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Other symptoms of COVID-19 are improving (exception: loss of taste and smell which may persist for weeks or months after recovery and need not delay the end of isolation).
(Note that these recommendations do not apply to immunocompromised persons or persons with severe COVID-19. Find more information at https://bit.ly/3qB62IR [CDC]). Health authorities should know that SARS-CoV-2 infected individuals do not need to be quarantined for weeks. Persistently positive RT-PCRs generally do not reflect replication-competent virus. SARS-CoV-2 infectivity rapidly decreases to near-zero after about 10 days in mild-to-moderately-ill patients and 15 days in severely-to-critically-ill and immunocompromised patients (Rhee 2020). Of note, RT-PCR cycle threshold (Ct) values (a measure for viral load) correlated strongly with cultivable virus. In one study, the probability of culturing virus declined to 8% in samples with Ct > 35 and to 6% (95% CI: 0.9–31.2%) 10 days after onset; it was similar in asymptomatic and symptomatic persons (Singanayagam 2020). A meta-analysis of 79 studies (5340 individuals) concluded that no study detected live virus beyond day 9 of illness, despite persistently high viral loads (Cevik 2020). In individuals who had mildly or moderately symptomatic SARS-CoV-2 infection and who present no symptoms for at least two days, a positive RT-PCR test 10 days or more after the first symptoms does not indicate infectiousness (‘post-infectious PCRpositivity’; Mina 2020). In most countries (for example, Germany, USA), health authorities do not require a negative SARS-CoV-2 RT-PCR test to end the quarantine. Autorities in Italy or other countries that even in late November continued quarantining people at home for two, three, four weeks or longer because of continuously positive RT-PCR results should take note.
Prevention Find a detailed discussion of SARS-CoV-2 prevention in the corresponding chapter on page 117. For everyday life, the following five rules of thumb are helpful: 1.
Avoid crowded places (more than 5-10 people). The more people are grouped together, the higher the probability that a superspreader is present who emits infectious particles tens or hundreds times more than a ‘normally’ contagious individual. Avoid funerals, and postpone religious services including weddings, baptisms, circumcisions, as well as team sports and choir singing until after the pandemic. Kamps – Hoffmann
