March 17, 2020
Know when to stay home and rest, when to call a doctor, and when to get tested
YONKERS, NY–With the growing concerns about the novel coronavirus now spreading rapidly in the U.S., it’s understandable that people who develop a cough or fever might wonder if they have COVID-19, the disease caused by the virus.
“There are going to be many individuals who think they have the disease, even if they’re unlikely to have been exposed and their symptoms are more consistent with other health problems, like the cold or flu,” said Gary LeRoy, M.D., a family physician in Dayton, Ohio, and president of the American Academy of Family Physicians.
Contributing to the confusion is that this is a rapidly evolving situation, where what is known about the disease changes by the day, even by the hour, LeRoy and other experts say.
The result: “Minor respiratory symptoms that otherwise people would dismiss are causing a lot of anxiety,” said Michael Hochman, M.D., director of the Gehr Family Center for Health Systems Science and Innovation at the Keck School of Medicine of USC in Los Angeles.
In addition, testing for the virus is still not widely available, making it difficult for people to know for certain when they are infected.
But at this point, some facts are clear: COVID-19 is a viral respiratory illness, with common symptoms of fever, dry cough, and, sometimes, shortness of breath. These range from mild to severe, and the most serious cases are potentially fatal, particularly in people who are older or have underlying medical conditions.
And like other viral respiratory illnesses, it’s thought that this new disease spreads primarily through close contact with an infected person, through the droplets produced during coughs or sneezes, according to the Centers for Disease Control and Prevention.
“This is definitely a situation we should be taking seriously,” Hochman said. “We shouldn’t dismiss it, but panicking isn’t helpful.” Carefully evaluating your symptoms, risk factors, and known exposure can help you decide when you can treat at home, when you should be tested, and whether you should reach out to a doctor.
Cold, Flu, or COVID-19?
Currently, three respiratory diseases caused by viral infection are circulating in the U.S., according to LeRoy: the common cold, the flu, and COVID-19.
It can be hard to distinguish among them because some symptoms overlap and others can vary substantially from person to person. Still, each of these infections tends to have certain defining characteristics that may give you some helpful clues.
Colds. These viral infections typically come on gradually, according to LeRoy, with runny nose, congestion, sore throat, and cough usually at their worst three or four days after onset. Colds can sometimes also cause headaches, body aches, and fever, but they’re generally milder than those associated with the flu.
Flu. This infection is notable for coming on fast and causing high fever, severe body aches, and extreme fatigue. Often, “it has a very sudden, abrupt onset,” LeRoy said. “It’s like a train hit you.” Occasionally, the flu can cause vomiting and diarrhea, but this is more common in children.
COVID-19. Fever, dry cough, and less often, shortness of breath, are the major tipoffs. According to a World Health Organization analysis of 55,924 patients, people infected with the new virus developed a fever in 88 percent of cases, a dry cough in 68 percent, and shortness of breath in 19 percent. The cough may be persistent, without easing at all throughout the day, according to LeRoy. People sometimes report being unable to catch their breath or to breathe or talk easily, or may feel out of breath after minor exertion, like walking around the house.
When to Seek Testing and Treatment
Most cases of COVID-19 are relatively mild and can be treated at home. And as with the flu and the common cold, there is no cure. While certain antiviral drugs, such as oseltamivir (Tamiflu), can sometimes limit the duration and severity of the flu, those drugs have not been shown to help with COVID-19, though at least one antiviral, remdesivir, is being tested.
Instead, as with the cold and flu, treatment typically focuses on easing symptoms by resting, drinking plenty of fluids, and using over-the-counter pain relievers for fever or accompanying discomfort.
When to pursue testing or get professional medical care can be more complicated, and depends on whether you’ve likely been exposed, the severity of your symptoms, and your age and underlying health.
Here is advice on when to reach out for medical care, based on those factors.
You have no symptoms, don’t think you’ve been exposed, and are at low risk. People in this group who are younger than 60 and in good health don’t need to get tested, Hochman said. Instead, simply practice basic infection prevention protocols. Wash your hands regularly with soap and water for at least 20 seconds, use an alcohol-based hand sanitizer with at least 60 percent alcohol if you can’t wash your hands, avoid sick people, and listen to recommendations from your local health department.
If you are 60 or older, or have a weakened immune system or underlying medical conditions such as lung disease, heart disease, or diabetes, experts also recommend that you try to avoid large gatherings and nonessential long flights.
You have no symptoms but have had contact with someone who has COVID-19. Currently, the CDC does not recommend that you be tested for COVID-19. But check with your local health department to see whether its guidance differs. Monitor your health carefully, and try to avoid public settings—if you can work from home, for instance, do so. It’s especially important to stay alert for symptoms if you are older than 60, immunocompromised, or have an underlying medical condition such as asthma.
You have mild to moderate symptoms but are at low risk and are unsure whether you’ve been exposed. If you fit into this group and are younger than 60 with no other medical conditions, you can monitor and treat yourself at home, Hochman said. Isolate yourself as much as possible, as you would with the flu. You can consider asking your primary care doctor or health department about testing, but it might not be available, depending on where you live. And call your doctor if symptoms worsen.
You have mild to moderate symptoms and are at high risk. If you’re older than 60 or have underlying health problems, contact your health department or doctor to see about getting tested, even if you are unsure whether you’ve been exposed to the virus. But note that testing may or may not yet be available in your region.
You have mild to moderate symptoms and know you have been exposed to someone with COVID-19: Contact your doctor or local public health department to see about getting tested, Hochman advises. Call by phone; don’t just show up at a doctor’s office or other healthcare setting, such as a clinic or emergency room, he said—the staff may want you to take special precautions, such as using an alternative entrance and wearing a mask upon arrival. Otherwise, you may expose others to the disease, or may be exposed yourself by other sick people.
You have severe symptoms: If you have a high fever, a persistent cough that continues to worsen, or shortness of breath that makes it hard to talk, contact a doctor immediately, no matter what your age or risk level. And if it feels like a medical emergency, with significant difficulty breathing for example, call 911, Hochman said. Tell the dispatcher you may have COVID-19 when you call, and if you have a face mask, put it on before emergency personnel arrive.