Monday, April 6, 2020

Then What the Fuck Was It???

Became symptomatic three Thursdays ago (19th). Lasted into the first weekend. Hadn't wanted to be a hyphochondriac or one of the people overwhelming the system. So, I avoided looking up symptoms to try to avoid psyching myself into any I wasn't already displaying. Sat on the increasing illness until that first Sunday night, then went to the CDC website and did the health survey-bot thing. It said, "call your GP about testing".

Called first thing that Monday (23rd). Their lines were, naturally, busy. I selected the "call me back" option. Day passed by with no callback. Since GP's office was due to close at 1700, I called at 1600 to find out, "yo: should I have maybe been called back by now". Got hold of one of the office staff. They said there was no record of my morning call, so, no, I wasn't on the scheduled to be called back. Naturally, I'm thinking, "damned good thing I don't really 'trust the system'." At any rate, she said the my GP was tied up, at the moment, but that she'd put me on the immediate call-back list.

GP called back about 20 minutes later. He ran me through my symptoms and reviewed my health-history chart. He agreed that my symptoms and their progression – combined with my overall health history (immunocompromised due to my arthritis medications) – would normally warrant getting the test. However, he wasn't going to prescribe one at that time. He reasoned that, because the tests take 7+ days to come back and was already four days into my symptoms, I'd presumably either be recovering or in an ER (where I'd get higher-priority testing as a result) by the time results came back. That said, he told me that if, at any point, my fever went over 101, to call immediately for a reassessment.

Couple days later, symptoms started to abate. But, a day and a half later, they returned and were worse.

Having, by that time read up on things, one of the things I'd read was that a lull followed by a return and worsening of symptoms was also a normal progress-path for COVID-19. The really unfun note about that particular progress-path was that it was the more-common one for the 20% of people that end up needing hospitalization. Dandy.

Saturday night, my temperature hit 101.7. Having hit the proverbial red line, I called the GP's after-hours number. The rotation-GP told me to switch from regular cold meds in favor of taking 1000mg/8h (3000mg/dy) of acetaminophen-only. She also prescribed me the test and instructed me to get the first appointment I could the immediately-following Monday (30th).

A few hours after taking the first 1000mg dose, my fever started to come down a skosh. The first 24 hours, it hovered in the 100.0s depending on where in the dosing sweet-spot I was. Tried to level things out a bit by switching from the 8-hour dosing of 1000mg to 4-hour dosings of 500mg. Flattened the peaks and valleys a bit by doing so.

Given that my arthritis meds already cause liver-sensitivity, I decided to follow-up with my GP a couple days later (Wednesday, Apr 1). Wanted to ask about reducing the daily intake. I wasn't relishing the thought of saving my lungs but killing my liver. GP informed me that they had patiets in clinical liver failure that tolerated over 2000mg/dy for extended periods. However, he agreed that it was probably better for me to do the "half as much twice as frequently" thing I'd already started doing and, if symptoms allowed, try to go to 500mg every 5-6 hours instead.

My symptoms were moderately controlled under that regimen between Monday and the Wednesday I'd called my GP back about dosing. Unforutnately, the night after talking to my GP, (Thursday, April 2nd) when temperature increased its upward trend to just shy of 103 even on 500mg/4h and was starting to experience right-lung constriction and pain to go along with increased violence of the hacking cough.

I thought I might have to call the ER to let them know to prepare for a possible COVID19 arrival ("possible" since results still weren't due till today). Didn't tell my wife about the ER thoughts or the lung pain and constriction because she was already freaked out by the progression of things and tends not to be proverbial "rock" when things start looking like they're at risk of going sideways.
 
At any rate, since whatever I have consistently been hitting its temperature-peaks around midnight and this spike happened around midnight (ironically, was a day or two after this spike that I read an article that said nighttime temperature-spikes were also normal for COVID-19), I decided I'd try going to sleep and see if things were less awful in the morning. Took a double-dose of Tylenol PM in hopes it would both knock me out and curb the temperature and coughing-spike. Woke up 7 hours later with my temperature back down in the mid 99.0s.

Friday wasn't much better (evening temperature continued to hover in the high 100.0s to mid 101.0s, lots of coughing, right lung not feeling quite up to par, diziness etc.), but it also wasn't worse. Since it wasn't worse, I opted to continue to defer care-escalation.

Saturday and Sunday things were starting to head in the right direction: I was able to keep my temperature in the high-to-mid 99.0s most of each day on 500mg dosings (4-5 hours Saturday; 6-8 hours on Sunday). Though, each time the thermometer did the "fever" urgent-beep, Donna would come running into the room to ask what the temperature was.

Hospital lab actually called me on a Sunday night (21:12 according to my phone logs) to let me know the results came back negative. I asked the dude, "then WTF do I have that's causing these symptoms on this trajectory and for this long??" Even my GP had said he expected the results to come back positive. He feebly replied "you'll have to talk to your GP." All I could think was "thanks, dude: real helpful."

As I'm want to do, especially when things don't seem to be adding up, I did some further reading on the virus and associated testing methodologies. Found out that, while the RT-PCR test pretty much never provides a false-positive, it had a better than 30% false-negative rate in China and elsewhere and appeared to be doing so at higher rates in the US. Further, one article I found hinted that initial testing-efficacy reviews (though they took care to note that their review of the two English-language studies they'd reviewed – others were in Chinese and they had't had a chance to translate, yet – had yet to be peer-reviewed) seemed to indicate that the oral test might be more prone to false-negatives than the nasal-test. The test I received was the oral test.

Further complicating things is that I had oral surgery in 1998. That surgery left me with a grossly-abnormal throat and posterior-sinus configuration (due to no longer having tonsils, uvula nor much of my soft palate). So, "who fucking knows".

Overall, I'm wondering if we'll ever find out what the accuracy-rates of early(ish) RT-PCR testing proves to be. I'm especially curious about the US and even collection-facility-by-collection-facility differences. Also curious if/when they might take to doing the test as a two-test battery across some period of days, especially given that China's results showed not-infrequent negative-then-positive testing-results both on asymptomatic and symptomatic carriers.