Dear Pillar PC Family,
This week I received rapid COVID-19 tests for use at the office and the CDC updated their guidelines concerning the length of quarantine after an exposure to include additional options for consideration. I wanted to share these items with you and discuss how you might be impacted.
The rapid COVID-19 test kits offer us several advantages over the standard PCR send out tests but are not for use in every situation. Understanding the timing of use and the situations in which they are reliable is important. It has been said that ‘bad data is worse than no data’ and no one benefits from a test result they like but is inaccurate.
Rapid Test Basics:
Rapid tests run in about 15 minutes and require only a swab of the front part of the nostrils. The swab is inserted about 1 inch on both sides versus the deep posterior nasal swab for the PCR test. Patients can do their own swab if the technique is validated and observed by a clinician. I will continue to offer COVID testing (both rapid and PCR send out) towards the end of each workday to minimize contamination risk for other patients, the Pillar staff, and myself. Rapid tests are $100 each. Many insurance companies cover out of network testing for COVID. Medicare is a notable exception. Patients can try submitting their invoice for reimbursement, but that is not a guarantee of payment. If you have symptoms suggestive of COVID-19 and need testing, please call us to schedule.
Rapid Test Limitations:
Rapid tests have been validated for use in patients within the first SEVEN DAYS of having SYMPTOMS. This is probably the most important point to make, especially given the new quarantine options. Rapid tests are not designed to be very accurate negative predictors and are not designed to be used after the first week of infection (or exposure). Both the manufacturer and the CDC recommend that negative rapid tests always be confirmed with a send out PCR test. I will continue to offer the send out PCR test at the office. Again, those collection visits are scheduled at the end of the day. Collection of the specimen is $25 (if done at the same time as a rapid test there is no charge as no additional PPE is being used) while the cost of performing the test will be handled by the testing company. They seek reimbursement from insurance carriers and the CARES act. Results come back in about two to three days.
CDC Quarantine Logic:
The CDC continues in its primary recommendation of a full 14-day quarantine for individuals exposed to COVID-19. Studies show that 50% of infections develop within 5 days of exposure while 97% develop within 10-11 days. Shortening the duration of quarantine increases the risk of returning an infected and contagious individual to society, and, therefore, spreading the infection. The change in options comes as an attempt to balance the burden of quarantine with the risk of infection.
Two New CDC Quarantine Options:
First, individuals exposed to COVID-19 can leave quarantine at 10 days (instead of 14) if they meet the same criteria as before, specifically, no symptoms of concern. The CDC continues to recommend a 14-day quarantine, if feasible, to maintain zero risk of spreading the infection. Leaving quarantine at 10 days carries a small, non-zero risk of developing and transmitting the infection. Alternatively, quarantine could end at 7 days with a negative test result. This would require a PCR send out test given the limitations of the rapid tests as discussed previously. Considering that send out tests take a couple days to process, this effectively only reduces quarantine to the same 10-day mark as described in option one. Quarantine cannot be ended prior to 7 days regardless of testing results.
Summary of My Recommendations:
First, if you have symptoms suggestive of COVID-19, which are classically body aches, fever, headache, sore throat, nausea, diarrhea, dry cough, and shortness of breath, typically developing in that order, contact the office for testing and stay home otherwise. We will perform the rapid test if it is in the first 7 days of symptoms and the PCR test if not. A negative rapid test will be confirmed with a PCR test.
Second, if you are exposed to COVID-19, please stay home and out of society as much as possible. Do not go to work, school, church, or a friend’s house for lunch. Smallpox died out when there were no new hosts in which it could live. You will be contagious for approximately two days prior to developing symptoms. I have counseled in numerous situations where individuals who ‘felt fine’ left quarantine only to infect a family member or friend a few days later.
Finally, if you can stay home 14 days, then that is clearly the best option. It offers the lowest risk to your friends and neighbors for transmission and is still the primary recommendation. If you are asymptomatic at 10 days from exposure or asymptomatic at 7 days AND have a negative PCR test on that day, then leaving quarantine could be considered. Please continue to utilize all the standard infection control measures of regular hand hygiene, utilization of masks, and physical distancing.
These are turbulent times and information seems to be flowing in from many directions. The Pillar PC team stands ready to help you sort through the barrage to figure out your best course of action keeping you, your family, and our community safe. We should not act rashly or from individual motives, as Scripture tells us that ‘The plans of the diligent lead surely to abundance, but everyone who is hasty comes only to poverty.’ (Proverbs 21:5)
If I or anyone on the Pillar PC team can be of assistance please reach out.
PS: I’m very happy to report that Marci’s quarantine will end tomorrow and she will return to her normal office schedule next week.
Mark B McColl, MD
Internal Medicine and Pediatrics
Pillar Primary Care, PLLC
“Healthcare without hassles, built for you.”
10437 Hardin Valley Rd
Knoxville, TN 37932