Cough, fever, chills — with fall fast on the way, symptoms alone won’t be useful in distinguishing Covid-19 from similar-looking cases of the flu. That means routinely testing for both viruses will be crucial — even, perhaps, after some patients have already died.
That will at least be true in New York, where officials recently announced a ramp-up in post-mortem testing for the coronavirus as well as the flu. Deaths linked to respiratory illnesses that weren’t confirmed before a person died are to be followed up with tests for both viruses within 48 hours, according to the new regulation.
“These regulations will ensure we have the most accurate death data possible as we continue to manage Covid-19 while preparing for flu season,” Dr. Howard Zucker, the state’s health commissioner, said in a statement last week.
Deceased hospital patients and nursing home residents, as well as bodies in the care of funeral directors or medical examiners, will be among those targeted for follow-up testing. If experts at a local facility can’t perform the test themselves, they can ask the state to run the test for them at its public health lab.
Although the results of these tests will be too late to change the course of treatment for the deceased, they can still help health officials track the prevalence of both types of infections, as well as indicate whether to warn close contacts of the deceased that they may need to quarantine.
“People need to know who around them was sick,” said Dr. Valerie Fitzhugh, a pathologist at Rutgers New Jersey Medical School. “If someone can’t be tested in life, why not test them soon after death?”
Putting regulations in place ahead of time will also encourage counties to bolster their testing readiness ahead of autumn and winter, when seasonal viruses like flu and respiratory syncytial virus, or R.S.V., tend to thrive, said Dr. Mary Fowkes, a clinical pathologist at Mount Sinai Hospital in New York. In many parts of the country, coronavirus cases are still ratcheting up every day — and will become more difficult to track when similar sicknesses muddle the picture.
“I think that is important to prepare for,” Dr. Fowkes said.
In the early days of the pandemic, New York, like the rest of the country, struggled to rein in the virus. Many illnesses went untested, including those of several thousand people whose deaths were later reclassified as presumed, but unconfirmed, cases of Covid-19.
A lot has changed since the spring, said Gareth Rhodes, deputy superintendent and special counsel at the New York State Department of Financial Services and a member of Gov. Andrew M. Cuomo’s virus response team. After a sputtering start to testing in March, New York is now running about 100,000 coronavirus tests a day, with positivity rates hovering around 1 percent or less. While hundreds remain hospitalized throughout the state, daily deaths attributable to Covid-19 have averaged in the single digits since late August.
The new regulations also stipulate that living patients with flulike symptoms or a known exposure to the coronavirus or a flu virus should be tested for both pathogens. That makes it less likely that a case will be missed in the first place.
“We track fatalities very closely,” Mr. Rhodes said. At this point, he added, New York’s coronavirus testing regimens in medical settings are pretty consistent. “You can’t really be a hospital in New York right now without testing,” he said.
The regulation doesn’t apply to all deaths — just those suspected of being linked to a respiratory illness.
That means the new rules on post-mortem testing probably won’t change coronavirus case numbers much, if at all. Since the announcement, made last Sunday, the Wadsworth state lab has not yet received a request to process a post-mortem test, Mr. Rhodes said.
The Coronavirus Outbreak ›
Frequently Asked Questions
Updated September 4, 2020
What are the symptoms of coronavirus?
- In the beginning, the coronavirus seemed like it was primarily a respiratory illness — many patients had fever and chills, were weak and tired, and coughed a lot, though some people don’t show many symptoms at all. Those who seemed sickest had pneumonia or acute respiratory distress syndrome and received supplemental oxygen. By now, doctors have identified many more symptoms and syndromes. In April, the C.D.C. added to the list of early signs sore throat, fever, chills and muscle aches. Gastrointestinal upset, such as diarrhea and nausea, has also been observed. Another telltale sign of infection may be a sudden, profound diminution of one’s sense of smell and taste. Teenagers and young adults in some cases have developed painful red and purple lesions on their fingers and toes — nicknamed “Covid toe” — but few other serious symptoms.
Why is it safer to spend time together outside?
- Outdoor gatherings lower risk because wind disperses viral droplets, and sunlight can kill some of the virus. Open spaces prevent the virus from building up in concentrated amounts and being inhaled, which can happen when infected people exhale in a confined space for long stretches of time, said Dr. Julian W. Tang, a virologist at the University of Leicester.
Why does standing six feet away from others help?
- The coronavirus spreads primarily through droplets from your mouth and nose, especially when you cough or sneeze. The C.D.C., one of the organizations using that measure, bases its recommendation of six feet on the idea that most large droplets that people expel when they cough or sneeze will fall to the ground within six feet. But six feet has never been a magic number that guarantees complete protection. Sneezes, for instance, can launch droplets a lot farther than six feet, according to a recent study. It’s a rule of thumb: You should be safest standing six feet apart outside, especially when it’s windy. But keep a mask on at all times, even when you think you’re far enough apart.
I have antibodies. Am I now immune?
- As of right now, that seems likely, for at least several months. There have been frightening accounts of people suffering what seems to be a second bout of Covid-19. But experts say these patients may have a drawn-out course of infection, with the virus taking a slow toll weeks to months after initial exposure. People infected with the coronavirus typically produce immune molecules called antibodies, which are protective proteins made in response to an infection. These antibodies may last in the body only two to three months, which may seem worrisome, but that’s perfectly normal after an acute infection subsides, said Dr. Michael Mina, an immunologist at Harvard University. It may be possible to get the coronavirus again, but it’s highly unlikely that it would be possible in a short window of time from initial infection or make people sicker the second time.
What are my rights if I am worried about going back to work?
Still, the regulation may come in handy if, for example, a death were to occur en route to the hospital or shortly after arrival, or if an emergency prompted a temporary lab closure so that tests could not be immediately run. Others might die at home, or elsewhere outside the care of a hospital or nursing home, without easy access to tests.
“This is designed to catch anything that fell through the cracks,” said Dr. Rosemary She, a pathologist at the University of Southern California’s Keck School of Medicine.
Thorough testing can also affect which bodies are autopsied at medical examiners’ offices, where resources and staff have been strained, said Dr. Erin Brooks, a pathologist at the University of Wisconsin-Madison. Someone whose cause of death can be confirmed by a positive test for the coronavirus, for instance, might not need to be investigated further.
A number of pathologists noted that while coronavirus testing for sick patients is just about ubiquitous in medical settings in other states, combination testing that includes the flu, including post-mortem testing, is not as common and may need to be considered.
More laboratories will most likely need to invest in tests that can detect multiple types of pathogens at once. One of the tests run at Wadsworth, for instance, is a so-called respiratory panel, made by a company called BioFire, that simultaneously searches for genetic material from more than 20 types of bacteria and viruses, including the coronavirus and multiple types of flu viruses.
Some experts have postulated that proactive measures like continued physical distancing and vigilant mask wearing might soften the blow of this year’s flu season, as they appear to have done in the southern hemisphere.
But “it’s in our best interest to prepare for the worst,” Dr. Fitzhugh said, “and hope for the best.”