They are 24 and 21, respectively, and healthy, co-habitating college graduates with good jobs. And they got sick. Both, off-set by just a few days, developed a dry cough and runny nose. Three days into their illness they developed a fever of about 100 degrees.
They called to ask if they had COVID. I said unlikely, to 0% chance. They said, how do you know? I said, you are young and have no exposure. No one at your job site, no one in your county, and only 3 have tested positive for COVID in your entire state. Both of you are breathing normally. Neither of you have been out and about. Don’t worry.
My explanation seemed to suffice. I told them to stay home so they don’t spread what ever they had and gave them some ideas for symptomatic treatment. They called later during a sojourn to Chipotle as they hated being cooped up all day. They said they felt better, so they decided to get out.
The next day, they called again. Their fevers were worse. I said, “Keep the temperature down and stay inside”. Also, don’t go to work. But, now they were worried. They were sure they had COVID. I said if they are really that worried, call their docs and see what they say. Docs have checklists and if you fit the criteria they may want to test you.
They called the doctors office and a nurse called back. The nurse was concerned. She said they may have COVID, but would ask the doc and call them back. Panic set in while they waited for a call, and one admitted they became anxiously short of breath after the call, confusing the history of illness.
The nurse called back and said the doctor did not think they had COVID or that testing for that was warranted. He did say, though, that they may have flu. If COVID is a concern, they were to stay away, but now, with flu a possible diagnosis, they were asked to come to the office to be tested for flu.
They called me, again. They asked if they had flu, but already were heading out to test. I said, “Why do you need the test? You are getting better and you can work from home, so there is really no good reason to know. Besides, you are going into a sick environment, or you may bring flu to the office”. What if the doc is wrong and it is COVID-19 rather than the flu? I joked, “For $15 I will tell you that you have the flu”. They laughed and said they just wanted to know.
So, off they went to the office. The flu test was negative. However, now, given the negative test for flu, the doctor told them they should call the public health department to get their view of COVID-19. After a call that allowed them to leave a message, they waited for a call back that came 4-5 hours later in the day. The public health department caller had been swamped with potential COVID-19 calls and then told them that the department does not deal with COVID-19. Instead, they were given the number for a hotline, and they started calling. They called four times and got only a ring, or a message. The next day they tried again. No answer came after three more calls.
Then, they called me back. It was Friday and they had a plan. They were getting better, still coughing, but without fever. They reasoned that even if it was COVID-19 they were in the clear for serious clinical outcomes and asked if they should go back to work on Monday. But, what about a 14-day waiting period? If you feel you have COVID-19, you should not go to work.
Both said they were good enough to go back despite a lingering minor cough. So, they went, soon to be sent home by policy, not symptom isolation, for the next 14-days.
I love this story; smart people who are ill but find it hard to stay at home should they have only a minor cold. In fact, I would bet that if COVID-19 were not a concern this scenario would have played out differently. They would not likely have called the physician and, instead, let the illness play itself out. The COVID=19 worry , also, must not have been that strong as it did not keep them in the home. Two visits outside the home, food and physician office, followed. Voluntary isolation under conditions of uncertainty may be difficult to maintain.
Note the confused stance of the medical system; stay home if you think it is COVID-19, but come in if it seems the flu. Neither illness, by the way, has useful treatments. But, checklists and telephone calls are not gold standard tests. Why call in someone for a flu test if COVID-19 might be the culprit?
The public health call was interesting. The physician thought that was the outlet for information and further decisions regarding testing. It was not. Then, the hotline failed as well. This story, in case you are wondering, did not occur in rural Rankin, Michigan where I grew up, but a major, mid west town renowned for information technology and a winning football team. This entire failed scenario cannot be blamed on lack of knowledge, resource or communication.
If we think, even for a moment, we will ever know the extent of the COVID-19 experience, or even what we should do with it, we are living a fantasy. If we think more testing is the answer (BTW: some data suggest 50% false positive tests), we are not thinking correctly.
I hope our response to this threat informs us for the next one we see. This is not the first or last, and likely not the worst. I hope that if there is something positive that comes from this event it is a more reasonable social, public health approach to such epidemics. But, for me, the most important interpretation of this story is that panic is not good public policy
