• Karen McPhail, RN, MSN

When to Get Tested If Exposed to Covid, SARS-CoV-2 and Other Key Considerations!

Updated: Dec 19, 2020


Many individuals have been reaching out this week asking about testing, timing of testing, post covid syndrome, and more. So today in our blog we will try to answer these common Covid -19, SARS-CoV-2 testing and basic management questions. This is to raise awareness and educate as there are so many people getting tested way too early after Covid exposure resulting in a false sense of security and a negative test result that is not truly correct due to the timing of the test. In terms of the basics, according to Harvard and the CDC, a person with COVID-19 may be contagious 48 to 72 hours before starting to experience symptoms. Current research suggests that people are actually most likely to spread the virus to others during the 48 hours before they start to experience real symptoms. This truly strengthens the reasoning and overall cause for face masks use, physical and social distancing, and diligent contact tracing, all of which can help to reduce the risk that someone who is infected, but in fact not yet experiencing symptoms may unknowingly infect and transmit the virus to others.

If you have been in close contact with someone who has COVID-19:

(Close contact is defined as within 6 feet of a person who has COVID-19 for 15 minutes or more throughout the course of a day / 24 hours).

  • Immediately self isolate! Quarantine at home! Stay home from work and other activities for 14 days from the last time you had contact with the COVID-19 positive individual.

  • Get tested, however, read carefully as this is a really important part - It is best to wait at least 5 days after you were in close contact with the person who is COVID-19 positive. If you get tested too soon, the test may not be able to detect the virus.

  • It is therefore advised that exposed individuals quarantine and wait to test until at least day 4 in order to limit false-negative results and to limit the need for sequential testing. The probability of a false-negative result in an infected person decreases substantially over the first 4 days after exposure. Because symptoms develop 2 to 14 days following exposure and most commonly between 5 and 6 days, further testing after a negative test result should be guided by symptomatology.

  • The covid PCR test that has received FDA approval is truly the “gold standard” for covid testing of an individual for acute COVID-19 infection. PCR testing is generally performed by taking nasopharyngeal swab. This test actually detects RNA (or genetic material) that is specific to the virus and can detect the virus within days of infection, even those who have no symptoms. The test can be done in a clinic, hospital, or even in your car. Turnaround time is longer, generally in the 2-3 day range but results can be in as little as 24 hours. When demand is high, results can take a week or longer.

  • Antigen tests Frequently referred to as a rapid test, are generally performed on nasal or oral swab specimens. Some antigen tests are approved for point-of-care use and deliver rapid results, and others require shipment of samples to a central laboratory. This test detects protein fragments specific to the Coronavirus. It can be done in a clinic, doctor’s office, or hospital. Turnaround time for results is usually very quick and in some cases, results can be reported within 15 minutes. Antigen tests generally have lower sensitivity than DNA tests, particularly in later stages of COVID-19, but positive test results are generally reliable. Despite their lower sensitivity, these tests may be useful when rapid results are required or when screening large numbers of individuals. For purposes of clearance for a specific setting such as return to school, however, a negative antigen test result will often not suffice. Backup with a PCR-based test is often required by local or state public health authorities.

  • Antibody tests can serve some limited utility in indicating previous infection with COVID-19, but are not useful for the diagnosis of an acute or active infection. Positive antibody test result do not however definitively confirm that an individual has protection against COVIS-19. Thus, these tests should not be used to make decisions on grouping people in classrooms or other facilities at this time, and individuals with positive antibody tests should continue to adhere to guidelines about masking, social distancing, and other preventive measures.

  • Tell your employer and work from home if you are able.

  • Even if you test negative for COVID-19, you really do need to stay home the full 14 days as it can take this long for symptoms to begin to appear.

  • Stay apart from others and do not share anything that others touch such as tv remotes, cell phones, utensils, cups, etc.

  • If you do not get sick, you can go back to normal activities and work after 14 days.

  • If you get sick or test positive, please continue to stay home and follow the instructions below relating to those with COVID- 19 or COVID-19 symptoms.

If you have COVID-19 and have symptoms, but have not gotten tested:

  • Stay home until all three of the following occur: 1. It has been at least 10 days since your symptoms first started. 2. You are fever-free for 24 hours, without taking any fever reducing medications. 3. Your your symptoms of COVID-19 have resolved.

  • Individuals may need to stay home longer than 14 days if their symptoms are not improving or worsen. Seek medical advise for symptom management. Individuals with medical conditions that weaken the immune system or place them a higher risk category for a more challenging case, or have been in the hospital for treatment may require more recuperative time. Speak with your healthcare provider if recovering for specific instructions along the way. Seek care and guidance via tele health platforms.

  • While recuperating, stay away from others and do not share any home, personal, and hygiene items.

  • Wear a mask if you have to be in the same room with others. Quarantine to another area of the home if able to do so.

If you have COVID-19 symptoms, but have tested negative:

  • Still self isolate as something is clearly still of concern health wise and needs to be sorted out and understood!

  • If you receive a negative test result but have symptoms, talk to your health care provider promptly and follow guidance.

  • It is important to be evaluated to find out if you perhaps have a different illness or condition. Follow their advice for how long to stay home, etc.

  • Until you have clarity on your condition and diagnosis, you should still stay home from work and other activities until you do not have a fever and have resolution of symptoms.

  • If you are a health care worker, talk to your employer, as guidelines may vary slightly. Some organizations after exposure require two negative covid tests, 24 hours apart, one being 5 days after exposure.


What is post covid syndrome and who are potentially long haulers?


Symptoms of post COVID-19 syndrome greatly vary. However, some of the more common and currently shown to be more longer lasting symptoms include difficulties in focusing and attention, headaches, brain fog, fatigue, intermittent shortness of breath, cough, chills and / or body aches, joint discomfort and / or mild swelling, chest pain, and a loss of taste or smell.

Long haulers seems to express an overall lack of feeling "normal" post covid infection and haven't fully recovered or returned to their pre-COVID-19 health weeks or even months after first experiencing their COVID-19 symptoms. These ongoing symptoms persist, negatively impacting ones overall quality of life. Recent research may provide further insight and predict who is more likely to become a long hauler. A recent study found that COVID-19 patients who experienced more than five symptoms during their first week of illness were significantly more likely to become long haulers. Specific symptoms including: headache, difficulty breathing, fatigue, hoarseness, and body / muscle aches experienced in the first week of illness may increase ones chances of becoming a long hauler. Advanced age and a higher body mass index (BMI) may also be indicators. Clearly more work needs to be done in this area as we will have many individuals falling into these categories and experiencing these challenges. The even longer term effects of COVID-19 are still unknown clearly and anyone can become a long hauler sadly. Do not give into misnomers. Younger, healthier individuals are in fact experiencing post covid syndrome and effects so we all need to be mindful in terms of prevention as much as possible. No one is immune sadly.

(https://www.health.harvard.edu/diseases-and-conditions/if-youve-been-exposed-to-the-coronavirus ).


These are stressful and confusing times so please reach out with any questions as things continue to unfold. We are doing our best to provide up to date guidance and information to clients and as a public health service.


Be mindful of the testing and management guidelines to ensure that you have peace of mind and do not potentially spread the virus to others inadvertently through early testing and improper management. Seek treatment when needed.


Reducing the length of quarantine may make it easier for people to quarantine by reducing the length of time that they cannot work and attend activities of daily living, but needs to be done with careful consideration. A shorter quarantine period can lessen stress on the public health system, businesses, etc, but again must be done with guidance and caution based on trends and testing. Some areas need to lock down and quarantine based on hospital admission numbers / available beds, upward trends, and other factors. Always follow current set guidelines. Remember to check in frequently on guidelines via credible sources. Wear a mask, stay at least 6 feet from others, wash your hands, sanitize highly used items, avoid crowds, and take other steps to prevent the spread of COVID-19.


Your local public health authorities make the final decisions about how long quarantines and self isolation should last, based on local conditions and needs. Always follow the recommendations of your local public health department if you need to quarantine or self isolate. Again and finally, if you have symptoms, immediately self-isolate, and contact your local public health authority or healthcare provider.


Sources:

https://ww.cdc.gov/coronavirus/2019-ncov/index.html

https://www.health.state.mn.us/diseases/coronavirus/returntowork.pdf

https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-testing-guidance/

https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-testing-guidance/

https://www.health.harvard.edu/diseases-and-conditions/if-youve-been-exposed-to-the-coronavirus



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