Think you have COVID-19 and need to be tested? Do not go to the Emergency Department. If possible, don’t just show up at your primary care provider’s office or an urgent care center, either. Best thing to do: call your PCP or a local COVID hotline.

Hospitals officials agree, the best way to keep everyone as safe as possible this winter is to separate COVID patients from the rest of the community.

“As you can imagine, the EDs are overwhelmed right now,” said Dr. Richard Martin, medical director for Geisinger Convenient Care in Danville, Pennsylvania. “For people that want a test, the Emergency Room is not the place to go.”

“You don’t want to encourage someone to just show up,” agreed Elyssa Johnson, associate chief advanced practitioner for Geisinger Convenient Care. “When available, call your primary care provider for direction. Or call our hotline.”

“We have established clinical pathways for providers to use to triage patients and get them to where they need to be seen,” said Jennifer Hannon, PA-C, Family Medicine of Evangelical-Lewisburg, Brookpark, in central Pennsylvania. Possible paths include managing symptoms at home, being seen at an urgent care site or being admitted to a Respiratory Department. “Ultimately, we’re trying to keep the patients who don’t need to be in the Emergency Room, out of the Emergency Room.”

It’s all a matter of finding the care each patient needs while limiting exposure to COVID or flu. So, patients with emergencies should head for the Emergency Department.

“If you’re sick for a few days and you’re getting short of breath and you’re starting to get into distress or have a high fever that won’t break, by all means, that’s what the ED is for,” Martin said.

Overlapping symptoms

“We are very busy because we’re kind of getting into the long-awaited second surge, which we anticipated would happen,” said Rutul Dalal, MD, medical director of Infectious Diseases at UPMC in the Susquehanna region of central Pennsylvania.

This winter brings a double whammy of influenza and COVID-19, not to mention the usual annoyances of coughs, fevers and the common cold. Unfortunately, differentiating between COVID and other infections is tricky.

According to the Centers for Disease Control, both COVID and the flu can share symptoms that include:

• fever/chills
• cough
• shortness of breath or difficulty breathing
• fatigue
• sore throat
• runny or stuffy nose
• muscle pain or body aches
• headache
• sometimes vomiting and diarrhea.

“That’s the problem we’re faced with,” Johnson said. “There isn’t a good way to differentiate at all, and that’s what’s making all of this so very complicated. There’s a wide spectrum of symptoms.”

“The only thing which is unique to COVID is, of course, loss of taste or smell. And you can have GI symptoms, such as nausea, vomiting and diarrhea,” Dalal said. “We have found that in people with COVID, at least 43 percent, to be exact, have diarrhea. A flu feels like a very bad cold. A cold typically stays with the upper respiratory tract area. You wouldn’t typically have shortness of breath, diarrhea, or loss of taste or smell.”

Typically, the common cold can last for days, whereas a mild bout of COVID infection settles down within four to five days. If a patient with the flu receives antiviral medication within 48 hours of symptoms, it can shorten the length and severity of the flu.

“That is not the case so much for COVID,” Hannon said. “Antivirals don’t seem to help COVID. Yet.”

“COVID is a very brand new virus, and we’re learning more and more about it even after so many months,” Dalal said. “And to avoid this confusion over whether you have the flu or the cold, that’s the reason the CDC is recommending everyone older than six months get the annual flu shot. But if you do happen to get the flu, if you have taken the flu shot, the severity is going to be milder.”

Ultimately, only the dreaded nasal swab test can diagnose a case of COVID-19.

If a person is exposed to COVID but has no symptoms, it’s best to get tested between Day 4 and 7 of the exposure. If the person is having symptoms, it’s best to call a health care provider, urgent care center or COVID hotline for directions on how to proceed.

“Truly, without a test there is not a good way to differentiate between a common cold and a mild case of COVID,” Johnson said.

“Until the results come back, you should consider yourself to be positive,” Dalal said. “Wear a mask around people. Isolate yourself. Take these precautions.”

Safe routing of all patients

Hospital professionals have studied COVID to create the safest pathways for their care systems. At Evangelical and UPMC, patients are encouraged to call their primary care providers for guidance. They can also call urgent care centers or COVID hotlines and receive orders for flu and COVID tests.

“As we head more into wintertime, it’s going to be important to weed out one or the other,” Hannon said, adding that self-swab kits tend to be less accurate than a professional test, providing a false sense of security. “Testing at our sites is 98 to 99 percent accurate. Our staff is trained to get the adequate specimen and use it competently.”

Patients arriving at Evangelical’s Emergency Department will be screened before entering the building in Lewisburg.

“We will have a respiratory room set up for patients to be evaluated and to keep them contained away from other patients,” Hannon said.

Geisinger has converted some of their existing convenient care sites into cold and flu centers. In the Susquehanna Valley, Convenient Care Danville, at 175 Northumberland Street, is now a designated cold and flu center. Convenient Care Shamokin Dam, at the Colonial Village Plaza, and Convenient Care Mount Carmel, 10990 Rt. 61, remain typical convenient care centers. People with cold, flu and COVID symptoms can visit the Danville site; all other conditions can be treated at Shamokin Dam or Mount Carmel. In all centers, appointments can be reserved online at geisinger.org/urgent#.

All Geisinger flu/COVID tests go through a system where patients receive a phone call or email in their MyGeisinger patient portal to report a positive test. If positive but treating symptoms at home, the patients will receive regular phone calls from Geisinger to monitor their symptoms for up to two weeks.

“The trouble with COVID is, you can have mild symptoms for a week. Then all of a sudden within a day you can get very, very sick and go into respiratory failure,” Martin said. “That’s why we prolong it to two weeks.”

Geisinger has established three ways of monitoring symptoms depending on risk factors and severity of illness. Patients can receive a kit with things like a thermometer, pulse oximeter and Tylenol. A Bluetooth device can be given to monitor temperature, blood pressure, etc. And a 24-hour, wearable device for people with co-morbidities can be used to monitor temperature, respiratory rates, movement, etc.

COVID fears

With their unenviable front-seat view of the virus, medical professionals have an insight into what to expect with COVID-19.

It’s important to note that care providers urge people to continue seeking medical advice for any health concerns as well as for regular maintenance for conditions like high blood pressure and diabetes.

“We don’t want people delaying seeking care due to the fear of COVID,” Hannon said. “All those other diseases are still very prevalent and need to be treated.”

In many cases, treatment is available through telemedicine. At the same time, research has given us mitigation tools like social distancing in waiting rooms, hand sanitizing and masking, and medical care centers have put careful thought into separating and containing COVID patients.

“We’re just reassuring patients that we’ll get them evaluated,” Hannon said. “We’ll get them the care they need.”

Equally important is the need to cooperate with mitigation efforts, or COVID will continue to spread.

“I don’t want to scare people, but I think personally the worst probably is yet to come,” Dalal said. “But we can avoid all this just by doing the basic things of hand hygiene, face masking and social distancing.”

He pointed out one bonus of these basic efforts that was seen in the Southern hemisphere during their recent winter: they had a milder flu season, something he hopes will also happen here.

“It is now in our hands how we want to proceed during the next three to four colder months,” he said. Adding that the CDC is stressing the importance of sanitizing hands, social distancing and especially wearing a face mask in public, he continued, “That is the only tool which can help us.”

Quarantining and self-isolation are also critical to preventing the spread of COVID-19.

“Those recommendations have been in place for as long as I’ve been practicing medicine,” Hannon said. “Wash your hands, cover your cough, stay home for your safety and everyone else’s.”

Dalal recommended any face mask but one with three layers is best.

“And of course, hand sanitizer, and always, always, always remember not to touch your mouth, your nose or any part of your eyes,” he said. “And I think if we do this, we can probably avoid the expected surge in cases.”

“Hopefully people will take this more seriously,” Hannon said, “and follow the precautions and recommendations that are set in place to control and contain these types of infections.”

“It’s very important,” Dalal said. “I won’t get tired of saying it because this is the only way.”