Do I need a PCR test?
November 4, 2022 6:00 AM   Subscribe

I have had a sore throat since yesterday. This morning I have a mild runny nose and a very mild sinus headache. My5 year old son has had a quite runny nose and some phlegmy cough since TUesday or Wednesday. I have negative covid tests. I'm going on a trip on Monday and today is the last day to cancel/change without losing a lot of money. Should I pay for a PCR test or can I assume it's not covid? Also, visit immunocompromised mom sunday?

I tested negative on a rapid test yesterday morning, last night and this morning. My son tested negative this morning, but with a cheek swab only. I could get a PCR test just for me for $125. If it turns out I have covid it would save me money to be able to cancel the trip now. If I don't have covid I'm out $125 (but get to go on the trip!). If I just assume I don't have it and don't cancel the trip and then it turns out I DO have covid (I would keep doing rapid tests until symptoms pass) then I would lose money AND miss the trip.

Also, getting a PCR test today would be a HUGE inconvenience that would also annoy people I work with who kind of really need me to be available today, but I'm leaving this job, so it's ok to annoy them if it comes that...I mean I don't want to be a jerk, but there's no possibility it will hurt me later in my job).

Also, we're supposed to go visit my immunocompromised mom on Sunday. It's not a big deal if she gets a cold, but we don't want her to get covid. If I continue to test negative until Sunday are we fine to do that, especially since symptoms will likely pass by then, or if I've had a sore throat do I really need a PCR test or more time before that's safe?
posted by If only I had a penguin... to Health & Fitness (28 answers total)
Best answer: My personal circle's experience with this round of Covid is that it dodges rapid tests until far later in the period that you would be infectious. At this point, my personal policy is that I will get a PCR if I feel unwell (particularly in the way you describe) since it seems like rapids -- at least in my circle's experience -- are not as quickly accurate as they used to be.

It will suck but I would get the PCR as soon as possible today. It's better to know than it is to guess, particularly with the calculus of your mom involved.

It's also worth noting that Flu A and strep have been ticking up pretty hard, I don't think you'd want your mom to have those, either. Or anyone else you might come into contact with while traveling. In my personal opinion, the math around traveling unnecessarily while sick has completely changed. It's not a great personal policy to give a planeful of people the crud, or the flu, or especially covid, just because it would be inconvenient to do otherwise.
posted by Medieval Maven at 6:05 AM on November 4, 2022 [6 favorites]

Response by poster: To clarify, we're driving, not flying, and my assumption has been that if this is not covid, it's a cold and it will be gone by Monday. The visit to my mom is separate/unrelated from travel. So we could skip the visit to my mom and still go on the trip. Obviously if I do a PCR and test positive then I'm sitting at home for however long it takes.
posted by If only I had a penguin... at 6:08 AM on November 4, 2022

Best answer: Agreed that you can't discount COVID this soon after symptom onset.

If paying for the PCR is a hardship, you could do a rapid test every day or two. If you're still testing negative on Sunday, it's much less likely to be COVID. If you go this route and are symptom-free on Sunday, I hesitate to tell you it's absolutely safe to see your mom (especially if your child is also visiting with her), so this is ultimately your call.

The people at work who you'd be inconveniencing today can kick rocks; you're not being a jerk by seeking time-sensitive medical testing.
posted by toastedcheese at 6:20 AM on November 4, 2022 [5 favorites]

Yes PCR.. Possible there are places you can get free PCR in your area? Check local health dept website? Limitation may also be several days till results so you may want to seek a rapid PCR.
posted by latkes at 6:30 AM on November 4, 2022

Best answer: I'm vaccinated and boosted, but I came down with Covid a couple of months ago. When I started having symptoms, I took a rapid test (one that was sent to me for free by the government), and it came back negative. I took another test the following day, and it came back very positive (the test line appeared quickly and became quite dark). I've also talked to other people who have reported similar experiences – i.e., the rapid tests are negative for the first day of symptoms.
posted by alex1965 at 6:37 AM on November 4, 2022 [2 favorites]

Best answer: My entire household was COVID positive with symptoms except me, I just had the symptoms. I never tested positive on a rapid test throughout the entire illness.

So yeah, if you need to cancel by today and it would affect your decision, then you should get a same day PCR.
posted by muddgirl at 6:58 AM on November 4, 2022 [1 favorite]

Ask your mom what she thinks, but I personally would encourage you to cancel your visit with her. Especially if it's unconnected to the trip.
posted by twelve cent archie at 7:00 AM on November 4, 2022 [3 favorites]

Best answer: It's not a big deal if she gets a cold, but we don't want her to get covid.

You also don't want her to get influenza or RSV. Whatever you decide about PCR, given the time of year (and barring other mitigating factors) I would err on the side of safety with your mom. ANd, yes, involve her in the decision if you go through with visiting with her, and consider mitigating measures (masking, outdoors, distance, etc.) regardless of the causative agent.

Payng for PCR is good, human (and humane) compassion in action. I say that as an exhausted epidemiologist.
posted by late afternoon dreaming hotel at 7:10 AM on November 4, 2022 [15 favorites]

Best answer: I currently have covid, and the symptoms you describe are exactly how it started for me. I'd get the PCR test.

Also, as someone who recently had the flu for the first time in several years (apparently my body has decided now's the time to contract everything), I agree with late afternoon dreaming hotel that you really don't want your mom to get that either.
posted by dizziest at 7:53 AM on November 4, 2022 [2 favorites]

Best answer: I suggest you try a rapid test Throat Swab as your next step.

When I got Covid in August, I tested negative for several days after symptom onset. I was pretty sure it was Covid, so on approximately the third day I did a throat swab and it came back positive. That was later confirmed by PCR.
posted by Winnie the Proust at 7:54 AM on November 4, 2022 [3 favorites]

Will PCR results even come back in time to cancel your flight? But yeah I wouldn't get on the plane or see your mom without testing, and I wouldn't trust rapids. Either way, I'd wear an N-95 or similar on the flight -- imagine everyone who gets your cold then having to make similar decisions and payments.
posted by slidell at 8:18 AM on November 4, 2022 [1 favorite]

Yes, PCR, but consider canceling the trip either way—you are not feeling well.
posted by capricorn at 8:19 AM on November 4, 2022

Best answer: My mom had some throat symptoms, no fever, and took a self test which came back negative. At my request (she’s traveling) she got both a lab antigen and pcr test, each of which showed she does, indeed have Covid. If you are asking if you need a better test, you need a better test. I’m sorry it’s inconvenient that’s not your fault and you’re unfortunately having to shoulder the burden of our collective failiure at dealing with this situation.
posted by Exceptional_Hubris at 8:55 AM on November 4, 2022

Response by poster: Thanks, all...Looks like it's unanimous...I got swabbed. I'm a little concerned by how cursory the swab was. I'm worried that most people getting tested these days just want a proof of negative for travel, so these private labs don't really have an incentive to go digging for virus. When I swab myself a rub my throat raw and then spend like 20 seconds poking around each side of my brain.

Anyway, we'll see. And note that if it's negative we'll only see my mom if we are well by then. I'm just assuming we will be because colds don't take that long and if it's not covid it's probably a cold. And I can't imagine we'll still be sick on Monday, unless it's covid. The problem with involving my mom in the decision that that her emotional coping method for risk is to deny it. I can't tell you how many times I've heard "Oh, I'm sure it's not covid. You're fine." over the past 2 years. And of course it's just reinforced by the fact that so far it always HAS been nothing. She's not a covid-denier or anything and we all have all our shots, it's just her way with all risks/fears etc. "Don't worry; it's nothing . It will be fine." I call it her annoying crystal ball.

And yes, PCR tests will be back in 3 hours, which is plenty of time to cancel our trip (which we will be going to by car, not airplane).
posted by If only I had a penguin... at 9:00 AM on November 4, 2022 [2 favorites]

PCR's very job is to amplify any little shred of virus that's in there. So it should be a lot more reliable with a cursory swab.
posted by Dashy at 10:30 AM on November 4, 2022 [2 favorites]

Just to add to the base of testing knowledge, I'll share my personal anecdote about PCR vs rapid tests:

Awhile back, my long-distance partner was due for a visit and informed me a few days beforehand that they had a sore throat, but that it could be due to allergies (their local pollen had spiked recently). They took a rapid test and it was negative. They took another the next day, also negative, so we concluded it was safe to visit. They took a third after they arrived, also negative. A day or two into the visit, their symptoms worsened and started having positive rapid tests, and then I got sick as well. I had several days of negative rapid tests, but also got a PCR and it was positive. This led me to learn more about the different testing technologies, and what I learned definitely would've changed my behavior.

I'm not an expert in this field by any means, so I'm happy to be corrected, but my takeaways were:
  • There's no really "right" answer about whether someone is infected because it depends on the definition. What we tend to care about is whether illness (that is, symptoms) or the potential to cause illness in others will occur. No method is perfect, so I think it's important to think about what questions we're trying to answer.
  • PCR is more costly and complicated because it requires lab work to amplify the presence of viral particles (specifically RNA, I believe). That makes it very good at detecting very early stages of infection, but at the cost of still being positive even when there aren't enough intact viral particles to lead to illness and/or transmission.
  • Rapid tests are fast and cheap because they don't include the amplification step and detect viral antigens (rather than RNA) which require a higher level of virus in the body to be positive. As such, they're less likely to be positive when there's too little viable virus to sicken/transmit.
Given the different characteristics, I see rapid tests as a valuable tool to track improvement (I and all my friends observed the positive line fading over time) and know how long to isolate. I also think they're a valuable tool to catch unexpected infection directly before having contact with large groups or vulnerable populations. They're good to help determine when you've recovered and as a reason to avoid activities that you're just about to do. However, I think they have a real potential to instill a false sense of confidence when used as a tool to decide what to do even a day or two in the future. For future decisions, PCR is far more beneficial.
posted by Cogito at 10:52 AM on November 4, 2022 [1 favorite]

I'd encourage you to cancel with your mom regardless, if only because if she gets sick with anything while you are away, it will be extra stressful. You could even tell her a bug is going around and you don't want her to get it.
posted by bluedaisy at 10:54 AM on November 4, 2022

Best answer: Like, the worst case scenario for not visiting your mom is that you miss a visit. The worse case scenario for visiting is that you give her a nasty bug, whether covid or not.
posted by bluedaisy at 10:56 AM on November 4, 2022 [2 favorites]

Best answer: > When I swab myself a rub my throat raw and then spend like 20 seconds poking around each side of my brain

You don't need to do that. Source: me, I worked at a COVID testing site doing PCR tests during the worst of all this. If someone didn't get a good sample the test would come back inconclusive -- not negative -- and if we had gotten many inconclusive results (we didn't) we would have definitely gotten reprimanded by the higher-ups. You can't fake swabbing (people tried) and get a negative result with a PCR test, in my experience.
posted by The corpse in the library at 10:59 AM on November 4, 2022 [6 favorites]

The corpse in the library: can you explain any more about how that works? I'm quite curious how the inconclusive distinction would be made. Is it just about the mass/volume of sample on the swab or what?
posted by Cogito at 11:03 AM on November 4, 2022

Response by poster: Negative.

And for those saying cancel with my mom, do you mean even if we wake up syptom free on Sunday?
posted by If only I had a penguin... at 11:22 AM on November 4, 2022 [5 favorites]

If I had a negative PCR and no symptoms I would visit my mom!
posted by latkes at 11:30 AM on November 4, 2022 [4 favorites]

Oh, one last thing to share:

The tool I've found most useful when making tough decisions with limited information is to imagine myself in the future scenario where the feared outcome has occurred. If I think I'll be able to look back on my decision and accept that I knowingly took an acceptable risk, I do it. All life entails risk, so the question for me is really: am I making a bet where I can morally/emotionally cover the loss, or am I deluding myself and just hoping to win so that I avoid the certain loss inherent in choosing not to bet.
posted by Cogito at 11:50 AM on November 4, 2022

> The corpse in the library: can you explain any more about how that works? I'm quite curious how the inconclusive distinction would be made. Is it just about the mass/volume of sample on the swab or what?

The swabs were swished around in a solution of mostly salt water and thrown away; the solution was what got tested. I don't know exactly how that works -- we sent the vials to a lab for that bit. The lab could tell if the sample had enough DNA from the patient's nose to be a valid result. Testing was done on just a small amount of the solution from each vial, not the entire contents.

(If a scientist shows up in this thread and says something different, listen to them and not me. I'm just passing along what I was told by higher-ups.)
posted by The corpse in the library at 12:42 PM on November 4, 2022 [1 favorite]

The "inconclusive" reading from a PCR test says "there wasn't enough genetic material in this sample to start with, so the answer isn't meaningful".

It's similar (though not the same) to the control strip on a rapid test: it's a way to determine whether the test itself was running correctly. On a rapid test, the control just tests whether there was enough viable reagents running through, not whether you had enough genetic material to work with.
posted by Dashy at 1:03 PM on November 4, 2022

Best answer: And for those saying cancel with my mom, do you mean even if we wake up syptom free on Sunday?
How often do you see your mom? Is this a special or rare visit? I'd say to be symptom-free on Saturday and Sunday at the very least because who knows how long something could be contagious? Some quick googling says that even a cold can be contagious past symptoms.
posted by bluedaisy at 2:15 PM on November 4, 2022

RSV is also circulating with similar symptoms to a COVID infection. How do I know? I have tested repeatedly and am negative for COVID, but I've got all the symptoms I had when I was COVID positive. And yet I would not visit your immune compromised mother, and I would also mask in public, because it is making me, my grandchild, and my kid (their parent) all very sick and weary and there is no reason to spread disease to people who are vulnerable.
posted by Peach at 6:25 PM on November 4, 2022

There’s a three in one PCR test that insurance will pay for testing RSV, Flu and Covid. Not in time for you this time, but an incredible resource for this coming hellscape of a winter. LabCorp Home Test Kit

For your visit with your mom, wear a well fitting N95 and that will mitigate spread of any virus you may be having. No reason to get your immune compromised mother sick with anything, especially with so much stress on the medical system. If it goes unexpectedly poorly, she may have trouble getting help. Protect her for your peace of mind.

If you continue to have symptoms, please wear a mask throughout your trip and don’t spread it to anyone else. Waste water is spiking like mad all over the country, even places where confirmed cases are down. PCR and rapid are both missing a lot right now.
posted by Bottlecap at 1:04 AM on November 5, 2022 [1 favorite]

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