Persistent Symptoms After Negative COVID-19 Tests: What to Do?

Negative rapid test for COVID-19 and normal test results, yet persistent illness?

Hello Dr.
Hong,
First of all, I do not have any chronic illnesses, a travel history, or overlapping exposure to confirmed cases.
I live in Taichung City, which is not a hot zone, and I was in good health and regularly exercising before the onset of symptoms.
My symptoms began on May 16, primarily consisting of a fever of 37.5°C, sore throat, and occasional dry cough.
I started self-isolating in my room, adhering to a regimen of drinking plenty of water, eating healthily, and getting at least 7 to 8 hours of sleep each night to recover.
By May 20, there was no improvement, so I went to the emergency department at Taichung City Hospital.
My temperature was 37.6°C, the rapid test result was negative, and my blood work, blood oxygen levels, and chest X-ray were all normal.
I returned home to continue self-management.
During this time, my fever and condition fluctuated.
In the following days, I experienced more pronounced chest discomfort (which is hard to describe; it’s not pain, I don’t have shortness of breath, and it’s not easy to cough, but I feel discomfort in several areas of my chest cavity), occasional throat irritation leading to dry cough, and symptoms of fatigue.
On May 31, I went to the emergency department at Taichung City Hospital again.
My temperature was 38°C, the second rapid test result was negative, and again, my blood work (including red and white blood cell counts), blood oxygen levels, and chest X-ray showed no abnormalities.
I returned home to self-isolate again.
After the visit, I felt some improvement for a few days, but about five days later, I started experiencing intermittent fever, chest discomfort, and fatigue, which have been fluctuating.
As of today, June 13, it has been almost a month.
Today, my condition has slightly improved; my temperature is normal without antipyretics, and the feelings of fatigue and chest discomfort have also slightly improved.
My throat is not painful, but there is still some discomfort.
Overall, I clearly feel that I have not fully recovered, and for about five consecutive days, I felt quite unwell, with a slight fever of 37.3°C and significant fatigue and chest discomfort.
Additionally, I want to mention that five days ago, I started taking the antibiotics prescribed by the doctor during my second emergency visit for three days, but there has been no significant improvement in my condition.

I believe my symptoms are not merely due to anxiety.
I want to clarify that my sense of smell is normal, and my taste is generally normal, but what has raised my concern is that since the onset of my illness, my tongue has had a peculiar numb sensation that is hard to describe, often accompanied by a metallic taste, which is most pronounced after eating or drinking.
As my illness progressed, this sensation became more noticeable, and even now, while typing, I can distinctly taste the metallic flavor and feel slight numbness, although I have not experienced geographic tongue or strawberry tongue.
This is a phenomenon I have never encountered in my life.
I would like to ask Dr.
Hong, given that both rapid tests were negative, and during the second emergency visit, I had a fever of 38°C and chest discomfort, with no abnormalities found on the chest X-ray, especially since my blood test results showed no abnormalities and my white blood cell count was normal, is it possible that I could actually have COVID-19 under these circumstances? (This is also why I have not sought further medical attention.) According to the information from the CDC in the United States, COVID-19 primarily relies on the body's immune response for recovery.
Given my condition, if it were indeed COVID-19, is it acceptable for me to continue self-isolating, drinking plenty of water, eating healthily, and getting at least 7 to 8 hours of sleep each night to recover? (However, I am fully aware that if I experience symptoms of wheezing or difficulty breathing, I must seek medical attention.) I apologize for the lengthy message and appreciate your understanding.

Cody, 40~49 year old female. Ask Date: 2021/06/13

Dr. Hong Yuanbin reply Internal Medicine

Hello, I'm not sure if the two tests you received were rapid antigen tests (ELISA) or PCR tests.
If they were antigen tests, there is indeed a high chance of false negatives, and you may need to consider getting an RT-PCR test for confirmation.
If both tests were PCR, the chance of false negatives is lower, which suggests you might be dealing with another viral infection, such as influenza virus, adenovirus, or rhinovirus.
I recommend getting plenty of rest and staying hydrated.
If possible, monitor your blood oxygen levels.
If you continue to have a fever, persistent discomfort, or a drop in blood oxygen levels, it may be necessary to consider visiting a larger hospital for further evaluation.
Thank you for your inquiry.

Reply Date: 2021/06/13

More Info

Hello, thank you for sharing your detailed health concerns. It sounds like you have been experiencing a challenging time with your symptoms, and I appreciate your thoroughness in describing your situation. Based on the information you've provided, let's address your questions regarding persistent symptoms after negative COVID-19 tests.

Firstly, it is indeed possible to experience lingering symptoms even after testing negative for COVID-19. This phenomenon is often referred to as "long COVID" or "post-acute sequelae of SARS-CoV-2 infection (PASC)." Many individuals report ongoing symptoms such as fatigue, chest discomfort, and cognitive issues long after the acute phase of the infection has resolved. The symptoms you describe, including fever, throat discomfort, and the peculiar metallic taste, can be part of this syndrome.

1. Negative Tests and Persistent Symptoms: The fact that you have tested negative for COVID-19 does not entirely rule out the possibility of having had the virus, especially if you were symptomatic during the time of your illness. Rapid antigen tests can sometimes yield false negatives, particularly in the early stages of infection or if the viral load is low. Additionally, some individuals may experience a post-viral syndrome that mimics COVID-19 symptoms without the presence of the virus itself.

2. Self-Care and Monitoring: Your approach to self-care—staying hydrated, eating healthily, and getting adequate rest—is commendable. These practices are essential for recovery from any viral illness. It is crucial to listen to your body and monitor your symptoms closely. If you notice any worsening of your condition, particularly with breathing difficulties or chest pain, seeking medical attention is imperative.

3. The Metallic Taste and Other Symptoms: The metallic taste and tongue sensations you are experiencing could be related to several factors, including medication side effects, dehydration, or even a post-viral symptom. While it is not uncommon for individuals recovering from viral infections to experience changes in taste and smell, it is essential to discuss these symptoms with a healthcare provider, especially since they are new to you.

4. When to Seek Medical Attention: As you mentioned, if you experience shortness of breath, difficulty breathing, or any other severe symptoms, you should seek medical care immediately. Additionally, if your symptoms persist or worsen over the next few weeks, it would be wise to consult with a healthcare professional who can provide a more comprehensive evaluation and possibly conduct further testing.

5. Long COVID Considerations: The CDC and other health organizations recognize that long COVID can affect anyone, regardless of the severity of their initial infection. Symptoms can vary widely and may require a multidisciplinary approach to manage effectively. If your symptoms continue, consider reaching out to a healthcare provider who specializes in post-COVID care.

In summary, while your current self-management strategies are beneficial, it is essential to remain vigilant about your symptoms. If they persist or worsen, do not hesitate to seek medical advice. Your health and well-being are paramount, and there are resources available to help you navigate this challenging time. Please take care, and I hope you find relief from your symptoms soon.

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