As covid cases surge, here’s what local doctors advise

If you’re feeling the early signs and symptoms of a respiratory infection — fever, cough, a sore throat, congestion, or even abdominal pain or diarrhea — it might be a good time to take a covid test, local doctors say.

Though the numbers have waned drastically from the early days of the pandemic, covid cases are up in Western Pennsylvania.

In Allegheny County, reported cases have been on the rise since June 9, when 132 cases were recorded. The last week of June saw a total of 218 cases in the county — which
is likely to be just the tip of the iceberg, as most cases are tested at home and not always reported.

According to state data, covid-related emergency room visits are still in the minimal range but were up 22% for the week ending July 6, according to CDC data. Westmoreland County case numbers are not available because the county does not have a health department.

Official CDC protocols for covid-19 changed this year. People are officially cleared to return to work or school if they have been fever-free for 24 hours without medication, and if their symptoms are mild and improving. The CDC also recommends wearing a mask and keeping a distance from people for five days to curb virus spread.

Knowing whether you have covid allows you to avoid contact with people who are high risk, said Dr. Donald Yealy, UPMC chief medical officer.

“We know that covid is a very dangerous infection for those at extremes of age, particularly the elderly, and those whose underlying immune system doesn’t function as well or (who) have underlying conditions,” he said. “It’s important (to know) so that you can modify your behavior, whether that is staying away from people or masking.”

Many health care professionals still follow more stringent covid protocols of staying home for five days after testing positive and wearing a mask for five days after that, said Dr. Amy Crawford-Faucher, a family physician and vice chair of the Primary Care Institute at AHN.

“That means minimizing contact with the people you live with and being away from work and other social gatherings for five days,” she said. “Basically, keep away from people until you’re feeling better. If you’re around high-risk people with living or working, the best thing to do to prevent spread is to wear a mask and to minimize contact.

“It might be overkill in the general public, but, of course, it makes sense in health care that we are being more careful.”

How best to test?

Taking a home rapid covid test is a good idea if you’re feeling symptoms. The tests aren’t perfect, doctors advise, so multiple tests over a few days are preferred.

“If you’re symptomatic and you get a negative test, you should repeat that test in 48 hours, because it may be that you didn’t have enough virus in your nose when you took the test the first time,” said Dr. Carol Fox, chief medical officer at Independence Health System.

The tests can sometimes show a positive result long after you are no longer contagious, Yealy said.

“Their advantage is that they’re readily available and can give pretty good insight into what you can do next,” Yealy said. “A good test that’s easily available sometimes is more helpful in the broad population than the perfect test that’s hard to get to.”

If you can’t determine when the first day of your symptoms was, you can use the first day that you tested positive, Crawford-Faucher said.

“No matter what you have, if it’s a respiratory illness, (it) is going to be contagious,” she said. “The considerate thing to do for your loved ones and the people you work with is to minimize contact if you’re feeling sick.”

Pittsburgh-based Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, said home tests are still useful even for new variants of covid. It’s best to use a fresh test, but an expired test showing a positive result is still a good indication of having covid. False negatives are more likely than false positives, he said.

“The variant has no impact on whether the test is positive or negative,” he clarified. “Home tests are useful for people who want to know their status and people who want to be linked to medications like Paxlovid.”

Testing — whether with a home test or a PCR test from a pharmacy or doctor — can be important if someone is high risk and eligible for Paxlovid treatment, which slows the replication of the virus in your body.

Other factors that make someone a candidate for Paxlovid include being overweight, being over 50 years old and having chronic illness, Crawford-Faucher said, but the range can be broad as to who would benefit from it.

“If someone is 80 years old, I’m going to recommend they take Paxlovid. We know the data on that group is pretty darn good in terms of preventing hospitalization and death,” she said. “If you’re 55 and healthy and have a mild case, I think it’s more a case of personal preference.”

It’s hard to know what the impacts or risks are of repeated infections, and what makes a person more likely to be infected multiple times compared to someone who has been infected once or not at all.

“There’s still a lot not known about the risks of developing long covid, except that we know that never having been immunized seems to increase the risk of long covid,” Crawford-Faucher said. “There’s still a lot we’re learning about this virus, in terms of why some people and not others are prone to reinfection.”

Getting vaccinated or boosted

The CDC recommended on June 27 that people get an updated covid vaccine this fall. Updated vaccines will be available from Moderna, Novavax and Pfizer later in the year, the agency said.

Most people at this point have either had covid at least once, gotten some level of vaccination or both, Crawford-­Faucher said. Updating the vaccine to match current variants gives additional protection.

“The role of vaccines has always been to minimize the risk of severe infection and death,” said Crawford-Faucher. “People are still dying from covid. Not with the numbers that we saw in 2021, but it’s still happening.”

Vaccination may not prevent all infections, but it helps make infections less severe.

“It’s not a force field to protect you from any contact with the virus,” Yealy added. “It just means when you come in contact, you’ll fight a better battle.”

Some individuals may have had covid without realizing it, Adalja said.

“Some people may have very mild illness and not even notice it, and some people may not have any symptoms at all,” he said. “You would only know that they have been exposed to the virus by looking at specific antibodies, and most people don’t get those tests done.”

People are still occasionally coming into the hospital with covid, Fox said.

“When people visit and come for things, we do ask them if they have respiratory symptoms. … If they say they do, we want to segregate them from other individuals,” she said. “We don’t do routine testing, but if people have respiratory symptoms, if you present to the emergency department with respiratory symptoms, covid is part of the differential diagnosis.”