You Have A Fever And A Dry Cough. Now What?

If you or someone in your household is sick with a fever and cough, you may be dealing with another symptom: the fear that you have coronavirus.

What are you supposed to do?

First of all, don't panic. Remember that it's still flu and cold season in the U.S., and seasonal allergies are starting up, too. Unless your symptoms are getting dramatically worse or you feel short of breath, you may not need to seek medical treatment (though it's OK to call your doctor and ask).

The second thing to know is that coronavirus testing is still limited at this point. Unless you're really sick, you've had contact with someone known to have COVID-19, or you've recently traveled to an area where there's a known outbreak, you may not be able to get tested to find out if you have coronavirus or something else.

In fact, even if you have traveled to an affected region, you may not be able to get a test. That's what happened to Shapri LoMaglio, a Washington, D.C., resident who returned last Wednesday from a nearly monthlong stay in Italy. When she got back to the U.S., airport signs told travelers to call their doctors if they started experiencing cold or flu symptoms.

When she woke up Sunday morning with a dry cough and congestion, that's exactly what LoMaglio did. But her doctor told her to call the CDC. After waiting 4 1/2 hours to speak to a person at the CDC hotline, she was told, "Call your doctor."

"I told her, I said, I feel like I'm in Groundhog Day," LoMaglio says with a wry laugh. She's now waiting for a return call from the D.C. Department of Health to see if she qualifies for a COVID-19 test.

In the meantime, her symptoms have resolved and she thinks she may have just been experiencing seasonal allergies. But she's isolating herself as best she can for now, just to be safe.

And that's exactly what public health officials are advising for people with mild or moderate symptoms: Avoid going to your doctor's office or a hospital to try to get tested for coronavirus if you don't have severe symptoms, such as shortness of breath.

Instead, stay home. Stay home. Stay home, already. It might be boring advice, but it's critical to stopping the spread of whatever you have. And you don't need to wait for a COVID-19 test or a doctor's instructions to do it.

Dr. Bruce Aylward of the World Health Organization notes that 90% of COVID-19 patients have a high fever as an early symptom and 70% have a dry cough. "It's not the sniffles," he says. "It's not a runny nose. That can be a symptom, but that's rare."

"Because this is such a novel situation, people want a novel approach to handling it. They want a novel way to better isolate themselves or some crazy new hand-hygiene technique," says Saskia Popescu, senior infection prevention epidemiologist at HonorHealth, a health system in Phoenix. "That's just not the case. These are tried and true methods — we just need to be really vigilant with them."

How isolated and for how long?

Self-isolating at home when you're sick — with coronavirus or any other respiratory infection like influenza — means not going out in crowded public places or on public transit. Just hunker down at home until you're fully recovered.

Do the basics to manage your symptoms. "Stay hydrated, take a fever-reducing medicine if you feel like you need to," says epidemiologist Jennifer Nuzzo of the Johns Hopkins Center for Health Security.

The CDC has a list of other tips, including staying away from family members as much as you can (especially those who are older or who have underlying health conditions). Cover your coughs and wash your hands afterward and frequently.

Don't share a drinking glass, and use your own towel. And if you live with other people, you should regularly clean the communal surfaces you touch often — doorknobs, faucet handles, toilets, remote controls and the like — with a household disinfectant or soapy water. (Note: Wipe, don't dunk, your phone or other electronics and only after unplugging them.)

"I think sometimes this is framed as 'lockdown,' " says Elisabeth Poorman, a general internist at the University of Washington Neighborhood Kent-Des Moines clinic, south of Seattle. "Very, very few people have been ordered to stay at home. This is a voluntary activity that people are doing to help keep others safe — they're not being imprisoned in their homes."

Popescu says there are some little things you can do if you're sick to stay home comfortably without infecting other people — again, whatever respiratory illness you have. "If you are going to do some home food delivery," she suggests, "[pay online] and have them leave it at the door."

Note that this is different from the "14-day quarantine period" now being discussed by public health officials in regards to most of the passengers coming off the Grand Princess cruise ship, for example.

"You quarantine when you've been exposed, but you're not sick — and that's for the 14-day incubation period," Popescu explains. "If you're sick, you're isolating at home. So that duration of illness can be short, it can be long. It really depends on the person."

Washington state's health department recently issued guidelines suggesting that people with COVID-19 symptoms but no firm diagnosis "should stay home away from others until 72 hours after the fever is gone and symptoms get better." The CDC recommends that people who test positive for COVID-19 consult with health care providers to determine when they're clear to go back to their usual routines.

"In an ideal world, every person could test themselves at any given time if they have these symptoms — so they know exactly what they have," Nuzzo says. "Then you could definitively answer, 'Yes, you have coronavirus, and therefore your family members may have been exposed so maybe they could stay home.' I just don't think that's realistic given where we are."

"Mania for testing"

Poorman says in Washington State, where there is clear spread of coronavirus going on in the community, she is fielding calls from worried patients who want to get tested.

"In the U.S. we have a sort of mania for testing," she says, "where if a test exists, you want it. We rarely stop and ask ourselves, 'What will we do differently if the tests are positive and what will we do differently if the tests were negative?' " That question is especially important now, she says, because there are not yet proven treatments for COVID-19.

The federal government has faced criticism for missing the opportunity to roll out robust testing across the country in the weeks before there were cases of community spread in the U.S.

Carlos del Rio, professor of medicine and global health at Emory University, says without the tests in place to do comprehensive surveillance, it's like the U.S. is "in a dark room and trying to find the exit by touching the walls."

The testing gap is a bigger public health issue, notes Nuzzo. "We need to figure out how we can test more people — including mildly ill people — so that we can better understand how much disease is out there and where it is," she says.

"But we can't just do that by simply having everybody showing up at random health facilities without some kind of plan for whether or not we want to include them in those efforts."

For now, people considered to be in more vulnerable groups will likely get prioritized for testing, says Krutika Kuppalli, an infectious disease doctor and a fellow at the Johns Hopkins Center for Health Security.

"If I have a symptomatic individual that's 65 and has a chronic medical condition compared to a 20-year-old who has mild symptoms, I would probably be more inclined to test the older person," she says.

Kuppalli says people who are immunocompromised and health care workers are also likely to get prioritized. For people who don't fall into these categories but do have symptoms, she says, the important thing is to take precautions not to spread whatever is making them sick.

In Phoenix, Popescu says, patients are showing up with mild flu-like symptoms wanting to be tested for coronavirus, but they can't get the test because they don't meet the current criteria for testing. "It's out of fear — which is hard, because you want to give them that peace of mind," she says. "When they leave without being tested, that's frustrating for them, but it's also taxing to the health care system."

For people who don't have any symptoms of a respiratory illness — the "worried well" — the CDC has a comprehensive checklist of things you can do to prepare in case there's an outbreak in your community or someone in your family gets sick.

The short version? Make sure you're informed on the current situation; the CDC website is a good source. Make sure everybody in your family is washing their hands well. And hoarding hand sanitizer and disinfecting wipes might be shortsighted — you want your neighbors healthy and protected, too, to stop the spread of this virus. Just stock up on a reasonable supply of the usual staples, as you would if a storm were coming.

Poorman, the physician in Washington state, says the spread of coronavirus is a reminder that we're all in this together.

"We tend to think about health as a very individual thing," Poorman says. "And we don't consider impact on the community and we don't consider the impact of our actions on people who have fewer resources. This is an opportunity to remind ourselves that if we don't take care of everybody, we're going to be affected."

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