Should you stay or should you go? How sick is too sick?

Image by NIAID on Unsplash

The dilemma: You have holiday dinner plans, but your nose starts to run and you have a shaggy cough. Now what? Even if your Covid-19 test is negative, what about the other 200 different viruses that are known to cause cold symptoms?

Situations like these have a lot of Americans asking, "How can we spend time together safely? How sick do you need to be to sit out the holidays a third year in a row?" writes Caroline Mimbs Nyce for The Atlantic.

She uses an episode to suggest an approach: "Paul Sax is a Harvard infectious-diseases specialist who likes to play poker. Every few weeks, he plays with friends in Boston. Recently, when it was Sax’s turn to host, one of the game’s regulars came down with a cold. The player tested negative for Covid but offered to stay home anyway. . . . Sax took him up on it. “Why go through the hassle of getting a cold?” he told Nyce, offering some practical advice: “If you’re going to the house of an infectious-disease doctor, don’t come with a cold.”

Flu season started early this year with Covid, the flu, and respiratory syncytial virus (RSV). And while testing can take out some of the guess work: "At-home Covid rapid tests are thought to be a good measure of infectiousness; some experts recommend that you can leave isolation by testing out," Nyse notes. "That’s not an option for the flu, RSV, or a cold."

Getting back to should you stay or go, Nyce writes, "For starters, pretty much everyone agrees that one symptom is an absolute no-go: fever. A temperature equals stay home, for at least 24 hours. (And no cheating with ibuprofen: You should be fever-free without pain meds.) Two other 'red flag' symptoms some experts mentioned are vomiting and diarrhea."

After fever and red flags, deciding how sick is too sick gets stickier. “Your individual health status is going to have an impact on how long you’re contagious,” Donald Milton of the University of Maryland told Nyce, citing flu data suggesting that children and people with obesity stay contagious for longer.

Sax told Nyse, “On average, a bad cold lasts 10 to 14 days. And yet people seem to have almost amnesia about that fact.”

Milton told her, “Basically, you need to ask people, ‘If you’ve got cold or flu symptoms, please stay home.’ If people who are recovering from a virus do come to the gathering, they should wear a mask.”

Then there's the curse of the lingering cough. "Once a person is past the initial phase of being sick, some coughs will continue to be caused by the virus, while others will be from irritation to the airways—almost asthma-like. And sorting out which is which is impossible," Sax told Nyse. Either way, “you’re not going to be very popular at a party if you're coughing a lot."