You’ve been exposed to COVID-19, or you’ve tested positive. Now what?

by Alexis Allison, Fort Worth Report
January 6, 2022

As one in three molecular tests in Texas returns positive for COVID-19 — the highest positivity rate in the state since the pandemic began — it’s likely you know someone who’s sick or exposed.

And with news of treatment shortages and shifting federal guidelines, navigating a loved one’s or your own illness can feel overwhelming. So, we’ve put together a local guide for what to do and when and where.

If you have further questions or know of local resources not included in this guide, please email them to alexis.allison@fortworthreport.org.

This information was last updated Jan. 6, 2022. 

I’ve been exposed to COVID-19. 

1. What does it mean to be “exposed” to COVID-19?

You’ve been exposed to COVID-19 if you’ve spent at least 15 minutes within six feet of someone who has tested positive.

A person with COVID-19 can be contagious two days before showing symptoms. So, if a person you’ve been in close contact with on Jan. 5 begins to feel sick on Jan. 7 and then tests positive, you may have been exposed.

2. OK, I’ve been exposed. What do I do now? 

Your next steps depend on your risk of infection.

If you aren’t vaccinated, or if you’re not boosted but you’re eligible for the booster, quarantine at home for five days and then wear a mask in public for five days more. A two-dose vaccine appears to be only 35% effective at preventing infection against the omicron variant.

A booster dose ups the vaccine’s efficacy to 75%. If you’ve received a booster shot or tested positive for COVID-19 within the past three months, you do not need to quarantine but should wear a mask in public for 10 days after your exposure. The same guidance applies to kids 5-17 who’ve been fully vaccinated.

Unless you’ve tested positive for COVID-19 in the past three months, the Centers for Disease Control and Prevention recommends getting tested five days after your exposure. If you test positive, isolate for at least five days from the date your symptoms began or, if you’re asymptomatic, from the date of your positive test.

If you’re feeling off, you can check your symptoms with the CDC’s coronavirus “self-checker,” though it’s not a replacement for a test. Symptoms can include everything from sore throat and cough to nausea and diarrhea.

3. Where can I find a test? 

Tarrant County Public Health provides free PCR tests for people ages 3 and older. You can find a health department testing site near you using this lookup tool. The tool indicates where and when you can find a test and whether you need to schedule an appointment or can simply walk in.

The results for these tests aren’t rapid. They may take a day or two — if you haven’t received them in three days, call the health department’s information line (817-248-6299) and press option four.

If you have general questions about testing or COVID-19, you can also call the hotline. When you call, you’ll receive a menu of options. Option one will connect you to a person who can answer your questions, though you might wait a few minutes before the person answers.

Retail pharmacies like Walgreens and CVS offer similar scheduling tools online. Both pharmacies provide different types of tests for free. You can also search for and make appointments at local testing sites through the websites gogettested.com and curative.com.

Finally, you can purchase at-home COVID-19 tests — if you’re able to find some in stock — online or in a retail pharmacy. If your at-home test comes back positive, you can submit your results to the county health department to help them keep track of local data using this form.

4. What’s the difference between a PCR test and an antigen test? 

Both types of tests help determine if you have COVID-19; however, they work differently. The PCR test is generally accurate but can take days to return results, whereas the antigen test can yield results in minutes but is more likely to return a false negative. Both tests can work with a nose swab.

5. When do I become contagious? 

You may be contagious 48 hours before you feel any symptoms. You can also transmit the virus even if you never develop symptoms.

6. If I’m not vaccinated, or if I’m vaccinated but not boosted, and I’ve been exposed, is it too late to get vaccinated or boosted? 

If you’ve been exposed, wait and get tested, according to Russ Jones, chief epidemiologist at Tarrant County Public Health. If you test negative and don’t develop symptoms, you’re “good to go” for the vaccine or booster, he said.

If you do test positive, it’s possible your natural immunity will last about three months. Don’t wait that long to get vaccinated or boosted, Jones said. He recommends seeking a vaccine or booster after two months to avoid reinfection — you can get COVID-19 more than once.

My test is positive. 

1. Does it matter which variant I have? How do I know? 

It might matter, but it’s difficult to find out. Early data suggests that the omicron variant produces a less severe disease than delta. Also, monoclonal antibody treatments from Regeneron and Eli Lilly may not be as effective against omicron.

“That’s a problem,” Jones said, because most places don’t have the ability to sequence the virus, which determines variant type. The county health department sends a sample of tests to the state health department’s lab in Austin, but results can take weeks, and the sequencing is “used as a surveillance piece” only, he said.

2. What are my treatment options? 

If you’ve tested positive and only have mild symptoms, you can treat yourself at home by resting, staying hydrated and taking over-the-counter medicines like Advil or Tylenol.

It’s also worth purchasing a pulse oximeter, which measures the oxygen level in your blood, according to Dr. Amy Faith Ho, an emergency medicine physician in Fort Worth. If your oxygen level drops below 90, that’s a sign you need to seek immediate medical attention, she said.

If you’ve tested positive and you’re not hospitalized, but you have a high risk of severe disease, the COVID-19 Treatment Guidelines Panel currently recommends the following four treatment options:

1. Paxlovid. This is the “Pfizer pill.” The U.S. Food and Drug Administration authorized Paxlovid for emergency use in late December. You need a prescription for Paxlovid, and you should start taking it within five days of experiencing symptoms. Here’s a Paxlovid fact sheet for patients. Availability in north Texas is limited right now, according to Nicole Shoquist, chief pharmacy officer at JPS Health Network.

2. Sotrovimab. This is a monoclonal antibody treatment that early data suggests works against the omicron variant. The Texas Department of State Health Services expects weekly shipments of sotrovimab moving forward, but “supply remains limited,” according to Douglas Loveday, spokesperson for the department, on Jan. 3. For example, state and private health care providers ordered more than 66,000 treatments of sotrovimab in the last two weeks of December, he said, but received just under 2,300 in the last week of December.

3. Remdesivir. This is an IV infusion and the first treatment the FDA approved for COVID-19 back in October 2020. Originally, the FDA approved remdesivir for hospitalized patients, but in late December the COVID-19 Treatment Guidelines Panel recommended it for people who aren’t yet hospitalized. The panel noted that, because remdesivir requires an IV infusion three days in a row, it may be logistically difficult to obtain. Also, its use in patients outside of the hospital would be considered “off-label.”

4. Molnupiravir. This is the “Merck pill.” The FDA authorized molnupiravir for emergency use a day after authorizing the Pfizer pill. You also need a prescription for molnupiravir and should start taking it within five days of experiencing symptoms. Here’s a molnupiravir fact sheet for patients. Supply is also limited in north Texas, Shoquist said.

The state health department is tracking the availability of some of these treatments throughout Texas.

If you’ve been hospitalized for COVID-19, the treatments you receive will depend on your  level of severity. Some patients may simply be discharged with at-home oxygen and monitored through daily telehealth calls, Ho said.

If you remain in the hospital, you may receive remdesivir, a steroid such as dexamethasone and supplemental oxygen. If the disease causes organ failure, “the hospital will address it organ system by organ system,” Ho said. Finally, if you become severely ill, you may require a ventilator and, later, ECMO, a process that bypasses your heart and lungs to oxygenate your blood externally.

3. How can I get an appointment at the Regional Infusion Center in Fort Worth?

A state-funded monoclonal antibody treatment center opened in Fort Worth in August.

To receive treatment at the Regional Infusion Center, you need a referral from a physician. That person should submit this referral form online. To be eligible, you need to be at least 12 years old and have an existing health complication like obesity, diabetes or pregnancy. The treatment is free.

If you have questions, call the treatment center’s hotline: 800-742-5990. You’ll first hear a menu of options and then be able to speak to a person.

Other local sites provide the monoclonal antibody treatment in Tarrant County. You can search for sites near you that may provide the treatment using the Texas Division of Emergency Management’s lookup tool.

4. How long do I have to isolate? 

In late December, the CDC shortened its recommended isolation period to five days after a person tests positive. If after five days, you’re asymptomatic or your symptoms are waning, wear a mask in public for the next five days.

According to research on variants before omicron, including delta, you’re most contagious the day before your symptoms begin, but can still spread the virus to others, on average, eight days afterward.

5. What if I live with other people? 

If possible, use a separate bedroom and bathroom — whether or not you have symptoms, according to the CDC. When you must be around other people in your home, wear a mask.

I need a vaccine or booster. 

1. I don’t have the vaccine. Which one is best for me?

It depends on your age. If you’re 5-17 years old, the Pfizer vaccine is the only one available for you. If you’re an adult, you can receive the Pfizer, Moderna or Johnson & Johnson vaccines. However, the CDC prefers the Pfizer and Moderna vaccines. The Pfizer vaccine is currently the only vaccine that’s received full FDA approval; the Moderna and Johnson & Johnson vaccines have also been authorized for emergency use.

To be considered fully vaccinated, you need two doses of Pfizer or Moderna, or one dose of the Johnson & Johnson vaccine. People who are moderately or severely immunocompromised should get a third dose of Pfizer or Moderna and, several months later, the booster.

2. How long do I have to wait until I get my booster shot, and who can get them?

If you received the Pfizer vaccine for your initial doses, you can get the booster five months later. For Moderna, it’s six months. For Johnson & Johnson, it’s two.

Every adult should get a booster shot, according to the CDC. If you’re 12 or older, you can also receive a booster shot from Pfizer.

3. I have a booster. Do I need another one?

The CDC has not yet recommended a second booster. However, Israel has recently recommended certain people get a second booster and is studying its efficacy against the omicron variant.

4. Where can I find vaccines or boosters? 

You can search for vaccination sites near you through the county health department’s lookup tool. Pharmacies like Walgreens and CVS also offer vaccines and boosters. Vaccines and boosters are free, regardless of insurance or immigration status.

5. People who are vaccinated get COVID-19 anyway. What’s the point of getting a vaccine or booster?

You’re less likely to become infected with COVID-19 and less likely to experience a severe illness if you’re vaccinated or boosted, according to the CDC. Furthermore, you’re less likely to die.

6. Which lasts longer or is better: immunity from getting infected or from the vaccine?

Neither form of immunity is complete, and both wane over time. However, vaccine-induced immunity may produce a more consistent antibody response than natural immunity. A growing body of research indicates that getting vaccinated after a person has had COVID-19 decreases that person’s risk of reinfection.

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

This article first appeared on Fort Worth Report and is republished here under a Creative Commons license.