What Should I Do With My Test Results?

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?

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Do Masks Work or Not?

“My friend told me that masks only work half the time and that there’s no difference between wearing them and not wearing them.”

This was an unsolicited outburst from my 10-year-old daughter the other day. She was quoting a girl in her class. I was not entirely concerned with the opinion of the preadolescent but was concerned about where this gross misinformation was coming from. While I didn’t investigate, I assume that this child did not do an exhaustive search of the latest literature on the effectiveness of face coverings in preventing COVID-19. This would mean that she was parroting something she heard from an adult. While I again did not investigate, I assume that this adult did not do an exhaustive search of the latest literature on the effectiveness of face coverings in preventing COVID-19 either. As is the case for many things these days, lack of knowledge is not an obstacle to the vehement expression of opinion. You only need to read an online article to form a strong and unwavering opinion of anything.

But since the question is floating around out there I thought I would give an updated answer to the question that just doesn’t seem to want to die: Do masks work or not?

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Is COVID testing reliable?

“We have had multiple family members with vague symptoms all of whom tested negative but the father is COVID positive. He then had a follow up test that was negative. Is this sufficient to clear him to go back to school?”

How about this one:

A person had congestion and achiness Monday. The next day she tested negative. She felt a bit better over the next few days but not back to normal (she was also running on very little sleep). A week later her symptoms started up again and were more severe. She is now recovering over the past few days. She has no known exposure. Do you think the negative test on day two clears her and her husband? Technically, she would be 10 days since the start of the second round of symptoms by next weekend but, if this is a second illness and is covid, her husband would not be.
Should she be tested today? Does that then put her and her husband into the questionable awaiting result group?

How would you answer? At best, if you’re wrong and say everyone is clear you could expose an entire school or community and lead to schools shutting down, more people stuck in quarantine, and great financial hardship. At worst, you could be the cause of serious illness or perhaps people dying.

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Why are we acting so crazy if people aren’t really dying from this!?!

“We are informing you that one student in 7th grade tested positive for Covid and a second 7th grade student is symptomatic and waiting for test results.  All students in 7th grade are considered “exposed” due to the student testing positive and they will need to remain quarantined at home through Friday, September 18th.” And thus it starts.

It took just over a week of schooling before the above message came by email. My 7th grader is now in quarantine. Fortunately she is not sick and wasn’t in close proximity to the infected kids (as far as she knows) so she didn’t likely get infected. Since there were a few kids who tested positive they sent the entire grade home. Unfortunately the news has put our house is in a minor state of turmoil. I know every other 7th grade family has had their lives unsettled as much or more than ours. For many it is much more than an inconvenience.

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The long-term damage from COVID you’re not hearing about

It is certainly important to give children responsibility as they grow up. Chores are more than just a means to keep the house in order, they are a means of teaching children the importance of contributing to the family, of giving up their present desires for a higher goal. While this is all wonderful for parenting books and magazine articles it generally ignores a major problem with children, especially smaller ones, performing these essential household duties – they’re typically not very good at them. This was our first problem.

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Maybe you can get COVID twice

Our national 6-month coronaversary has arrived. It’s now been 6 months since our world turned upside down. The world is not the same place it was in January, a statement that is as obvious as it is disconcerting. It’s funny how something can seem like it was just yesterday and a lifetime ago at the same time. I think this summarizes the past 6 months:

  • Do you get the coronavirus from Mexican beer?
  • Where’s Wuhan?
  • There’s no toilet paper!
  • There’s nowhere to get tested.
  • You don’t need to wear a mask.
  • Fauci is our savior!
  • Hydroxychloroquine will save us all! Anyone who disagrees is part of the conspiracy.
  • Fauci doesn’t know anything!
  • You can inject clorox?
  • Everyone needs to wear a mask!
  • You can’t tell me to wear a mask!
  • Does anyone remember sports?
  • It’s all gone, let’s open up the bars and restaurants!
  • We shouldn’t have done that.
  • I’m getting a puppy!
  • I shouldn’t have done that.
  • Opening up schools is irresponsible unless it’s not.
  • I need an air hug.
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In defense of Dr. Fauci

I wasn’t sure what to do with her. She’d now been in the hospital with her COVID pneumonia and respiratory failure for 10 days when she started to rapidly deteriorate. The night before she was intubated which is never a good thing with this virus. When I saw her she was thrashing in the bed with a cacophony of beeping alarms and agitated nurses. Her blood pressure and oxygen saturation were dropping. Was this the COVID progressing? Was it a new infection? Did she aspirate? Was fluid backing up into her lungs? Should I change her ventilator settings? What if my ventilator changes worsen her oxygen levels and she codes? Should I give her diuretics? That may worsen her kidney function. Should I broaden her antibiotics? This may lead to side effects or induce resistant bacteria. Should I more heavily sedate her? This could lead to terrible brain dysfunction and worse outcomes if I give too much for too long.

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I hope the nonbelievers are right

It was another week working in the ICU and, even though it was August, it felt more like the previous April. We had a rise in the number of COVID-19 cases and were suffocating a bit trying to breathe through our surgical masks and N95 combos. It was a typical busy COVID Thursday morning, the bustle of doctors, nurses, and the rest of the ICU staff creates a buzz of activity. I was rounding with the team of residents, nurses, and respiratory therapists and we were nearly finished. Our last patient was a newly transferred, very anxious lady with COVID-19 who had rising oxygen requirements. We sorted out her medical problems and treatment plan and were relieved to be done with rounds. She was in room 16.

A few hours later we got a call about a woman in another part of the hospital who was deteriorating rapidly. In spite of being on 100% oxygen given through a high flow nasal cannula she still had very low oxygen levels. She was pale, sweaty, and breathing unnervingly fast. She was rushed into room 17.

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The vanishing ventilator shortage and how we are all biased

It is quite amazing how everything gets turned on its head so rapidly these days. Up becomes down and black becomes white. While it seems like years, it was only 4 months ago that no one was wearing masks, schools were shutting down, and Floridians were afraid of New Yorkers traveling south. Now our very own President said to wear (but didn’t actually put on) a mask, kids are starting to buy supplies for the fall, and New Yorkers run in fear from any senior citizen with a tan who is wearing colorful golf pants.

One of the major changes that I have noticed is that we have not been talking about the fear of ventilator shortages for some time. I remember sitting at COVID-19 emergency planning committee meetings back in March where we were scrounging to find every machine that could be jerry rigged to ventilate a patient. I was in contact with companies who make CPAP machines to see if we can rent them to ventilate COVID patients in an emergency. We were even coming up with crazy and unthinkable plans to put multiple patients on a single ventilator. The fear of having to choose who goes on a ventilator was in the forefront of all of our minds. These challenges dominated the news as well and motivated the government to invest $3 billion to build more ventilators as part of the emergency response.

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Should kids go back to school this fall?

In our home we have transitioned from home school to home camp. This has not been a dramatic shift. The main difference for the kids has been a combination of less time on zoom and a major relaxation of hygienic standards. The famous psychologist Abraham Maslow created a pyramid categorizing a hierarchy of human needs from the basic physiological needs to the lofty need for self actualization. With this as my inspiration, I have created a COVID-19 parenting hierarchy of needs moving from most basic and necessary to what have become lofty aspirations.

  1. Food and water. This is the lowest level neglected by only the most deplorable of parents. This, as of now, has not been impacted by the pandemic in quantity although quality has certainly suffered.
  2. Injury Prevention. This includes preventing the children from injuring themselves or their siblings. It also includes maintaining parental sanity so the parents don’t injure the children. The pandemic has, only on rare occasion, challenged this rung of the hierarchy. After several dozen interjections, at some point even the most patient of parents will be resigned to let the kids fight it out to resolve the dispute. This can occasionally lead to injuries but casualties are unavoidable in wartime.
  3. Clothing. Under normal conditions, putting clothing on the children is typically mandatory. This was abandoned early on in the pandemic. The 4 year old is free to wander naked so long as he only pees on the tile flooring.
  4. Bathing. We have now achieved a level where as long as there are no visible maggots or obvious foul odors this has become completely optional.
  5. Education. This has been handed over entirely to the internet.

It is clear then why most parents are awaiting their school districts’ plans for the fall with great anticipation.

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