covid-19 testing

COVID-19 Testing

Hot Off the Press – COVID-19 Testing

 

“I’ve been exposed to Covid 19!
What should I do?”

 

First, contact your own doctor for specific advice.

We are your child’s doctors and the following guidelines are only meant as interpretations of the CDC’s
guidelines and the Texas Department of Health guidelines to address the overwhelming number of messages
and calls we have received recently. https://dshs.texas.gov/coronavirus/testing.aspx
These guidelines should not be used in place of your own doctor’s medical advice.
In addition, special guidelines apply for health care workers- contact your employee health dept for guidance.

Guidelines for action to be taken in the event you are notified of a Covid-19 exposure:
1. Find out if the Covid-19 contact actually had a positive test by PCR*.
2. Determine when your last contact was with that person, how close of contact (masks in use?) and if
the person was sick (with symptoms) at the time of your direct contact.
3. Stay home and self-quarantine** for 14 days from the last time of your close contact with any
symptomatic Covid-19 positive person if masks (both persons or N95 and eye protection for you) and
social distancing were not fully observed at the time of contact.
4. Self-Monitor** for symptoms in yourself and your child:
– Check daily temperature (100.4 is fever)
– Monitor for symptoms: sore throat, headache, cough, congestion, vomiting, diarrhea, shortness of
breath, chest pain, fatigue.
5. If you or your child develop symptoms, you and your child should be tested* or self-quarantine under
your doctor’s specific instructions and close virtual care.
6. After 5-7 days of no symptoms, if you would like to be tested, you can* or you can continue to self-
quarantine until Day 14 of no symptoms. Do not test before 5-7 days from exposure, if you do not have
symptoms. The test could be false-negative.
7. After 14 days of self-quarantine, if you have no symptoms, release from quarantine.
8. Continue to use safe practices of social distancing, mask wearing when indoors, frequent hand washing
especially before eating and around bathroom breaks. Avoid crowded places like indoor restaurant
eating since a mask cannot be worn while eating. Children over 2 years old can safely wear a mask.
* PCR testing by nasopharyngeal swab when symptomatic is the most accurate method of diagnosis of the
SARS-2 virus (Covid-19 infection). See more on test types below.

**Self- Monitor vs Self-Quarantine:
Self-Quarantine means to isolate from all persons with whom you were not already in direct contact with at
your own home prior to exposure. It means strictly staying home, mask wearing, keeping distance, and good
hand washing. It is for 14 days as long as you do not develop any symptoms of illness. If you are already ill,
then you should also isolate yourself to one room and a separate bathroom as feasible and stay confined until
you have NO symptoms for at least 10 days, confirmatory negative covid-19 test or as instructed by your
doctor. People who have symptoms of Covid-19 while under self-quarantine should seek virtual care from their
doctor and use the ER if symptoms are rapidly worsening or as instructed by their doctor.
Self-Monitor means check your temperature every day and monitor for any signs of illness. In an infant who is
not verbal yet, those signs may be sleeping longer, eating less, crying more. Other signs can be fever (100.4),
fatigue, cough, congestion, sore throat, headache, vomiting, diarrhea, or shortness of breath (normal respiratory
rate in an infant is 40-60 breaths per minute).

Testing Methods:
PCR testing it is the gold standard for diagnosis of Covid-19 infection. It can be done by nasopharyngeal swab
(collected by health care worker) and tested for multiple genes (Quest and other commercial labs) or by nasal
swab (self-administered) and tested for a single gene (local Walgreens and clinics).

 

The PCR test on a nasopharyngeal swab (collected by doctor) sent to Quest or other commercial labs takes
3-8 days for results and is 99% sensitive and 99% specific. It is the gold standard for diagnosis of Covid-19
infection. This is the method we use for our patients.

The PCR test on self-administered nasal swabs (Walgreens or home testing through LabCorp) is 99%
specific, but can have up to a 20% false negative rate. It only takes 24-72 hours for results. We advise this for
parents of our patients who do not have a regular doctor to consult, but would need to be tested. Local Urgent
Care facilities can also see patients who have symptoms and need evaluation and testing.

Rapid Antigen testing by Nasal Swab at local labs is not PCR, but simply a test for detecting presence of the
virus. If there is not much virus to detect or the swab is not collected very well, it can give a false normal result.
The advantage is fast results- available within 15 minutes. When positive, you can be sure that you DO HAVE
infection by the SARS-2 virus which causes Covid-19. When negative, it really does not mean anything at all,
and you should consult with your doctor.

Serology testing (blood tests) are for IgG antibodies. CDC does not recommend IgG tests for people without
specific guidance from their doctor.

We order IgG tests for SARS 2 virus only under the circumstance that a child has symptoms or signs of Covid
19/MIS-C and it is too late to obtain an accurate nasal swab or the initial nasal swab is negative and we highly
suspect the illness.
PLEASE DO NOT contact us with requests for antibody testing if your child does not currently or recently have
symptoms of Covid 19 (cough, fever, congestion, shortness of breath, diarrhea, vomiting, sore throat) and
symptoms or MIS-C (extreme fatigue, concerning rashes, fevers 101 or more for > 24 hours, mouth sores,
swollen glands, persistent cough).
EVERYONE wants to know if they could possibly have had Covid-19, and if they have protective antibodies
against SARS-2, but unless Houston is selected by the government as a surveillance community, that type of
testing is not available. We will not order SARS- 2 IgG tests for “reassurance” only.

Some camps are requiring Covid-19 PCR nasal swab for camp attendance.

Please notify us if your child
needs such testing as we prefer to collect the sample 10 days before the deadline date since Quest can take up to
8 days for results. IgG testing is not performed for camp attendance reasons.

Covid-19 Contact Scenarios:

Contact has a positive serology (blood test) for SARS 2 IgG, has no symptoms and negative PCR nasal
swab – No increased risk to you. Continue usual social distancing, mask wearing and hand sanitation
techniques.

Contact is remote- a friend of a friend tested positive for Covid 19 by PCR:
– If YOUR friend has no symptoms and has been tested at Day 5-7 from the contact and negative results- No
increased risk to you.
– If YOUR friend has self-monitored for 14 days and has no symptoms- No increased risk to you.
– If YOUR friend has symptoms, they should get tested or self-quarantine until symptom free for at least 10
days. You should avoid contact with that friend during that time frame.
– If YOUR friend is tested and positive by PCR, you should self-quarantine for 14 days from your last contact
with the friend. Get tested if you develop symptoms OR if you are still without symptoms at Day 5-7 from your
last direct contact with the Covid 19 positive friend, consider testing. Do not test before Day 5-7 of quarantine if
you have no symptoms. There is a high rate of false negative tests in that situation.
– If YOUR friend has symptoms, but was without symptoms the last time you had direct contact with them
AND decides to not test- you should self-monitor, but you do not have to quarantine or test. You should avoid
contact with the friend until they are symptom-free for at least 10 days.
– If your friend has symptoms and decides to not test AND you were around your friend while they had
symptoms – You and your friend should both self-quarantine separately. If you develop symptoms, you should

either continue to self-quarantine until you are without symptoms for 10 days OR you should pursue testing. If
you have no symptoms at the end of 14 days, you should avoid contact with the friend until they are symptom-
free for at least 10 days.

Contact is my child’s daycare teacher- If the teacher had direct contact with your child, stay home and
monitor for symptoms. If no symptoms develop by Day 5-7, consider testing at that time or continue to stay
home and monitor until Day 14 from last known contact with the teacher. If your child has symptoms, notify us
through OhMD to review symptoms and schedule testing.

Contact is a teacher at my child’s daycare, but not my child’s teacher– If the school remains open, you can
continue to send your child. Monitor for symptoms. No need to restrict or test unless symptoms develop or the
school notifies you that there was confirmed direct contact with your child.

Contact is a playmate/classmate of my child– If your child had close interaction with the positive contact, stay
home and monitor for symptoms for 14 days or consider testing at Day 5-7 from last contact if still
asymptomatic. If your child develops symptoms, notify us through OhMD to review symptoms and schedule
testing.

Contact is my house cleaner– Require the house cleaner to show proof of negative test or doctor’s note once
symptom free for 10 days before returning to work. Stay home and avoid close contact with others for 14 days.
Monitor symptoms in your family for 14 days. Test if symptoms develop.

Contact is my child’s nanny – Since the nanny has direct contact with your child, self-quarantine and monitor
for symptoms for 14 days. After 5-7 days, if there are still no symptoms, consider testing for your child OR
continue the self-quarantine for 14 days. If symptoms develop, notify us by OhMD to review symptoms and
schedule testing. For Nanny to return to work, it will be necessary that a negative test is confirmed or a doctor’s
note clearing Nanny for return to work after 10 days of no symptoms.

Contact is on my child’s sports team– If your child played on the same sports team directly with the child who
tested positive by PCR, self-quarantine your child for 14 days. If symptoms develop, contact us through OhMD
with the symptoms and to set up testing. If no symptoms develop by Day 5-7, you can either test your child or
continue the quarantine until Day 14 of no symptoms.

Camp notified me that someone tested positive for Covid-19 and was at camp the same time as my child- You
might not be able to find out if the positive camper was ill while at camp (symptomatic or asymptomatic) and if

the camper had direct contact with your child. Since that information may not be known, self-monitor your
child closely with daily temp checks and try to stay home as much as possible for 14 days. If you are informed
that is was actually a camper in your child’s cabin (direct contact), strictly quarantine your child for 14 days. At
Day 5-7 from the time your child arrived home form camp, if there are no symptoms, you can either test your
child or continue the self-quarantine until Day 14.
Some camps are requiring Covid-19 PCR nasal swab for camp attendance. Please notify us if your child
needs such testing as we prefer to collect the sample 10 days before the deadline date since Quest can take up to
8 days for results. IgG testing is not performed for camp attendance, not even for “reassurance.”

Coworker tested positive for Covid-19- If you have direct contact with the co-worker and the co-worker left
work sick (symptomatic), self-quarantine at home for 14 days unless you were wearing PPE (N-95 or both
wearing regular masks) and doing strict handwashing. If the co-worker was asymptomatic at time of exposure
and PPE and hand-washing was observed, self-monitor. If you develop symptoms, contact your doctor for
evaluation and testing. Your child does not need testing unless you develop symptoms or you have a positive
test.

Frequently Asked Questions:
What is my child’s blood type? Blood types are not routinely done on babies, but it may have been done at the
birth hospital. If it was done, you can look in your child’s baby book or medical records for the blood type on
the discharge summary. There is NO reason to have your child’s blood type drawn unless surgery is anticipated.
Blood type testing is by venipuncture and we do not run blood types through our office. You should not make
decisions about your child’s activities based upon blood type.

Where can I get tested?
https://dshs.texas.gov/coronavirus/testing.aspx
Where can my child get tested?
If your child has symptoms, we will evaluate them. If there is not another reason to explain their symptoms, will
collect the sample and send for testing. Tests require 3-8 days for results.

I want to get antibody testing for my child. Can you do that?
If your child does not have symptoms or signs of MIS-C, we are following CDC guideline and we are NOT
drawing blood for antibody testing. Refer to the testing section of this document for more explanation.