Submitted by Susan Swords, MD
March 16, 2020
"Hold my hand!" I said to my husband as the nurse jabbed a long Q-tip to the top of my nostril and wiggled it around. This past Saturday morning, I was tested for coronavirus.
I am a primary care doctor practicing on the South Shore and watched with alarm over the last few weeks as our federal government minimized the risk of the rapidly spreading coronavirus. I read with fear accounts from doctors in Italy overwhelmed with the sickest patients suffering effects of the coronavirus and woke with panic each night that we were on the edge of a coming tidal wave.
Last week, as I saw numerous patients in clinic, anxiety began to worsen day by day as I suspected we were not testing enough mildly symptomatic patients and the 1st and 2nd degree contacts of known cases to keep ahead of the exploding virus pandemic. I felt helpless as more and more patients fell ill across the state, first a drip and then a trickle, while meanwhile the federal government hindered our ability to widely test (as is needed to keep a highly contagious disease from spreading) with layers of mismanagement.
And then I got sick. First a runny nose, then a cough, then sinus pain and pressure that progressed to a hacking dry cough. Normally, this would be par for the course as a physician and mom of a young child. I made my employer aware of my symptoms and was told it was safe for me to come to work; of note, my employer was advising me based on their most current recommendations from CDC and DPH. I went to work and wore a mask once the cough started mid week. This is a protocol I’ve practiced through numerous winter colds over the years.
A nagging anxiety followed me all week, as my cold symptoms lingered. I told myself it was because I’m pregnant, and being a pregnant doctor in the midst of coronavirus leads to obvious anxieties.
On Friday, March 13, at approximately 5 pm, the Massachusetts DPH released new, relaxed testing criteria for who could be tested. The very first criteria stated that health care providers with direct patient contact and any symptoms of respiratory illness whatsoever should be tested. Even a mild sore throat qualified you for testing. Immediately, I texted the doctor from our practice who was on call for urgent care that weekend. He agreed that I qualified for DPH testing and agreed to see me (and my husband, incidentally, who is also a physician with similar dry cough, at the same time.) The next morning, we masked up before we left the house, 4 year-old in tow (to avoid my elderly mother in law having to babysit). We put a mask on her as well.
I would like to clarify, that I did not specifically suspect I had coronavirus. The odds are that I do not. There are numerous viruses that can cause a respiratory infection with dry cough. However, it is vital that if I do have coronavirus, that I not come in contact with patients, especially sick and elderly, while infected.
And now, I am home, unable to care for patients while my own test is pending. Although, as stated, odds are that I do not have coronavirus, why am I hoping beyond hope that I test positive?
To answer that question we have to review an important and unavoidable fact: Estimates are that 50-60% of the country, if not the world, will get the virus (at this point we develop as a population something called herd immunity, at which point the spread tapers off.) The virus is beyond containment at this point.
Back to me. If I test positive, it means I (like most healthy people under 50) I will have a mild illness. A dry viral cough is something that I’ve had before and can deal with.
Second, if I test positive and my cough subsides, I will know that I may have immunity to coronavirus. This will allow me to resume taking care of patients with some reassurance that my immune system has already developed some immunity to the virus. (There is a lingering question about whether individuals can become re-infected, however, but that has yet to be strictly determined.) More testing will likely be needed to know if I am still shedding virus and whether it will be safe for me to resume patient care. I am not sure about the answers to these questions right now.
If I test negative, I will likely still go back to work, but I will have to live with anxiety about contracting the virus and being one of the few young healthy individuals to have a severe complication. I am pregnant, which puts me at higher risk of complication if I do get the virus. Health care workers in other countries in their 20s and 30s have died from coronavirus, so this is not an abstract threat. I’ll also have to live with the anxiety of contracting the virus and having no symptoms, and passing it along to someone, whether a patient, family member or friend, who might die. That is a big burden.
I don’t have a lot of answers right now, even as a physician. Like the rest of the country, I am taking this day by day. And for now, I’m hoping for a positive test.