After a 12-day odyssey of my husband being sick with symptoms suggestive of COVID-19 and being unable to access the most accurate testing for COVID-19, I posted my last blog borne out of frustration. The next day, I read an article in the New England Journal of Medicine on Rapid Diagnostic Testing for SARS-CoV-2.
An updated protocol for testing for COVID-19. The author, Paul Drain, M.D., gave a protocol for testing for COVID-19. The recommendations are for at-risk patients (over age 65 or otherwise immunocompromised), with mild-to-moderate symptoms of COVID (cough, congestion, fever, fatigue, loss of sense of smell, or some combination of those symptoms.)
1. Take a rapid antigen test as soon as symptoms develop.
2. If test is negative and if symptoms persist, repeat rapid antigen test in another two days.
3. If second antigen test is positive, you have COVID-19. Call your doctor.
4. If second antigen test is negative, do a PCR test. This is more accurate.
The PCR test can take three to five days to get the result, but it turns out that there is also a rapid PCR test, which comes back within one day. According to my online search, the rapid PCR test is available at a few centers near my home in Denver. However, the rapid PCR test may be more widely available in other communities.
If the rapid PCR test or the standard PCR test comes back positive, you have COVID-19. If you are at risk for progression to severe disease, then you might be eligible for antiviral treatment. These have recently become available, or have recently been recommended for use outside the hospital setting. You would have to discuss with your doctor whether you are a candidate for one of these outpatient meds. I suspect supplies are limited, so they would be reserved for those at significant risk for progression to severe disease.
Of course, if a person is short of breath, turning blue, has low oxygen levels on a pulse oximeter, is running a high fever, is otherwise obviously in distress, please go to the Emergency Room. The protocol listed above is only for the mildly to moderately symptomatic person, someone whose symptoms are manageable and does NOT need supplemental oxygen or hospitalization.
The protocol above is useful because one would get an accurate COVID test within five days of developing symptoms. This is important because if you are a high-risk patient, the window for starting these new treatments is short. You need to start treatment by day five after symptoms onset for Paxlovid or by day seven for IV Remdesivir.
The bottom line
Plan A: At the onset of symptoms, on the first or second day of illness, do a rapid antigen test. This is especially important if you are at high risk. If the result is positive, call your doctor, to report the result and for further guidance. If it is negative, do a second rapid test in two more days. If the second test is positive, call your doctor. If it’s negative, call your doctor anyway. Ask him or her if you can get a PCR test. With luck, they will expedite a rapid PCR test for you, with results available within 24 hours. If the PCR test is positive, then you would have gotten the result within five days of onset of illness. This is important if your doctor deems you a candidate for the antiviral treatments currently available because the treatments must be started within five to seven days of onset of symptoms.
Plan B: A correspondent, someone who commented on my blog, said that he and his wife were sick last October with symptoms suggestive of COVID-19. They are in their 60s. Their doctor skipped doing any testing and assumed it was indeed COVID-19 and started them on antivirals.
I suspect for high-risk patients who are moderately ill, Plan B is optimal. Being symptomatic — showing the symptoms of full-blown COVID-19 infection – is a powerful indicator, despite whatever the lab tests show.
Dr. Janet Tamaren 