When I was growing up watching sports there used to be a segment on Monday Night Football entitled “You Make the Call”. The audience would be shown a specific play that required referee intervention. We would then be asked to play pretend referee and decide if it was a touchdown, a penalty, or some other point of rules contention concluding with the phrase “You make the call”. The game would cut to commercial and a lively debate would usually ensue. When the commercials were over they would show the play in slow motion and give you the correct call. I thought it would be a good idea to do a COVID-19 version of “You Make the Call”. I’ll give you the scenario and you can decide how you would respond if you were the doctor.
He woke up in the morning with a bit of a headache. It was not that bad and he hadn’t slept much so he attributed the headache to sleep deprivation. His throat was a bit scratchy but he had allergies every fall and this was typical for him. He decided to get tested to be safe. His rapid antigen test was positive and he is calling to ask you what he should do. What would you tell him to do?
She got a call that morning from a coworker who tested positive. She works in the next cubicle and they had ate lunch together in the breakroom. She was definitely exposed. She decided to get tested. Her rapid antigen and PCR are negative. She is calling to ask if she can end her quarantine. She also wants to know the reason for the answer.
She has had a fever for three days. She had a rapid test and a PCR test both of which are negative. She still feels terrible with a persistent cough and temperature of 103. She want’s to know if she should get another test?
He woke up 3 days ago with a high fever, terrible muscle aches, and a dry hacking cough. His wife made him get tested. His rapid test was negative but his PCR is not back yet. He was told it would take five days. He feels much better and is of the strong opinion that, since he “was negative”, he probably caught some other virus. He wants to attend an upcoming family reunion picnic and thinks COVID-19 is either a Chinese or liberal conspiracy to limit personal liberty. He didn’t even want to ask a doctor but his wife wants your approval of his opinions before she’ll let him go. What would you tell him?
Now’s where we pause the program and go to commercial so you can discuss. Since this is not a commercial enterprise and I don’t make any money from this website you’ll have to just stop and think on your own.
So what would you tell them? As you can see these can be very difficult questions to answer, especially in real life when there are real consequences. That’s why there are guidelines to help. The guidelines are based on the best evidence out there. Keep in mind that guidelines are meant to be guides and not laws that cannot be broken. They are not perfect and usually change over time as new research is done but, at any given moment, they are your best bet. In other words, if you don’t know what to do, put your money on the expert opinions.
Recently a volunteer ambulance service in my neighborhood organized drive-up testing to help ease the logistical stress. A few other doctors and I created an FAQ page to hand out to those getting tested to help guide them on how to respond to their test results. It’s basically a reformatting of the CDC and other recommendations in a different format. I offer it to you below to help you in case you need to get tested and don’t know what to do with the results. I hope it helps.
Should I Get Tested?
It is important to understand that no test is perfect and the results are not yes or no but give you a probability of infection that needs to be taken in the context in which the test was taken. Below is a general guide for how to approach SARS-CoV-2 testing.
You should consider getting a COVID-19 test if you are symptomatic or have been in close contact with someone who tested positive. People without symptoms and who have not had a close contact should not get tested unless directed so by their doctor.
What counts as close contact?
- You were within 6 feet of someone who has COVID-19 for a total of 15 minutes or more
- You provided care at home to someone who is sick with COVID-19
- You had direct physical contact with the person (danced with, hugged or kissed them)
- You shared eating or drinking utensils
- They sneezed, coughed, or somehow got respiratory droplets on you
What If My Test is Positive?
If your rapid test is positive you have been diagnosed with COVID -19 and should not get further testing. If you’re positive you should do the following:
- Begin your isolation period which will last a minimum of ten days from symptom onset.
- Your isolation should only end after 10 days have passed from symptom onset, and you have been fever free without medication for 24 hours and have improving symptoms. Some people have fevers for more than 10 days in which case isolation will be longer.
- Your isolation period begins from the first day you had symptoms.
- If you do not have symptoms it begins from the date of your positive test.
- Contact anyone that you were in close contact with in the 2 days prior to the onset of your symptoms or positive test (if you did not have symptoms). Inform them that they were exposed and need to quarantine for 14 days from that exposure. People in quarantine should not be around others and must avoid all public places for a full 14 days.
- If a covid-positive patient cannot be isolated from the rest of their family, family members who are in contact with them will need to quarantine for the 10 days that they are in isolation and an additional 14 days starting from the end of the isolation period.
- If it is possible, family members should avoid all close contact with the covid-positive patient as soon as possible. Their 14 days of quarantine begins from the last close contact.
What If My Rapid Test is Negative?
Unfortunately, there is a significant number of false negative test results with the rapid antigen tests. Therefore, if your rapid test is negative you will be getting a PCR test sent to confirm the results. You should remain in isolation until you find out the results of the PCR test.
If your PCR test is negative it is much less likely that you have COVID-19 and you do not need to isolate according to current guidelines BUT:
- If you continue to have symptoms, or if your symptoms worsen you should remain in isolation and get another PCR test 2 days after your first one.
- If the second test is negative you can assume you did not have COVID-19.
(You may still have to quarantine If you were exposed. Remember, isolation is different from quarantine.)
What If My Rapid Test is Positive But My PCR is Negative?
In a case where there is a positive rapid test followed by a negative PCR it is much more likely that the rapid test is correct and the PCR is not. For that reason you should consider yourself to have COVID-19 and follow the instructions listed above for those who test positive.
What If Both Tests Are Negative But I Still Have Symptoms?
Both the rapid antigen test and the PCR test are imperfect and there is a chance that both give false negative results. For this reason if your tests are both negative but your symptoms have not improved or have gotten worse you should isolate and get a second test 2 days later.
Please be aware that, just like all aspects of COVID-19, these recommendations are based on the current understanding of how the virus is transmitted and the accuracy of the tests and may change with the emergence of new research.