Can We Stop Testing for COVID?
Which testing guidelines make sense in a post-pandemic world?
Every winter, viruses such as influenza, respiratory syncytial virus (RSV), parainfluenza virus, adenovirus, human coronaviruses, rhinovirus, human metapneumovirus, and others cause hundreds of thousands of people in the United States to be hospitalized and tens of thousands to die.
What should we do now for people who have congestion, cough, sore throat, runny nose, fever, muscle aches, and joint aches—all symptoms of COVID as well as these other winter viruses? As of 2023, the CDC recommended that the following people should be tested for COVID:
• Everyone with respiratory symptoms. If positive, patients should be isolated until they are symptom free and no longer testing positive.
• Everyone who is exposed to someone known to have COVID.
• Everyone who will soon encounter someone at high risk for severe COVID.
Most people no longer follow these recommendations. What makes the most sense now that the pandemic has subsided?
If you have symptoms of a respiratory viral infection, and are in a high-risk group, test for COVID. If you have COVID, take Paxlovid or remdesivir early in the illness. This will dramatically lessen your chance of suffering severe disease. If you aren’t in a high-risk group, don’t test for COVID.
During the pandemic, many people felt that if they had respiratory symptoms but tested negative for COVID, they could go about their daily activities as before, reassured that they weren’t spreading a harmful virus. This doesn’t make much sense. Other winter respiratory viruses can be similarly deadly. For example, every year in the United States:
· Influenza causes 140,000 to 800,000 hospitalizations and 12,000 to 60,000 deaths—100-200 of those deaths occur in children.
· RSV causes 150,000 hospitalizations in children and 100 to 300 deaths. In the elderly, RSV causes between 60,000 to 120,000 hospitalizations and 6,000 to 10,000 deaths.
· Parainfluenza virus causes about 50,000 hospitalizations in children.
In other words, you don’t have to have COVID to be sick or to die or to transmit a virus that could harm or kill others.
As COVID hospitalization and death rates are now approaching the rates of other viruses, wouldn’t it make sense to treat them all the same? Given this, I recommend that if you have symptoms consistent with a viral respiratory tract infection such as sore throat, congestion, cough, or fever, and you aren’t in a high-risk group, don’t test for COVID. Just assume that you have COVID or one of these other respiratory viruses and stay home until you no longer have significant symptoms, especially fever. If you can’t stay home, wear a mask until your symptoms are mostly gone; and do the same for children who can wear a mask. With all of these viruses, the majority of individuals shed infectious virus for up to five days, but the most contagious period is within the first few days. For those who can’t or won’t wear a mask, keep them home until they are significantly better.
This is the best way to lessen the burden of all these terrible diseases. This approach would mean a dramatic change from what we have been doing thus far. But it makes more sense than treating COVID differently from these other infections when all can be harmful
I like this. We are back to suffering an epidemic of “presenteeism” as people go to work and children to school with “just a cold.”
The worst I’ve seen recently was a family of 5 who got floridly ill at Disney, decided not to test because they had to make the plane, wore no masks despite febrile illnesses, and only tested for Covid when they got home.
They were all positive, and we can assume the ripple effects extend well beyond the passengers on the plane, 95% of whom did not mask, or found respirators too burdensome.
Except that non high risk individuals are also susceptible to long covid and could therefore benefit from taking Paxlovid, which would mean testing. Also, for those of us who are truly high risk, Covid is more than just another upper respiratory infection. A test confirming Covid therefore would at least alert those infected to take even further precautions for the benefit of those who are at higher risk. Too early to treat Covid like just another respiratory infection.