agforlife97 said:
Dr. Not Yet Dr. Ag said:
JimInBCS said:
That's astounding to me that the Pediatrician wouldn't test them after having significant exposure to you, if for no other reason than to quarantine in case of positive. Perhaps he/she recommended quarantine anyway, which would perhaps explain not testing.
There is really no point in testing asymptomatic or really even symptomatic individuals that don't require hospitalization who live with someone that tested positive. They have already been exposed and almost definitively have it. If they test negative, it is highly likely to be a false negative, so the test loses all its diagnostic value, and now becomes dangerous as a false negative falsely reassures patients that they don't have it. Just assume they have it and treat as such. Now if there is diagnostic uncertainty as symptoms could be explained by an alternative infection, then sure, test.
People tend to put too much value in tests. It seems I get yelled at daily now for telling people I can't test them due to lack of ability to test patients not requiring hospitalization.
What is the criteria for hospitalizing someone right now in San Antonio? Has the criteria evolved since the first cases happened back in March?
Entirely up to the ER doctor's discretion. My thought process generally goes like this when I have a suspected case: 1. What are their vital signs? (O2 sat < 92% is essentially an automatic admission for me). 2. How do they look? (If they appear to be in significant respiratory distress that isn't clearly due to a panic attack, they will likely require admission). 3. What are their age and risk factors? (Generally don't do any lab work, imaging, or testing if they are young, healthy, and have no hypoxia, tachypnea, or significant tachycardia). 4. What do the labs show? (If I decided to do labs, as labs really are not as important as how the patient appears and their vital signs, but might push a borderline case into an admission if there are significant abnormalities like evidence of end organ faiiure, markedly abnormal inflammatory markers, or other concerning abnormalities).
I modify my cutoffs for admission based on risk factors. I'll discharge a 24 year old with O2 sats of 94%, but a 72 year old on chemo with an O2 sat of 94% with a positive test is at minimum getting labs, and is very likely to get admitted unless everything looks perfect or the patient is requesting that I do all that I can to keep them out of the hospital. This is all fluid; however, given that if we no longer have beds available, we will need to limit who needs to be admitted, which is a point that we are getting dangerously close to.
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