Think Before Testing - And Fuel Up for the Long Haul
MEDICAL AND MENTAL HEALTH UPDATE
Today I can’t help but share a personal note. But first I will try to answer a frequently asked question from patients this week:
Even though I feel well, should I get a COVID-19 test…
before I go visit family?
before I merge “pods” with another group?
if I have been in a high-risk situation (in a crowd i.e. closer than 6 feet to someone with known or suspected COVID-19; recent airplane travel; too many other examples here to name….)?
if I am going to Maine where a negative test is required to avoid a 14-day quarantine on arrival?
“just to know”?
The answer is: it depends on your health issues and your particular situation. BUT! I can try to help you think about it here. (With full disclaimer that this is not a substitute for individual decision-making with your doctor—recall that I am married to a lawyer.)
Let’s start with understanding the limitations of the testing for COVID-19 (using the nasal swab to detect the virus’ genetic material or RNA):
The test has a 20-30% false negative rate, so unfortunately you are not in the clear if you test negative.
A negative test—even if thought to be a TRUE negative—is only a snapshot in time. You can get infected anytime, anywhere, if not using mitigating measures (remember MOSH PIT!)
There can be operator error in administering the tests which only adds to the false negative rate. Labcorp now offers home testing (you can order a test to administer on yourself), which is great in theory to reduce the chance of infecting the test administrator, but not so great if you are at all squeamish and don’t get a good sample of your deep nasopharyngeal passage.
Timing matters. If you participated in a high-risk exposure (intentionally or not) and you do pursue testing, you should wait at least 4-5 days after the exposure to get tested. This is when the test is more likely to pick up the presence of virus. However, remember that a high-risk encounter warrants behavior AS IF you had the virus, meaning quarantining at least until the test result is back or ideally 14 days because (as above) the testing is imperfect.
Let’s give some case examples:
A protester who wore a mask AND ALWAYS stayed 6 feet apart from others outside probably doesn’t need to get tested. The combination of distancing, mask-wearing, and being outdoors makes the likelihood of transmission very low. HOWEVER, it was impossible for many protesters to stay 6 feet apart in which case testing should be considered.
People who participated in large gatherings of people (group rental houses, indoor parties, bars, any crowded indoor spaces) should seriously consider getting tested, particularly if masks were not worn.
People who have been carefully following the rules and are about to see loved ones or merge pods with another family don’t necessarily need testing because of the false negative rates of the test and because a negative test can give people a false sense of security. BUT this of course depends on the state you are coming from and the underlying health conditions of all parties.
People traveling to Maine or Alaska? Sure, get a test (like my husband and son George did 3 days ago). They are currently on the road to Maine with a box of PB + J makings, hand sanitizer, and my husband’s puppy-dog energy for father-son bonding. Here’s the thing: even though they tested negative, they COULD pick up COVID at a rest-stop (God forbid the toilet plume!) along the way. But they have been—and will continue to be—very careful so the risk is very low. Nonetheless when they arrive, they will continue to lay low, avoiding indoor dining and father-son club-hopping) because we can’t abandon the rules of mitigation, regardless of a negative test, until we have a vaccine or therapeutics. (They will also be in the middle of a forested nowhere so that helps!)
People with very few risks—those of you who deserve GOLD STARS for your calm vigilance with masks, distancing, hygiene, and avoiding crowded indoor public spaces—I don’t recommend getting tested “just to see.” Even if you are merging pods with another family or going to visit someone outside your pod, a negative test result just isn't that helpful.
In an ideal world, we’d have 100% accurate testing for active virus, in which case random surveillance of asymptomatic people would add TREMENDOUS value. In fact, we’d likely be able to shut this virus down if we knew who the silent spreaders were! Remember that community spread is happening largely because of people WITHOUT SYMPTOMS but who are carrying, shedding, and spreading virus.
But as Mick Jagger reminds us, we can’t always get what we want.
The problem, MICK, is that we want what we want for crying out loud!! We want to see family, crowd into bars and restaurants, and be done with this awful nightmare! Myself included.
And if I may pause for a minute of self-reflection, I feel very frustrated and sad today. I’m upset that so many people seem to have given up on fighting back this beast and aren’t fully aware of the collective effort this battle requires.
FULL DISCLOSURE: This is not to say I am judging people who rent a beach house, gather in groups, fly on airplanes, or take risks that I might not take. Not at all. I am taking risks every day, at my job but sometimes for selfish reasons. GUILTY AS CHARGED.
But here’s my problem: I am seeing so much suffering, loss, and trauma in my patients and around the country (like anyone with open eyes can see) that I worry about how much more people can take. And I worry that sometimes we forget how much our actions affect other people.
In addition, I am so accustomed to telling people things they don’t want to hear (as a doctor but also as a mother of teens) that my empathy tank is low right now.
With age—and particularly during the pandemic—I have become more direct with patients and with people in general. Sometimes I might seem unempathetic.
So for anyone who knows me well, please don’t confuse my blunt affect for lack of love and affection. I think I’m just pacing myself for a long haul.
Meanwhile, I am going to work on refueling my empathy tank. It fills up by writing this little ditty today after what feels like a long hiatus (three days!) compared to my daily updates. Even though my practice has been open this whole time, my job is back in full swing. So writing twice a week feels like the right balance for me. I hope you will stay tuned because there is a lot to get through together.
And in case you missed us yesterday, CLICK HERE to watch me and the incredible Michelle Palmer, Executive Director of the Wendt Center for Loss and Healing discussing grief, trauma, and the unique challenges of the pandemic. The work that she and her team do is truly inspiring.
I will check in next week. In the meantime, be well.