Thread by @jakescottMD

As an ID doc who regularly sees #COVID19 patients & is responsible for starting & discontinuing isolation, a few comments:

I understand why there’s distrust but Trump may actually no longer be infectious at this point.

Thread

https://twitter.com/jdiamond1/status/1315093470940282880

(The fact that he wasn’t properly isolating before this evening is a different story.)

(2/n)

Most people are most infectious from 2 days before to 5 days after the onset of symptoms. This excellent thread by @mugecevik explains this much better than I could.

(3/n)

https://twitter.com/mugecevik/status/1308080067998822401

We err on the side of caution & typically isolate for 10-20 days, depending on the severity of illness and the immune status of the patient. These decisions are not easy and are made on a case-by-case basis. We primarily use symptom-based criteria, NOT TESTS.

(4/n)

#SARSCoV2 RNA shedding is often prolonged (for weeks) but the duration of infectious (replication-competent) virus is relatively short. The detection of viral RNA (eg, by PCR) does not necessarily indicate infectiousness.

(5/n)

I think that the CDC criteria are reasonable:
- 10-20 days have passed since symptom onset and
- At least 24 hours have passed since resolution of fever without the use of fever-reducing medications and
- Other symptoms have improved

(6/n)

cdc.gov/coronavirus/20…

This CDC criteria incorporated data that are summarized here with references:

(7/n)

cdc.gov/coronavirus/20…

Per CDC, it’s not 10 or 20 days but 10 to 20 days.
Whether Trump had moderate or severe disease is not entirely clear, given the limited info. It’s considered severe if a patient requires O2 support or if the O2 saturation is <94% on room air, so he may have had severe disease.8

Recommendations for discontinuing isolation are different from recommendations on when to discontinue quarantine for people who have been exposed (which is 14 days from exposure).

(9/n)

It’s tempting for people who have not been infected to insist that those w/ infection remain in isolation for longer than what is necessary, but excessively prolonged isolation has a number of consequences that impact patients’ mental health, families, & the economy,...

(10/n)

...and can lead to unnecessarily long hospitalizations, which can deplete resources (including available beds & PPE), and can increase the risk of hospital-associated complications.

End