Here's what experts recommend when monitoring potential symptoms of COVID-19.

April 17, 2020
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If you don't already have a plan in place for what to do if you think you have the coronavirus, now's the time to get up to speed.

The good news is that most people with a novel coronavirus (COVID-19) infection only have a mild case and are typically able to self-isolate and recover at home, according to the Centers for Disease Control and Prevention (CDC). The agency also offers specifics on how to care for someone with the coronavirus and a checklist of requirements that must be met before leaving self-isolation. (Reminder: Immunocompromised folks may be more likely to experience severe cases of COVID-19.)

But there's important info that isn't addressed, like when, exactly, you should self-isolate from people in your home (and, you know, the general public) if you think you have the coronavirus. Tests for COVID-19 are still scarce in many parts of the U.S., and it can take days to get your results even if you do manage to get tested, says infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security. So, if you wait around to definitively confirm whether you do, in fact, have COVID-19 before taking the right precautions, you could be actively spreading the virus to others.

In a perfect world, you'd live out the rest of your stay-at-home order blissfully baking bread and catching up on your Netflix queue without worrying about how to handle a coronavirus infection. But in reality, there is a risk of contracting the virus, even from doing something as minor as going to the grocery store or handling your mail—especially if the virus is circulating heavily in your area. So, it's important to think about this stuff in advance. Below, experts break down when (and how) to self-isolate if you think you have the coronavirus.

First, a recap of the wide range of COVID-19 symptoms, because it matters here.

Above all, it's important to stress that COVID-19 is a new virus that was only discovered in late 2019. "We're learning more about it every day," says Dr. Adalja.

That said, by this point, you can probably recite the main symptoms of coronavirus in your sleep: dry cough, fever, shortness of breath. But not all people experience the same symptoms of COVID-19. Emerging research suggests that diarrhea, nausea, and vomiting can be common in people with the coronavirus, along with loss of smell and taste.

The World Health Organization (WHO) has a broader list of COVID-19 symptoms than the CDC, including:

  • Fever
  • Tiredness
  • Dry cough
  • Aches and pains
  • Nasal congestion
  • Runny nose
  • Sore throat
  • Diarrhea

In general, "symptoms usually start off mild with fever, dry cough, or intermittent shortness of breath on day one," says Sophia Tolliver, M.D., family medicine physician at The Ohio State University Wexner Medical Center.

But again, that's not always the case. "There are potentially some patterns [of symptoms] that are more common than others, but none are 100-percent consistent," explains Prathit Kulkarni, M.D., an assistant professor of infectious diseases at the Baylor College of Medicine. "Even if there is a common pattern, it may or may not occur in any one individual occasion."

Basically, there are a bunch of different symptoms you could come down with that could be COVID-19 or could be a sign of something else entirely. (See: The Most Common Symptoms of Coronavirus to Look Out for, According to Experts)

So, when should you self-isolate if you think you have the coronavirus?

From a public health perspective, the safest approach is to self-isolate immediately upon noticing any symptoms that are "new or different" compared to how you normally feel—including the aforementioned symptoms that appear to be common signs of COVID-19, says Dr. Kulkarni.

Think about it this way: If you always develop a runny nose and cough when pollen season hits, it's probably safe to assume allergies are to blame when you develop those same symptoms during that time of year, explains Dr. Kulkarni. But if you have zero history of allergies and suddenly develop the same symptoms, it might be time to self-isolate—especially if those symptoms linger, notes Dr. Kulkarni. "The symptoms should seem different or notable in the sense that you didn't cough twice and then the cough went away," he explains. "They should be persistent."

If you develop a fever, on the other hand, self-isolate right away, says Dr. Adalja. "You should assume that you have coronavirus at that point," he adds.

Once you self-isolate, Dr. Tolliver recommends calling your doctor ASAP about the next steps. Your doctor can help assess your risk of having COVID-19 complications and determine whether you can manage your symptoms at home, explains Dr. Tolliver. They can also help you decide if (and how) you should get tested. (Related: At-Home Coronavirus Tests Are In the Works)

While experts recommend self-isolating whenever you're in doubt about your symptoms, it's understandable that you don't want to go into isolation for kicks. If you feel pretty sure that your symptoms aren't COVID-19, consider distancing yourself from the rest of your household and monitoring your symptoms to see if they turn into something more within a day or two, says David Cennimo, M.D., assistant professor of infectious disease at Rutgers New Jersey Medical School. During that time, Dr. Cennimo recommends practicing what he calls "at-home social distancing."

"You don't have to lock away in one room, but maybe don't sit on the couch together [with the rest of the household] when watching TV," he says. You'll also want to make sure to continue washing your hands frequently, covering your mouth when you cough, and disinfecting commonly touched surfaces (you know, all the coronavirus prevention practices you've already mastered). And, again, call your doctor as soon as you can and stay in touch with them regularly.

Keep in mind: Some people with COVID-19 have "intermittent" symptoms, meaning the symptoms come and go, notes Dr. Adalja. So, paying attention to how symptoms change day-to-day is especially important. "Don't assume that you're OK as soon as you feel OK," he says. (Here's a more detailed breakdown on how to isolate at home if you or someone you live with has COVID-19.)

When can you leave self-isolation?

The CDC has pretty clear guidance on this. In the event that COVID-19 testing isn't available to you, the agency specifically recommends ending self-isolation when you meet the following criteria:

  • You haven't had a fever for 72 hours, without using fever-reducing medication.
  • Your symptoms have improved (particularly cough and shortness of breath—be sure to consult your doc about the progression of these symptoms).
  • It's been at least seven days since your symptoms first appeared.

If you are able to undergo testing for COVID-19, the CDC recommends leaving self-isolation after these things happen:

  • You no longer have a fever, without the use of fever-reducing medication.
  • Your symptoms have improved (particularly cough and shortness of breath—be sure to consult your doc about the progression of these symptoms).
  • You received two negative tests in a row, 24 hours apart.

Ultimately, talking to your doctor regularly throughout the experience—rather than trying to figure it all out on your own—is crucial, notes Dr. Tolliver. "Currently, it's very difficult to tell who has or does not have a COVID-19 infection. It's impossible to tell just by looking at someone," she explains. "There is never any harm in contacting your primary care physician to discuss any mild, moderate, or severe symptoms, even if you think symptoms could be a false alarm. Better to err on the side of caution than carelessness."

The information in this story is accurate as of press time. As updates about coronavirus COVID-19 continue to evolve, it’s possible that some information and recommendations in this story have changed since initial publication. We encourage you to check in regularly with resources such as the CDC, the WHO, and your local public health department for the most up-to-date data and recommendations.

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