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@rchusid@med-mastodon.comOnce again a patient with upper respiratory symptoms just told me they do not have Covid because they had a negative home Covid test. A positive test is pretty reliable in saying Covid is present but a negative test (especially if not doing serial tests) does not rule out Covid. Still limit contact with others and wear a high quality mask. Even if not Covid, there is no point in spreading other viruses to others.
I have been given the Moderna Covid vaccine 6 times so far. I get my healthcare from the Dept. of Veterans Affairs, that's where I received all 6 shots. I do wear a mask going into stores. My local VA medical center still requires masks for everyone entering the hospital.
@rchusid so, did they have covid? Because there's a REALLY infectious upper respiratory thing going around that's not covid, but comes with a week+ of coughing and no fever. I'd love to know what it is.
@tito_swineflu Unless such patients get a positive test on serial testing or go for a PCR there is no way to know for sure. Most just wait it out without further testing.
@rchusid I'm curious about those of us who have gotten it, but it's not covid. I know 8 people who have had it in the last months, all have had multiple negative rapid tests or pcrs. Onset from exposure is 1 day or lower, and symptoms are a wracking cough that can last for a week or two, no fever, no sinus involvement.
@tito_swineflu There are definitely viruses other than Covid out there.
@tito_swineflu I just got a message regarding a patient with symptoms and negative home test previously. Symptoms persist and test is now positive.
@rchusid No-one I'm talking about has ever tested positive for covid, including both 3-4 days of negative home test and including pcr tests.
@tito_swineflu If they had a negative PCR then most likely it was a virus other than Covid. If they only had negative home tests, it may or may not have been Covid. It sounds like a nasty but non-Covid virus was circulating among these people you know.
@rchusid Yes. As I've been saying, this is a nasty, non-covid virus that is circulating among these people. The question is whether or not it's new or weird or something that we just don't normally get.
@tito_swineflu Most likely it is a an old virus. Some have always had more severe symptoms than others. After not getting sick if people were taking Covid precautions the last couple of years I also think some people might see a cold as more severe than they might have in the past pre-Covid.
@tito_swineflu One consideration in this when I talk to patients who have been sick for a few days and say they don't have Covid based on a single test is that it won't affect what I do (assuming they are recovering) once we hit five days. If there is a positive test in the first five days Paxlovid will be a consideration. Beyond that it would be interesting to know but doesn't matter as much as long as they recover.
@rchusid I had Covid for over a week before the third test I took came up positive. I assumed I did so I stayed home and was careful.
@rchusid I don’t understand how folks with “not Covid “ think it’s ok to breath in my face. If you’re sick, wear a mask, stay home and stay away from me.
@rchusid I’m worried about my elderly mum at home with full time carers. She hates people wearing masks around her, hasn’t left the house for a year but has caught covid twice from carers and a visiting hairdresser. Now her carer is sick again - all the symptoms of covid but one RAT says negative. Mum doesn’t care if she catches it again, but fails to understand she can pass it to family members and other visitors. The family don’t seem to care and were angry with me for masking up at Christmas lunch. None of them know about long covid because it isn’t on TV or in the news.
@VLar It is hard when people don't take it seriously
@rchusid how many at home tests coming out negative would it take to reasonably assume that you are in fact (despite having symptoms) negative? (I’m asking for me, this is my situation right now; severe symptoms except smell & taste which are stronger than usual, not weaker, and one negative at home CDC test)
@HelloAndrew At least 2-3 and this is not certain. If rapid tests are negative but you think it might be Covid, get a PCR. Of course isolate if possible and wear a high-quality mask around others even if never have a positive test. One reason to check by PCR would be if you are a candidate for Paxlovid if positive.
@HelloAndrew By the way, it is off label but often testing the throat as well as nose will pick up positive results if a sore throat when the nasal test is negative.
@rchusid spent a bunch of time trying to set up a PCR test in my area and it looks like everything is being scheduled a week out which seems insane because by then it’s too late to qualify for paxlovid. I’m already four days out from symptom onset so also the overnight results probably wouldn’t be fast enough to qualify even if I can get the test first thing tomorrow morning. So infuriating! Also the quest diagnostic schedule site crashes right before you get to set your day.
@HelloAndrew It is probably too late to matter but around where I live patients have often managed to schedule themselves for testing more rapidly through pharmacies than I can get a tests scheduled for them through the hospital lab.
@rchusid spent 6 hours trying to set up a pcr test, only local option is rite aid, appointments made only through quest, website was broken, finally got a workaround from quest tech support (2 hours on hold) set appointment, but then quest website said I had no appointments set. Called rite aid to verify appointment, they said their only test administrator is out sick all week, quest set appointments cannot actually occur.. No paxlovid for me then! Absolutely infuriating!
@HelloAndrew You would think that this far into the pandemic such systems would work.
@HelloAndrew The FDA ruled about a week ago that Paxlovid could be prescribed without a positive test. It sounds bizarre but your situation might be a case where it might be considered. Maybe talk to your doctor about it.
@rchusid I had heard that some doctors will prescribe it with the administration of a PCR and then discontinue the drug if the result was negative but I asked my primary facility today and they said none of their doctors feel comfortable administering the test and none of them will prescribe paxlovid without the test. At this point I think my only possible hope might be finding a doctor via telemedicine that is not part of my primary facility. Any ideas?
@HelloAndrew That might work
@rchusid I googled paxlov telehealth and found a bunch of top of the Google advertising links specifying commercial programs that look possibly sketchy but down the page I found a link that said the state of California has instituted a new system where they are paying for free telehealth visits for this and I was able to set one up for tonight at 9:15 PM so wish me luck I guess!
@HelloAndrew Good luck
@rchusid got it! 5 minutes on the phone.
So easy, no payment, many doctors available after hours!
Highly recommended!
https://aghealth.ucdavis.edu/news/california-helps-make-covid-19-telehealth-services-accessible-all
@rchusid or as Will Wheaton would say "don't be a dick" - whether it's a cold virus or something else - I'd rather not get it.
@rchusid Astonishing how casual people are about other respiratory illness when we just found flu is associated with Alzheimer's.
@rchusid There's a certain subset of patients who deny they have Covid because it's politically incorrect among their peers to admit it...
@toxtethogrady In this case the people who tell me they don't have Covid because they did a negative test are not lying. They just misunderstand. But others probably do.
The dishonesty which I had the most problem with was a handful of patients claiming they were vaccinated when they were not. Any patient caught doing that was discharged from my practice as soon as I could determine (by checking with the state registry and their pharmacy) that they were not vaccinated.
@toxtethogrady @rchusid Ohh those checks are strictly illegal here in the Netherlands. As a matter of fact, not the inquiries but the answers.
@JohanDiederik @rchusid So how many of those vaccinated people who dropped dead from Covid were not really vaccinated? And how many of those who it was claimed died of heart attacks brought on by the vaccine never actually got vaccinated?
@toxtethogrady @JohanDiederik The people who spread such claims generally just make up numbers or use very unreliable "data." People falsely claiming to be vaccinated are probably a miniscule amount of their exaggerated numbers of people supposedly harmed by vaccines.
@toxtethogrady @rchusid "Not Covid" is a popular illness.
@chipmcdonald @rchusid Meat Loaf had it. Diamond died from it. I'm not sure that's what their death certificates said...
@toxtethogrady I can't remember the celebrity (someone I didn't know anyhow, but that's not saying much), but I looked at a number of different headlines regarding "suffering from myocardial problems after a bad cold".
I'm sure there are lots that have died from it (it looks like Pele "died of pneumonia" did, given what people that knew him said... There is obviously editorial decisions being made to not rock the "not covid" boat.
On Friday afternoon, I started to feel achy in arms & chest. Saturday morning I felt somewhat worse & was coughing. Saturday afternoon I took a home Covid test. Negative.
Saturday night intense chills & 14 hours of sleep. Sunday I took Covid test. Positive. It's as though it takes some time to build up enough to be detectable.
I've had 2 Pfizer vax, 2 Moderna boosters, 1 bivalent boost, & I always mask in public indoors — but new variants are v. infections.
Now taking Paxlovid.
@Leisureguy @rchusid last year I went from PCR negative to RAT positive in 13 hours. Now that's some intense viral replication!
@Leisureguy @rchusid For me exactly the same story, in the beginning of november. 5th time testing: pos. after temp rising.
Friday afternoon was Day 0. Day 3 I got Paxlovid and Day 3 evening took first dose. Can now detect metallic taste. Not too bad. Be glad when this will have run its course.
I stay inside my apartment since I imagine I'm shedding the virus like a big dog.
@rchusid Even if testing multiple times! When a virus was going through my school I was testing every other day. Since I mask I got sick after the students, who were all testing negative. I was still testing negative a few days into having symptoms, but a COVID molecular test result was positive
@rchusid that's the bain of my existence trying to understand #COVID and longer term outcomes, people will confidently report negative results as not having had an episode of COVID. This leaves us with "hospitalized COVID patient" as the exposure variable we can use.
#epidemiology #StatisticalModels