Here is a scenario with which I have been presented four or five times today and every day for the last 10 days.
I ( we) were with some friends last weekend and they had been with some other friends the previous weekend and got a phone call today that one of them was positive. Should I get a swab tomorrow?
So let’s break this down. How did they test positive? If it was a swab that is a concern, if it was an antibody test less so. As I have written before, on average, antibody tests become positive 12 days into the illness at which point the virus can’t be recovered and the risk of acquiring the illness is negligible. You need to know what was the exposure, indoors or out, social distancing and time of exposure before deciding it’s significance. Then you need to decide what the second individual or groups exposure was to the first group with the same questions. The second question about should I have a a test today is easy. No. The odds of having a positive nasal swab on the day that you first develop symptoms ( and the people in this scenario have NO symptoms) is 0%. You should wait until the 3-4th day. Early negative results are reassuring, but inaccurate. What follow are some recommendations released today from UT Health which are based on a study published in the Annals of Internal Medicine. It is kind that they were thinking of me and didn’t think that I had access to this information from other sources, but I put it here so that you will know that, while knowledgeable, I’m not making this stuff up.
Dr. Thornton,
Good afternoon, I hope this email finds you well. At UT Health SA we would like to provide community physicians with the listing of sites for screening and with the message to avoid the ED unless the physician deems necessary for the patient. Please, share this with your team, your doctors, and anyone who could benefit. I have also attached this resource in Word document to print if needed.
**Here is a reference weblink to the list of current testing sites in Bexar County to help keep your patients out of the ED.
What to Know about Testing for COVID-19
COVID-19 tests are important tools for diagnosing COVID-19 infection. There are limitations to any test and these tests work best in diagnosing people who have symptoms of COVID-19 infection.
Who should get tested?
Anyone who develops new symptoms after an exposure to someone with COVID-19 should get tested. People who have been exposed to someone with COVID-19 but don’t have symptoms can consider testing but should wait until the right time to prevent inaccurate results.
When should I get tested?
If you have symptoms concerning for COVID-19, you should get tested. After exposure to someone with COVID-19, you are at potential risk for developing infection for 14 days after the exposure. If you have been exposed to someone with COVID-19 but don’t have new symptoms, it is important to wait for 8 days after the exposure to reduce the chances of an inaccurate test. ( I suggest 3-4 days which will give a sensitivity of 70%, but they are more conservative).
Why should I wait to get tested?
It takes time for the SARS CoV-2 virus that causes COVID-19 to become detectable, even with the sensitive tests being used. For example, getting a test the day after an exposure gives you a 100% chance of a negative test even if you later develop infection.
**Where should I get tested?
Several testing sites are available throughout the San Antonio area and are listed on the San Antonio Metro Health web site.
https://covid19.sanantonio.gov/What-YOU-Can-Do/Testing/List-of-Testing-Locations-in-Bexar-County
**It is not advised to go to the Emergency Center at a hospital just for testing. Emergency Centers at hospitals throughout the city are very busy taking care of symptomatic patients with COVID-19. If you go to one of these centers for testing, you might potentially become exposed to someone with symptomatic COVID-19 disease waiting to receive medical care.
What does a negative test result mean?
If you are asymptomatic but have been exposed to someone with COVID-19, it means that you don’t have detectable COVID-19 at the time of the test but it doesn’t change the 14 day window of infection risk you have from exposure. You should continue to monitor twice daily for fever and symptoms for the full 14 days.
What does a positive test result mean?
You have detectable COVID-19 and can potentially transmit the infection to others. You should self-isolate and follow the instructions provided by the testing site that has provided your results. Additional information on what to do can be found on the CDC web site.
https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/index.html
Please, reach out if we can do anything for you or your patients. Stay safe and thank you for your time!
Sincerely,
Lisa Hartman
Physician Relations- Senior
Marketing, Communications & Media
UT Health San Antonio
7703 Floyd Curl Drive, Mail Code 8037
San Antonio, TX 78229-3900
(C) 210-687-8921
uthscsa.edu
So, if you have been exposed to someone who has been exposed to someone and wonder what to do, let us know.
Please think of the details of the questions posed to enable us to give you the best advice.
Finally, if you have a runny nose and scratchy throat, you probably don’t have Covid-19. Wait a few days, take some non sedating antihistamines before you convince yourself that you have Covid-19 and call us.
