Greetings to our patients and families.
We have seen an increased number of patients coming in for testing of COVID19 after the holidays of Thanksgiving, Christmas and New Year. We have also received a number of calls about testing after exposure to COVID19. So I would like to try to explain our policy for testing. First, a little background information is perhaps a bit helpful to understand our policy.
The most likely time for a person to develop symptoms after exposure is in the period of 2-7 days after exposure, but rarely someone can develop symptoms after 7 days, so current guideline about the duration for quarantine after exposure to someone with COVID19 is 14 days. Most people (80-90% of adults, 90-99% of children) who have mild symptoms will recover after 10 days, and that is why the guideline for patients who test positive for COVID19 is to stay in quarantine for 10 days. Viral shedding has been documented to continue in some patients up to 6 weeks. So for patients who come out of quarantine, wearing a mask is still recommended.
The purpose of testing for COVID19 is to find out if a person has the infection and therefore potentially infectious to others. If a person is already in quarantine due to exposure, he is not going to spread the infection, and therefore he does not need to be tested in the quarantine period. If a person is coming out of quarantine at the end of 14 days, he may need to get tested to see if he may be an asymptomatic carrier, per school or work requirement. Getting tested in the middle of a quarantine period (e.g. 1-4 days after exposure) while asymptomatic does not help that patient or anyone else, as he still needs to remain in quarantine. We had tested some patients in that situation and tests had come back negative, and then a few days later, the patients developed symptoms consistent with COVID19. The tests we did on those patients were therefore falsely providing a sense of relief and wasteful in retrospect.
We have only a limited number of test kits. We need to ask ourselves whether a test result, positive or negative, will affect care for a particular patient or any contacts of the patient.
Therefore our policy is to limit the test, restricting it to 1. patients who have symptoms that are possibly due to COVID19; 2. patients who are at the end of a quarantine period, and only if their schools or workplaces require a negative test result to return.
Beyond these two categories of patients, there may be patients who have “extenuating” circumstances and want to be tested. These patients will be referred by our front desk staff to speak to a physician first before scheduling a visit for testing. For any patient or parent who do not agree with our policy, there are free test sites that the state runs. One can find them by googling “Stop the Spread” online.
The COVID vaccines are being administered to health care workers in the Phase One of the state vaccination program. Some of our staff (myself included) have received them already and will get the second dose 1 month later. The general public (adults) will be vaccinated in Phase Three in the Spring. Clinical trials in children 12 years and older are being done for the Pfizer and Moderna vaccines before they can be approved for mass immunization. My hope is that children will be vaccinated this summer. So there is light at the end of the tunnel. Happy New Year.
Tien-Lan Chang, M.D.
Pediatric Associates of Malden