Imagine you are a middle aged male or female and after four days of lying in bed with a fever, cough, runny nose and general malaise that is nowhere near improving, you decide to go to an emergency room to get checked out. When you get to your local er, you take a number and wait with the rest of the patients in the packed waiting room to be called by the triage nurse. Once she sees you she first asks "Have you travelled in the last four weeks?" You answer honestly , "No". "In the past two weeks, have you been in close contact with a probable or confirmed case of covid-19?" Your answer, "No, I don't think so." "In the past 2 weeks have you been in contact with someone with an acute respiratory illness who has travelled?" Again, "No, I don't think so." The nurse then asks you a few more standard questions, takes your vital signs, listens to your chest and puts you on a stretcher right away. It turns out that you have a high fever and a fast heartbeat so you are transferred into the emergency room and put on a cardiac monitor.

There are no private rooms left in the ER so the only thing protecting you from others is a curtain. The nurse puts you on DROPLET precautions - used when influenza is suspected - and makes sure you know to keep your mask on because you are coughing. She draws some blood, sticks a q-tip in your nose (to test for influenza), gives you tylenol for the fever and does an electrocardiogram on you. You then ask her "will you be testing me for corona?" She replies "no, you don't fit the criteria". You then go for a chest x-ray and return to your stretcher.

A few hours later the er doctor comes to see you and says you have pneumonia and consults both an internal medicine and an infectious disease specialist. Your influenza test is negative and your blood tests are normal except for a slightly elevated white blood cell count. You are put on intravenous antibiotics for the pneumonia and both of these doctors again ask you the same questions the triage nurse did. You are still not tested for Covid-19 as you do not fit the current criteria. You are then admitted to a ward, put in a 4 bedded room for a few days and improve, so you are sent home.

I have seen many similar cases such as this in the last few weeks and they are worrisome because we do not know if this patient had/still has, Covid-19 or not. If the answer is yes, than the curve - rate of infection - all our government officials want to flatten, will likely get steeper. The symptoms for influenza are identical to Covid-19 and the test for Covid-19 is just as easy as it is for influenza so isn't it prudent, in an unprecedented state of emergency, to test for this virus at the same time we test for influenza?

Nathan Friedland RN

Roxboro

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