetic material in patients and the antibody test is looking for the presence of an immune response to the virus.

SARS CoV 2 has been detected in feces of infected patients, but it is not clear whether that virus is infectious. In addition, waste water has been shown to contain the virus, but standard municipal sanitation practices or use of a septic tank has been shown to inactivate the virus.

Urine contains waste products from the human body that can be dissolved in water. Hormones, sugar, vitamins and certain proteins can be found in urine. RNA and DNA can be found in urine as well. 

Urine tests, such as those you mention in your question, require a high concentration of the substance to be in the urine.

A recent study out of China was able to detect SARS CoV 2 in urine of one patient out of 17 with confirmed disease. Other peer reviewed studies were unable to find viral RNA in urine. These studies used a technique called RT-PCR to detect the viral RNA. This technique amplifies minutely small quantities of viral RNA and brings the concentration up to detectable levels.

Who knows what the future holds? That is the beauty of science. But at present, we do not have the ability to detect the minuscule amount of viral RNA in urine without amplifying it first.

•  •  •  •  •

“I am a cashier at Walmart. I had something similar to COVID-19 in December, however no breathing problems. Am I safe to visit my 2-week-old grandson? I shower, wash my hair and wear clean clothes and wash my hands when visiting. I also work daily, sanitize frequently and wash my hands every chance I can. I also wear a mask when working and visiting. Am I putting my grandson in danger?”

The answer:

Social distancing is hard and it must be truly difficult when a new family member is born.

When we are first born and until we are about a year old, our immune systems are immature. The responses we build to microbes takes time and the littlest among us have not been around long enough to have the same responses that adults or even older children do. This makes infants more susceptible to infections.

In a recent study out of China, of more than 2,100 children with suspected or confirmed COVID-19 in between late December and early February showed that about 11% of infants had severe or critical illness. Children in other age groups had lower rates of severe or critical illness (about 7% for children ages 1 to 5, 4% for ages 6 to 10, 4% for ages 11 to 15).

Other studies are showing an inflammatory illness that may be linked to COVID-19. This response that is seen in children is severe and rare. It has to deal with an immune response that leads to a cytokine storm. Our innate response, the one we are born with, has the ability to make our blood vessels leaky in order to let white blood cells into our tissues where the infection is. It does this by releasing cytokines, proteins that allow the immune system to communicate with cells and tissue of the body. This response is usually localized, but in some children it becomes systemic causing the blood vessels all over the body to be leaky; this results in severe symptoms such as organ failure and shock.

From your question, it appears that you are doing things to reduce your risk of infection. If you feel that you had COVID-19 in December, I urge you to request an antibody test. This could help determine if you did have COVID-19.

With respect to visiting your newborn grandson, I support respecting the community directed stay-at-home orders. He is still developing his immune system and is in a risk group because of his age. You and your family can speak with the child’s pediatrician to see what the case counts are in your area and then determine what level of risk is acceptable to you as a family.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“Can you be a carrier of COVID-19 and not have any symptoms – as in you’re immune to the virus but still carry and spread the virus?”

The answer:

Yes, there are asymptomatic carriers, however no one can truly determine the impact of asymptomatic cases on spread until there’s more testing.

Can these people who are completely asymptomatic, who never develop any symptoms, transmit the infection? That’s still an open question, and no one knows for sure. Experts say these carriers without symptoms make it even more important for people to wear face masks in public.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I was really sick with upper respiratory turned into bronchitis turned to pneumonia in late December to middle of February. Is it possible I had COVID? Would an antibody test still show antibodies if I did? I had almost all the symptoms.”

The answer:

When did SARS CoV-2 emerge? 

That is one of the big questions of 2020.

Science uses a method called the molecular clock to determine when new pathogens emerge. 

SARS CoV-2 is an RNA virus. It uses an enzyme to copy itself called RNA dependent RNA polymerase. This enzyme is sloppy in its copying. The rate of mistakes it makes is able to be tracked.

Using this technology, scientists at the Imperial College of London collaborated with the World Health Organization to determine that SARS CoV-2 emerged between Nov. 6 and Dec. 13 in Wuhan, China. Couple the new respiratory virus with the ability to be anywhere in the world in 24 hours and ...

Testing can help sort out whether a person has recovered from COVID-19. The test that will determine if a person has had an immune response to the infection is the antibody test. IgG antibodies are present in a person after she or he has had an infection that resulted in an adaptive (specific) immune response.

If you are curious about your status, you can seek out an IgG antibody test. The more data that can be acquired about positive cases, in any stage, will help answer the question of when. It is possible, however, that we will never know when it emerged.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I am wondering how it could be possible to see my significant other during the coronavirus pandemic. We live separately, and I have been quarantined while he has continued to do basic things such as grocery shop and goes to work two times per week, always following recommended precautions. We are wondering if he were to do a PCR test for coronavirus RNA combined with an IgG and IgM antibody test, could this provide a sufficient picture upon which to base a decision to see one another, or not? “

The answer:

Social distancing is so hard! All of us have someone we want to see.

In public health there is something called risk reduction. It refers to using strategies that minimize the risk or harm certain human behaviors come with – for example, wearing a bicycle helmet when riding a bike. If you wear a helmet, you are less likely to have a traumatic brain injury if you wreck. You still ride the bike, just in a safer way.

With SARS CoV-2, becoming more lax on your social distancing is not the same as wearing a bicycle helmet when riding a bike. SARS CoV-2 is spread via airborne droplets by people who may not know they are sick yet. Even people who are practicing social distancing may not know they have been exposed because they could have come in contact with people who don’t know they are infected yet.

Testing can help. The test for genomic RNA of SARS CoV-2 will let a person know if he or she is actively infected at that time. The antibody tests would show that you are in the first stages of an adaptive immune response (IgM) or that you are in the later stages or recovered from COVID-19 (IgG). 

However, this is only a snapshot of the infection risk. It only says that at the time of the test, the individual is SARS CoV-2 free. If that individual goes out in the community the next day, he or she could be exposed to someone with the virus and become infected.

Until we have more testing, two-thirds of our population recovered, or a treatment is found, it is best to keep socially distant.

As always the risk assumption is yours; however, the recommendation is to maintain social distance. 

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“Are drug users, especially intravenous, more likely to spread COVID-19 or other viruses and diseases than non-drug users?”

The answer:

SARS CoV-2 is spread via respiratory droplets. Anyone can spread the infection if they have symptoms and we are seeing studies that show asymptomatic transmission in about 35% of individuals (recent studies from the New England Journal of Medicine).

Now is a good time to remind everyone that human behavior contributes to the spread of any infectious disease. When we consider COVID-19, we can reduce the spread by wearing a mask in public, washing our hands, and maintaining social distance.

Injection drug users are at a greater risk for blood-borne pathogens, such as Hepatitis and HIV, as well as having a greater risk for sepsis, a bacterial infection in the blood. As for other drug users, according to the National Institute of Allergy and Infectious Diseases, because SARS CoV-2 attacks the lungs it could be a serious threat to those who smoke tobacco or marijuana or who vape. People with opioid use disorder and methamphetamine use disorder may also be vulnerable due to those drugs’ effects on respiratory and pulmonary health.

In short, anything that decreases lung functioning can lead to more severe COVID-19 disease.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I am a nanny and was asked to enter the family’s home wearing a mask. I assumed they (mom, dad and 41/2-year-old) would also be wearing masks. They did not. I wear one to protect them and vice-versa, correct?”

The answer:

There are no formal guidelines on what should be done in this situation. Childcare is a necessity for many families, even if they are working from home. In this situation, I would recommend that you all (mom, dad, child and nanny) keep each other apprised of your health situation. Have a discussion about your exposures and risk factors for SARS CoV-2 (for example, do you live in a home with an essential worker) be truthful about each other’s movement (or lack there of) in the community. If you are nannying for another family, be sure to inform all parties involved.

After this conversation, decide together on a safety plan that makes everyone comfortable.

For example, everyone has their temperature taken daily before work starts. If symptoms become apparent, all are notified.

Maybe you have certain rooms that are for family only in the home, maybe you and the child remain in one area of the home.

Through working together as a unit, you can be sure to address all concerns and come to an agreement in which everyone feels safe.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“The news keeps saying people under 18 rarely transmit the disease. However, what evidence is this based on? I read that children under 18 don’t get the disease, or very mildly and don’t transmit. But how many children have had the disease? How many children under 18 have actually been tested? If we do not have facts on children under 18 how can we say that they rarely get it and they do not transmit it?”

The answer:

We don’t have all the facts yet on how COVID-19 affects different populations, or know how many people have had the virus. And this is especially true with children.

It seems that children may not have symptoms that are severe, but we do know they get the virus. There have been a few cases (not locally) where kids are intubated, and respirators were used for children. Children can still pass the virus to their older family members who can have much more severe symptoms.

Everyone, including children, should follow the recommended precautions to prevent the spread of the virus.

– Dr. Uchenna Okereke, infectious disease specialist, Conemaugh Physician Group.

• • • • •

“Is it safe for my young children to visit grandparents? We have not left the house since March 12, aside from work. My husband and I are both health care workers. Grandma has also been self-isolating at home. Now that some restrictions are being lifted, we were wondering if family visits are OK. My 2-year-old misses his grandparents terribly.”

The answer:

Social distancing is hard on our mental health. It can be even harder for young children. My students and I created a toolkit that contains some information on how to talk to your child about COVID-19. Here is the link: www.johnstown.pitt.edu/coronavirus-toolkit.

As of now, our region, the southwestern portion of Pennsylvania, is under stay-at-home orders. This is to decrease our exposure to other individuals. We do this because of the R0 – the number of how infectious a virus is. If the average R0 in the population is greater than 1, the infection will spread exponentially. If R0 is less than 1, the infection will spread out be it slowly, and it will eventually die out. For SARS CoV-2 that number is 2.5-3. This means that one infected individual can infect up to 3 others.

If a person is expressing symptoms of COVID-19, we know to stay socially distant; however, studies have shown that asymptomatic transmission is occurring. This means that some individuals could be spreading the virus and appear to be healthy, making it difficult for anyone to know if they have been exposed or not.

The choice is, of course, yours. 

But the recommendation is to maintain social distancing in our area.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown 

•  •  •  •  •

“Do current COVID-19 tests tell you what stage of the disease you’re in? Two family members were tested, with someone going to their home and drawing blood. The next day, one of them was told they were at the acute stage of the virus and that the other was at the end stage of COVID. I have not heard that kind of testing before and am concerned they are being scammed. 

“I have only heard positive, negative results; or positive or negative for the antibodies. Why these different tests?” 

The answer:

Molecular testing identifies people with the virus, and an antibody test can tell whether someone has been previously infected.

Qualitative real-time reverse transcriptase Polymerase Chain Reaction (PCR) nasopharyngeal swab is either positive or negative. If positive, this indicates that RNA from the virus was detected, and that the patient is considered infected with the virus and presumed to be contagious.

There are several types of COVID-19 antibody blood tests. 

One is a blood finger prick IgG/IgM Rapid Test which takes 10-15 minutes for the results and are either negative or positive (a colored line appears, just as a pregnancy test). The IgM test line is usually positive (colored) four days after becoming infected with the virus, but “false negatives” can occur if within less than four days, because the incubation period is estimated to be between 1-14 days. 

IgG antibodies are usually detected (colored line) 7-21 days after symptoms develop, and this test also identifies if someone has been previously infected. 

IgG testing can also be done on a lab machine – which requires a tube of blood, and takes approximately 45 minutes to 1 hour. The results are reported as positive or negative based upon a cutoff numerical result.

Therefore, a positive IgM antibody test result indicates early COVID-19 disease, and IgG indicates a later phase, or someone who has been previously infected. Antibody testing has received Emergency Use Authorization (EUA) from the FDA. Antibody testing is being reviewed by the FDA, and final FDA approval is pending.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •  

“What is the possibility of getting virus from meat with the problems the packing plants are having?”

The answer:

SARS CoV-2 is transmitted by respiratory droplets. While there are many reports of workers at meat packing plants getting sick with COVID-19, there are no reports of transmission via food.

It is good to remember that SARS CoV-2 is able to be viable on plastic for a few days. It is good to follow hygiene practices to prevent the spread: wipe your packages down and wash your hands after putting your groceries away.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My wife is returning to the United States from Warsaw, Poland. She is taking a train from Warsaw across the Polish/German border to Frankfort, Germany, directly to its airport. She is an American citizen with a valid passport, a plane ticket, and has submitted all required forms to the Polish government and U.S. Consulate in Warsaw and Berlin.

“When she arrives at her hub U.S. airport, she will be screened at Washington Dulles, and after screening is advised (not ordered) to self-quarantine upon her arrival at her ultimate destination, Indianapolis, Indiana. Is there an appropriate location where she should go for 14 days to self-quarantine alone? I assume she cannot go to our residence where our family, children and me, are already in self-quarantine.

“Finally, if I can arrange for her to be tested for the COVID-19 virus either serologically (finger-prick testing) and/or nasal swab testing, and the results are negative for the coronavirus, is it then prudent for her to come to her family at our residence and self-quarantine with us?”

The answer:

Ideally, she should self-quarantine (self-isolate) in a private apartment. If a private residence is not available and she wants to stay with her family, then she should self-isolate in a private room (basement or other private portion of the residence), and use a private bathroom if possible. 

Whoever else lives in your home should also stay at home.

If she tests negative, she still needs to self-quarantine/self-isolate for 14 days in a private room and use a private bathroom, because the incubation period for the virus is estimated to be between one and 14 days. After 14 days, if she has had no known exposure to a confirmed case, and she remains asymptomatic, she can stop the self-quarantine.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“I wanted to pass out roses on Mother’s Day. Can you get COVID-19 by someone holding the stem that has COVID-19 or will it not affect flowers?”

The answer:

We know that SARS-CoV-2 is viable on many surfaces for a few hours to a few days. However, plants are not one of the surfaces that have been tested.

Since the virus is spread via respiratory droplets, it is more likely that someone with COVID-19 would transmit the infection when they coughed near you, not from touching the flower.

As with anything we touch, it is good to practice hand hygiene and avoid touching your face until you have washed your hands. 

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“My 90-year-old mother lives with me. She recently had a fall and was sent to a nursing home rehabilitation facility. While there, she tested positive for the virus without symptoms. When she does get to return home, should I be tested due to my suppressed immune system? I have most of the symptoms listed for COVID, but have not been tested.”

The answer:

Since you have symptoms, a history of immune suppression, and a known exposure to a confirmed case (your mother), I recommend that you get a PCR (Polymerase Chain Reaction) nasopharyngeal swab test – which detects RNA from COVID-19.

This test will require a physician’s order. If this test is positive, the patient is considered infected with the virus and presumed to be contagious.

You should self-isolate in your home while you wait for your result. What you subsequently should do depends on whether your PCR test is positive or negative. I recommend you follow up with your primary care physician.

I would also consider a blood test, which detects IgG antibodies to the protein of SARS-CoV-2.

This antibody blood test is being reviewed by the FDA.

It is not known for certain whether individuals infected with COVID-19 and who subsequently recover will be protected, either fully or partially, from future infection with COVID-19, or how long protective immunity may last.

Concerning when your mother can return home, that depends on her condition and progress at the rehab facility. I suggest you ask her physician there.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“My cat has tested positive for the coronavirus. I have no symptoms and haven’t been tested. I informed my employer and after working most of my shift he sent me home stating I have to get tested and I need to have my vet send over my cat’s records. Can they do that?”

The answer:

Cats get the intestinal form of coronavirus that can cause diarrhea. They also so get feline infectious peritonitis (FIP), which is also a coronavirus that is deadly to cats. This is not COVID-19 and is not zoonotic to humans.

So when you said the cat was tested, do you mean tested and positive for coronavirus or COVID-19? If your cat is positive for intestinal corona or even FIP, then there is no risk of infection to humans. If it is COVID-19, which I highly doubt, it is a reportable disease to health officials.

According to the CDC guidelines, there is no need to get tested if you do not display any of the symptoms they mention – such as coughing and fever. Finally, until now, there is no scientific evidence of transmitting COVID-19 from animals to humans. More important, corona virus in cats (intestinal form) does not equal COVID-19 at all.

– Dr. Fayez Assad, medical director, Johnstown Veterinary Associates

•  •  •  •  •

“Should we assume the opening up to the green phase will be months away from now? When do you expect large gatherings such as wedding receptions, concerts, etc., to be allowed again?”

The answer:

The reopening of Pennsylvania, and our region specifically, to the green phase is going to be decided by case data. As it stands now, a region must have 50 new cases or fewer in a 14-day period to move to the yellow phase. The green phase will follow that – when we see a sharp decline in cases.

The decision to move through the phases is going to depend on data. That data is dependent on accurate testing and contact tracing of individuals who are infected. The Pennsylvania Department of Health is working to collect the most accurate data with Carnegie Mellon University.

An important thing to point out here is a number we call the R0. 

This indicates the contagiousness of an infectious disease. For COVID-19, this number is between 2.5 and 3.0. That means that one infected person will transmit the disease to as many as three people. To move to the green phase from the yellow phase is going to require people to follow the rules. 

If the public observes the rules – wearing a mask when out in public, aggressively washing their hands, and avoiding gatherings of 25 or greater – then we can move through the yellow phase more quickly.

In short, we are in this for the long haul. Viruses such as SARS CoV 2 don’t go away. We must either have a vaccine to prevent the disease or have two-thirds of the nation recovered from the illness. I implore everyone to urge officials to make more testing available, to aid public health officials when asked for information, and to limit your exposure to others (until one of the above occurs).

Together is the only way we can decrease our time apart.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

"I had severe symptoms in March, was hospitalized and tested. The test came back positive on March 16. My husband had mild symptoms, but he wasn’t hospitalized nor tested. As an essential worker, I had to be re-tested in order to go back to work, so on April 23 my husband and I got tested. I was negative and he was positive. Now what do we do?"

The answer:

The CDC recommends two strategies for returning to work. One is a test-based strategy that states you should have two consecutive negative molecular (genome) tests in which the swabbing has been done greater than 24 hours apart. The other is a non-testing based strategy where you must be fever free for 3 days and be at least 7 days removed from when symptoms started.

The CDC also recommends that an individual with a laboratory confirmed case who is asymptomatic should wait 10 days before returning to work.

This situation is in the in-between. You are negative, but your husband is positive. If we take the guidelines and adapt them to your situation, it may be prudent for you to wait the 10 days before returning to work. At the very least, it is prudent to be sure your husband is fever free for 3 days and that it has been 7 days since his symptoms started before you return to work.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“Can coronavirus testing be done anonymously, similar to STD testing?”

The answer:

At this time, all COVID-19 testing requires an order from a health care provider, and the specimen must be collected by someone trained to do it, such as a nurse. The ordering physician shares the test results with the patient. So it is not a fully anonymous process, currently. 

But health care providers work diligently to protect your personal health information, so you can feel confident getting a test if it is recommended.

– Emily Korns, director of marketing communications, Conemaugh Health System 

• • • • • 

“I am a 67-year-old woman, active and in good health. I rent my basement to a traveling nurse who is working at a local ER. She has already had one COVID-19 scare and was quarantined until her results came in – thankfully negative. “However, she could of course become positive at any time. Should I be concerned?”

The answer:

If this nurse is compliant with Department of Health and CDC recommendations including personal protective equipment, proper hand washing hygiene, and if she is following hospital ER infection protocols, the risks to others including yourself should be minimal.

You have already established separate living areas if the nurse is in your basement. Practice social distancing and good hand washing, and frequently clean surfaces you may both touch. I also recommend you both wear face masks when in the same area of the house.

Finally, we should all be thankful for nurses and all health care personnel for their care.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber. 

• • • • •

“I am hearing more and more that this virus causes clotting in the body – causing strokes and organ failure due to bodies being riddled with clots. But we can’t take NSAIDs (nonsteroidal anti-inflammatory drugs) such as Ibuprofen, which have been known to thin the blood and prevent clotting. What can we do to prevent the clotting aspect of this virus?”

The answer:

In our cases locally, we have not yet seen the severe clotting described by the reader, or deaths attributed to clots or pulmonary embolism, but we recognize this is a complication. 

Most likely, this level of clotting is due to sepsis brought on by a very severe form of the infection. In the hospital, patients may be prescribed a medication, such as heparin to avoid clotting. For the average patient at home with a mild or moderate case of COVID, anti-clotting therapy doesn’t seem to be indicated.

If you have a personal history or family history of blood clots, this is important information to share with your primary care physician or your emergency care provider. With COVID-19 or any condition where you may be inactive due to illness, it’s a good idea to try to move around a bit to keep blood flowing, even if it’s just getting up to walk around the couch.”

– Dr. Uchenna Okereke, infectious disease specialist, Conemaugh Physician Group.

• • • • •

“I’m a 50-year-old male with severe asthma and hypertension. Both diseases are well controlled with medications. I realize that I have two high risk factors for COVID-19 complications if I became infected. However, I never get sick. Given that I have a strong immune system, does that make me any less likely of becoming infected with COVID-19?”

The answer:

It is important that your asthma and hypertension are both well controlled, and that you have a good immune system. Patients that are immunosuppressed or immunocompromised are at a higher risk of infection and complications.

However, there are other important contributing factors including behavior (contact length and frequency), virulence of the virus and environment (crowding, poor air quality and pollution). Therefore, immune status is not the only determining factor whether or not you become infected with COVID-19.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I’m 67 and was diagnosed with the virus about two weeks ago. I’m quarantined and have shortness of breath, but have been to emergency room twice and all tests are good. How long does it take for symptoms to subside?”

The answer:

There are no specific answers for duration of illness or exact recovery time, and each patient is different. Those with milder symptoms may recover in 7-10 days. Others with more moderate or severe symptoms may take 3 to 4 weeks.

I also read medical reports of patients who were hospitalized with significant complications and were subsequently discharged, but were still not completely recovered at 10 weeks or longer.

I certainly hope that your symptoms resolve soon, and it is very important that you follow up with your treating physician.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

“Does spraying the soles of my shoes with bleach without wiping kill the coronavirus instantly, or does It take some time? Is there a better way to clean them to prevent the virus from spreading into the house?”

The answer:

COVID-19 is spread via respiratory droplets and anything that those droplets get on. The term for this is fomite transmission.

Research has shown that the virus can survive on surfaces for a few hours to a few days, depending on the surface. A disinfectant such as bleach will destroy the virus. You may spray with a bleach solution (1/3 cup of bleach per gallon of water) or use a household disinfectant spray (such as Lysol) and allow the shoes to dry. This can take a few minutes.

Another option that can be done is to wipe the shoes down with a hydrogen peroxide wipe (it only takes 30 seconds for these wipes to kill). Lastly, you may use a 70% alcohol-based solution to wipe the shoes down and allow them to dry (this can take up to a minute).

If you are worried about bringing the virus into the house, you may want to spray the shoes outside your home and bring them in after the 30-180 seconds has passed. That’s what I do!

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

“If someone is asymptomatic yet positive for COVID-19, how long would they be considered contagious?”

The answer:

Great question.

If you test positive:

• Notify your close contacts and let them know they should quarantine at home for 14 days. This includes your family members.

• Self-isolate in your home until each of the following conditions are met:

1. It has been at least 7 days since your symptoms first appeared, AND

2. It has been at least 3 days since you have not had a fever (without using fever-reducing medications) and your respiratory symptoms (cough, shortness of breath) are improving.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“We have all these stories of how many caught the coronavirus and how many deaths have been recorded, but not one single number on people who have recovered from it. Is there an accurate estimate of COVID-19 recoveries in Pennsylvania?”

The answer:

An accurate figure does not exist. They may start collecting hospital discharges, but since only 10% of all confirmed COVID-19 cases end up in the hospital, it doesn’t mean that much. They aren’t really “recovered” when they are sent home anyway.

If someone gets a positive test, stays home while the illness runs its course and returns to the self-distancing world, that person is not being checked or reported as recovered. Not to mention hundreds, probably, who get mild symptom but are just being told to stay home, and then recover without even testing. They aren’t even showing up on the daily positive report.

– Randy Griffith, health care reporter, The Tribune-Democrat

•  •  •  •  • 

“Should we be concerned, as we soon turn on our air conditioning, about airborne spread of coronavirus?”

Answer:

COVID-19, SARS-CoV-2, is droplet transmission. The airborne droplets travel through the air and can make it about six feet. When you add an air conditioner, you are adding strong airflow into the equation. This would allow the airborne droplets to travel farther.

If you are using the air conditioner in your home and no one in your household is sick, then you don’t need to worry about transmission. What can be of concern is, if social distancing is lessened and you are in a public building with air conditioning with a symptomatic (or asymptomatic) COVID-19 patient, the six-foot rule may not help. The air flow from the air conditioner would allow the droplets to transfer farther than the average of six feet.

Reference: Lu J, Gu J, Li K, Xu C, Su W, Lai Z, et al. COVID-19 outbreak associated with air conditioning in restaurant, Guangzhou, China, 2020. Emerg Infect Dis. 2020 Jul [4/15/20]. https://doi.org/10.3201/eid2607.200764

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

"What if my car inspection is due? Is there a grace period? I really don't want to take my car to a shop right now."

The answer:

For driver licenses, photo ID cards and learner's permits scheduled to expire from March 16, 2020 through April 30, 2020, the expiration date is now extended until May 31, 2020.

– Pennsylvania Department of Transportation website (https://www.penndot.gov/pages/coronavirus.aspx).

• • • • •

"When in a risky area (such as a store), you might encounter someone within the 6-foot recommendation who is sneezing, coughing or simply asking for your help, and you could feel compromised and at risk.

"Would more personal immediate actions reduce the COVID-19 risk, aside from the obvious of keeping your mouth closed or wearing a mask or goggles?

"Although unorthodox to some, would blowing your nose (carrying tissues) and/or blinking your eyes, despite no real need to, mitigate being infected if the virus is airborne – followed by a thorough washing of your hands, mouth, nose and eyes (area or drops) when possible?"

The answer:

An excellent and practical question.

The Centers for Disease Control and Prevention recommends “wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain” – grocery stores and pharmacies, and especially in areas of significant community-based transmission.

The right way to wear a face covering or mask is to cover your entire nose and mouth, which means that the face mask should be tight-fitting underneath your chin. It will be less effective if you remove it from your face when you’re in a crowded store, such as to speak to someone.

An important takeaway from the CDC’s message is that covering your face when you leave the house must not replace thoroughly washing your hands. 

It’s also worth emphasizing that sewing your own face mask may not prevent you from acquiring the coronavirus in a high-risk situation, such as lingering in crowded places.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

"Can I catch COVID-19 from my cat or my dog?"

The answer:

There have been some studies that are looking into whether domesticated cats and dogs can get SARS-CoV2. These results indicated SARS-CoV2 could replicate in cats and that SARS-CoV2 could be transmitted via respiratory droplets between cats, though it appears that it is not highly contagious between cats.

They also show that dogs are not really susceptible to the infection.

These studies show that cats can catch it from you, but none have shown that cats can transmit the virus to humans. That work has not been done, so the answers is we don't know yet.

The best approach right now for cat owners is to keep their indoor cats inside and their outdoor cats outside.

For more information check out this article in Nature: www.nature.com/articles/d41586-020-00984-8. It is a good summary of the work that has been done so far.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown

• • • • •

“I would like to know if it’s normal for a person to experience symptoms (day 1) and feel better over the next few days, only to experience those same symptoms on day 10-11 that were far worse.”

The answer:

Another excellent question.

Patients may have a mild common cold-like illness and/or an uncomplicated upper respiratory viral infection with symptoms such as fever, fatigue, cough, muscle pain, sore throat, shortness of breath, nasal congestion or headache. Rarely, patients may initially have diarrhea, nausea and vomiting.

The above symptoms may improve, or progress in 7-10 days to a severe viral pneumonia leading to acute respiratory distress depending upon the immune status of the patient, age, and other chronic underlying medical conditions.

– David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

"With summer and warmer weather coming soon, can the coronavirus be spread by mosquitos?"

The answer:

I can understand your concern – my goodness, what would we do it this were true!

Infectious disease transmission types are two basic categories: Direct (person to person) and indirect (which involves an intermediate carrier). Indirect transmission can come from fomites (inanimate objects that transmit disease), vehicles (food and water) or vectors (living things that transmit disease).

COVID-19 (SARS-CoV 2) is spread by airborne droplets, a form of direct transmission. That means it is spread by coughing, sneezing and talking. There are all kinds of modes of transmission – ways that infectious diseases spread – but this one is only airborne droplets.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown

• • • • •

"We have scheduled a Bahamas trip in September with Carnival Cruise Lines. They have not canceled yet. Is it OK to keep this vacation or should we cancel?"

The answer:

"Cruise lines all have different policies. Generally, people are waiting (to cancel)."

– Epic Journeys

For more information, contact your travel agent. For information specific to Carnival Cruise Lines, visit: www.carnival.com

• • • • •

“I work in a nursing home as a certified nursing assistant. If one of the residents goes to the hospital and tests positive, does our upper management have the right to not disclose this information to employees.”

The answer:

There is no requirement from either CMS (Centers for Medicare & Medicaid Services) or the Pennsylvania Department of Health that nursing homes or hospitals are required to inform employees of confirmed cases. But we do expect facilities to take steps to protect the health and safety of residents and share information with those who may be affected.

– Pennsylvania Department of Health

•  •  •  •  •

“I am a registered nurse and I want to know how long is a surgical mask, fabric mask or N95 mask effective?

“I do home care and can work one-on-one with one patient for up to eight hours a day in their home, or visit up to four patients in one day and am provided with surgical masks.

“In searching for an answer, I came across an article in the International Journal of Infection Control, 2013, that suggested that face masks are no longer effective beyond two hours of use!

“What renders them ineffective? Is it the moisture that accumulates? If so, could I recycle the surgical mask I wear with the same patient after it dries? My employer is unable to provide enough masks for me to change the mask every hour (changing every two hours doesn’t make sense if it’s rendered ineffective by two hours!).

“I share custody of my children (ages 11 and 14) with my ex, and my husband shares custody of his children (ages 13, 16 and 18) with his ex, so we have five children coming and going between homes and being exposed to their other parents and step-parents (but no other children) in their other homes. My step-kids’ mom is a social worker and continues to work in-person with people in the public.

“As an RN doing in-home visits and infusion therapy for medically-vulnerable patients, I fear that I have too much external exposure outside of my control to maintain a low-risk of being exposed, becoming a carrier, and therefore infecting the vulnerable population I care for.

“My fear is that I will need to choose between my husband and me being able to see our children and my continued work as a nurse in the community. What advice can you offer?”

The answers:

Excellent and interesting questions.

I’m not aware of any evidence-based data that states face masks are ineffective after two hours. In my opinion, if the patient contacts are not high risk for COVID-19, and/or not confirmed COVID-19 positive, a surgical face mask may be used the entire day, unless the mask becomes soiled. If the face mask becomes soiled, then it should be changed immediately.

A healthcare worker administering an aerosol treatment must wear a N95 mask – and a surgical mask on top of the N95. The surgical mask must be properly disposed of after the treatment. The N95 mask may be reused by the same healthcare worker that day if not soiled.

Regarding your living and working situation, your concerns are understandable. You can mitigate risks by limiting in-home visits to only those patients that are absolutely necessary, and not routine visits. You also need to follow strict Pa. Department of Health and CDC guidelines by frequent hand washing before and after each patient encounter, wearing gloves and a face mask as described above, and washing your hands when you return home.

Social distancing is very difficult with children; however, you can limit other outside family contact exposures. It’s impossible for healthcare workers (myself included) who are treating patients in the home, in doctors’ offices or at the hospital to eliminate all patient contact or exposure. This is the profession we chose.

– David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  • 

“Why do the experts say that this week and next week will be the worst for COVID-19? I understand the virus is out of control, but how do they know what is to come in the next two weeks? What makes these weeks different?”

The answer:

The next two weeks are going to see more cases of SARS CoV2, COVID-19. This is because more testing is being done nationally.

Another thing to consider is the disease course. The incubation period, where an infected individual is asymptomatic, can be up to 14 days with an average time of 4.5 days. The symptomatic phase is about 14 days. 

Mild symptoms last for about five days with severe disease to follow on days 5 through 8. 

Some patients, about 20%, have some type of respiratory distress that may require hospitalization and this can last from days 8 to 12.

If we take all of these things together (more testing and the number of sick people from two weeks ago), it is quite possible that we will see a great number of new cases and a higher death toll in the coming weeks.

It is so very important to keep social distancing in place; it is our best defense at flattening this curve of new infections and slowing the spread of SARS-CoV2.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown. 

•  •  •  •  •

“A vaccine for COVID-19 might be available in 12 months. How helpful will it be if this coronavirus mutates by then, as the flu does yearly?”

The answer:

This is a great question. SARS-CoV2 or COVID-19 is definitely mutating. The question is whether that mutation will happen in a part of the virus that effects transmissibility or disease course (symptom severity).

Coronaviruses have an ability that Influenza doesn’t, they proofread their genomes before they package it into a new virus. This means that SARS-CoV2 mutates at 1/3 to 1/2 the rate of Influenza.

Variants may happen with this virus, but with the slow rate of change individuals will be protected for years after acquiring the infection or getting vaccinated. This is different from the months of protection seen with influenza.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

•  •  •  •  •

A New Jersey-based reader of The Tribune-Democrat asked:

“My daughter and her entire family of five have been extremely ill with all of the symptoms of this virus including temperatures as high as 104. My daughter, an X-ray tech, and her husband, a first responder, were tested at separate times and separate sites and to our surprise, the results were negative. My daughter was also tested for influenza which was negative. Is there another virus going around that mimics COVID? Should their results be trusted? Have there been false negative results?”

The answer:

All excellent questions.

With rapid influenza tests, there can be 20-30% “false negative” results. Therefore, if you believe an individual has acute influenza, and a negative rapid flu test, you should still treat for flu.

There are other viruses going around including adenovirus, parainfluenza, and RSV (respiratory Syncytial virus). There is a viral panel test that a physician may order which tests for these other viruses.

Regarding COVID-19 testing, the PCR (Polymerase Chain Reaction) which detects RNA from the COVID-19 virus is very accurate, but a negative result does not rule out the possibility of COVID-19 based on the timing of the exposure and the incubation period of the virus.

So a negative result should not be used as the solo basis for patient management decisions.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

•  •  •  •  •

"My family (husband, myself, 3-year-old and 18-month-old) has quarantined for the past week and a half. We have a livestock feed business at our house that we continue to operate, but we have one or two customers at any given time and have been following the 6-foot rule, along with disinfecting twice a day. We have only done grocery pick up and drive-thru for a couple lunches just to get out of the house. My mom and sister have been quarantining at a different location for the same amount of time, following basically the same guidelines. If all of us quarantine for two weeks with absolutely no symptoms, would we be safe to then only have contact with my mom and sister? I realize you can’t predict with 100% certainty, but your thoughts would be greatly appreciated."

The answer:

Although risk may be minimal if the relatives are local, there’s still risk and kids are not good at understanding social distancing. Children especially don’t practice good hygiene, and exposing them to older adults could be risky for both.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

"When you report about the cases of the coronavirus, why don't you name the town or city for the confirmed cases?"

The answer:

At Conemaugh Health System we understand how concerned the community is about the spread of COVID-19. And, as healthcare providers, we are obligated by law to protect the privacy of all of our patients. We will not, and cannot, share identifying information about our patients without consent.

We do share our patient data in real time with the Pennsylvania Department of Health (and in turn, the CDC). This includes test results, symptoms, diagnosis, and demographic information related to COVID19 or any other infectious disease. These public health experts are responsible for mapping the spread of disease and interpreting the data, and they do a great job of it.

It may seem important in today's environment to know details about those infected in the community – their age, where they work, their address – so you can determine your risk of exposure. However, this can have the unintended consequences of causing panic and singling people out as targets for unwelcome attention.

The public health message will be the same whether someone lives in your neighborhood or not – stay physically distant, wash your hands, don't touch your face, disinfect surfaces and watch for symptoms. The best advice right now might be to behave as if everyone has COVID-19, rather than trying to determine who does or doesn't.

– Emily Korns, director of marketing and communications, Conemaugh Health System

Health institutions must adhere to federal privacy guidelines as stipulated in the Health Insurance Portability and Accountability Act (HIPAA):

"The HIPAA Privacy Rule establishes national standards to protect individuals’ medical records and other personal health information and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically. The rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. The rule also gives patients rights over their health information, including rights to examine and obtain a copy of their health records, and to request corrections."

– U.S. Department of Health & Human Services (HHS.gov)

• • • • •

"I have rheumatoid arthritis. Am I considered high risk for contracting COVID-19?"

The answer:

The short answer is yes. Autoimmune disorders that are a result of inflammatory conditions put the individual at a greater risk for all types of infectious diseases.

With RA specifically, individuals can be on immunosuppressive drugs. This can subdue the non-specific immune response to viruses. Science doesn’t know if you are at a greater risk of contracting the virus, but you are at a greater risk of severe symptoms if you do.

For more information on inflammatory autoimmune disorders and COVID-19, I suggest you check out this website: www.creakyjoints.org.

– Jill D. Henning, Ph.D., associate professor of biology at the University of Pittsburgh at Johnstown.

•  •  •  •  •

"Can you contract the influenza virus unknowingly, and then contract COVID-19 virus with diagnosed known symptoms detection at or around the same time? And if so, would your risk of life be greater having both and to what extent? Also, would the flu show up when tested for COVID virus, or would it go undetected?"

The answer:

Influenza symptoms are fever, chills, muscle aches, cough and tiredness. These symptoms come on quickly; you can wake up feeling fine and six hours later be sick.

Symptoms of COVID-19 are fever, dry cough and shortness of breath, which is consistent with the viral pneumonia it causes. COVID-19 is a slower onset, the illness ramps up over a period of days. In fact, you can divide the slow onset into three stages: 1. asymptotic incubation period, where the virus may or may not be detectable; 2. non-severe symptomatic period, where you can detect the virus and; 3. severe respiratory symptomatic stage, with high virus levels in the body.

It would be unlikely that you would unknowingly have influenza. It is possible to have both infections, it is just unlikely.

Since both viruses infect the lungs, in different cell types, that presents a greater risk to your health and life.

Some tests for COVID-19 use a nasal swab or oral swab and compare the genetic material captured on the swab with the genetic code of COVID-19.

There is a new test that was just approved by the FDA that will be using a clumping reaction, like what is done for strep throat. This test is quicker and produces results in 15 minutes or less. Since these test are specific for COVID-19, they would not be able to show infection with influenza. A test specific for influenza would be needed to determine infection.

– Jill D. Henning, Ph.D., associate professor of biology at the University of Pittsburgh at Johnstown.

• • • • •

"For other, and possibly this, coronavirus, does the route of transmission affect symptoms? Is it possible that the lungs could be spared if a person contracted the virus via the eye or digestive tract instead of through the air?"

The answer:

Viruses are specific to a certain cell type. Think of it like the key for your front door only one key will open that door, that key is specific to your door. Viruses are like the key. If the right lock isn’t present on the cell, the virus can’t get in.

So when we think about route of transmission, the virus is transmitted in the way that will best get it to the cell that it wishes to infect. For COVID-19, its specific cells are found in the part of the lungs called the alveoli; these cells help with gas exchange. So if you come in contact with the virus, it will seek out the specific lung cells to infect. If it gets in your eye, the ears, nose and throat are connected and the virus could get to the lungs. If it comes in via the digestive tract, it is harder for the virus to get to your lungs.

– Jill D. Henning, Ph.D., associate professor of biology at the University of Pittsburgh at Johnstown.

•  •  •  •  •

"Is anyone identifying persons who had contact with the COVID-19 infected? These contacts should be self-quarantined."

The answer:

"We identify those who were exposed, use the Pa. Department of Health Risk Assessment, and follow Pa Department of Health guidelines and recommendations.

"Regarding self quarantine: Yes, and again based upon the Pa. Department of Health risk assessment and following Pa. Department of Health guidelines and recommendations."

– Dr. David Csikos, Chief Medical Officer, Chan Soon-Shiong Medical Center at Windber.

The Pennsylvania Department of Health website can be found at health.pa.gov.

On this topic, the DOH says:

• Isolation separates sick people with a contagious disease from people who are not sick. Isolation is usually voluntary, but in an emergency, officials have the authority to isolate people who are sick.

• Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick. Quarantined people may or may not become sick; but separating them from those who were never exposed helps prevent the spread of the disease. Quarantine can be voluntary, but in an emergency, officials have the authority to quarantine people who have been exposed to an infectious disease.

• • • • •

"If someone gets the virus and recovers, is that person immune from the virus and probably won't get it again?"

The answer:

The Los Angeles Times reports that China has seen more than 100 cases of individuals being released from hospitals and later testing positive for the coronavirus a second time. A man, 36, died five days after being declared virus-free and discharged. 

Keiji Fukuda, director of Hong Kong University’s School of Public Health, said the likely reasons are testing errors and patients leaving hospitals too soon.

“If you get an infection, your immune system is revved up against that virus,” Fukuda said. “To get reinfected again when you’re in that situation would be quite unusual unless your immune system was not functioning right.”

– Los Angeles Times reports

 • • • • •

"If someone has traveled to a known hot spot for COVID-19 in a state such as California or Washington or out of the country, how are other employees and clients protected if an employee refuses to do a self-quarantine after travel and/or contact with potential COVID-19 risk factors and continues to come in contact with people at the workplace?"

The answer:

The Occupational Safety and Health Administration (OSHA) recently published Guidance on Preparing Workplaces for COVID-19, outlining steps employers can take to help protect their workforce. OSHA has divided workplaces and work operations into four risk zones, according to the likelihood of employees’ occupational exposure during a pandemic. These different classifications can inform employers on how to treat their workplace during this pandemic.

Employers have a duty to provide a safe workplace to all employees, this includes exposure to COVID-19 in the workplace. Employers should be understandably concerned about providing a safe environment for their employees and, as such, may ask employees about the areas they have recently traveled to and if they may have had any exposure to COVID-19.

If an employer concludes that an employee may pose a health threat to other employees, the employer can require that the employee stay home for the duration of the COVID-19 incubation period, which has generally been assigned as 14 days. They can also ask employees to seek medical attention and/or get tested for COVID-19, but cannot require them to do so. The employer also has no obligation to report a suspected or confirmed case of COVID-19 to the local, state, or federal health departments. Only healthcare providers that receive confirmation of a positive test are mandatory reporters.

In short, the employer cannot require the employee to self-isolate, but must take steps to protect other employees from any potential exposure, including sending the potentially infected employee home.

Here is a link to some more helpful information that was recently published by my law firm: https://www.muslaw.com/covid-19-update-mitigation-of-employment-law-risks/

– Katelin Montgomery, associate attorney with the law firm Meyer, Unkovic and Scott LLP, in Pittsburgh.

• • • • •

“Can a person have coronavirus and flu virus simultaneously?”

The answer:

“It is possible to get two infections at the same time. For example, you can have a common cold, from a virus, and that can lead to a bacterial infection in the sinuses. Yes, you can get the flu and COVID-19 at the same time. It is recommended that if you haven’t gotten your flu shot yet that you do so now. It won’t protect you from COVID-19, but it will keep you from getting the flu.

“Symptoms are similar for both illnesses with the major difference being that COVID-19 causes shortness of breath due to the viral pneumonia.”

– Jill D. Henning, Ph.D., associate professor of biology at the University of Pittsburgh at Johnstown.

“When older adults fly, can they get tested upon arrival so they don’t need to be secluded for 14 days?”

The answer:

The tests that are available on the market are antibody tests and SARS CoV-2 genome tests.

The antibody tests show if a person is having an adaptive or specific response to the virus; the genome test is indicative of an active infection, as viral RNA is present. These tests, particularly the genome test, give a snapshot of what is happening on that day.

Individuals who are exposed to SARS CoV-2 won’t show symptoms for five to seven days, on average. A test upon landing would not be sufficient to say that the individual is not in the incubation period of COVID-19. 

The person could have been exposed to the virus on the plane. This is why the 14-day quarantine is recommended.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

A reader of The Tribune-Democrat asked:

“So my husband started feeling bad Monday night with a fever. The next morning he still had a fever and headache. He got tested and was negative. He went back to the doctor and was told to take it again. He’s finally fever free on Friday. So my question is: should he go take it again if now he doesn’t have symptoms and how long should we wait for him to join the family again?”

The answer:

Does he have a cold or is it COVID-19? COVID-19 often causes symptoms similar to those a person with a bad cold or the flu would experience (fever, shortness of breath, loss of taste and smell, coughing). It is more likely to suspect coronavirus if you have respiratory symptoms (like mentioned above) and you have been exposed to someone suspected of having COVID-19, or there has been community spread of the virus that causes COVID-19 in your area.

Since your husband’s physician recommended a test again, I would heed that advice. Out of an abundance of caution, you could have your husband wait 10 days before returning to family life.

Some clinical research has shown that individuals are no longer contagious by 10 days after symptom resolution.

If you wish to be more cautious, you could have him wait 14 days.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

A reader of The Tribune-Democrat asked:

“I tested positive on June 28 and completed my 14 days. I got tested again and tested positive again, but the only symptom I have is a slight cough. Is it possible that the virus is slowly going away?”

The answer:

It sounds like you are recovering. I recommend you continue to follow CDC safety precautions, including wearing a face mask.

The decision to discontinue home isolation should be made in the context of local circumstances. Options include a symptom-based or a test-based strategy.

These are fully described at https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

A reader of The Tribune-Democrat asked:

“I have a friend who tested positive for COVID-19. He spent time in a hospital and quarantined for two weeks. He says he’s on day three of not being symptomatic. Is it safe for others to be around him? Or should he do another round of 14 days self-isolation?”

The answer:

Your friend is improving.

The decision to discontinue home isolation should be made in the context of local circumstances.

Options include a symptom-based or a test-based strategy. These are fully described at https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html

If your friend meets CDC criteria for ending self-isolation, he should be clear. I recommend continuing CDC safety precautions, including wearing a face mask.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

Have a question about coronavirus, also known as COVID-19? Send questions to tribdem@tribdem.com.