Hi, I’m back as Robin-Schoenthaler-the-Boston-cancer-doctor-who-writes-missives- about-Covid.

(And yes, feel free to share.)

Today I’m talking about Testing and a bit about Our Young Adult Children.

Massachusetts is still okay. We saw our numbers go up in March, we shut down, cases and deaths slowly declined, we reopened in a stepwise fashion in May/June/July and numbers have stayed low. Cases will creep up this summer, but hopefully as expected.

A lot of the rest of the country is in the soup. They had low or rising numbers, they opened up, their numbers went gigantically up. If they didn’t shut down or pull back drastically, there is no end in sight. So there is so much anguish in so many many places.

A huge huge HUGE part of managing all this is testing.

First off, let’s be clear: why do we do testing at all? To help treat sick people, yes, but a huge part of the reason is to keep contagious people at home. If contagious people stay at home, the buck stops there; problem solved.

There’s a lot of testing going on in Massachusetts right now including eight places where you can get free swab tests even if you’re asymptomatic. (In other parts of the country, lamentably, it’s still hard to get tests, or the chemicals in the tests, or even the swabs. Sigh).

The science of testing has improved greatly. As a reminder, there’s two general kinds of tests:

swab (for virus, to show if you HAVE the virus, ie, to see if you are infected and contagious after exposure)

blood (for antibodies, to show if you HAD the virus in your body)

Two caveats about antibody testing:

— this is not the right test to see if you are currently contagious

— some early tests were super lousy, the current tests are better

But: no medical tests are perfect. Ever. Mammograms have false negatives. Colonoscopies can have false negatives. You can even have false positives for syphilis! (Good luck explaining that to your spouse, though.)

False negative swabs in Covid— where the test is negative but you actually do have Covid right that minute — are a vexing issue but this is the nature of viruses: they take a while to build up in our bodies. The swab tests can’t always detect them early on.

It turns out waiting a bit after exposure gives you the highest chance of an accurate test.

Your “best” results (highest likelihood of getting an accurately positive test) is 5-8 days after exposure or around day three of symptoms.

Real Life Example One: Sunday night you have dinner at an inside hightop table of your favorite restaurant — the one that plays 60s R&B really loud — with your beloved gal pal. She has buffalo wings that are so spicy she keeps yelling “Whooooo, baby!” and leaves her grody napkins all over the table but you love her anyway. The next day she gets tested for work and OMG she’s positive.

What does this mean? It means:

  1. It means she was contagious when you had dinner.
  2. She was probably contagious for the last few days and she should alert her friends and family.

3)  She should stay home self-isolated for ten days even if she doesn’t get symptoms.

4)  You are now at high risk to have Covid because you were inside, you were close to her, she was yelling, and maybe because of her napkins. You also need to self-isolate.

5)  It does NOT mean you should get swab tested for the virus that night. If you wait at least five days the chance of a false negative will be smallest: you need time for the virus to multiply inside you to the point where it’s detectable.

6) It means next time you go out with a friend you will eat outside on a quiet patio at a big table, or just take the dang wings home.  I personally am not eating inside a building for the duration, period.

Real Life Example Two: you start to feel achy and “off” on Monday so you stay home. On Tuesday you work from home, on Wednesday you spike a temp and have a headache. Should you have gotten swab tested for the virus on Monday?

Probably not; the false negative rate on Day One of symptoms is around 40% but that’s cut in half to 20% by Day Three.

What does this mean?

1) It means if you go in as soon as you get a symptom, and then the test is negative, you should not consider it an absolute negative. If you stay sick — particularly if you get sicker — you need to stay in touch with your doctors and go get another test.

2) It means you did good because you paid attention to your body and you paid attention to society and you STAYED HOME when you didn’t feel well. Good job!

3) It means you need to continue to stay home for ten days after symptoms start as you remain contagious during that time. (Please note that this can be longer if you have severe Covid (eg hospitalized) or are immunocompromised).

What do you think will happen if you go get tested three weeks later? Will you be negative? Yes, most of the time. The infectious virus has left your body.

But what if you are positive after three weeks? Does this mean you are still contagious? No. This most likely means there are pieces of covid RNA still in your nose, but no real, live, healthy, intact, whole, and most importantly CONTAGIOUS corona viruses.

Positive tests after ten days do not seem to mean you are contagious.

Could you get re-infected? We don’t know but it doesn’t look ominous right now. There’s a lot of newspaper/internet articles wondering about it, but so far there have only been a tiny handful of medical articles where re-infection looks genuinely possible. I’m not (yet) worried about immediate reinfections.

Can you stay symptomatic? Yes, absolutely, and the more severe the symptoms you have when you’re sick, the more likely you are to have lingering symptoms. This disease is only seven months old so we’re just starting to get the earliest handle on this.

Okay, that’s it for testing for now.

I just want to include a note about the wonderful young adults in our lives who have gone back out into their worlds of work, recreation, social outings. Most of them in Boston have done so safely and charmingly and they are just as concerned about their elders as we are.

The important thing is to not let your guard down around our young adult children. We love them so and they look like the picture of health and vigor and it’s so hard to imagine we can’t hug them or pull down our masks.

But the reality is they are the ones who are spreading this now, often asymptomatically and completely unwittingly. At the start of this it was people from other countries or conferences or front-line workers but now it’s us, our hard-working youth and our loved ones.

Sometimes we can feel so powerless in the face of this virus but the reality is we are stronger than we think. All we need to do is follow the science and do what it has taught us: if we mask, stay physically distanced, stay home when sick, and wash our hands, the transmission buck will stop with us.