Exposed! –A Doc’s Perspective

The ‘fun’ has once again begun, and between the barrage of exposures, possible exposures, questionable symptoms, and doubts and fears around vaccination, I am being repeatedly asked for advice. It only seems apropos to make a basic statement perhaps lending insight to the most common situations surrounding COVID-19 these days.

Before you read the following, please allow me to be ABSOLUTELY CLEAR about something: “There is one thing that we know, which is that we know nothing.” All statements I make are based on SOUND REASON in keeping with my medical background, which, beyond medical school, includes 5 years of post-graduate training, and nearly 15 years of independent practice in multiple settings which not only include private practice Primary Care but also tertiary hospitals, community hospitals, urgent care, group practice, home care, and congregate/communal settings (correctional health). But we are learning new information with every passing day– every passing minute, even, thanks to the 24hr news cycle, “citizen reporting”, social media and the like. What we “know” now indeed has the chance to be debunked tomorrow. The notion of “doing research” is losing meaning. There is far more value — although far less reliable calibration — in being WISE.

With all due respect, my physician colleagues and I “read the internet” very differently from how folks without similar background and training do. I am only posting the following because multiple people are asking for *my feedback* on whether or not to get tested, or how and when to get tested now that we are getting through the holidays. For this reason, I am not adding any specific references. Heaven knows the public has decided to seek their own sources, for better or for worse. If you can read this, you can read 1000 other articles or (God forbid) Facebook posts and the like. At the end of the day, you are still going to make your own choice.

Please only continue reading if you plan to respect my opinion. I have no crystal ball predicting who will read this, so I am clearly not here to prove ‘you’ wrong, whoever you might be. Just stating my own case. Thank you kindly in advance for all mutual respect shown.

There are fundamentally two reasons to get tested for COVID as an outpatient:

1. To minimize risk of passing along the infection

Anyone who believes he/she is at risk for being COVID(+) but is capable of strictly quarantining should simply proceed with quarantine if at all possible. Recommended duration of quarantine has varied greatly over the past 2 years, but at this time if someone is fully vaccinated/boosted and remains fully asymptomatic for 5 days after a suspected exposure, quarantine for that individual can be stopped at that point.

For someone whose vaccination status is not in keeping with the CDC/WHO recommendations, it is important to bear in mind that risk of transmissibility and/or severe disease is understood to be elevated. Outcomes in such regards are FAR FROM BLACK-AND-WHITE. But given the evidence we have access to thus far, it is advisable to quarantine more strictly if you are not fully vaccinated/boosted compared with those who are, in the range of 7-10 days.

If a negative swab of respiratory secretions can be obtained NO SOONER than 48hrs after the suspected exposure AND an individual remains asymptomatic, then quarantine can be stopped. It is still advisable to socially distance and stay masked for at least what would have been the duration of recommended quarantine, to help support public health and safety.

If there is an upcoming interpersonal encounter with a high-risk person that cannot be avoided within a 10-14 day time frame following a suspected exposure, a negative test result should be obtained before proceeding with the encounter.

If AT ANY TIME someone develops symptoms potentially suspicious for COVID and is capable of strictly quarantining and is not sick enough to need hospital admission, the advice is to simply proceed with quarantine until 48hrs of having no fever without medications to reduce fever (such as Tylenol or ibuprofen), AS LONG AS symptoms are resolved.

If someone has no fever but continues to have other respiratory symptoms, show courtesy and common sense by keeping your secretions as far away from other people as you can.

Testing requirements for specific situations like travel, access to events, elective medical procedures and so forth are SPECIFIC to the agency or entity. As a Primary Care Physician, I in no way can predict what the specific requirements are, whether in regard to timing of obtaining a test, selecting a type of test (e.g., rapid or PCR or… etc), producing a finalized test result, and so on and so forth. In order to help providing appropriate testing/results for an individual, I NEED TO READ THE POLICY that an individual is trying to adhere to. I am terribly sorry, but a verbal description of what is thought to be required is not enough for me to be helpful.

2. To justify treatment for a COVID infection

Outpatient medical therapy for an active COVID infection, thus far, remains highly difficult to access and involves jumping through multiple specific hoops. At my office, we have tried to assist some patients with obtaining an outpatient monoclonal antibody infusion but have been unsuccessful mostly due to limited supply and appointments. As a result, I am holding off on advising it for my patients until it seems more realistically available.

I feel it is riskier to send mildly/moderately ill patients to a closed infusion suite that contains confirmed COVID cases, not to mention requiring patients to leave their homes multiple times trying to obtain an approved confirmatory test, when compared with staying home and engaging optimal self-care (that is, resting and hydrating like it is your job, and if you are sick with COVID, this IS your job).

In other words, because treatment options for mild/moderate cases are extremely limited, essentially no change in approach would be advised regardless of whether a test is positive or negative. So if someone can quarantine and maintain the right level of supportive care (again: hydration and rest), there is no reason to test. COVID-POSITIVE STATUS SHOULD BE ASSUMED. Remain quarantined until essentially asymptomatic for 48hrs. Stay masked when in the presence of others thereafter. USE. COMMON. SENSE.

The primary indicator to seek hospital-level care would be respiratory distress. Other indicators would be high fevers (>103’F) or listlessness (prolonged deep sleep very difficult to arouse).

If AT ANY TIME someone contracts significant respiratory or infectious symptoms of any nature that seem severe enough to warrant a hospital admission, that person should proceed to the closest hospital Emergency Department without delay. Testing and any appropriate treatment would be rendered there.

Navigating the transition between a Pandemic and a Post-Pandemic World is tough on everyone. Let’s please all try to stay mindful of this.

We all wish the world were a better place. Many of us want to actively contribute to the world becoming a better place. If you have the bandwidth for that, wonderful! What you can offer is authentically needed.

But in sooooooo many cases, the most important contribution someone can make is to simply take care of him/herself without disproportionately draining the limited resources around. Please don’t pour out from an empty cup only to become the next vortex of need.

Stay well, seek wisdom, and be kind.

One Reply to “Exposed! –A Doc’s Perspective”

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: