From the Guidelines
If you have a negative COVID-19 test but are still experiencing symptoms, you should contact your healthcare provider for further evaluation, as a negative test result should be confirmed with a standard NAAT when a clinical suspicion for COVID-19 remains and no alternative diagnosis has been reached, according to the Infectious Diseases Society of America guidelines 1.
Next Steps
When a patient tests negative for COVID-19 but continues to exhibit symptoms, it is crucial to consider the possibility of a false negative result, especially if the test was conducted too early in the course of the infection. The patient's symptoms could be attributed to another respiratory illness, such as influenza, RSV, or a common cold.
- Continue to rest and stay hydrated to help manage symptoms.
- Over-the-counter medications like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be taken for fever and discomfort as directed on the packaging 1.
- For congestion, consider using saline nasal sprays or over-the-counter decongestants.
- If the patient has a cough, honey (for adults and children over 1 year) or cough suppressants containing dextromethorphan may provide relief.
Monitoring and Retesting
It is essential to monitor for worsening symptoms, such as difficulty breathing, persistent chest pain, confusion, or bluish lips or face, which require immediate medical attention.
- False negative COVID tests can occur, especially if tested too early in the infection, so consider retesting in 24-48 hours if symptoms persist or worsen 1.
- While waiting for further medical guidance, continue to limit contact with others to prevent potential spread of any infectious illness.
Clinical Considerations
The Infectious Diseases Society of America guidelines suggest using standard NAAT over rapid Ag tests due to higher sensitivity, thus reducing the risk of missing a diagnosis of SARS-CoV-2 infection 1.
- The performance of Ag tests may change as new variants emerge, making it critical to monitor their performance for diagnosing new-variant COVID-19 1.
- Research to identify epitope binding regions that can improve sensitivity while maintaining specificity is needed to enhance the accuracy of Ag tests 1.
From the Research
Next Steps for a Patient with a Negative COVID-19 Test Result
- A negative COVID-19 test result does not necessarily rule out SARS-CoV-2 infection, especially if the pretest probability of disease is high 2
- Patients with a negative test result who are still experiencing symptoms should be evaluated for differential diagnoses, as many may be suffering from non-infectious diseases or other conditions 3
- The use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be considered to manage symptoms, as evidence suggests they do not increase susceptibility to infection or worsen disease outcomes in patients with COVID-19 4, 5
- Clinicians should consider a patient's exposure to someone with a confirmed or probable case, signs or symptoms of COVID-19, local or population-specific COVID-19 prevalence, and presence of an alternative diagnosis when interpreting test results 2
- A symptom-based approach is preferred over a test-based approach for discontinuing isolation precautions for most patients with COVID-19, as prolonged shedding of viral RNA does not necessarily correlate with infectivity 2
Considerations for Patient Care
- Patients with complex underlying diseases, such as active malignancy or immunosuppression, may require timely expert medical care and evaluation for differential diagnostics while providing isolation and ruling out of COVID-19 3
- The presence of comorbidities and clinical findings should be taken into account when assessing the likelihood of COVID-19 in patients with a negative test result 3
- Clinicians should be aware of the potential for anchoring bias and consider alternative diagnoses in patients with a negative COVID-19 test result 3