“People are scared, they don’t know what to do next,” writes primary care doctor Jennifer LaBonte in a recent blog. On a recent night on call, she reports, “EVERY SINGLE CALL was from someone with COVID symptoms or exposure wondering what to do.”
Why? I wondered. Then I checked various public health websites–and discovered that the answers to these questions aren’t necessarily that easy to find.
So I thought I would summarize the recommendations of experts from CDC, Departments of Health and infectious diseases and internist colleagues to help answer this common question.
First–what kind of symptoms might prompt you to think you may have COVID?
The typical symptoms of COVID infection may include some but not necessarily all of the following:
Cough
Shortness of breath
Fever
Chills
Muscle aches
Headache
Sore throat
A new loss of taste or smell
That last finding is highly suggestive of COVID infection. But it bears mentioning that we are learning that this disease is a great imitator: according to the CDC website, “atypical presentations have been described.” It can look like heart disease, stroke or have gastrointestinal symptoms.
IF you have some of the above COVID symptoms: what should you do?
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A little more detail on those recommendations:
1. Seek Medical Advice. You will want to connect with your doctor or a nurse consulting line directly– by phone. This is true particularly for those age 60 or older and those with medical conditions like diabetes, heart disease, lung disease, or a weak immune system because those persons are at risk for more severe illness; they should reach out for medical advice when they first notice symptoms.
What if you don’t have a healthcare provider and/or you don’t have insurance? If you are in Massachusetts and need help finding a doctor or getting health insurance, call MassHealth’s Customer Service Center at (800) 841-2900 TTY: (800) 497-4648 or email Health Connector online at www.mahealthconnector.org.
To talk to a provider, MA DPH suggests that you connect with www.buoy.com/mass to check your symptoms; the MA DPH website says that “buoy” will tell you who to contact to receive care. Another approach is to call MassHealth (800) 841-2900 and request that they assign you a provider if you don’t have insurance or a provider.
- Testing: You should get tested for COVID. A couple of important points about testing.
- You may need an order from your doctor to get a test.
- Where to go to get tested? Here is a list of test sites and here is an interactive map of all Massachusetts testing sites; there are a number of useful filters, like: drive-in availability, testing for children, referral required, and zip code.
- If a test site requires a doctor’s referral and it is a weekend, you may want to go to a site that does not require a doctor’s order.
- You should also call the testing site ahead of time–the hours and times are highly variable and some are not open every day and the insurance plans accepted vary from site to site.
- What test should you get? You want to ask for the PCR test, which is generally a nasal swab test that looks for active infection. Soon a saliva test will be available also.
Many sites are offering a “package” that often includes a different test, called an antibody test: this is obtained to show whether you have had infection in the PAST. There are three problems with this test: first, it isn’t useful if you need to diagnose an acute infection (i.e. find out whether or not you are sick NOW). The second problem is that the test hasn’t been standardized. Third, the antibody test can be very expensive, particularly if you don’t have insurance (up to $250 at some sites here in Massachusetts).
According to Dr. Eric Rubin, editor of the New England Journal of Medicine, who spoke about COVID yesterday at the Massachusetts Medical Society Annual Meeting, the “antibody and antigen tests are relatively poor. The antibody might correlate with infection, but the tests out there are not good. In my opinion,” Dr. Rubin said, “I would only use them in the context of clinical trials.”
Bottom line: at this time, you don’t need the “package”. You just need the best test used to diagnose active infection: the PCR, which usually requires a nasal swab.
What if your test is negative? Do you definitely not have COVID infection? A negative test does not completely eliminate the possibility that you have COVID infection. You might be early in the infection and not have enough virus to be detected by the test.
The PCR test has a high false negative rate. So if your test is negative, but you have many symptoms that you and your provider feel are consistent with COVID, you may want to assume that you do have the infection. On the other hand, if your test is positive, you definitely have COVID; there are very few “false positives.”
- If your test is positive, you need to self- isolate.
What does this mean? It means staying in one room of your house and limiting exposure to other family members. If possible, try to have your own bathroom that you do not share with others. You should try to wear a mask if possible when around others. Clean down commonly used surfaces and wash hands frequently.
Let the people you have been in contact with know that you have COVID if you feel comfortable doing that; let your provider know so that the DPH can get in touch with contacts if you don’t.
See Treating COVID infection at Home for more recommendations.
How long to stay in isolation? Currently, the CDC is advising either of the following:
To isolate for 10 days after the onset of symptoms AND three days with NO fever AND you are symptom free;
OR
Two negative PCR tests: according to CDC, “If you will be tested, you can be around others when you have no fever, symptoms have improved, and you receive two negative test results in a row, at least 24 hours apart.”
Medical Disclaimer: The suggestions given here are not intended as a substitute for the medical advice of your physician. The reader should regularly consult a physician in matters relating to his/her health and particularly with respect to any symptoms that may require diagnosis or medical attention. For additional questions, please call your healthcare provider for reliable, up-to-date information on testing, symptom management and transmission of COVID-19.
Up Next: What to Do if You think you have been Exposed to COVID Infection?
For more information
- How Should I Care for COVID Infection at Home
- What Should You do if You Are Exposed to Someone with Confirmed Covid-19
- Mayo Clinic advice on what to do if you think you have COVID infection.
