Test your Patience (and your Knowledge on Covid Testing)
MEDICAL AND MENTAL HEALTH UPDATE
Welcome to a new week. If you’re anything like me driving home on this Monday night, you want EASE. You want coffee not to have spilled down your blouse, the dog not to have peed on the rug, and dinner to make itself. You want the kids to be alright. You want simplicity, predictability, and calm.
You want your self-sufficient, stain-resistant, social-yet-studious kids to deliver you dinner and a small prize for getting through the day. You want a self-walking, non-urinating dog.
But until pigs fly, today I’ll spoon-feed you some drama-free COVID guidance and info.
I’ll revisit testing, quarantine, and isolation as a continuation of last week's post on COVID protocols for when you have symptoms or test positive.
Why? Because I've had more than a few positive COVID cases over the last week.
Why? Because people are intermingling, cavorting, letting their guard down.
Why? Because we are human.
What to do? Have fun but be safe! Double down on MOSHPIT rules, because the more risks we take, the more the virus flourishes. And consider getting TESTED.
TESTING UPDATE: WHAT KIND OF TEST SHOULD YOU GET?
If you are sick:
If you have a sore throat, runny nose, headache, muscle aches, cough, loss of taste/smell, and/or diarrhea, for example, you should talk to your doctor and ideally get the gold standard nasal swab PCR test. Turnaround times are much improved from this summer though can still take up to 5 days for results.
Alternatively, you can get a rapid test (either PCR or antigen test), with the understanding that a rapid test, particularly a rapid antigen test, is less accurate than a PCR test.
So what am I doing for my symptomatic patients in whom I suspect COVID?
The patient gets a PCR test and begins isolation. If the PCR test comes back negative and my clinical suspicion for COVID is still high, I order a second PCR test. Two negative PCR tests makes a COVID diagnosis very unlikely, however a positive PCR test means 10 days of home isolation (unless hospital care is needed) and alerting all close contacts to quarantine for 14 days.
If my sick patient wants a rapid test, I try to simultaneously order a PCR test because the rapid tests—while they can result in as few as 15 minutes—are not as accurate as a PCR test, particularly if negative. (The false negative rate of rapid tests is high; the false positive rate is low.)
If you are not sick and you want a test because of a potential COVID exposure:
You need to wait at least 3-5 days after an exposure to get a test.
If you are a close contact of a suspected or proven COVID patient, you need to quarantine for 14 days regardless of your test result. It can take up to 14 days after exposure to become infected.
Recall that a close contact is technically defined as someone in the same household, someone who was within 6 feet of an infected individual for 15 minutes or more OR someone who was in contact with an infected person’s body fluids (e.g. droplets from a cough, sneeze, kiss, or shared water bottle).
But let’s face it: there are so many nuances to every human encounter that it can be difficult to know who and when to quarantine. (This is when your doctor can help.) For example, you should probably quarantine for 14 days even if you were not closer than six feet for a full 15 minutes from the COVID patient if:
You were indoors, closer than six feet, and without a mask for any length of time with the person with COVID. For example, I have a patient who developed COVID after 10 minutes of sitting at a bar next to and talking to her friend who had COVID and didn’t know it at the time.
You were indoors at any distance from the COVID patient for more than 15 minutes. For example, I have a patient who got COVID from an indoor wedding reception even though the person with asymptomatic COVID was only about 10 feet from my patient—but they were without masks for over five hours in a poorly ventilated space.
What’s the upshot?
Get specific advice about your unique situation from your doctor, always. Indeed there are nuances to every clinical situation which is why this blog post can’t be a substitute for specific medical advice.
Get tested if you are sick, and don’t trust a single negative test (especially if it is a rapid test or antigen test) if your symptoms are highly suggestive of COVID.
Get tested if you are a close contact of a positive case, but know that you have to quarantine for 14 days even if you test negative. If you test positive or develop symptoms during your quarantine, you need to start a 10-day isolation from the day of the positive test or symptoms onset—and to notify all close contacts.
Don’t hesitate to get a test if you think you were exposed, but understand that a) you must wait at least 3 days after the exposure, b) the testing is less accurate in asymptomatic folks than it is in patients with symptoms, and c) a negative test is only a snapshot in time.
And last, couldn’t widespread testing help get us out of this whole mess?
YES!! I continue to hold out hope for the development and widespread distribution of (albeit less sensitive) antigen tests that are so cheap and easy-to-administer that we could use them daily at home and could trade a lower sensitivity for high frequency of use.
To be clear, these are different from the Abbott BinaxNOW rapid tests that the White House announced it is purchasing and distributing today. While the Abbott tests are indeed a step forward, they are not being distributed in nearly the volumes we need to control the pandemic.
We could beat this beast if we were to blanket the country with cheap, rapid, at-home paper-strip tests. Anyone who follows “This Week in Virology” podcast, Michael Mina, MD, at the Harvard School of Public Health or www.rapidtests.org knows what I am talking about. The technology exists. The FDA is slowly coming around to the idea.
I’ve been singing this song since June and was delighted yesterday to hear from my dear friend Phoebe Olhava, MD, from medical school in Boston, about her ongoing efforts to advocate for this paper-strip technology as a way to open schools! Go, Phoebe, go!
Meanwhile, join me and Dr. Clay Ackerly TONIGHT at 8 pm on Facebook Live for our next COVID Q & A. Bring your burning COVID questions! We’ll have fun. (And I will post the video later in the week.)
I will see you later this week. Until then, be well.