How to Avoid Covid

For the first time in three weeks, I live in a Covid-free house.

Day 0: My husband was the first to get sick. He woke up with severe congestion and a headache, but tested negative for Covid on an antigen test. In an abundance of caution, I put on an N95 and he began isolating in our bedroom. Two relatives staying with us chose not to mask. I set up a table in the hallway so that I could deliver meals and medication to him contact-free. We all expected him to test negative the next day and then he would be able to rejoin us.

The next morning he had a fever and tested positive.

Day 1: He called his doctor, who prescribed Paxlovid. My relatives masked up, and I pulled out the supplies I had accumulated for this very situation–hand sanitizer, latex gloves, bleach wipes, over-the-counter decongestants, cough drops, surgical masks to put over my N95, thermometers, a pulse oximeter–and staged them around the house. He started the Paxlovid, but his fever kept going up. That evening, it got to 103 degrees and I started packing a bag for the emergency room. Several hours later, the fever began to go down.

Day 2: I was certain that I would get sick next. In the meantime, I carried meals upstairs and brought dirty dishes down. My husband felt ghastly–headache, fever, congestion, coughing, sore throat, brain fog, and intense fatigue. At least four times a day, he texted me his vitals (temperature, oxygen saturation, blood pressure, heart rate) and I recorded them on a log sheet. I worried about his temperature and his saturation rate. A low sat rate is among the problems that send many people to the hospital with Covid.

Where did he get it? My husband and I have had our Covid vaccines and two boosters. We were holding off on getting the bivalent booster until closer to the holidays when we are likely to be in more high-risk environments. We have worn masks in public since April 2020, and socially distanced to an extreme until recently. Our best guess is that he caught Covid at an indoor concert we attended three days before his symptoms began. I wore an N95 for the entire event. He wore a triple layer cloth mask because it seemed to give him a tighter seal and prevented his glasses from fogging.

Day 4: Both of the relatives who had been staying with us tested positive. One was mildly congested, and the other was asymptomatic. We lived with the windows open in every room, and fans and air filters running on both floors, to keep fresh air circulating through the house. I wore my N95 around the clock, except when I was eating outside or using my CPAP machine while sleeping.

Day 5: My husband finished Paxlovid and felt much better. He was still coughing, but otherwise felt ok. However, he tested positive again. Yes, CDC guidance said he could end isolation because he had no fever and his symptoms were resolving. CDC does not require people to test to end isolation. But given that I am very high-risk and was still testing negative, we decided to err on the side of caution. My husband stayed in the bedroom. I continued to sleep on the couch. We decided to wait until he had two sequential negative tests before letting him out.

Day 6: For most of our marriage, my husband has been my caregiver. Seven years ago, he had a disabling stroke and I became a caregiver too. Over time, we reconfigured our relationship to take care of each other in the ways we each need. Now with him confined to our room, I was back in crisis mode like when he first had the stroke–taking care of him and everything in the house. My body went through the motions, doing what was necessary, while my brain stopped participating. Instead of reading or listening to podcasts or watching tv, I did a lot of sitting and staring into space, worrying about how we would cope when I inevitably tested positive too.

Day 10: For several days, my husband was feeling better. The most annoying thing was a spell of feverishness and slightly elevated temperature every afternoon. But on Day 10, Covid seemed to come roaring back. His headache, congestion, brain fog, and fatigue were almost as bad as when he first got sick, with some nausea added in for good measure. The rebound was upon him.

Rebound: I know people say that it’s Paxlovid rebound, as if the drugs cause the virus to resurge. It turns out that many Covid cases have a rebound, even without Paxlovid. The rebound may be caused by a robust immune response, not an increase in virus. CDC guidance says that anyone with rebound needs to isolate for another five days, whether they took Paxlovid or not, so it was just as well that we kept him isolated.

Day 15: His CDC-recommended additional five days of isolation ended, but he continued to test positive. At this point, he felt much better, with only lingering congestion and slight headache. And he was bored. He had tried to keep himself occupied with different interests each day, but as everyone with ME knows, being confined to a single room for weeks is very difficult to take.

Ending Isolation: When is it truly safe for someone to come out of isolation? According to Dr. Daniel Griffin of This Week in Virology, transmission has not been seen after Day 10 except in severely immune-compromised patients. The rapid antigen test is not a reliable measure of infectivity. I guess my husband could have ended isolation after Day 5 or 10 (or 15), depending on which part of CDC guidance we chose to follow, but we don’t regret waiting longer.

Day 19: At long last, my husband tested negative twice (on two tests 48 hours apart) and came out of isolation! And I tested negative throughout the entire time–the only person in the house not to catch Covid.

So how did I avoid Covid? Here is what I think protected me.

1. I began wearing an N95 as soon as he showed symptoms, and I kept wearing it 24/7 for three weeks. Putting on the N95 immediately was key, because the other people in the house did not mask that first day and they both caught Covid.
2. He isolated at the first symptoms, despite a negative test, and stayed isolated for three weeks.
3. We used a table in the hallways to pass items to each other, and we stood at least 10 feet apart when speaking to each other (both of us double masked).
4. I wore gloves when I handled dishes and trash, and I washed and sanitized my hands constantly.
5. We kept windows open throughout the house except when it rained. We already had air filters on each floor of the house, and my husband kept a fan running in a bedroom window to increase air circulation.

Minimizing Covid severity. We are vaccinated and boosted, which is the most important thing you can do to prevent severe Covid disease. My husband’s doctor prescribed Paxlovid as soon as he tested positive. Tracking my husband’s vital signs helped us monitor his condition, and would have told us if he was getting worse (like if his sat rate dropped).

Good fortune. This experience was awful, but it was mitigated by many things. We could afford to stockpile the supplies that got us through these three weeks: rapid antigen tests, masks, gloves, hand sanitizer, over-the-counter medications, thermometers, a pulse oximeter, and a freezer full of food. We live in a house that is big enough for him to comfortably isolate in our bedroom and have his own bathroom, and I could stay in my own space on the first floor. Multiple friends and relatives came to our rescue, practically and emotionally. We knew enough about the science that we reached out for Paxlovid, and that drug is free (for now). My husband’s doctor was easily accessible whenever we had questions or concerns. We’re both disabled, so we weren’t being pressured to come back to work too soon and we know how to cope with isolation.

It’s also true that we could have done everything right and I could still have caught Covid. I know I probably will, at some point.

All we can do is prepare as best as we can. Get vaccinated and boosted. Wear an N95 (seriously, where one everywhere you go). If you can afford it, purchase supplies that will help get you through illness and isolation. Know if you are eligible for Covid medications (Paxlovid, Evusheld, remdesivir, molnupiravir) and make a plan with your doctor in case you test positive.

Avoiding Covid is possible, but it is not guaranteed. In the current “the pandemic is over” environment, it’s up to us to protect ourselves and each other. Winter is coming.