Assessment of COVID-19: Practical Questions and Insights for NPs and PAs

Assessment of COVID-19: Practical Questions and Insights for NPs and PAs Posted By:
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How long should people isolate when they test positive for COVID-19?
The CDC recommends that one should stay home for at least 5 days following a positive COVID-19 test and isolate from others within the home. If you are asymptomatic or symptomatic but improving (and you are fever free for 24 hours without the use of any fever-reducing medications), you may end isolation after Day 5. However, if you are symptomatic and symptoms are not improving, you should continue to isolate until your symptoms are improving and you are fever free for 24 hours without the use of any fever-reducing medications. Either way, it is important to wear a mask after ending isolation through Day 10.

Can you initiate COVID-19 treatment for patients based on symptoms alone, or do they need to have a positive COVID-19 test?
It is best if the patients have a confirmatory test because many symptoms of COVID-19 overlap with other respiratory illnesses, such as influenza and respiratory syncytial virus. In our emergency department, we have seen several patients who thought they had COVID-19 but were found to have acute HIV infection. COVID-19 at-home tests are readily available and take 30 minutes or less to administer.

What would be your next step in managing a 68-year-old patient who had a positive COVID-19 rapid antigen test, was treated with a 5-day course of nirmatrelvir plus ritonavir, and is now experiencing viral rebound symptoms and retests positive for COVID-19?
It is not unusual for patients to experience viral rebound whether treated or not treated with a COVID-19 antiviral agent. Although many patients report a reduction in COVID-19 symptoms after starting antiviral treatment, some patients continue to have symptoms despite treatment, and others have recurring symptoms after treatment. In a patient who was just treated for COVID-19 and now tests positive again, this is part of the natural history of the SARS-CoV-2 infection, and we should offer supportive care such as resting and staying well hydrated.


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Filed under: Infectious Diseases , Public Health , NPs & PAs

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