As we continue to progress with increasing vaccination rates against COVID-19, we will see the gradual reduction of contact precautions and an increase in social contact outside of the home. Also, the upcoming spring weather will be associated with an increase in allergy symptoms. Both of these factors will cause an increase in the number of patients who need to be assessed for COVID infection and ultimately receive documentation to return to school and athletic activities. This documentation will require our doctors to assess the likelihood of COVID infection being present and to perform a physical examination to help assess whether the patient is able to be in public.
Please remember, that the CDC still recommends persons having COVID symptoms OR a positive COVID test should isolate for at least 10 days from the start of their illness. The isolation should continue until a person is: at least 10 days from the start of the illnesss; is fever free for 24 hr off medication; and has had at least 3 consecutive days of improving symptoms. Because the majority COVID cases are either asymptomatic or involve only mild symptoms, this approach will help to significantly reduce the spread of COVID in our community.
There is presently no uniform guidance on testing for school, work, sports, and travel clearance. Our doctors recognize that there are circumstances where patients have illness symptoms which are not related to COVID. Though there are multiple factors to consider in every case, our doctors will generally follow the protocol below when deciding to document whether a patient can return to public activities:
- All patients presenting with a primary symptom of COVID: fever, shortness of breath, significant cough, loss of taste or smell, chest pain, or diarrhea will require a 10 day quarantine before being considered for clearance; even if a COVID PCR is negative (fever will be considered rectal/oral temp greater than 100.3 deg F; diarrhea will be considered more than two watery stools for two consecutive days).
- A patient presenting with symptoms of illness that do not include one of the above primary symptoms of COVID can be considered for clearance if there is a negative COVID PCR test (*immediate testing is now endorsed, no waiting time is necessary); AND there is no fever for 24 hr off medication; AND there are at least 3 days of improving symptoms. If the COVID test is done outside of our office, the the patient should wait to be seen until these criteria have been met.
- A patient who has had no symptoms but has had a significant COVID exposure (being within 6 feet of a COVID + person for at least a total of 15 minutes in a 24 hr period) needs to follow CDC recommendations and quarantine for 10-14 days (CDC guidelines allow doctors to consider ending a quarantine period after 10 days without testing or after 7 days with a negative test obtained on or after the 5th day of illness). If this patient requires a doctor's evaluation to obtain a note to return to public activity, then the patient needs wait until his or her quarantine is over before being seen in our office.
- A patient who has tested positive for COVID, had mild or no symptoms, and is planning to return to competitive sports will require an in office examination prior to receiving written documenation for clearance. The patient should not exercise until cleared by a physician, and the visit should not be scheduled until the patient has met the following criteria:
- at least 10 days from the positive test (needs to provide documentation of test date if done outside of our office), AND
- at least 24 hrs symptom free off fever-reducing medication (acetaminophen, ibuprofen, naproxen)
- A patient with moderate symptoms of COVID (4 or more days of temp >100.4, myalgia, chills, OR lethargy; hospitalization for COVID like symptoms) will require referral to a cardiologist to receive clearance for sport once they meet the criteria outlined in (4).
Since every case will not neatly fall into one of these categories, our doctors will use their best clinical judgement to fully assess all patients to determine when clinical factors make it safe to allow an individual to return to public activities. We appreciate your cooperation and ask that you regularly visit our page outlining our general office procedures during COVID to keep up to date with what we require for safe interaction with our office during this challenging time. Also see specifically how we will evaluate patients with symptoms of illness in our office.
(Originally created 11/24/2020)