Coronavirus Q&A: I took a trip and caught COVID. What should I do? When can I go home?

NPR regularly answers frequently asked questions about life during the coronavirus crisis. If you have a question you’d like us to consider for a future post, email us at goatsandsoda@npr.org with the subject line: “Weekly Coronavirus Questions.” See an archive of these FAQs here.

I flew away on a trip, and I caught COVID. Now what?

So you've joined the millions of travelers who are taking off this summer, headed for vacations, weddings, family reunions, conferences. And you flew to your destination.

You arrive, you're having a great time. Then you feel a little off. Your throat is scratchy. Maybe you start coughing. Or your head feels as if it is about to float off your body like a rogue balloon.

Sigh. Time for a COVID test. The bad news: You're positive!

What do you do now? Where do you stay? Can you score some Paxlovid if you're a good candidate for this or another anti-COVID drug? And the big question: When can you fly home? True confession: It happened to me. Here's what I learned from the experience and from interviews afterward with COVID experts.

Prepare for COVID before the trip starts

Actually, the first question is: Did you prepare for a possible COVID case before taking off?

Any traveler who has yet to go on a summer trip needs to keep in mind that the pandemic is still going on. Surges are happening across the U.S. and in popular tourist destinations like France, Italy and Spain.

That means your trip planning can't just focus on what to see and where to eat. You need to think about COVID prep, too. The COVID experts we interviewed suggest these pre-trip steps:

Pack self-tests and high quality (N95 or KN95) masks. Because you sure don't want to have to hunt them down in an unfamiliar place. Also: bring along a thermometer and pulse oximeter so you can monitor your health should you get infected.

Make sure you have easy access to your online medical records. In the event you need to seek antiviral treatments, the prescriber needs this info to determine if you have any health issues or are taking medications that might cause problems if you start a Paxlovid regimen.

If you're eligible for a booster, roll up your sleeve before departing. It's not ironclad protection against infection but could mean a less severe course of disease.

If you're going out of the country, consider buying travel insurance. A policy can ensure that you can get care in a foreign country or a medical evacuation if need be.

Check to see if your destination country has any COVID testing requirements for arrivals or departures. (The U.S. last month dropped its requirement that arrivals from other countries test for COVID.) But finding out the rules and regs in another country can be tough – websites can't always keep up with all the updates, notes Dr. Henry Wu, a professor of infectious disease medicine at Emory University and director of its TravelWell Center. A tour operator or hotel where you plan to stay might be a good pre-trip source if you strike out in your hunt for official info online.

Brush up on local medical source. If you're in a country that doesn't have a strong health care infrastructure or is in a remote area, see if you can get the answer to this question from a local source in advance, Wu suggests: Where should I call if I become really sick?

Be prepared financially. You'll want to put aside some extra money for your trip if COVID strikes, to spend on additional nights at a hotel and unexpected health-care and other costs.

Finally, if you know anyone at your destination, touch base with them before departing. They could be your guardian angel if you need a COVID assist. Make sure you have their contact details in case of emergency.

What to do when you get that positive test

Now, back to our drama: I went on vacation and all I got was a lousy case of COVID!

When you find out you've got COVID, the Centers for Disease Control and Prevention has this recommendation: "Do not travel until a full 10 days after your symptoms started or the date your positive test was taken if you had no symptoms." The goal is to keep you from infecting others while you are still contagious.

So you'll have two types of concerns: rearranging your travel plans – and figuring out when you can return home.

First, let's consider the immediate logistics.

Where will you stay?

You can try to extend the course your current lodging. Hotel representatives we interviewed suggest asking the property if they're open to a guest who's isolating with COVID. A hotel that says yes will probably also tell you that there will be no housekeeping services — but you can ask for towels, room service or food dropped off from a delivery app to be left outside your door (which should have the "do not disturb" sign on the knob at all times). If the hotel isn't open to hosting a guest with COVID or your room just isn't available, look for a new lodging option.

Uh-oh. My rental car is due back!

Unless you can drop it off in a contact-free situation and walk back to your isolation lodging, you've got a dilemma. Fortunately, rental car companies understand. Really. Of course, different companies have different options. Gabriel, a very helpful customer service rep for Avis, says that depending on the circumstances, his company might send a team to pick up the car, arrange for a tow or authorize another driver to return the car. Or if you want to hold onto the car until you're recovered, they might be able to extend your rental, perhaps at a reduced rate given the circumstances.

If all else fails, you can rely on the kindness of others. When I found myself in this situation, my daughter's friend's boyfriend offered to return our car – about an hour's drive. I paid for his Uber back but he wouldn't take a penny for his good deed. As my daughter's friend put it, "being sick [is] a tricky pickle to be in right now. We would love to help."

Getting Paxlovid (or another antiviral treatment)

Even if you'd like to bring a precautionary stash of the drug on your trip, you are not allowed to do so by the terms of the Food and Drug Administration's emergency use authorization for Pfizer's Paxlovid pill, which is recommended for people at risk of severe disease, like older folks or those with certain medical conditions.

But time is of the essence with Paxlovid. You want to start your twice-daily dose of three tablets within 5 days of testing positive. You can contact your primary care physician and give them the name of a local pharmacy. Or you can Google a telehealth portal that will take your info and put in a prescription. That could cost around $75 for the service. Or you can take advantage of the brand-new FDA ruling. Not every pharmacy is on board, but pharmacies that offer "test to treat" services are a likely option. Check out the Department of Health & Human Services' online locator tool to find participating pharmacies.

And, um, how do you get the prescription if you have COVID? The pharmacy I used told me, "You know you CANNOT COME IN to pick up the pill because you have COVID." Some pharmacies do have delivery or drive-through options. If you have a family member or friend at your destination, ask a favor. If you're out of options, you could turn to an online service like TaskRabbit, which can help you find someone to hire to run an errand for you.

If the only alternative is picking it up yourself, says Dr. Jill Weatherhead, assistant professor of adult and pediatric infectious diseases at Baylor College of Medicine, "make sure you have on a KN95 or N95 mask."

When can I come home?

That's the big question, of course. The CDC's 10-day guideline is what infectious disease doctors recommend as well. It's definitely prudent.

"We have isolation protocols for a reason – to reduce the spread for others," says Keri Althoff, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health. And there is a risk of spread "if you're sitting next to someone on a plane" – or any kind of transportation, like a bus or train, that puts you near others. What's more, the person in the next seat could have underlying conditions that puts them at severe risk if they contract COVID.

But no authorities in the U.S. enforce the 10-day rule.

And waiting 10 days to end isolation can be a challenge.

"Being far away from home is not ideal. Home is more comfortable," says Dr. Preeti Malani, an infectious disease physician at the University of Michigan. Being stuck a few hundred miles or more from home when you're down with COVID can be stressful – you may feel pressured to return to work after 5 days off, face child care issues, worry about home and garden upkeep or whether your pet sitter can keep on the job.

"Don't underestimate the mental gymnastics of trying to figure out when to head home," says Althoff. "It's emotional, it's mental, it's financial. It's hard." And you're trying to make these decisions at a time when you're not feeling well.

What's more, even CDC advice is a bit confusing because there's another piece of its guidance that recommends 5 days of isolation after an infection while you're at home and not on a trip. For folks who aren't traveling, CDC says: "People with COVID-19 should isolate for 5 days and if they are asymptomatic or their symptoms are resolving (without fever for 24 hours), follow that by 5 days of wearing a mask when around others to minimize the risk of infecting people they encounter."

The end result is that many people are making their own decisions about when to travel.

Some travelers who just tested positive for COVID might say, I'm going home right now. BAD IDEA. Not only because they're putting others at risk, but because they may find that if the flight is long, they could grow sicker and sicker as the hours pass. All the experts who we interviewed agree: Don't do it!

(As an aside, our panel of experts also stressed that an uninfected traveler should assume that if they're on a plane, bus or train, there's going to be at least one passenger with COVID, which is a good reason to continue to mask up while traveling.)

Other COVID travelers might feel up to driving after, say, a few days, so they'd cancel the flight and rent a car – contact-free, of course – and head home. But, of course, that's easier to do if it's an 8-hour drive versus a 3-day expedition that involves finding places to stay and eat without putting others at risk.

And then there are folks who figure, maybe it's OK to isolate until they're feeling better – then they'll make the journey home. And maybe that's sooner than 10 days.

Keep in mind that you are typically most contagious in the 2 days prior to a positive test and the 5 days after, says Weatherhead.

"If you're feeling better and symptoms are going away after that 5-day period [when you're most infectious], travel is still not recommended — but putting on an N95 while traveling would be best," she says.

But symptoms aren't always a reliable barometer of your condition. "It's hard to know how infectious you are," she adds. Coughing of course is a way to spread the disease, but "a lot of people have coughs for weeks and that doesn't mean you are infectious."

Are tests useful?

The infected traveler might figure that a negative COVID test is a thumbs up to fly home. But you could test positive for many days after symptoms are gone – one NPR colleague saw the positive line pop up for 20 days. And the doctors we interviewed said by that time, you're likely not carrying enough viral load to infect others. Even if you are testing positive after, say, a week, "there is a very low probability of transmission if you are feeling asymptomatic," says Althoff.

So let’s say your symptoms are pretty much gone — and it’s been, oh, 5 to 7 days since you first tested positive. How do you travel without putting others at a big risk?

"If you feel bad, don't travel," says Baker.

But if you're feeling OK enough to make the journey, wear a mask – preferably an N95 that fits well. "In the name of goodness, think about those who are around you," says Baker.

Should you share your diagnosis with your seat mate?

A colleague had an interesting question. If you're flying home, say, a week after your first tested positive, should you inform an unmasked passenger next to you?

"I think that would cause pandemonium on the plane," says Baker. "I would keep my mask on and lean away." And maybe have a snack and a beverage in an isolated corner of the airport before you board the plane so you don't need to drop your mask for a bite or a sip.

Also, even though we're all pandemic weary, it's important to take stock of how far we've come. Here's Malani's assessment: "If two years ago you told me we'd have tests we can put in our pocket — and if we get sick, [be able to] call up a virtual portal and five minutes later get an antiviral prescription ... no one could have imagined that!"