TEMPERATURE CHECKING. Used as a cheap screen, everywhere you go, you get your temperature checked. However, as an isolated tool, it is pretty useless. Temperature checking is neither sensitive or specific for Covid infection. Plenty of people infected with SARS-Cov-2 who are not yet symptomatic have normal temperatures. Our local hospitals have even stopped doing it as a screen for incoming staff. We have instituted a symptom screening procedure using a website we need to check in with every day. One more thing to add to the daily list of things to do!. This is also not perfect since it relies on you being honest with your symptoms. In addition, some of the symptoms are experienced pretty regularly in situations which have nothing to do with Covid. An example is shortness of breath which can also occur with allergy flare-ups but if you mention it, everyone gets excited and they run for the hills. Are we still doing it in the office? Yes. It makes people feel like we’re doing something!
WHEN SHOULD I TEST AFTER AN EXPOSURE?. Complex question with variable answers. After an exposure during which you get infected, 97% of people will have a positive test within 5-7 days. Not sooner. It can be as long as 14 days but most will be within a week.
Context however is important. Was the person only symptomatic with tests pending or did they actually have Covid? Was the person themselves exposed to someone so you are 1 person removed? Family close contact is different from casual exposures.
The general rule of thumb is that:
- If you have symptoms, then test right away. If you don’t have symptoms, wait -7 days. While waiting for results, self-isolate. The list of symptoms has grown from the traditional fever, cough and shortness of breath. We now also include:
- loss of smell or taste,
- loss of appetite,
- vomiting or diarrhea,
- rash on fingers or toes,
- unusual fatigue
- Chills and/or body aches
- Sore throat
- If you do not have symptoms but the exposure was significant, wait a minimum of 5 days before testing. Testing earlier will likely be negative, even if you contracted Covid from that specific exposure. As a word of comfort, within the first 2-3 days of contracting Covid, you will not be infectious since there is not enough virus to spread. This is the same reason testing is useless this early. If you were exposed and saw Grandma the next day, she will be fine.
If you turn out to be positive, the recommendation is to self isolate for 10 days after onset of symptoms. If you still have symptoms at the end of 10 days, that is probably OK since some symptoms like cough and alterations of smell and taste can persist for many weeks and even months. I have seen a few very long-term issues with taste and smell in my practice. If you have a fever, you should be fever free for a minimum of 48 hours as well.
For sicker people, like if you had a stint in the ICU, you need to quarantine for 20 days after symptom onset.
TESTING AFTER INFECTION. In general, this is not necessary and can be confusing. Depending on the test, you can remain positive for months after infection. You are NOT infectious, but there is still some genetic material from the virus which tests are picking up on. HOWEVER, if you develop symptoms again, you may be re-infected and you may need to be re-tested. In this situation, you really should consult with your doctor or an infectious disease specialist for the latest on recommendations.
NEGATIVE TESTS. I wrote a quick note about this earlier. Although helpful, they are by no means a “pass”. You could test positive as soon as 12 hours after a negative test because of rapid viral replication.
IMMUNITY AFTER INFECTION. There is no such thing. First of all, although there is some protection after an infection, or upcoming vaccination and that the chances of catching it again in the months after infection are lower, there are no guarantees. There have been numerous cases of re-infection. Not a tremendous number but there definitely are some. Most have had a less significant infection the second time around but some have been worse. If other coronavirus infections are any indication, within a year, there is no more protection. Including from the T Cells which are permanently in your system. This may be because of viral mutation or simply, levels of immune cells which are too low. Add to that your overall health status. You MUST continue vigilance with respect to the basics of protection.
Remember that this is a new virus. Even though we have been dealing with it for 9 months, like a pregnancy, we are still learning. For example, the WHO just came out with recommendations about NOT using the antiviral Remdesivir. According to some of their studies, it may not actually do much of anything. More on this later.
In the meantime, do all the things you need to do to stay safe and protect all those around you.
I heard a great Budhhist quote from a podcast interviewing vegan activist Dr. Melanie Joy. She coined the term “Carnism” which is the belief system that eating certain animals is “Natural,normal and necessary” while eating others is not. It is very culturally driven.
“We all have within us the seeds of GREED, HATRED and DESIRE. We also have within us the seeds of LOVE, COMPASSION and EMPATHY. Our job is to simply water the right seeds in ourselves and in others”.
We need more of the later qualities to not only get through the Covid epidemic, but to survive our own extinction.
Stay safe and be well.
AC