What to Do When Different Groups Test Positive for COVID-19? Insights from Dr. Li Tongzeng's Live Q&A on Haodf Online

Do asymptomatic individuals need to take medication? How can the elderly, pregnant women, children, and individuals with underlying health conditions reduce their risk of severe illness? How should pregnant women and lung cancer patients use medications appropriately after infection?

On December 21, addressing numerous concerns raised by netizens, the online healthcare platform “Haodf Online” invited Li Tongzeng, Chief Physician in the Department of Infectious Diseases at Beijing Youan Hospital and a medical expert at Xiaotangshan Fangcang Hospital, to answer questions and provide clarifications through a live video stream. Below are some of the most popular Q&As.

Li Tongzeng, Chief Physician of the Department of Infectious Diseases at Beijing You’an Hospital and Medical Expert at Xiaotangshan Fangcang Hospital

Q: Can elderly individuals be monitored at home?

Li Tongzeng: Individuals aged 80 and above should not take this risk. For those aged 70 to 80, if their underlying conditions are particularly stable, they may be monitored at home; however, if their conditions are unstable or relatively severe, they should seek hospital care early.

In elderly patients, COVID-19 initially presents with fever, cough, and sore throat, symptoms that may appear similar to those in younger individuals. However, while younger patients typically begin to recover after four to five days, older adults may only be at the onset of disease progression. They may develop dyspnea (shortness of breath); if this symptom is neglected, it can become severe by the end of the first week. By the time hypoxia develops, pneumonia has already progressed to a serious stage, necessitating heightened vigilance. Therefore, the clinical course differs significantly between elderly and younger patients, and one must never assume that the disease trajectory observed in younger individuals applies to the elderly.

Q: An elderly person has an infection but no fever. Is this a good sign?

Li Tongzeng: There is no good or bad about this. The absence of fever in elderly patients with infection does not necessarily indicate mild symptoms. Elderly individuals are particularly prone to developing pneumonia, which can be severe even without high fever. Therefore, we should not rely solely on body temperature; instead, we must closely monitor for signs such as shortness of breath or wheezing after activity, as well as dyspnea and tachypnea. Even in the absence of fever, vigilance must be maintained.

Question: A 66-year-old elderly patient is on day 9 of infection, experiencing persistent generalized weakness and profuse sweating with minimal exertion. The body temperature is currently normal. Is this condition severe?

Li Tongzeng: If there are no symptoms such as coughing or shortness of breath, the issue is likely not serious. Although 66 years old is considered elderly, it is still a relatively safe age. If sweating excessively, it is important to replenish water and electrolytes. Many people, upon hearing advice for a bland diet, simply drink more water without replacing electrolytes, which can easily lead to electrolyte imbalances. If symptoms do not improve after rehydration, I recommend visiting a hospital for evaluation to check for severe electrolyte disturbances.

Question: For elderly individuals with underlying health conditions, what medications can be taken for a high fever of 40°C if ibuprofen is not used?

Li Tongzeng: Elderly individuals with underlying medical conditions can choose acetaminophen, provided they do not have severe liver function abnormalities.

Question: Can a 70-year-old elderly patient with underlying conditions take Azvudine tablets immediately upon infection?

Li Tongzeng: Azvudine tablets were approved by the National Health Commission in the Ninth Edition of the Diagnosis and Treatment Protocol for the treatment of adult patients with moderate COVID-19.

For elderly patients aged 70 with underlying conditions, the specific comorbidity must first be identified. Azvudine should be used with caution in patients with severe hepatic or renal impairment. However, elderly patients with underlying conditions may use Azvudine if they do not have severe hepatic or renal dysfunction.

If an elderly patient presents with severe symptoms, hospital evaluation is necessary. Tests such as a complete blood count (CBC) and chest CT scan should be performed to assess the risk of pneumonia. If dyspnea develops on days 4–5, immediate medical attention is required. Patients with unstable underlying conditions must be hospitalized for treatment.

Question: My father is a lung cancer patient. How should we manage his care after he contracts COVID-19?

Li Tongzeng: Being over 60 years of age and having underlying medical conditions are both high-risk factors for severe COVID-19. If an elderly patient has lung cancer, they present with two risk factors; therefore, hospitalization for antiviral therapy is still recommended to reduce the risk of severe disease. A CT scan and complete blood count (CBC) can be performed to assess the current clinical status. If the physician determines that the condition is stable, home observation may be considered, providing peace of mind. Antiviral medications should be taken if indicated.

The key issue now is that most hospital outpatient clinics do not stock antiviral medications, necessitating hospitalization. Therefore, it is essential to communicate with your physician; if antivirals are indeed unavailable in the outpatient setting, you should strive to be admitted for inpatient care whenever possible.

Q: I had lung cancer surgery at age 50. Do I need to go to the hospital immediately if I test positive for COVID-19?

Li Tongzeng: If lung cancer surgery was successful, achieving a radical cure, with good postoperative recovery and favorable physical condition, there is no need to go to the hospital immediately upon testing positive for COVID-19. Given the patient’s relatively young age and successful surgical outcome, home observation can be adopted initially.

However, if a relatively large portion of the lung lobe is surgically removed, thereby impairing respiratory function, it is advisable to monitor blood oxygen levels. Purchase relevant monitoring devices for home use; if hypoxia is detected, seek medical attention promptly.

Q: What should breast cancer patients do if they test positive for COVID-19 without being vaccinated?

Li Tongzeng: All cancer patients are considered to have underlying conditions, which are high-risk factors for severe disease. Therefore, antiviral therapy is recommended to reduce the risk of severe illness. Antiviral treatment at most hospitals requires hospitalization. Some online internet hospitals also sell Azvudine tablets; you may check whether they can be purchased online.

Pregnant Women Section

Question: I tested positive for COVID-19 during the first trimester of pregnancy and am very afraid. What should I do?

Li Tongzeng: It is understandable to be concerned about both the mother and the baby if a pregnant woman tests positive for COVID-19 during the first trimester. However, guidelines indicate that the third trimester and the perinatal period are high-risk factors for severe disease—that is, the period shortly before or after delivery. During this time, hormonal levels are relatively unstable, posing greater risks to the mother. There is no need for excessive concern during the first or second trimesters, as the risk profile is no different from that of the general population.

This virus is relatively mild for pregnant women and has little impact on the fetus. If a fever occurs, pregnant women can use acetaminophen to reduce their temperature; ibuprofen is not recommended. Other medications should be avoided whenever possible. If medication is necessary, it is best to consult a doctor.

Question: A pregnant woman at 18 weeks of gestation may have an infection. Her current body temperature is 37°C and may rise further. What medication should she take?

Li Tongzeng: There is no need for excessive concern. At 18 weeks of gestation, the risk profile is the same as that of the general population; neither group is at high risk for severe disease.

Regarding medication, acetaminophen is the first-line choice for pregnant women. For cough relief, consider consuming honey and using a humidifier to alleviate symptoms. If symptoms worsen, seek timely medical attention or consult a pharmacist regarding appropriate medication options. Immediate hospital care is required if any abnormal signs occur, such as dizziness, palpitations, abdominal pain, or vaginal bleeding.

Question: How long after taking ibuprofen can I breastfeed?

Li Tongzeng: There are no restrictions. Ibuprofen and acetaminophen are the two safest antipyretic and analgesic medications with the most well-established efficacy. Both drugs can be used by breastfeeding women without affecting lactation or posing any risk to the infant.

Question: My child has a fever of 40°C, and the fever is not subsiding even after taking antipyretics. What should I do?

Li Tongzeng: A fever of 40°C can present in two scenarios. In the first scenario, the underlying condition is not severe. If the patient’s mental status remains relatively good, it is necessary to evaluate the reasons for the persistent high fever. One possible cause is insufficient medication dosage, which should be calculated based on the child’s body weight in kilograms.

The second factor to assess is whether fluid replacement is adequate; insufficient fluid intake can also impair the effectiveness of fever reduction. It is often difficult to reduce fever in children on the first day. Persistent high fever is a high-risk indicator for severe disease. If adequate fluids and medications have been administered but the body temperature remains at 40°C without any decline, or fails to drop below 39°C, and the child’s general condition is poor, prompt medical attention is required, particularly for younger children.

Question: My 3-year-old child has an infection, with a fever of 38.4°C and headache. What medication should be administered?

Li Tongzeng: For a three-year-old child, fever and headache can be effectively treated with either ibuprofen or acetaminophen; either of these two antipyretic analgesics is suitable.

If this occurs within the first two days, it is relatively normal. Antipyretic and analgesic medications can relieve both fever and pain. If the body temperature decreases and the headache subsides after medication, continued home observation is acceptable. However, if the headache persists after the fever has resolved, particularly if accompanied by altered mental status, encephalitis or neurological damage cannot be ruled out, and prompt medical evaluation at a hospital is required.

Encephalitis complicating COVID-19 is relatively rare. Children have never been a high-risk group for severe COVID-19, and they are less likely than adults to develop complications, so there is no need for excessive concern. However, if headache persists after fever subsides, especially when accompanied by symptoms such as lethargy, drowsiness, refusal to eat, frequent vomiting, or irritability and fussiness, prompt medical attention should be sought. Medical evaluation is also warranted if the body temperature remains above 38.4°C for more than three days.

Question: My 11-year-old child tested positive for COVID-19 and has a heart rate of 130 bpm. Is this concerning?

Li Tongzeng: A heart rate of 130 bpm is too fast. It is unclear whether the patient currently has a high fever. If tachycardia occurs during high fever, it may be due to the elevated body temperature. In such cases, antipyretics should be administered promptly to reduce the fever. If the heart rate drops below 100 bpm after the fever subsides, continued observation may be considered.

However, if the heart rate reaches 130 beats per minute in the absence of fever, this is definitely too fast and requires prompt medical evaluation. Although myocarditis complicated by COVID-19 leading to arrhythmia is rare, if such symptoms occur without high fever, urgent hospital visit is necessary.

Q: How can I determine if I have COVID-19?

Li Tongzeng: First, have you actually had any contact with individuals infected with COVID-19?

Second, are there any symptoms of COVID-19, such as fever, cough, sore throat, nasal congestion, runny nose, myalgia, and fatigue? Are there also symptoms like nausea, vomiting, and diarrhea? Other symptoms include hypogeusia, hyposmia, and a bitter taste in the mouth.

The third is to test whether nucleic acid or antigen is positive. If two of these three are positive, it indicates infection; if only one is positive, the likelihood is relatively low.

Question: How long is the incubation period for COVID-19?

Li Tongzeng: The incubation period refers to the time from infection to the onset of symptoms, which can be as short as one day and as long as four to five days, with an average of three days. Symptoms appear within 5 days in 95% of infected individuals; 95% of cases do not exceed 5 days, and 99% do not exceed 7 days, with the majority developing symptoms within 5 days.

Q: On the third day of testing positive, my throat feels like “swallowing razor blades,” and I have a slight fever and cough. What should I do?

Li Tongzeng: If low-grade fever, a "throat like swallowing razor blades," and coughing appear on the third day, this is a typical course of the disease; everyone experiences it this way.

If the pain is severe, antipyretic analgesics can be used. Additionally, lozenges to relieve sore throat and ice-cold beverages (the colder, the better), taken in small sips, can help alleviate pain. Furthermore, drink plenty of water and maintain air humidity, as moist air can also relieve throat symptoms.

Question: No fever for 4 days since infection; will fever develop later?

Li Tongzeng: If other symptoms are present, such as cough and sore throat, an infection may be suspected, or infection can be confirmed through antigen or nucleic acid testing. The absence of fever is not a concern even if these symptoms occur, as not everyone develops a fever. Among symptomatic individuals, 70%–80% experience fever, while 20%–30% do not.

For young individuals with normal immune function, the recovery phase typically begins after four days, and recurrent fever is unlikely. However, symptoms such as nasal congestion, runny nose, cough, and sore throat may persist for approximately one week. Most people require about a week to achieve basic recovery, while some may take around 10 days or even longer. Nevertheless, the vast majority of patients fully recover within two weeks.

On day 4, the fever subsided, so I believe it is unlikely to return. In some individuals, fever may occur during the initial days, abate in the middle, and then recur on days 5 and 6; this pattern should raise suspicion of a secondary new infection. The natural course of COVID-19 typically involves the most pronounced fever on days 2 and 3, a decline on days 3 and 4, and resolution of fever by days 5 and 6.

Question: What should I do if I have a persistent cough?

Li Tongzeng: The cough does indeed persist for a relatively long duration, potentially lasting 10 days or even around two weeks, but it will gradually subside over time.

There is no need to worry about coughing, as it is a self-protective mechanism. When viruses replicate extensively in the upper respiratory tract, they cause damage to certain cells. The immune system responds to clear the viruses, and after completing their task, inflammatory cells become cellular debris within the body. This debris, along with necrotic respiratory epithelial cells, is expelled as sputum. Ultimately, the purpose of coughing is to expectorate sputum, effectively cleaning up the “battlefield.”

Monitor whether you have phlegm. If phlegm is present, prioritize expectorant therapy; agents such as ambroxol, acetylcysteine granules, and guaifenesin can help loosen mucus. These can be combined with antitussive medications, such as dextromethorphan or pholcodine. Additionally, maintain adequate hydration and use a humidifier in your room, as moist air and humidity can alleviate respiratory symptoms.

Question: Will I have a fever again after taking a bath?

Li Tongzeng: At any stage, bathing is permissible as long as physical strength allows; it will not cause a recurrence of fever, and avoiding contact with others eliminates the risk of contracting new pathogens.

Bathing is actually very safe; the only risk is that some individuals who are weak or fatigued may be prone to falling, so it is essential to keep bathing time as short as possible.

Question: If family members are infected with different viral subtypes, can those who have already tested negative be reinfected by those who remain positive?

Li Tongzeng: No. After infection with one subtype, antibody levels in the body remain relatively high for 3–6 months and decline thereafter. Young adults with normal immune function are generally protected for about six months, while immunocompromised individuals are typically protected for at least three months. Cross-protection exists even across different subtypes; for example, BF.7, which is prevalent in Beijing, and BA.5.2, which is prevalent in Guangzhou, are both sublineages of BA.5 and thus closely related.

Therefore, after being infected with one subtype, we also have protective immunity against other subtypes; at the very least, reinfection will not occur within three months. Thus, if some family members have already tested negative while others have not yet done so, there is no cause for concern, as reinfection will not take place.

Q: Do asymptomatic individuals need to take medication?

Li Tongzeng: It can be clearly stated that asymptomatic individuals do not require medication. The medications currently in use fall into two categories: antiviral agents and symptom-relief drugs. Asymptomatic individuals require neither antiviral therapy nor symptom relief; therefore, no medication is necessary. They simply need to wait for their nucleic acid test or antigen test results to turn negative. Generally, home isolation for seven days is sufficient to end isolation.

Q: Is a 74-year-old patient who has undergone gastrectomy for gastric cancer suitable for receiving the COVID-19 vaccine?

Li Tongzeng: Patients with any type of tumor are at high risk for severe illness and should actively receive vaccination. Whether they have undergone surgical treatment or are receiving radiotherapy and chemotherapy, as long as their condition is currently stable and they are not undergoing radiotherapy, chemotherapy, or hospitalization, they can receive the COVID-19 vaccine. Active vaccination is recommended because these individuals face a relatively higher risk of developing severe disease if infected with SARS-CoV-2; therefore, they should complete the vaccination series as soon as possible.

Q: Can I still receive the fourth vaccine dose after recovering from a COVID-19 infection?

Li Tongzeng: If you have recently recovered from a COVID-19 infection and tested negative, there is no need to get vaccinated in the near term. This is because your body has already produced antibodies against the Omicron variant that caused the infection, and additional vaccination will not further boost your antibody levels. However, since antibody levels decline approximately six months after infection, it is advisable to receive the fourth vaccine dose after this period. Therefore, immediate revaccination is unnecessary.