Wait for it. Wait for it. Waiting for it.

If you’ve been infected with the COVID-19 coronavirus and managed to survive, you may be wondering how long your symptoms will last and how long you will remain contagious. After all, isolating yourself can be as enjoyable as bouncing toilet paper rolls off your head, which, by the way, you shouldn’t do.

The problem is the severe acute respiratory syndrome–related coronavirus-2 (SARS–CoV-2) can be legen, wait for it, freaking confusing. There seems to be tremendous variability in the types of symptoms and the duration of illness that COVD-19 can bring. So getting COVID-19 can feel a bit like playing craps, in more ways than one.

Let’s take the duration of contagiousness question. “Seven days after your symptoms first appeared,” may seem like the answer if you were to look at some public health web sites. For example, the Centers for Disease Control and Prevention (CDC) recommends that you stay isolated until the following conditions have been met, assuming that you don’t have testing available:

• You have had no fever for at least 72 hours (that is three full days of no fever without the use of medicine that reduces fevers) AND
• Other symptoms have improved (for example, when your cough or shortness of breath have improved) AND
• at least 7 days have passed since your symptoms first appeared

Similarly, the U.K. National Health Services (NHS) indicates that “if you have symptoms of coronavirus, you’ll need to self-isolate for 7 days” and adds that after 7 days:

• if you do not have a high temperature, you do not need to self-isolate
• if you still have a high temperature, keep self-isolating until your temperature returns to normal

The NHS website also states that “you do not need to self-isolate if you just have a cough after 7 days. A cough can last for several weeks after the infection has gone.”

Ah, but some studies call into the question this seven-day threshold. A study of nine patients hospitalized with COVID-19 that was published in Nature found that patients were shedding the virus for lengths of time that ranged from 4 to 10 days, which means that some went beyond the seven-day mark. In this case, “shedding” doesn’t mean like taking off your denim vest, but rather still having virus in the back of your throat so that you may still be contagious. Now, nine patients isn’t a large study. But a somewhat larger study that had 66 patients with COVID-19 published in the Chinese Medical Journal showed that the median time from patients first having symptoms to finally having a negative test for the virus was actually was 9.5 days. That means half the patients were still shedding the virus and potentially contagious well into the second week after symptoms first started. In fact, the longest that someone shed was 11 days after symptoms first started.

What if you’ve had COVID-19 symptoms but no longer do? Surely, you are no longer contagious if you feel recovered from the infection. Well, not necessarily, and don’t call me Shirley, to adapt a quote from the movie Airplane! Just look at a study published in the American Journal of Respiratory and Critical Care. For the study, a team from Chinese PLA Hospital (De Chang, Guoxin Mo, Xin Yuan, Yi Tao, Xiaohua Peng, Fusheng Wang, Lixin Xie, and Enqiang Qin) and Yale University (Lokesh Sharma and Charles S Dela Cruz) continued to collect throat swabs from 16 patients who had COVID-19 after they had been discharged from the Treatment Center of PLA General Hospital in Beijing, China. The study revealed that half of the patients were still shedding virus for one to eight days after their symptoms had resolved. Yep, patients were still potentially contagious for a median of 2.5 days beyond when they last had symptoms.

All of this suggests that the seven day threshold may be a bit short if you want to be safe, safe for others, that is. Instead, you may want to keep yourself isolated for at least two weeks after your symptoms first started.

Of course, your symptoms could very well end up lasting for two weeks or more. In the study led by Chang, patients had symptoms for an average of eight days, but about a quarter of the patients had symptoms for longer than 11.5 days. There are examples of people having symptoms even beyond two weeks. For example, in a research letter published in Emerging Infectious Diseases, Takeshi Arashiro, Keiichi Furukawa, and Akira Nakamura from Asahi General Hospital in Chiba, Japan, reported on two patients with COVID-19. One had symptoms for three days and the other for 17 days.

Does two weeks seem long? Well, consider the stories of patients having symptoms even longer, beyond two to three weeks. For example, Marianne Garvey reported for CNN about how singer Pink’s 3-year-old son Jameson was still having a fever after three weeks. Here’s Pink describing her and her son’s experience on The Ellen Show:

There you go. Freaking confusing indeed. On February 24, 2020, the World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus said that in Wuhan, China, “They found that for people with mild disease, recovery time is about two weeks, while people with severe or critical disease recover within three to six weeks.” These are still rough estimates. The actual distribution seems more like your hair is getting during social distancing: all over the place. More studies are needed to get a better sense of the range of possibilities and how many people have symptoms for how long.

In general, there’s still much to learn about this virus. The SARS-CoV2 is like a stranger who got into the driver’s seat of your car while you were in the back seat doing who knows what. No one knows much about this stranger except that it wants to reproduce a lot in your car, which is quite gross. And since most cars have never seen such a driver, your drive can be rather bumpy and unpredictable. So while you may have some rough ideas of what may happen, you will have to wait for it. Wait for it. And maybe keep waiting for it.

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