8

Source

This may sound like yet another anti-trump post, but, really I am more concerned for my own health, and that of my family. He is just an easily accessible example (feel free to migrate this to a medical site, if we have one). Inevitably, some whom we know have succumbed, and we are concerned about meeting them.

WASHINGTON (AP) — The White House doctor said that President Donald Trump was no longer at risk of transmitting the coronavirus but did not say explicitly whether Trump had tested negative for it.

Then how can it be said that he can no longer transmit it? How am I to decide whether to allow others into my home, if they have not tested negative (or, even if they have)?

In a memo released Saturday night by the White House, Navy Cmdr. Dr. Sean Conley said Trump met the Centers for Disease Control and Prevention criteria for safely discontinuing isolation and that by “currently recognized standards” he was no longer considered a transmission risk.

Does anyone here know what these "current standards" are? Could you please provide a link? Thanks.

Some medical experts had been skeptical that Trump could be declared free of the risk of transmitting the virus so early in the course of his illness. Just 10 days since an initial diagnosis of infection, there was no way to know for certain that someone was no longer contagious, they said.

Ok, this part is trump question. I believe that that was the initial announcement. Is there any public record of the initial diagnosis? Just curious, as a side question.

Back to the important stuff - can you tell me whether someone is considered no longer a transmission risk after X days from the start or the end of their covid infection? I imagine that it would be from the end, but would like confirmation - especially as to the value of X.

Mawg says reinstate Monica
  • 201
  • 1
  • 5
  • 1
    That might be part of it (probably is), but what I want to know is how/when a doctor can say that someone is no longer contagious. It might be some combination of a negative test & some number of days elapsed; I would like to know how/when that statement can be made to undrstand if I can make a similar statement to allow me to decide to associate with people who have been infected. – Mawg says reinstate Monica Oct 11 '20 at 11:53
  • There is ongoing disagreement among doctors, epidemiologists and other experts whether or not the claim is true. At the end of the day, we simply don't know for sure. Covid-19 was originally known as the '2019 novel coronavirus'. It's novel, new. We really don't know that much about it yet. This time next year, sure, we'll probably know. – Mast Oct 12 '20 at 16:50
  • @Mast what claim are you referencing? Otherwise, I agree that explicit, definitive, universal agreement among the experts on COVID-19 is probably not going to happen for sometime. – BobE Oct 12 '20 at 18:04
  • @BobE Whether or not having had Covid-19 once will provide immunity or not. 'Herd immunity' was a hope at a time. – Mast Oct 12 '20 at 18:11
  • @Mast Drifting off-topic, but from what I've read "herd immunity" is/was a theory that mathematically made sense as it applied to the spread rate of COVID-19. OTOH, once having contracted (and survived) COVID, it would seem that the best advice doctors can currently give is that a person is probably resistant to reinfection for a few months. Only time will tell about the permanence of that protection. – BobE Oct 12 '20 at 18:22
  • 1
    @BobE Exactly. It being a novel virus, we don't have the foggiest whether resistance is significant and/or lasting. – Mast Oct 12 '20 at 18:23

2 Answers2

9

As far as I can tell the most relevant CDC guidelines are the "Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance)"

Patients with mild to moderate illness who are not severely immunocompromised:

  • At least 10 days have passed since symptoms first appeared and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved

Note: For patients who are not severely immunocompromised1 and who were asymptomatic throughout their infection, Transmission-Based Precautions may be discontinued when at least 10 days have passed since the date of their first positive viral diagnostic test.

Patients with severe to critical illness or who are severely immunocompromised1:

  • At least 10 days and up to 20 days have passed since symptoms first appeared and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved
  • Consider consultation with infection control experts

The document also notes

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

So it appears that a mostly time-based decision is supported by the CDC guidelines. But there are some important conditions here that are not based on the duration of the illness alone, but on the symptoms and the severeness of the illness.

In the case of Donald Trump we simply don't have all the information that is necessary to apply these guidelines.

  • 4
    It was publicized in the past that Trump was taking an aspirin a day as a cardiac precaution, this is very normal and nothing to be alarmed about. However, the aspirin he is taking today as a regular medication will simultaneously act to reduce a fever. The only way of qualifying as a being "without fever" by the above standards would be to discontinue the regular daily dose of ASA – BobE Oct 11 '20 at 21:08
  • This doesn't really address the question of what empirical data there is in support of those guidelines. – Acccumulation Oct 12 '20 at 17:12
6

Here is a nice graphic that aggregates data from CDC & WHO that demonstrates the stages of Covid19 progression.

Notice that the contagious/infectious period tends to begin 3 days after exposure, reaches a peak about 5 or 6 days after exposure and gradually diminishes over the period of 10/11 after initial exposure. By the 16th day after exposure the anticipated infectionness is near zero.

Note, however the persons may continue to test positive well after infectiousness ends (up to three months).

As it applies to Trump, we do not know when he was exposed, nor do we know when his last negative test occurred prior to his first positive test. Similarly, we do not know if he has tested negative since returning from Walter Reed (although I would be very surprised if he has had a PCR negative result yet).

Link

BobE
  • 680
  • 3
  • 10
  • "I would be very surprised if he has had a PCR negative result yet)." - if so, we might possibly have heard – Mawg says reinstate Monica Oct 12 '20 at 06:57
  • Do you have any information as to what empirical data this is based on? – Acccumulation Oct 12 '20 at 17:13
  • The sources for this graphic are CDC and WHO publications and guides, The graphic was assembled (using those sources) by Business Insider. – BobE Oct 12 '20 at 17:58
  • 1
    You said the graphic was put together by Business Insider, but I cannot seem to find it. I am having trouble seeing the image properly due to the resolution of the image. Can you please provide a link to the source of the image? – Chris Rogers Oct 16 '20 at 10:30