Couple with COVID probably needn’t isolate from each other

Dear Advice Team: I cannot find anything in the medical or popular literature that addresses whether it is safe for two people who are in a couple (and live together) and who both have COVID at the same time (and clearly have linked transmission — with positive antigen tests only one day apart) to sleep and otherwise interact closely with each other without wearing masks. Can two people retransmit virus to each other and prolong their respective infections (and infectiousness) under these circumstances?

Dear Reader: The reason you can’t find anything in the medical or popular literature is because even infectious disease experts aren’t aware of any studies that have examined this potential issue closely.

That means there are no “science-guided” and definitive answers to your question, according to UC Berkeley infectious disease expert John Swartzberg.

However, there’s good news: Multiple infectious disease experts in the Bay Area contacted for this column were in agreement that you needn’t be too concerned. Here’s why.

With the exception of a few infectious diseases, such as scabies, medical professionals advise people who live together and have both come down with the same viral infection not to worry about ping-ponging the disease back and forth.

The caveat is that we can’t know this with 100% certainty, but the odds are very unlikely, infectious disease experts say.

In fact, in Swartzberg’s words: “The risks of continuing to live together and be together during that illness are negligible” — assuming that both people aren’t just suspected COVID-19 cases but are confirmed, like yourself.

There is also a medical precedent for this. When hospitals are hard-pressed for space, they often do what’s called “cohorting,” where they put all the people with the same contagious illness together to share a room. This hasn’t proved to be an issue, Swartzberg said.

The CDC’s guidance puts it clearly: “Residents with confirmed COVID-19 may be housed in medical isolation as a cohort (rather than in single cells) even if they tested positive on different dates.” The agency goes on to say that by living together, cohorting residents can mitigate some mental health concerns associated with individual medical isolation.

Earlier in the pandemic, I remember the pseudo-scientific theories about viral load, or that if someone who had COVID-19 was exposed to a person who also had COVID-19, they could add more infection onto each other and therefore prolong their illnesses.

According to UCSF infectious disease expert Peter Chin-Hong, it’s safe to say we can poke a big hole through that notion.

“The prevailing thought in science and medicine is that you can’t really get more viral load in something you’re already protecting against,” said Chin-Hong, referring to the immune response that kicks in after encountering an infection. “You can’t inject more virus in you, and feel sicker.”

By comparison, two people with colds could, in theory, be in a far riskier transmission situation, said Chin-Hong, noting many instances where someone gets reinfected with a different cold just after getting over their first one.

That’s because hundreds of viruses cause colds — but with the BA.5 omicron coronavirus subvariant accounting for the vast majority of COVID-19 cases in California, it’s highly likely that if a couple are sick with the disease, they got it from the same version of the coronavirus, he said.

But even on the off chance that the individuals came down with two different variants of the coronavirus, the antibodies they develop postinfection would be protective for both, given how closely the variants resemble each other.

Chin-Hong, too, says couples who both have COVID-19 shouldn’t feel like they need to

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isolate themselves from each other. “People should feel free to find community with each other because it’s such an isolating experience,” he said. “I think it’s a really important thing.”

Stanford infectious disease specialist Dean Winslow fully agreed, saying he couldn’t think of any instances where two individuals in a couple who both have COVID-19 should isolate themselves

from one another.

“There’s no evidence that that would be harmful,” said Winslow. “In fact, I think it would make a lot of sense psychologically.”