As more Mainers have contact with COVID cases this winter, it’s important to know about testing and treatment options in case you develop COVID or are in close contact with a known case.
Everyone is tired of hearing about and thinking about COVID-19 but unfortunately, the disease is surging throughout Maine with more Mainers dying every day. COVID will be with us for a while longer. While this article addresses testing and treatment, we must continue to be diligent with masking, hand-washing, and physical distancing.
Who Should Be Tested
Ultimately, the decision of who should be tested is a decision between a patient and their doctor. But from a public health perspective, people should be tested if they have symptoms of COVID-19 or have had close contact (defined as being within 6 feet for a total of 15 min or more – but beware that this is not a perfect rule) with another person known to have COVID. There are other specific situations that warrant testing so if you have a question, please contact your doctor.
Which test should I get?
If there is one take-away point from testing for COVID it is this: No COVID test is perfectly accurate and each individual patient’s context matters.
If you are getting tested, you need to get the proper test at the right time. Your doctor can help you decide which test that is but I hope to provide some guidance here.
An individual’s story matters. For example, if one of my patients calls wondering about testing after their spouse tested positive, my advice will be much different than if the same patient calls about testing after having spent 10 minutes with a friend whose co-worker tested positive for COVID-19.
Rapid Tests
Most rapid tests are antigen-based. Antigens are molecules or proteins that are markers for a specific pathogen. For the coronavirus, antigen tests check for proteins on parts of the COVID viral particle.
Antigen tests take samples from the nasal or oral passages and place the sample into a reagent, all to be read by a testing machine as positive or negative. Most of these tests return results in about 15 minutes.
The biggest challenge with antigen tests is their accuracy. While antigen tests, if performed properly, rarely result in a false-positive test, their false-negative rate can be significant. This means that a subset of patients who test negative on rapid tests will actually have COVID-19.
The accuracy of these rapid tests is increased when only patients with symptoms are tested. In my practice, I only use a rapid test for symptomatic patients with rare exceptions.
In a study released just this week, among symptomatic patients, the Sofia antigen test had a sensitivity of 80% (20% false negative rate) while it’s specificity was 99% (1% false positive rate). But for those without symptoms, the same test had a sensitivity of 41% (59% false negative rate) while its specificity was still good at 98% (false positive rate).
The other major consideration with antigen tests is test timing. These tests are approved for use within the first 5 days of symptoms. I like to test my symptomatic patients as soon as possible.
So if you’re within the first few days of a COVID-like illness, a rapid test is a great first step. If you are an asymptomatic close contact or are outside of the first 4-5 days of symptoms, I usually recommend molecular-based testing.
For those interested in reading more about specific situations and the nuances of rapid testing, the CDC has a nice graphic in Figure 1 here.
Molecular Testing
PCR (polymerase chain reaction) testing is the most widely-available molecular test to detect small amounts of the virus causing COVID-19. In PCR, small amounts of genetic material are amplified to make millions-billions of copies of the target, allowing easier and more accurate detection. For a virus like COVID, PCR-type testing is the gold standard test because fewer copies of the virus are needed to detect infection.
The CDC recommends that most patients who were exposed to the coronavirus get tested 5-7 days after exposure. This is based on studies demonstrating when PCR-based testing is most likely to detect virus.
That being said, while more sensitive (fewer false negatives) than rapid testing, PCR tests can still report false negatives. Because detecting this virus is still novel, the ranges of false negatives are wide but based on the literature, it appears to be <5-40% based on the test used. I usually tell my patients that we need to take negative results with a grain of salt, especially if someone’s symptoms match up perfectly with COVID.
Please keep in mind: If your symptoms and story are concerning for COVID, remember that none of these tests are perfectly accurate and that your individual circumstances matter. There have been a handful of situations where I’ve instructed patients to quarantine or isolate based on their stories alone, regardless of test result. If you’re concerned about your test results or your symptoms, please speak with a doctor. If you’re being tested for COVID, it is also important to isolate at home until your results are back and you have received guidance from a healthcare provider.
Where should I get tested?
The best and most affordable places to get tested in Maine are through the state’s testing sites. For a list of locations, please see here. These sites provide free PCR and rapid testing (at the Portland Jetport, rapid tests are $25). The two challenges I’ve seen with these sites are 1) their poor availability of appointments, which is always changing and 2) there is little to no counseling provided about an individual’s circumstances.
If you have a primary care doctor, I would recommend checking with them since most of these offices are doing testing. They can also provide counseling about your individual situation and risk factors.
There are a handful of independent practices like mine that offer telemedicine counseling and testing for our own patients and outside patients as well. Costs are higher than through the state but availability and turnaround times are usually better.
Other locations like national chain pharmacies and urgent cares will require an insurance card or a waiver from the state of Maine. Urgent care facilities also require a provider visit before testing which may or may not be covered by insurance. Costs can be high and turnaround times vary – I’ve seen from 1-10 days.
Can I prevent COVID? Are treatments available?
There are no known preventive treatments aside from doing the things the public health experts have been preaching for a year: Masking, physical distancing, and handwashing.
If one of my patients is looking for ways to either reduce the likelihood of COVID or treat it if they have it, I recommend the following:
- Optimize your sleep (7-8 hours/night) to keep your immune system healthy
- Manage stress as able – meditate, exercise, declutter your home and professional lives as able
- Eat healthy foods – veggies, fruits, nuts, beans, seeds, legumes, whole grains, some low-fat dairy and occasionally some meat if desired (preferably omega-3 containing fish); minimize sugars (both natural and added) and processed foods to reduce inflammation
- Consider vitamin D3 at 1000 IU daily – there are studies noting a potential association with vitamin D deficiency and COVID hospitalization; there is no causation proven but a moderate dose of vitamin D3 is reasonable for most people
- Consider zinc 15-30mg daily; zinc can help your immune system and a low dose in the 15-30mg range may help and will not create a copper deficiency
Aside from these lifestyle and natural options, I encourage patients to treat their symptoms if they are troublesome: Honey for cough and Tylenol (acetaminophen) or ibuprofen for fever/aches are reasonable places to start.
There are a couple of recently-approved monoclonal antibody drugs but, as an integrative family physician, I’m not comfortable using these yet. Reasons being: they are very new, the studies are not very strong, they are not cheap, they require an IV infusion in a healthcare setting (something we should try to avoid during a pandemic), and they have side effects. I’m always skeptical of new pharmaceutical treatments like these that haven’t been proven to save lives.
- Bamlanivimab – In a trial of 452 patients with mild to moderate illness, the risk of hospitalization was lower, particularly among patients with worse baseline health. No decrease in death was noted.
- Casirivimab-imdevimab – 799 patients received this drug, and the rates of ER visits/hospitalizations were lower (3% drug group, 9% placebo group).
Thank you for reading. If you have questions or concerns about COVID or other health-related issues, please don’t hesitate to reach out to me at [email protected]
Happy new year, and stay healthy!
Ben Hagopian, MD
Maine Integrative Family Care
www.mainefamilycare.com
Dr. Hagopian will be participating in our COVID update webinar on January 27th. Register now.
More Reading
For more tips on prevention, visit Joel Hall’s article, COVID-19: How to Prepare for the Emerging Threat.
About the Author
Ben Hagopian, MD
