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:

“Where is the COVID-19 vaccine in Cambria County? When can we expect the administration of the vaccine into the arms of people 75 and older who are not in nursing homes? What is the delay?”

The answer:

The Pennsylvania Department of Health is working on ways to increase access to the vaccine, including at pharmacies. The state has not yet revealed its strategy for meeting the new guidance for seniors. At this time, I honestly don’t know the exact date when the vaccination of people 75 years and older will begin.

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

• • • • •

“My best friend in Nashville has cancer. I will be going up the third week in February after I quarantine for two weeks. Which would be better for me? 

“The vaccine or quarantining?”

The answer:

Both quarantining for two weeks and receiving the COVID-19 vaccine are advisable.

You should receive both doses of either the Pfizer or Moderna vaccine and wait one to two weeks after the second injection to obtain full protection. However, getting the vaccine may not prevent you from spreading the coronavirus. Therefore mask-wearing, social distancing and good hand-washing hygiene are still recommended for those who are vaccinated against coronavirus.

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

• • • • •

“If I had vaccined (both doses), but was exposed to COVID, do I still need to quarantine?”

The answer:

Vaccinated individuals can still become infected with SARS-CoV-2, the virus that causes COVID-19. 

The reason is that the vaccines are 95% effective at preventing COVID-19, that means that few (5% of those vaccinated) may still get sick after exposure.

It takes our bodies about 14 days for the Moderna vaccine and seven days for the Pfizer vaccine after the second dose to build up the response to the virus. If you are exposed in that time or even later, it is possible that you could be infected.

For now, the recommendations are to not assume complete immunity after vaccination. To be abundantly cautious, you should quarantine for at least seven days. Even those who are vaccinated should wear a mask when in public, practice social distancing and wash their hands regularly.

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

• • • • •

“After receiving my second vaccine and a family member gets the virus, do I still have to quarantined since I am vaccinated?”

The answer:

Vaccinated individuals can still become infected with SARS-CoV-2, the virus that causes COVID-19. The reason is that the vaccines are 95% effective at preventing COVID-19, that means that few (5% of those vaccinated) may still get sick after exposure.

It takes our bodies about 14 days for the Moderna vaccine and seven days for the Pfizer vaccine after the second dose to build up the response to the virus. If you are exposed in that time or even later, it is possible that you could be infected.

For now, the recommendations are to not assume complete immunity after vaccination. To be abundantly cautious, you should quarantine for at least seven days. Even those who are vaccinated should wear a mask when in public, practice social distancing and wash their hands regularly.

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

• • • • •

“Can spouses of veterans get their COVID-19 shots at the same time as they do?”

The answer:

The VA is now offering COVID-19 vaccine to these two groups:

• Veterans living in long-term care facilities.

• VA healthcare personnel.

After these two groups, the VA will begin to offer COVID-19 vaccines to more veterans who are at high risk of severe illness from COVID-19.

I recommend you contact the Department of Veterans Affairs regional office in your county, or contact your VA healthcare team.

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

• • • • • 

“My husband and I tested positive on Dec. 5. We had mild symptoms. We tested positive again on Dec. 13 (but we’re feeling fine), then on Dec. 19 tested negative. 

“Is it alright to get the vaccine on Jan. 14?”

The answer:

Thank you for your question and choosing to get vaccinated.

Yes, you can receive the vaccine after being infected with SARS-CoV-2 as long as you are not experiencing acute symptoms of the infection.

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

• • • • •

“I work in health care and tested positive for COVID-19. The first dose of vaccines have started and anyone who has tested positive are the last to be vaccinated. 

“Is this right? Is there scientific evidence to back this up? I have heard that you can get the virus twice?”

The answer:

What a great question. The reason individuals who have recovered from COVID-19 are asked to wait to get vaccinated is because your body has mounted an immune response to the virus naturally. There is scientific evidence that this immune response can last for up six months or more. In fact, one recent paper suggest that immunity can last for a few years!

The delay of 90 days is to allow those that have not been infected to mount the same response that you did naturally.

Thank you for your question.

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

• • • • •

“My sons and I hunted outdoors with my brother on Dec. 20. My brother stood by our open truck window and spoke across me to my daughter. On Dec. 22, my brother tested positive for COVID, my son and I both participated in a National Guard Testing on Dec. 23 and both received negative results. On Dec. 28, my son and I both spiked symptoms and subsequently tested positive on Dec. 29. Is it possible that my brother was our direct contact and it took eight days to develop symptoms?”

The answer:

Yes. Symptoms of coronavirus disease (COVID-19) may appear two to 14 days after exposure. This time after exposure and before having symptoms is called the incubation period.

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

• • • • •

“My daughter has had the first Moderna vaccine and is due to get second vaccine dose on Jan. 19. She tested negative for COVID virus two days ago and positive today. Can she receive the immunity injection?”

The answer:

What a great question and one that may also be on the mind of others. It is recommended that individuals who are infected with SARS-CoV-2 in between doses (after the first does of the vaccine but before the second) should wait until their acute symptoms resolve before getting the second dose. This goes for both the Moderna and the Pfizer vaccines.

The first dose of both vaccines will provide about 50% protection against acquiring SARS-CoV-2, the virus that causes COVID-19. So, your question may be relevant for others in the same situation.

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

• • • • • 

“My husband rode for 10 minutes in a vehicle with a co-worker on Dec. 29. 

“On Dec. 31, this person tested positive for COVID. Not sure when symptoms appeared. They both had surgical masks on, they had a window cracked. My husband is diligent about hand-washing. 

“He was not made aware of the positive co-worker until Jan. 2, so we (myself and three kids – 13, 10 and 3 months) were around him for those four and a half days. 

“My parents visited twice, he rode in vehicle with my dad, he went to stores and work one day. Once he found out of his exposure on Jan. 2, his work put him off 15 days and he began mask-wearing in our home, slept separate and won’t hold our baby, cleaning extra, etc. He’s getting a test (which seems to me like equal risk for exposure to what he had at work). 

“How cautious should we be in our home since we have already been exposed for days? How worried should my parents be since they visited? If his test is negative, can we be a little less cautious and sleep in the same bed again (our baby sleeps with us)?”

The answer:

If your husband tests negative seven days after his exposure and he reported no symptoms during daily monitoring, then his quarantine can end.

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

• • • • •

“If one received the first shot of the Pfizer vaccination on Jan. 4, learned he was positive on Jan. 9 after having a PCR test on the 7th as a preventive weekly regimen at work, should there be any issue to prevent taking the second Pfizer vaccination shot around the 25th of January? Does the positive diagnosis pose an issue? Do one’s symptoms affect whether the second shot can be taken? Also, after testing positive, is one still considered contagious after the 14-day quarantine period?”

The answer:

It is recommended that individuals who are infected with SARS-CoV-2 in between doses (after the first does of the vaccine but before the second) should wait until their acute symptoms resolve before getting the second dose. This goes for both the Moderna and the Pfizer vaccines.

The first dose of both vaccines will provide about 50% protection against acquiring SARS-CoV-2, the virus that causes COVID-19. So, your question may be relevant for others in the same

Vaccinated individuals can still become infected with SARS-CoV-2, the virus that causes COVID-19. The reason is that the vaccines are 95% effective at preventing COVID-19, that means that few (5% of those vaccinated) may still get sick after exposure.

It takes our bodies about 14 days for the Moderna vaccine and seven days for the Pfizer vaccine after the second dose to build up the response to the virus. If you are exposed in that time or even later, it is possible that you could be infected.

For now, the recommendations are to not assume complete immunity after vaccination. To be abundantly cautious, you should quarantine for at least seven days. 

Even those who are vaccinated should wear a mask when in public, practice social distancing and wash their hands regularly.

If you quarantine for 14 days and do not develop symptoms, then you are free to end quarantine and safe in the knowledge that your exposure did not cause an infection. If you were isolating, as a result of symptoms or a positive test for COVID-19, and you did so for 14 days, are fever-free for at least 24 hours without medication and your symptoms have improved, then you are safe in the knowledge that you are not contagious.

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

• • • • • 

“My husband received test results that he was COVID positive Nov. 26. He had minimal symptoms, such as a regular cold. I started to feel sick that same day, I tested Nov. 29 with a negative result. My symptoms included chills, fever, sweating and body aches. I continued to have fever and was not getting better and retested Dec. 5, with another negative result. 

“The doctor had checked the X-ray ordered, and it was determined I had pneumonia, and received prescription for an antibiotic. I continued to feel ill for a total of two weeks, first day of feeling better was Dec. 10.

“Fast forward to Dec. 25 and I have been in contact with COVID again. My youngest son tested positive Dec. 31. 

“I, too, tested same day and came back negative again. Is it possible that I didn’t test ‘in time’ the first time or is there a possibility that certain people will just test negative every time? Looking forward to your answer as family and friends are baffled by this.”

The answer:

You didn’t mention the type of tests that were done. There are several possible explanations.

First is false negative results. Negative rapid antigen test results do not rule out COVID-19 infection.

Second, a negative molecular Polymerase Chain Reaction (PCR) result can occur in the early or late stages of COVID-19 infection.

You could consider a blood test for SARS-CoV-2 IgG antibodies. If that blood test is positive, it indicates you were previously infected with COVID-19 in the past, but it doesn’t give an exact date.

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

• • • • • 

“I hate to take up your time but I find this question of the utmost importance. 

“I was sick last Thursday, I am a first responder and my agency had me go to the area hospital immediately to get tested. I had the SARS-COV-2 PCR test and it was positive. I have all of the symptoms listed for COVID. My wife has been by my side and is also sick with all of the same symptoms except that she can taste and smell, which I still can not. She just came back from being tested at the local community college that is offering tests. This was the first available date after the holiday that the site was open and she could get tested. They gave her a antigen test which came back negative. How can this be? I am afraid that they may have given her the wrong test and she has asthma. 

“I am very worried about her and this will ease my mind. “

The answer:

You and your wife had different tests. 

Your test was a molecular Polymerase Chain Reaction (PCR), and your wife’s test was a rapid antigen. Negative rapid antigen test results do not rule out COVID-19 infection.

I recommend your wife retest with a swab PCR. I also advise her to quarantine separately pending the results of her PCR test.

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

• • • • • 

“My mom lives with me on a temporary basis. She went to her permanent home (I drove her) where she is the only occupant, several months ago with plans to return to live with me in a few short months. 

“Although we have been practicing the safety protocols as outlined by the CDC or neither of us has had or has COVID-19, with the numbers rising in the state coupled with the new strain that is making its way across the country, is it safe for her to return to live with me right now? I would be driving to get her.”

The answer:

I do not advise travel at this time.

I do recommend COVID-19 vaccination as soon as the vaccine is available.

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

• • • • •

“I’m in Phase 2 with chronic illnesses – three at least – HIV, hepatitis C and liver damage. What do I need to do in order to get the vaccine?”

The answer:

Each state has different COVID-19 vaccine distribution guidelines.

I suggest you contact your local health department for assistance and instructions.

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

• • • • •

“I saw on your website in which questions were being asked regarding to COVID and how certain situations should be handled. I wanted to pose a question from an employer perspective. We had an employee test positive for COVID-19 (via nasal swab) at the end of September. The employee was asymptomatic at the time and never showed any symptoms, but we had this employee

work from home for a period of two weeks.

“This same employee got tested again with a nasal swab in the middle of November because this person was given a reward of some sort for getting tested with a local organization. The test results came back as detected. Does this mean this person is positive for the coronavirus again or is this the same occurrence from two months ago? Also, is this person considered contagious and should we have the employee work from home again? Again, the employee is asymptomatic.”

The answer:

In your question you did not mention the type of test that was done. 

Both the rapid test and the genome test use nasal swabs.

The rapid test is good for detecting positive individuals who are symptomatic. It is less so for those individuals who are asymptomatic. The genome test can detect positive individuals from about three days after exposure and infection until the virus is cleared. The clearance in some individuals can last for a few weeks to months after the infection has resolved.

Think of it this way: If you have a large group of people, 800,000, in a field, it could take a few days to weeks to clean up after them. 

The same thing happens with your immune system. One cell can produce up to 10,000 viruses and many cells become infected in an infection. The clean-up can take time.

Several factors come into play when determining how long the clean-up will take. It is difficult to determine, from your question, if the individual is in the clean-up phase or if they were reinfected.

Data shows that a small percentage, less than 1%, of individuals are reinfected with SARS-CoV-2.

That number may change as new data is collected and more testing is done.

I cannot say for certain what the reason is for a positive test a second time, but the above options are two possibilities.

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

 • • • • •

“If I get both of my Moderna vaccine injections, and three weeks go by after my second injection, can I safely travel to the Caribbean (Turks and Caicos) and not have to quarantine upon my return? I live in Washington, D.C.”

The answer:

The Moderna vaccine is highly effective at preventing you from getting a symptomatic infection with SARS-CoV-2.

However, science is not yet certain about your ability to transmit the virus to others after vaccination. What I mean is that you will not get sick, but you may make others sick.

You will need to continue to wear masks, maintain social distance and observe quarantine even after vaccination, until such time as science can determine if vaccinated individuals are able to be asymptomatic carriers of the virus or not.

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

• • • • •

“My husband works in a school and was in the building until Nov. 23. I work from home and have worked from home since March. All of my children are attending school virtually. 

“My husband and I have left home rarely and try to order groceries for curbside pickup, etc. 

“When we do go somewhere public, we wear masks and socially distance. Three weeks ago, my daughter’s best friend spent the night (she and her mom have been isolating together) and my son spent the night at my sister’s house (she and her family had the virus a few months ago.)

“Last weekend all of my kids were sick with what I assumed was strep throat. Shortly after, I began to show symptoms. I was tested on Nov. 25 and my test came back positive on Nov. 27. On Nov. 28, my three kids and my husband were tested. My kids no longer feel sick but one has a lingering sore throat. We received their results last night and all four of them have tested negative.

“Until now, my only explanation was that my husband is an asymptomatic carrier and infected the rest of us, as he is our primary connection to the outside world right now. How likely is it that he was asymptomatic and my kids were symptomatic and they are already testing negative after infection?

“Or is it more likely that they just haven’t tested positive yet? We are all isolating at home together but were operating under the assumption that we were all positive.”

The answer:

In your question you didn’t mention the type of test that everyone had. If you all had the rapid test, a negative result only means that you were negative at the time of the test. If you all had a genome test, it is more sensitive, and you can trust the negative results.

The rapid test is better at detecting positive patients when they are symptomatic. A negative result in an asymptomatic person only says that at the time of testing you were negative.

As for how you got SARS-CoV-2, I cannot say. There is a hypothesis that says approximately 15% of individuals with SARS-CoV-2 are asymptomatic and never develop symptoms, but that is just a hypothesis. We are not doing enough testing in the U.S. to determine if that hypothesis is true.

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

• • • • •

“My husband had a kidney transplant. When the vaccine is available he will receive the vaccine shot. I am 63 and do not qualify for the vaccine shot. My question is: would I be able to receive the vaccine shot, since we live in the same house? I was the kidney donor to my husband. He received my left kidney.”

The answer:

Distribution of the vaccines are being coordinated by the health departments of each state. Given that you are not in a high-risk group, you may not be able to get the vaccine when your husband does. I suggest you reach out to your family physician to learn about vaccine distribution in your area.

The good news is that once we reach about 80% vaccination in the population, the virus will have a harder time spreading in the population as more it won’t have any susceptible hosts. Take comfort in knowing our most vulnerable populations are being prioritized.

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

• • • • •

“I work with people with autism. We try and keep their masks on as much as possible, but because they are people with disabilities, they are exempt from the mandate. On Monday, I worked with an elementary-aged patient with autism at their school. The patient did not have his mask on and I was within 6 feet for an hour and a half.

“Tuesday, I was around the patient, but was able to socially distance. Again, the patient did not have his mask on for most of the time.

“On Wednesday, at around lunchtime, the patient developed a fever. The fever stuck around with a sore throat for less than 24 hours. So, the patient was essentially sick for less than 24 hours.

“The patient’s exposure was from six days prior. On Friday, the patient tested positive via a rapid test. Patient has been asymptomatic since Thursday afternoon. 

“Patient’s mother and twin sibling both tested negative. I took a rapid test on Thursday as well as Sunday. Both of which returned as negative. I also took a PCR on Sunday. Do I need to still self-quarantine? This is day five with a negative COVID test and from what I understand most symptoms show up within five to six days.”

The answer:

Yes, you should self-quarantine separately for 14 days. You are a close contact of a person diagnosed with COVID-19. Negative rapid antigen test results do not rule out COVID-19 infection. Also, the mean incubation period for the SARS-CoV-2 (COVID-19) virus is estimated to be five days with a range of two to 14 days.

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

• • • • •

“I received the COVID Moderna vaccine on Dec. 29. The next day, my husband developed symptoms and tested positive. I then became symptomatic and tested positive Dec. 31. My question is: will having the vaccine around the time of my diagnosis increase my symptoms and increase my risks?”

The answer:

I understand your concern and am sure you are not alone in this situation.

There are two ways our bodies can develop immunity to an infection:

1. By getting vaccinated and

2. By becoming infected naturally (via exposure). It takes our bodies about 10-14 days to develop the necessary antibodies to provide protection from infection, regardless of how we were exposed.

It is very possible that you were exposed and pre-symptomatic when you received the vaccine due to the long incubation period of SARS-CoV-2. You should suffer not negative side effects from having the vaccine during your pre-symptomatic phase of infection.

It is important to remember that the first dose of the vaccines are approximately 50% effective at preventing infection and the second doses increase that to 95% or more.

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

• • • • •

“Can a person with a severe urinary-tract infection with e-coli in his/her culture throw a false positive for a test?”

The answer:

No.

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

• • • • •

“I participated in AstraZeneca’s Phase 3 trials and received my second shot 10 days ago. They are still not unblinding the studies and I would like to help them in the studies, but at the same time, I really would like to know if I got the placebo or the real thing. If I went myself to get a blood test for antibodies, would that show up that I have the vaccine? 

“Also, can I keep those results from AstraZeneca so this way they could still use me for testing?”

The answer:

When individuals sign up for and agree to terms in a clinical trial such as the one you describe, there are certain things you agree to abstain from. I do not know the terms of your agreement with AstraZeneca, but I would expect that in that document you agreed to remain blinded as to which you were receiving, placebo or vaccination.

While I understand your desire to know if you were immunized or not, I urge you to read over the agreement you made with AstraZeneca before scheduling any antibody testing.

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

• • • • •

“I am being treated for CLL with prednisone (10 milligrams) and Rituxan intravenously every three months. Will I be able to take the vaccine when it becomes available?”

The answer:

The coronavirus vaccine immunization guidelines have not yet been approved and released. When the vaccine becomes available, I recommend you discuss vaccination with your treating medical oncologist.

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

• • • • •

“My husband was exposed directly between Nov. 4 and 7. When we found out, we both got tested on Nov. 9 and received negative results back on the 10th. On Nov. 13, he started to show symptoms, so I scheduled him another test for Nov. 15 and he was positive this time. I decided to get retested so I would have a quarantine time line and got retested on Nov. 19 and just received negative results again. All of our tests were the PCR test. How is this possible, we have taken zero precautions at home between us? Also, how long do I have to quarantine if I have been exposed for over 16 days now?”

The answer:

Regarding your husband, if he is not immunocompromised, he can stop isolation after at least 10 days have passed since his symptoms first appeared and at least 24 hours have passed since last fever without the use of fever-reducing medications, and symptoms have improved. If your husband is immunocompromised, then at least 20 days of isolation is recommended since symptoms first appeared.

You are a household contact and should self-quarantine separately for 14 days. This will be 14 days from the date your husband with COVID-19 is released from isolation.

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

• • • • •

“I was dating a guy before the pandemic who works in retail. When the pandemic hit, we stopped dating because he was still interacting with customers on a daily basis. In May or June, he got COVID. I’m wondering if that means I could start dating him again or would I be at risk of him passing on germs from his customers even though he has already had the virus? I really liked the guy and it would be great to be able to see him again, but I definitely don’t want to put myself at risk and I also have roommates who I can’t in good conscience put at risk.”

The answer:

An interesting question, who’s safer?

Regarding the guy you previously dated, reported COVID-19 reinfection rates have been low to date. It is not known for certain how long antibodies stay in the body after infection, or how long protective immunity may last. And you may be at higher risk from your roommates.

Hopefully, the vaccine and broad immunization will soon be available.

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

 • • • • •

“I have a close friend who is a 30-year-old male. He was diagnosed with COVID-19 while taking a flight. They sent him directly to ICU and then he started coughing up blood. That was almost two months ago. 

“He has edema in his lower extremities. He has tested again positive for the COVID-19. What is his chances of full recovery? Will he be a carrier all his life? Can he give it to someone that is 73 years old? Will he always have a disability?”

The answer:

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

His prognosis for full recovery depends upon his immune status, if he has any preexisting medical conditions, and whether he develops lung or heart problems from the COVID-19 infection. His young age is a good prognostic factor. I’m certainly hoping for a full recovery, and time will tell.

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

• • • • •

“Do you have to have a negative COVID-19 test to receive vaccine?”

The answer:

This is a great question and one that I am sure many others have.

Current recommendations do not require a negative COVID-19 test to receive the Pfizer or Moderna vaccines.

However, if you are symptomatic for COVID-19, it is advised that you wait until your symptoms resolve before you receive the vaccination.

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

• • • • •

“On Dec. 21, I went to a local testing site for a rapid test in Hauppauge, New York. The person administering my nasal swab test had a mask on, but it looked like a typical surgical one and not a tight-fitting N95. She had no additional protective equipment such as a visor on while administering the test. Because she may have seen a lot of patients so far, am I at risk of potentially being exposed to COVID-19 from her? Are all test administrators required to take a test themselves (or at this point, be vaccinated?).”

The answer:

In my opinion, your risk is probably low.

At our medical center, test administrators are not required to be routinely tested. COVID-19 vaccination is strongly encouraged, but not mandatory at our medical center.

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

• • • • • 

“I had the Pfizer COVID vaccine this morning and get COVID tested tomorrow for surgery in a week. Will this be a problem?”

The answer:

No.

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

• • • • •

“If I obtained the vaccine, do I need to quarantine away from my 70-year-old husband and wear a mask around him?”

The answer:

Thank you for your questions. I appreciate your concern for your family members.

The Pfizer and Moderna vaccines for COVID-19 do not contain any virus. 

Instead, they contain a biological molecule called messenger RNA. This molecule will be made into the viral spike protein and your body will mount an immune response to it.

The lack of virus in the vaccine means that you are not contagious. It is safe to interact with members of your household without a mask after the vaccine.

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

• • • • •

“What happens if your spouse gets the COVID-19 vaccine and you don’t? Can you get sick from your spouse?”

The answer:

The vaccine for COVID-19, whether it is from Pfizer or Moderna, contains no virus. 

Instead, what these vaccines contain is RNA. RNA is a biological molecule that is nucleic acid. Most of us are familiar with DNA, the biological molecule that holds all our genetic material and is a nucleic acid. 

DNA is used to make RNA in a process called transcription. Think of it like this, if you wanted to write “Hello” in Spanish, you’d write “Hola.” They are the same word with the same meaning, just using a different set of letters. That is what happens with DNA and RNA, same message different make-up.

That RNA is then translated into proteins, another type of biological molecule that does the work.

If you wanted to turn “Hola” into a gesture, you’d wave. That is like what occurs in translation of RNA into proteins. You turn a word into an action.

The COVID-19 vaccines have a bit of SARS-CoV-2 RNA in them, the bit that makes the spike protein. The spike protein is what the virus uses to get into our cells.

Our bodies will take the RNA and translate it into this spike protein. Then our immune system will recognize that spike protein as something to be destroyed and mount a response to it. This response will generate antibodies that will protect us, with 95% certainty, from infection with SARS-CoV-2.

Some vaccines have what is called live virus contained in them and can result in someone who receives that vaccine being contagious with the pathogen. Since the COVID-19 vaccine is only RNA, it cannot be transmitted. There is no risk of acquiring the infection from someone who has been vaccinated.

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

• • • • •

“Could these new vaccines help those already infected? Someone should be trying it on some of those seriously infected? Would help hospital immensely.”

The answer:

CDC 2020 recommendation is that defer vaccination in persons with known current COVID-19 infection until the person has recovered from acute illness and no longer requires isolation.

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

 • • • • •

“My husband became symptomatic on Dec. 25 and tested positive on Dec. 27. My youngest son, 12, started with GI symptoms on Dec. 27. They have both been isolating in separate bedrooms since symptom onset. I have been quarantined downstairs bringing supplies up masked and distanced. I am an optometrist and have had Type 1 diabetes for 33 years. I have been extremely diligent in my precautions to avoid this virus. However, Tennessee is currently a global hot zone. I could get my vaccine this week by our health department. Is that advisable or should I wait until quarantine period is over?”

The answer:

I am very happy to hear that you are following isolation protocols for your sick family members.

Since you are in the medical profession, you can get the vaccine in accordance with the Tier One roll-out. Guidance from the CDC suggests that your possible exposure does not preclude you from getting the vaccine. However, if you become symptomatic, it is advised that you wait to get the vaccine until your symptoms resolve.

You will need to contact your local hospital to arrange vaccination. The roll-out for healthcare workers is being coordinated by each state’s health department.

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

• • • • •

“My girlfriend is a 39-year-old nurse. She contracted COVID-19 at work. She is almost over it now. But now, she keeps falling asleep very randomly. I mean literally in the middle of a sentence.

“She has no history of narcolepsy either. She’s mostly laying down when it happens though. But when she’s up and walking around, she’s fine. My question is: is that a normal side effect?”

The answer:

Narcolepsy is a sleep disorder which often includes periods of excessive daytime sleepiness.

According to researchers, evidence suggests that narcolepsy arises from the interaction of genetic, environmental and triggering that then lead to an immune-mediated loss or dysfunction of neurons in the brain.

In other words, COVID-19 infection may trigger an immune system reaction that can attack brain neurons leading to narcolepsy.

I recommend your girlfriend consult either a sleep specialist or neurologist for further evaluation and treatment.

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

 • • • • •

“After receiving the COVID-19 inoculation, is there a delay of 10 to 30 minutes before departure?

“This would cover a shot reaction to the recipient.”

The answer:

Vaccine side-effects are generally minor, including mild soreness at the injection site. However as a precaution, the person should be observed 15 to 30 minutes after vaccination for a remote chance of a severe allergic reaction.

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

• • • • •

“I do not live with my parents. My dad tested positive for coronavirus/COVID-19. He and my mom quarantined at home. 

“My mom had three tests (the full test with nasal swab, not the rapid) during a 14-day timeframe when my dad was ill and tested negative each time. My dad’s symptoms fully subsided and he then had a follow-up, full nasal swab test and tested positive again – his PCP let him know that people can still test positive for some time after infection and recommended he not get another test. After 20 days, on his physician’s guidance, he ended his period of isolation at home.

“My parents would like myself and my boyfriend to spend some time with them in their home, masks off. We did frequently see them pre-COVID-19 diagnosis given we have parallel, strict approaches to living in the pandemic. Is my dad still infectious from his previous bout with COVID-19? What is the level of risk in being in their home? I am unsure of whether and for how long the home/air in the home can hold the virus.”

The answer:

Sometimes the virus is persistent in detectable levels up to 12 weeks after infection, but likely isn’t infectious. However, households are, and will continue to be, important venues for transmission of SARS-CoV-2 (COVID-19). Therefore, studies have recommended preventative actions such as increased mask-wearing at home.

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

 • • • • • 

“My mom began having COVID symptoms on Nov. 23. Her boyfriend in the same household had symptoms before her but wasn’t tested initially. After my mom became sick, they both got tested and both came back positive. My sister then started having symptoms on Nov. 26. She also tested positive and tested positive for the flu as well. They have all done their 10-plus day quarantine. They have gotten tested since and still have tested positive. I want to visit my family. Is there any way they could still be contagious? My sister went to the ER twice for her symptoms. I do not live in my parents’ home. Should I wear a mask at all times if I do? Is there anything specifically I should avoid in my house?”

The answer:

Sometimes the virus is persistent in detectable levels up to 12 weeks after infection, but likely isn’t infectious. If none of them are immunocompromised, they may stop isolation after 10 days and resume normal activities. If any are immunocompromised, then 20 days of isolation is recommended.

I also recommend wearing a mask and other preventative actions including social distancing (which is difficult with family) and good hand-washing hygiene.

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

• • • • •

“Both my wife and I tested positive for COVID this past Sunday. We are taking vitamin D3, zinc hydrochlorine and vitamin C. My question is: Can we cross infect each other if one recovers sooner than the other one?”

The answer:

Since both of you are infected with the same pathogen, SARS-CoV-2, you need not worry about infecting each other if one recovers first.

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

• • • • •

 “My husband received the Pfizer vaccine. 

“I’m assuming because this isn’t a live virus vaccine, there would be no shedding? I realize following distancing and masking is still mandatory, but, would that help give me any potential benefit/immunity to COVID-19 since we live in the same house?”

The answer:

What a great question. I am sure others in your situation are wondering the same thing.

Both the Pfizer and Moderna vaccines are mRNA vaccines. This means that they use our cell’s own process to make the spike protein of SARS-CoV-2, the virus that causes COVID-19. 

This spike protein is then broken down by the cell and shown to the cells of the immune system in a process called antigen presentation (think of it like an introduction to the body). The immune system will then mount a response to that spike protein causing the individual to possibly have injection site pain, tiredness, and after about a week a swollen lymph node in the armpit closest to the injection site.

Since there is no virus in the vaccine, there will be no natural infection and no possibility of contagiousness. However, you are correct in your assertion that your husband will still need to wear a mask in public and continue to maintain social distance and hand-washing. Science does not yet know if a vaccinated individual will be capable of being a carrier for the virus.

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

• • • • • 

 “Thank you for your feature where experts answer questions related to COVID-19. (These questions provide valuable understanding for how COVID-19 works and how we should think about COVID-19 scenarios that are more specific than you can find in a general article on the internet. I have enjoyed reading through many of them.)

“I have read through most or all of the questions and have not seen one that addresses my question so I would like to see if an expert can weigh in on it.

“My question is regarding transmission from outdoors to indoors. Virtually all articles out there are for outdoor-outdoor transmission or indoor-indoor transmission. Let’s say that you are having a landscape company do some improvement to your yard which would require several workers to be in your back or front yard for many hours and possibly multiple days. Due to the aerobic nature of the work and being outside none of the workers wear masks. Is there any risk of an ‘outdoor-to-indoor transmission’ if one of the workers is actively shedding the live virus and the house is directly downwind? How much would open windows versus closed windows play a role in the answer? Would the risk be classified as virtually zero, extremely low, low, medium? 

“Does the risk change with factors such as distance to the house, time, HVAC parameters, etc.? This hypothetical scenario would also have application to so-called ‘window visits’ that many people are doing at nursing homes to see older friends and family, where they visit for potentially multiple hours and possibly without masks on for both the inside and outside people. I have tried to find information that may help provide input to this question but have not found anything of value or substance. Any information you can provide on this scenario would be great.”

The answer:

Your question is a good one. There have been many studies looking at how transmission of SARS-CoV-2 and its variants, are occurring. 

These studies show that less than 10% of transmission of the virus is occurring in outdoor settings where mitigation efforts are in place (mask-wearing).

There have been studies that look at ventilation systems and how the virus is spread due to airflow inside. Airflow direction certainly plays a role in airborne transmission inside. If we consider the physics of the situation you describe, there are many factors that must be considered (windspeed, amount of humidity, respiration rate of the contagious person, distance from the house, amount of sunlight and the intake of air into the house).

Airborne transmission means that the virus is surrounded in small lightweight mucus debris. That particle has mass and will eventually be pulled to the ground due to gravity. 

In windless conditions inside, the particle can travel about 6 feet. When you factor wind outside into that, it can increase the distance the particle can travel before it reaches the ground. However, outside, you must consider all the other factors that would affect the virus. Humidity comes into play, more humid, the virus will be viable longer. Sunlight also comes into play, the UV light from the sun can decrease the viability of the viral genome. 

Plus, consideration must be given to the other factors I mentioned.

Taken together, I would hypothesize that the risk is very low for outside-to-inside transmission.

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

• • • • • 

“If one has had a past single occurrence of Guillain Barre Syndrome – obviously excluding recurrent/chronic forms – is there any one of the upcoming COVID vaccines that may be better to take? It is understood that a conversation with your medical provider would be warranted, but it does not seem at this point that such a provider would have enough legacy data to help guide this decision, and it also seems that contracting COVID could present greater risk.”

The answer:

A large epidemiological study in the United Kingdom found no association between COVID-19 and Guillain-Barre Syndrome.

Dr. Anthony Fauci recently said people who’ve had Guillain-Barre Syndrome, should not get the COVID-19 vaccine “because you might trigger a similar, serious response.” Dr. Fauci’s recommendation was made out of an abundance of caution.

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

• • • • •

“My husband became infected with COVID earlier this week. We isolated him to the upstairs master bedroom and I moved downstairs/slept on the couch. Unfortunately, a few days later I tested positive for the virus. 

“My symptoms are less severe than his, but we both definitely have COVID. Since we both are positive with the virus, can we sleep in the same room again? Or is it possible he has a more severe version of COVID than me and I should continue to isolate from him?”

The answer:

You and your husband can isolate together, as long as, we’re sure you’re both positive.

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

• • • • •

“I was exposed to COVID-19 about 31/2 weeks ago and was under quarantine for 14 days with no symptoms. Yesterday, I woke up with symptoms. Is it possible to get symptoms after 31/2 weeks? I’m concerned I was unknowingly exposed after quarantine and now have exposed others. I have a call into my PCP and will probably be tested.”

The answer:

I agree you were probably exposed a second time after your quarantine.

If you are not immunocompromised, I recommend you self-isolate for 10 days after symptom onset and follow-up with your primary care physician.

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

• • • • •

“I tested positive for the COVID-19 virus. I have had fever, nausea and no appetite. I am scheduled for a total knee replacement on Jan. 15. Is it safe to have that surgery after recently having the COVID-19 virus?”

The answer:

If you are not immunocompromised, I recommend at least 10 days of isolation since symptoms first appeared. If you are immunocompromised, at least 20 days of isolation is recommended since symptoms first appeared.

I advise you to contact your primary care physician and orthopedic surgeon as soon as possible for further instructions and discuss whether to cancel your elective total knee replacement surgery. You also need to get checked for possible COVID-19 pneumonia.

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

• • • • • 

“I recently got out of quarantine. Do I have to wait to get the shot? I’m a health-care worker.”

The answer:

An important question.

SARS-CoV-2 (COVID-19) infection or exposure (CDC 2020):

• Persons with current COVID-19 or asymptomatic SARS-CoV-2 infection: Defer vaccination in persons with known current COVID-19 infection until the person has recovered from the acute illness and no longer requires isolation. Based on current evidence, that reinfection is uncommon within 90 days following initial infection, vaccination may be delayed until near the end of the 90-day period.

• Persons with history of COVID-19 or asymptomatic SARS-CoV-2 infection: Based on Pfizer clinical trials, vaccination is safe and likely effective in persons with evidence of prior COVID-19 infection. Vaccination should be offered to persons regardless of history of symptomatic or asymptomatic infection. 

Viral testing for acute or prior infection for the purpose of vaccine decision making is not recommended.

• Persons with known SARS-CoV-2 exposure: Vaccination following exposure is not likely to be effective for preventing the disease from the exposure. Persons with known exposure should wait to seek vaccination until after their quarantine period has ended. For persons in congregate settings (long-term facilities, correctional facilities), residents with known exposure may be vaccinated; however, if COVID-19 is strongly suspected and viral testing results are pending, consider deferring vaccination.

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

• • • • • 

“I was wondering how long after a COVID-19 vaccine would antibodies show in an IgG test?”

The answer:

If your body develops an immune response, which is the goal of vaccination, there is the possibility you may test positive on some antibody tests. Antibody tests indicate you had a previous infection and that you may have some level of protection against the virus. Experts are currently looking how COVID-19 vaccination may affect antibody testing results.

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

• • • • •

“Our 26-year-old son moved into his own apartment on Dec. 17. He and his best friend were exposed to the virus on Dec. 19. His friend has not had any symptoms but tested positive on Dec. 24. My son had nausea and vomiting on Dec. 23 and body aches and chills beginning that night. He also tested positive on Dec. 24. He had a fever for three days. He never lost his sense of smell or taste. He has been symptom free now for 30-plus hours. Can we see him on New Year’s Eve and/or New Year’s Day or is that too early?”

The answer:

I understand the desire to see family at this time of year. We have traditions and are all craving a sense of normalcy. However, since it has not been 10 days since symptoms have begun, it is risky to visit with your son. He is very likely still shedding the virus and may spread it to you.

I wish I had better news for you.

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

• • • • •

“I keep hearing people say that they/their friend/family member never left the house and yet contracted COVID-19. Are these likely just not true statements or are there documented cases like this? I suspect that maybe they never left the house but had visitors or perhaps got too close to a delivery person. 

“What I’m trying to understand is the actual prevalence of this happening or the actual prevalence of the virus transferring from food packaging or other delivered items. Everything science-based that I have read says that this risk is low and yet I also read anecdotes from a lot of people saying that they are sheltering in place and still caught it.”

The answer:

Experts believe the SARS-CoV-2 (COVID-19) virus spreads mainly from person to person. I agree that visitors may be the source. Masks are more important than originally thought.

Another way to catch the new coronavirus is when you touch surfaces that someone who has the virus has coughed or sneezed on. You may touch a counter top or doorknob that’s contaminated and then touch your nose, mouth or eyes.

The virus can live on surfaces such as plastic and stainless steel for two or three days. To stop it, clean and disinfect all counters, knobs, and other surfaces you and your family touch several times a day.

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

• • • • •

“My husband and I disagree about spending time with our grandchildren and extended family. The grandkids’ parents are in regular contact with at least five other households. 

“My grandson is 3 months old and had open heart surgery when he was 3 weeks old to have a narrow part of his aorta removed. He has other heart issues that will need further surgery when he is older. He is not on immunosuppressant medication. My husband thinks it is perfectly OK to go hang out with the grandkids. The parents have 10-minute COVID tests that they received from the hospital and he is of the opinion that if the test is negative, he can spend time there without a mask.

“I disagree and refuse to go over there. My husband says he is going without me. They only live about a mile away, so he plans on going over at least once a week (and is not happy about my decision to not go for Christmas).

“My concern is if I need to isolate and stay away from him if he is spending time at another household?”

The answer:

Negative rapid antigen COVID test results does not rule out infection. There is risk associated with outside home visitors and considering the number of your grandkids parents’ exposures.

Social distancing is very difficult with family members. I do recommend wearing a mask and good hand-washing hygiene when visiting.

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

• • • • •

“At the grocery store, or any store, which is safer to use – the regular register checkout line, or the self-checkout?”

The answer:

When you are out in public, it is best to keep your distance from others and to wear a mask. If there is a self-checkout available, that will reduce your contact with others. Remember to wash your hands often.

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

• • • • •

“I was exposed to COVID-19 on Nov. 26, became symptomatic on the 29th, and tested positive on the 30th. I luckily had only a mild case and am feeling better. I have isolated from my family since my symptoms began. They have tested negative three times and are symptom-free. I tested again on Dec. 8 and unfortunately, my results are still positive. Does this mean I am still contagious? I am hoping to end isolation, but don’t want to infect my family. I read that sometimes patients who were symptomatic will test positive for three months after getting better. Help!”

The answer:

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.

If you are not immunocompromised, you may stop isolation and resume normal activities after 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.

• • • • •

“I had a PCR COVID-19 test on Oct. 26 that came back negative, then a PCR test on Oct. 29 that came back positive and a PCR test on Nov. 1 that came back negative. Was my positive a false positive or just low viral load that didn’t amount to anything? I have several autoimmune diseases and have been extremely careful, but I work in senior living where we have positive cases (I’m not a caregiver though). I’m just trying to figure out if it was a true positive or if the PCR can still throw out false positives?”

The answer:

A positive PCR (molecular Polymerase Chain Reaction) test result is highly accurate, and I believe you were infected with the SARS-CoV-2 (COVID-19) virus. The negative PCR test on Nov. 1 was probably in the late or recovery stages of infection, or that PCR was a false negative. You could consider a blood test for SARS-CoV-2 IgG antibodies. If that blood test is positive, it indicates you were previously infected with COVID-19, but it doesn’t give the exact date.

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

• • • • •

“My husband tested positive on Dec. 11 and 12. He had both a rapid test and regular test. I had a regular test on Dec. 11 that was negative. I had another regular test that I am awaiting results from. He developed mild cold symptoms a few days ago, but has had no fever. How long should we both quarantine? I have been in the same room with him and using the same bathroom as him. We have been disinfecting everything that is touched after each contact with the surface. When he is cleared to return to work, do I need to spray the entire house with disinfecting air spray or how long will the germs be able to infect us in our home?

“I know he should be isolated to one room but I know he will not agree to that and he will get upset if I suggest it. I will continue to disinfect all surfaces, keep distance within the same room and wash hands frequently. We have been sleeping in separate rooms since Dec. 11. When will we be OK to resume sleeping together and normal activities?”

The answer:

If your husband is not immunocompromised, his isolation can end 10 days after symptoms first appeared, and he can then resume normal activities. Ideally, you should quarantine separately. Your quarantine can end after Day 10 without testing and if no symptoms have been reported during daily monitoring. Or your quarantine can end after Day 7 if a diagnostic specimen (swab molecular Polymerase Chain Reaction – PCR) tests negative and if

no symptoms were reported during daily monitoring.

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

• • • • •

“My husband was exposed to COVID on Dec. 7, and started showing symptoms about four to five days ago. He tested positive, and I tested negative. We have been sleeping in the same bed every night (except tonight), and been around each other without masks. For how long should I self-isolate/quarantine? And same with him? We have two very little boys so logistics are challenging. I already had to stop work since we now don’t have childcare while we’re in isolation. Just trying to figure it all out. Because I tested negative, do you think that means I have the antibodies or that I wasn’t exposed long enough?”

The answer:

If your husband is not immunocompromised, his isolation can end 10 days after symptoms first appeared, and he can then resume normal activities. If you are immunocompromised, then 20 days of isolation is recommended since symptoms first appeared. Ideally, you should quarantine separately. Your quarantine can end after Day 10 without testing and if no symptoms have been reported during daily monitoring.

Or your quarantine can end after Day 7 if a diagnostic specimen (swab molecular Polymerase Chain Reaction – PCR) tests negative and if no symptoms have been reported during daily monitoring. Regarding your negative test results, there are several possibilities. First, you may have had a robust neutralizing antibody response to the virus. Secondly, your test was a false negative. Lastly, you may have tested too early. The incubation period for the SARS-CoV-2 (COVID-19) virus can be two to 14 days, with an estimated mean of five days.

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

• • • • •

“Our daughter and son-in-law had COVID-19 with symptoms beginning the Sunday prior to Thanksgiving. They both fully recovered and they and the children are now symptom-free except that the kids all have perpetual allergies and frequently do not cover sneezes. They are not tidy nor clean people, and their house is always dirty. They are offended we don’t want to come and visit. They would not want to wear masks if we visit, either. 

My husband and I are older than 60 and we will be visiting my mom-in-law, who is 83, in a few weeks. Are we being overly cautious or should we just try to get over our concerns that we could still catch the virus from them?”

The answer:

I recommend continuing preventative actions, including wearing a mask. At this time, I do not advise visiting your elderly mother-in-law who is 83 because of increasing COVID-19 cases and related deaths.

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

• • • • • 

“An employee had been off work with COVID and has just been given the green light to return to work. However, her husband just tested positive. Can she still carry the virus and expose other employees at work if she returns? Just trying to keep everyone safe.”

The answer:

The employee was released back to work. All employees should continue preventative actions, including masking and good hand-washing hygiene.

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

• • • • •

“My husband became infected with COVID earlier this week. We isolated him to the upstairs master bedroom and I moved downstairs and slept on the couch. Unfortunately, a few days later, I tested positive for the virus. My symptoms are less severe than his, but we definitely have COVID. Since we both are positive with the virus, can we sleep in the same room again? Or is it possible he has a more severe version of COVID than me and I should continue to isolate from him?”

The answer:

You and your husband can isolate together, as long as you’re sure you’re both positive.

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

• • • • •

“My daughter is having a group of friends for Christmas Eve. My daughter husband and three grandkids want to come visit us Christmas Day. My husband has cancer and I am on dialysis, 72 years old. 

“Is this risky?”

The answer:

Oh my yes! It is risky. The majority of cases of COVID-19 are coming from small group gatherings in individual homes.

I know it can be hard to talk to family about these issues, I suggest that you offer for them to visit outside and distant while wearing masks.

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

• • • • •

“Hello, I was reading your answers to questions about COVID and I was wondering if I can ask a couple of my own as I can’t find this info anywhere and would like to more accurately judge our risks.

“1. How much of a risk is grocery or other shopping or similar activities – being indoors with other people in fairly large buildings with masks mandated for everyone and generally keeping 6 feet apart and not touching face etc? Can you still catch it through the eyes or by passing too close to someone or is the risk minimal if both are in masks? Does there need to be some time limit, such as 10-15 minutes to get infected or would walking through a potential ‘cloud’ of virus be enough?

“2. I keep hearing people say they have no idea how they got infected, even those who followed all precautions, wore masks and goggles, stayed home and had everything delivered and sanitized with gloves etc. It’s really scaring me. How do you believe these cases can happen?

“3. How much of a risk are children’s activities outdoors such as soccer or just playing, where they are wearing masks but not necessarily distancing far enough due to age? How much can the virus spread between two masked individuals outdoors?”

The answer:

These are very relevant and important questions. I understand your concern and realize how the barrage of information and ever-changing situation can cause anxiety.

This global pandemic has showed the power of science and has allowed the general public to see behind the laboratory doors (so to speak). In many other situations, science has the answer and provides it. This time the public is learning right along with the scientists. It isn’t like they show on TV, right?

I see a common theme in your questions, what risks should I be taking? We all have a risk bank, just as a coin bank, we can choose where to spend that risk based on situation analysis.

Grocery stores and other areas where people gather masked and distant present a level of risk depending on the level of community spread of SARS-CoV-2, the virus that causes COVID-19, in your area. 

Carnegie Mellon University has an excellent tool to help determine the level of community spread in your area. You can find it by Googling CMU Covidcast. I cannot say for certain what the risk is in your particular area. That tool will help. 

Higher levels of community spread will mean greater risk in public.

SARS-CoV-2 has a long incubation period coupled with a period before symptoms start of a few days where individuals appear healthy and are spreading virus like wildfire. This is how people get sick with COVID-19 and can’t place where they got it. Think of it like this, do you remember every item of good you consumed last week? Thinking about all your contacts in the past four days can be difficult.

As for children’s activities, research shows that children have as high or higher viral loads as adults, but with milder symptoms. The main symptoms I children involve gastrointestinal issues and a mild fever.

If community spread is high in your area, children are at risk, too.

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

• • • • •

“My family of three traveled to a private condo for Thanksgiving week at the beach on Nov. 21. We brought our own groceries, we drove straight through for 14 hours only stopping for gas and restrooms. We were vigilant with mask-wearing, hand-washing and using hand sanitizer consistently. 

“We did not gather and did not have any contact with anyone other than buying coffee/takeout twice while masked and distanced. The condo had been empty the week prior to our arrival and when we entered, I immediately Lysol-sprayed every room and Lysol-wiped all hard surfaces. We all tested on Nov. 25 to prepare to return home and all tested negative. It was a thorough nasal swab, but we noted it was not as deep or pointy as the tests we have had prior – were not sure if this was a PCR test, our results came back one to two days later (all negative). We returned home on Nov. 28 and all tested again Nov. 29 with PCR swab test and on Nov. 30, two of the three of us were positive and our teenage daughter was negative. We have isolated in part of the house for 10 days, our daughter has been quarantining upstairs for 14 days from Dec. 1. We were fortunately all asymptomatic the entire time. 

“Now that our isolation and her quarantine are over, can we stop wearing masks in our home and can we all sit together again at the dinner table and on the couch or do we need to continue to mask at home? We are fully following measures inside and outside of the home, and practicing good handwashing and sanitizing at home but want to move about the house without masks if possible.”

The answer:

In my opinion, your family of three does not need to mask at home. Outside of your home, everyone should mask. If you have visitors or outside family members in your home, everyone should mask and socially distance.

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

• • • • •

“My boyfriend visited his family on Thanksgiving and tested positive (PCR) shortly after. He did not have a fever but he did experience mild symptoms (cough, chest tightness/difficulty breathing, stuffy nose) and only very recently stopped coughing Dec. 13. I’m wary about seeing my boyfriend even though his isolation period has ended. However, I miss him and it is likely that I won’t be able to see him until the new year if I go home to my family without visiting him this week. Is it wrong/dangerous if we hang out?”

The answer:

Your boyfriend’s isolation has ended, and he can resume normal activities. I do advise him to wear a mask and practice other preventative actions.

Gatherings with family members who do not live with you can increase the chances of getting or spreading COVID-19 or the flu. 

As cases and deaths continue to increase rapidly across the United States, the safest way to celebrate holidays, is to celebrate at home with the people you live with.

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

• • • • •

“My daughter and I both became ill with sore throat, fever, chills, headache – just like the flu. 

“On Day 5, my daughter lost her sense of taste and we had her and my son tested via nasal swab for COVID (he had no symptoms; I was too sick to leave the house and test). She was positive – so it is an assumption I was positive as well since we had the same symptoms, although I was much sicker and still recovering almost three weeks later. Per the health department, we remained in quarantine for 10 days after the first symptom date and my son remained in self-isolation for an additional two weeks. My son tested negative on the first test – and has consistently been negative through several additional tests. My daughter is required to test negative before she can return to certain activities – she has tested inconclusive twice in the past eight days. We are now almost three weeks out from the initial symptom/illness. Is she considered contagious? I have read that inconclusive should still be interpreted as positive and she should not be around others, but other articles indicate she is no longer contagious.”

The answer:

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.

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

• • • • •

“Thank you for this forum. My husband and I have followed every guidance since the beginning of the pandemic. He is 64 and in excellent shape (triathlete) and the only medical issue he has is asthma. He goes to work every day, where he has a private office and his own lounge area and restroom. And because he is out in the world, he also shops for the items we cannot get delivered.

“Everything we get is wiped down with Clorox wipes before entering our home. I am 56 and retired. I’m fairly healthy having had to retire because I had a viral attack five years ago that made me very sick with inflamed lymph nodes. Otherwise, I take no medications and keep active by walk/running my dog in middle of day when no one is outside. We don’t socialize, we don’t go to bars or restaurants, and celebrated Thanksgiving by ourselves as recommended.

“On Dec. 8, my husband had to use his rescue inhaler in the middle of night (first time in a few years) and was having restless sleep. 

“On Dec. 9, he came home midday feeling sick with flu-like symptoms. I sent him straight upstairs to isolate and began to disinfect all the surfaces, change bedding, etc.

“On the morning of Dec. 10, he was still symptomatic (night sweats, body aches, fever) so we got us both rapid tested for flu and COVID. We were both flu negative, but he was COVID positive. I tested negative for both. 

“In the afternoon of Dec. 10, I began to have a cough, severe headache. Then on Dec. 11, I had a virtual visit with Teledoc because I developed shortness of breath, low-grade fever (100.3) and muscle aches. She said my test was most likely false negative. I will have PCR test and antibodies checked.

“If I test positive, can my husband and I begin to share a space again? Or do we stay separate, because we were infected at different times with potentially different viral loads? I’m very confused about what to do inside our house when both are sick.”

The answer:

There is no problem isolating together, as long as we’re sure you’re both positive. 

Duration of isolation is at least 10 days 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. Therefore, your husband’s isolation can end on Dec. 19, and your isolation can end on Dec. 20, if no fever and symptoms are improved.

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

• • • • • 

“My husband and I took a trip to Disney World with our two daughters and their respective husbands and children. Upon our return, four of the six adults and two of the children tested positive for COVID-19, and the other two adults who had no symptoms whatsoever did not get tested immediately.

“My question is, if my husband and son-in-law’s tests come back positive, do I need to extend my quarantine until he is finished with his? And if they are negative, could they still get sick from the rest of us? Is it common for family members who have not been isolated from sick ones, do not get the virus? I’d like to add that my husband had an antibody test done which came back negative.”

The answer:

Since your husband and son-in-law were exposed to positive individuals, they will need to quarantine for at least a week, even with a negative test result. If they test positive, they will need to self-isolate for at least 10 days from the time symptoms start.

I gather from your question that you are positive. If your husband and son-in-law are self-quarantining away from positive individuals, they are reducing their exposure and along with that, their risk. You will need to maintain your isolation until it has been at least 10 days since your symptoms have begun, you have been fever free for at least 24 hours without medication, and your symptoms have improved.

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

 • • • • •

“Is there anything you can take for COVID-19 besides the vitamin C DB zinc to help with the healing?

The answer:

I assume you are referring to oral meds and not intravenous remdesivir or monoclonal antibodies.

Dexamethasone (a potent oral or intravenous steroid) is for investigational use, potential clinical benefit for hospitalized patients with suspected or confirmed severe COVID-19 requiring supplemental oxygen or mechanical ventilation.

Olumiant (baricitinib) received emergency use authorization (EUA) by the FDA for use with remdesivir in hospitalized patients with suspected or confirmed COVID-19 patients requiring supplemental oxygen or mechanical ventilation.

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

• • • • •

“My husband started showing symptoms of COVID-19 on the Saturday after Thanksgiving and got tested. I was not really experiencing symptoms, but my employer told me to get tested. Both of our tests were negative. 

“I returned to work. My husband found out he was in direct contact with a positive case, tested again, and came back positive. I then came home to quarantine. My employer told me there was ‘no need’ to get tested due to the fact I live with my husband. She said I was a ‘probable’ case. They started my quarantine on the day I got tested. Ten days later, I returned from work and saw my family immediately. Now I am wondering if there was any chance I did not catch the virus from my husband until the last day of his quarantine (two days before my quarantine ended). Could I be walking around positive? I never developed any symptoms. It feels like an impossible question to answer. I just want to know if I put my family at risk by visiting them the day my quarantine ended.”

The answer:

I can understand your concern for your family. This pandemic has created much worry and anxiety about our loved ones. It is difficult to discern your timeline from what you wrote, but from what you have stated, the risk to your family from the visit is low. The incubation period for SARS-CoV-2 is 14 days, if it has been that long since you have seen your family and you are not sick, then all is well.

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

• • • • •

“Monoclonal antibody treatment seems to be an actual cure for those treated early. It stops the progression of the disease and would certainly stop all deaths and hospitalizations if it was available to everyone. It has been reported that celebrities, the well-connected and very rich people have been privileged to receive this and recover quickly. Why isn’t this available to everyone and why hasn’t this been manufactured so that it is available. People don’t have to die every single day. I have rarely seen this mentioned in the news and am terribly disturbed that we have a way to stop people from dying and nobody is talking about it.”

The answer:

The investigational intravenous monoclonal antibodies have been granted an Emergency Use Authorization (EUA) by the FDA. These monoclonal antibodies will be allocated to state health departments by the U.S. Department of Health and Human Services (HHS) based on case counts and severity of outbreaks. These state health departments will be responsible for allocating the antibody to local health facilities.

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

• • • • •

“My dad presumably got COVID-19 from his brother on Nov. 21. 

“The day after Thanksgiving, my mom was the first person in the household to begin exhibiting symptoms, then my brother, then my dad. Everyone started getting better and my dad’s symptoms peaked on Dec. 9 – since then everyone in the house has been on the up. I want to go home to spend Christmas with them but my dad just took a COVID test on Dec. 17 that came back positive – is it safe for me to visit? I’m also concerned that there might be a living virus lingering in the house on surfaces and such. Is it safe for me to visit so soon after they’ve all just recently started recovering? If my dad did get it from his brother on Nov. 21 – it will have been a month since the initial infection happened. Can I go home on the 24th and not get sick?”

The answer:

I understand how much you want to see your family. The situation that occurred with your family members as a result of the Thanksgiving get together is what Public Health officials are hoping to prevent by asking people to forgo visits over the winter holidays.

Most transmission is occurring when families get together in small groups and don’t practice social distance, wear their masks or wash their hands on the regular. It is easy to feel safe and secure in your familial home.

SARS-CoV-2 thrives in that exact environment. It is a virus that is transmitted via airborne droplets and aerosols. It has a long incubation period before symptoms start and individuals who are infected are contagious days before symptoms start.

Most individuals will be non-infectious after about 10 days of symptoms. There are individuals who are infectious longer, but that is rare.

Your father is likely shedding the virus but is not infectious. The virus causes a significant amount of damage to the body. That takes time to clean up. One infected cell can release between 8,000 and 10,000 viruses. That clean up, done by the body’s immune system, can take weeks. Think of it like this, if you held a party with 20,000 people in your house, it would take some time to clean

up. The party is over, but the garbage remains.

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

• • • • •

“I had the virus in March. I was tested for antibodies in June and again in September. I had more than 2,500 antibodies. My husband was just diagnosed positive for the virus. Questions: Can I carry the virus even if I have antibodies? Can I get the virus again? 

“Do I have to be quarantined from him and others?”

The answers:

Excellent questions!

There is not enough information currently available to say if or how long after infection someone is protected from getting COVID-19 again. This is called natural immunity. Early evidence suggests natural immunity from COVID-19 may not last very long, but more studies are needed to better understand this.

It is also not known at this time if you have natural immunity or if after receiving the COVID-19 vaccine, can you transmit the virus to someone who has not been vaccinated or who has no natural immunity. This is why it’s still important to wear a mask, socially distance and practice good hand-washing hygiene after being vaccinated. I’m hopeful that these questions will be soon answered after more people are vaccinated.

Since your husband was diagnosed positive for COVID-19, I recommend you self-quarantine separately. Your quarantine can end after Day 10 without testing and if no symptoms have been reported during daily monitoring. Quarantine can end after Day 7 if a diagnostic specimen (swab molecular Polymerase Chain Reaction – PCR) tests negative and if no symptoms have been reported during daily monitoring.

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

• • • • •

“My husband is 74 with heart disease. He has a pacemaker. He had back surgery seven weeks ago because he could barely walk. I take care of him and the household. I am a fairly healthy 60-year-old woman. 

“He will probably be able to get the vaccine early on in the distribution cycle because of his high risk health issues. Will I be able to get vaccinated at the same time he does, because I am his primary source of help? I am basically his caregiver.”

The answer:

I commend you for all you are doing for your family.

Each state has regulations and a distribution plan for the COVID-19 vaccine. I cannot say what the distribution plan is for your state. Given your age, you may have to wait on the vaccine. I suggest you contact your primary care physician for more information regarding your state’s plan.

If you are unable to get the vaccine but your husband is, he will be protected and you can protect yourself (until you can get vaccinated) by wearing a mask, washing your hands regularly and practicing social distance.

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

• • • • • 

“Our 11-year-old grandson flew to Pennsylvania from Miami, Florida, to be with his father for Thanksgiving. He flew there with his other grandmother. In that family gathering, there were two other children (ages 1 and 8) who had been having fever off and on, but nobody knew this. Our grandson started with some symptoms two to three days later as well as the others.

“Our grandson is now positive and also the grandmother and the stepmother. His father is the only negative so far (I suspect it’s false negative). They will stay there and quarantine and wait to retest.

“I have a couple of questions. Should the father (negative and no symptoms yet) isolate and quarantine? Does the family have to isolate separately, from each other if they are all coronavirus positive? After 10 days or a negative test, can he fly back to Miami and does he have to isolate and quarantine again in Florida?”

The answer:

The father is a close contact, and he should self-quarantine separately according to the latest CDC guidelines below.

• Quarantine can end after 10 days without testing and if no symptoms have been reported during daily monitoring.

• When diagnostic testing resources are sufficient and available, then quarantine can end after day seven if a diagnostic specimen (swab molecular Polymerase Chain Reaction – PCR) tests negative and if no symptoms have been reported during daily monitoring.

Other family members who have tested positive for COVID-19 can isolate together, as long as, we’re sure they’re all positive.

In my opinion, your grandson may fly back to Florida after his 10 days of isolation, but he must wear a mask. I don’t recommend that he self-isolate again in Florida; however Florida may have specific requirements for returning residents.

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.

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