COVID-19 in Puerto Rico: symptoms, testing, treatment and video visits

COVID-19 symptoms

Symptoms usually appear 2 to 14 days after exposure, most often around day 5. The most common, according to the CDC:

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Sore throat
• Congestion or runny nose
• New loss of taste or smell
• Tiredness
• Muscle or body aches
• Headache
• Nausea, vomiting or diarrhea

COVID-19 testing: at home or with a provider

If you have symptoms, you can use an over-the-counter antigen home test from a pharmacy, or get tested by a health care provider.

A negative home test does not rule out COVID-19. The CDC, citing the FDA, says people with symptoms should have two negative antigen tests taken 48 hours apart before ruling out infection.

If you test positive: take steps not to infect others, watch your symptoms, and if you have risk factors for severe illness, seek care right away to discuss treatment.

COVID treatment: who qualifies for antivirals and why we review your medicines

If you have COVID-19 and are more likely to get very sick, medicines are available that lower the risk of hospitalization and death. Higher-risk people include older adults (especially 75 and older), people who are unvaccinated, and people with conditions such as diabetes, heart or lung disease, obesity, pregnancy or a weakened immune system.

Timing matters: the antiviral pills (nirmatrelvir with ritonavir, or molnupiravir) must be started within 5 days of the first symptoms, and remdesivir, given by IV at a health facility, within 7 days. The CDC says you don’t need a positive test to start treatment if you are at high risk.

Nirmatrelvir with ritonavir interacts with many other medicines, though most people can still take it. That is why the doctor reviews everything you take before prescribing it. If appropriate, the doctor can prescribe medication. We do not prescribe controlled substances.

Flu or COVID?

Flu and COVID-19 are so alike that only a test can tell them apart. If your COVID-19 test is negative and you have fever and aches that came on suddenly, it may be the flu, where antivirals work best in the first two days. In Puerto Rico, a fever with pain behind the eyes or bone pain can also be dengue.

Isolation and home care under current CDC guidance

Stay home and away from others while you are sick, including people you live with. The CDC says you can go back to normal activities when, for at least 24 hours, your symptoms are getting better overall and you have had no fever without fever-reducing medicine.

For the next 5 days take extra care around others indoors: improve ventilation, wash your hands, wear a well-fitted mask and keep your distance. This matters most around older adults and people with high-risk conditions.

At home: rest, drink fluids, and use acetaminophen or ibuprofen for fever and aches as the label directs. If you need a doctor’s note, the doctor can provide one after the visit.

COVID-19 in children

According to the American Academy of Pediatrics (AAP), COVID-19 can cause serious illness in children too, and young children are more likely to get very sick and need hospital care. Children with obesity, asthma or other lung disease, diabetes, sickle cell disease, heart or immune conditions, or complex medical needs are at higher risk.

Treatments exist for some high-risk children, but not every antiviral is approved for every age: for example, nirmatrelvir with ritonavir is for ages 12 and older, and molnupiravir is for adults only. The doctor will tell you whether your child qualifies or should be seen in person.

Most children with mild symptoms recover at home with rest and fluids. Do not give aspirin to a child. Get care right away if your child is breathing fast or with difficulty, has the chest pulling in with each breath, is very drowsy or hard to wake, won’t drink, or has gray or bluish lips. We see children from 6 months; the doctor is a general practice physician, not a pediatrician. See video visits for children.

When to be seen in person or go to the ER

Call 911 or go to the ER if you have trouble breathing, persistent chest pain or pressure, new confusion, can’t wake up or stay awake, or pale, gray or bluish lips, nail beds or skin. Also get in-person care if your symptoms get worse after several days, if you can’t keep fluids down, or if you are at high risk and past the window for antiviral pills.

Prevention and long COVID

The COVID-19 vaccine is the best protection against severe illness. We do not give vaccines; ask your own doctor or a pharmacy. Wash your hands with soap and water, cover coughs, and stay home when sick.

Some people still have symptoms 4 weeks or more after infection (long COVID). If that is you, the doctor can advise you and help with follow-up or lab orders.

Frequently asked questions

Can I get a COVID antiviral prescribed by telehealth?

Yes, in an online doctor visit, if the doctor judges that you are at high risk of severe illness, that you are within the window when the antiviral works, and that it is safe with your other medicines. You must be physically in Puerto Rico during the visit.

My home test was negative but I have symptoms. What should I do?

Test again 48 hours later. One negative home test does not rule out COVID-19 in someone with symptoms. Stay home in the meantime and, if you are at high risk, get assessed early.

When can I go back to work or school?

Per the CDC, when for at least 24 hours your symptoms are improving and you have had no fever without fever-reducing medicine. For the next 5 days wear a mask and take extra care around others.

Related pages

• Online doctor visit
• Flu (influenza)
• Sore throat
• Persistent cough
• Dengue warning signs
• Online doctor for kids
• Doctor's note
• Sick on vacation in Puerto Rico