Antibody Test

Did my wife and I have an early US case of COVID-19?

Photo by Hush Naidoo on Unsplash

It was the second week of January and nobody had heard of SARS-CoV-2 or COVID-19 yet. My wife was down with the flu, the second time of the season. It was bad. Incessant coughing and fever, in bed for six days. On day three she started complaining that she felt like she “couldn’t take a full breath.”

I moved to the guest room when the coughing started, but I still went into our bedroom to bring her food and ginger-ale, and cough medicine, and to check on her, and keep her company.

At first it was “just the flu.” Our main concern was not infecting our daughter, who would swim in her first high school district swim meet a week later. Then my wife started to complain about shortness of breath, and I started to worry. The last time she’d been so sick was the swine flu pandemic of 2009. Luckily, just as I started to think about urgent care, she turned a corner. She was still coughing, but was stronger, up and moving about, back at her desk, working.

Then I got sick.

I get a flu shot every year. I know it doesn’t always work on everyone, but I hadn’t been really sick in years. Not even a cold. I didn’t feel bad that Tuesday morning, so I went to work. A partner team from California was in town on a week long visit, and I was the liason. Later that week, they would join us at our leadership retreat in a nearby hotel. I was scheduled to speak. It was a shitty time to get sick.

By lunch, I didn't feel right. I took some ibuprofen and texted my wife, but decided to hang in there for the day. By mid-afternoon I couldn’t deny it any more.

At four P.M. my wife texted:

Her: How you feeling?
Me: I was not too bad for a while. Starting to lose steam. Sort of vaguely achy, and I feel like I need to cough all the time but not actually coughing.
Her: That’s not good.

A coworker said it was like watching me deteriorate before her eyes. I went home

My wife had changed all the bedding and we switched bedrooms — the guest room was too close to our daughter’s bedroom for me to stay in — and switched roles.

Down for five days, I missed the offsite. My boss gave my talk. My cough was incredible, unstoppable, unlike anything I had experienced since pneumonia when I was fourteen. Not even really like that, either. Although my ribs hurt from coughing, I wasn't congested. My nose and sinuses were clear. There was no phlegm. Inside, it felt like a thin liquid was dripping down my bronchii. My lungs itched, but there was no way to scratch them. Between fatigue and pain it got hard to generate much coughing force.

Then there was the fever. Ibuprofen could barely control it. Three or four times a day, I’d swing between teeth-chattering chills and bed-soaking sweats. My throat hurt as bad as it had ever hurt, but it wasn't strep. No tell-tale white patches like you find with strep. Just dark red and inflamed.

Late on the second or third night, I began to understand assisted suicide. But it was just the flu; I knew I’d get better soon. Without that hope, I'd have been in despair.

I did get better. The worst symptoms only lasted a day or two. Still, something about this flu felt different. For the first time in our lives we’d bought surgical masks, and wore them in the house to keep from infecting our daughter. I only left my room when the girl was at school or in bed. Even then I’d “suit up,” putting on a mask first, then washing my hands, before venturing out to the kitchen, grabbing a couple things, and retreating to cover.

By day five I was still coughing, but otherwise felt a lot better. I couldn’t say as much for my wife. Although she was up and moving around, she hadn’t fully recovered. She still couldn’t really get a full breath of air, and we wondered if she had a secondary infection, maybe walking pneumonia. After a virtual consultation with a doctor, she was prescribed antibiotics—a ZPak. But it didn’t have the immediate turn-around effect that you expect from antibiotics when you’re fighting a bacterial infection. She just kind of slowly got better over the next week. We were never sure if the antibiotics helped.

The kid never got sick. One day about a week later she said her throat hurt a little. That was the last we heard of it. We forgot the whole thing. For a while.

Five weeks later we were sitting in the living room, watching TV. I was half listening while skimming the news on my phone about this weird epidemic in China.

“Hey, how many of those surgical masks do we have left?” I said.

“About half a box. Maybe six?”

“We should think about getting some more.”

The price gougers were already out on Amazon, but we managed to get a few cloth masks and one disposable PM2.5 mask for not too much money.

Over the next weeks we watched the wave come. One day my colleagues in the Bay Area got the news that they could work from home, and they all fled instantly. Meetings were canceled with the excuse “heading home” or “on the bus”. In Austin, SXSW was cancelled. The first confirmed case in Austin came two days before spring break, and the schools just went on break early. My team was told to work from home. Schools extended the break by a week, and then another. We know how that ends, the kids finished the year from home. I’ve been back to the office exactly one time, a few days after the lockdown started, to pick up a few other things from my desk.

In time, the news started to come out about cases in the USA in as early as January or even December. Steve Wozniak said he and his wife had had a strange illness with a horrible cough and was claiming to be patient zero. Was it possible that we’d had it too? My wife’s best friend teaches ESL, and has students from Wuhan, China in her class. She came down with a cough the week before we did. A colleague from my team’s China office visited my team in January as well.

Here’s a quick rundown of our symptoms:

  • Rapid onset. I felt okay in the morning, and was in bed with chills by dinner time.
  • Spiky fever and chills, increasing in severity over two or three days.
  • No nasal congestion or runny nose.
  • Severe, unproductive (dry) cough.
  • Shortness of breath.

So we wondered. In February, I had returned home to Pittsburgh for a funeral, where I spent a week sharing a bedroom with my brother at my mom’s house. He returned back home to New York, where his daughter promptly came down with something that the doctors had called “combined flu and whooping cough.” Then as soon as she recovered, she went to New Orleans for Mardi Gras. We joked that our family was the vector that had infected the two biggest hotspots in the country!

But it was just a joke. Mostly. We’d been sick so early. And yet, if it were true, it would be such a relief — yes, I know, epidemiologists are saying there’s “no evidence” that infection leads to immunity. I’ll get to that below.

But until we could get an antibody test, the only safe course of action was to behave as if we hadn’t had it. And so we did. When we talked about it with our friends, I would say things like “I bet we had it back in January,” but I was just spitballing, finding something interesting and strangely hopeful to talk about in a rough time. Regardless of our hopes, we were staying home, ordering in our groceries, and wiping down our Amazon packages with Clorox wipes, just like everyone else.

It was a mistake to talk about it this way. One of our friends, desperate, I think, to be released from social isolation, started saying that if we’d had it, then surely she must have had it too. Unlike us, she acted like she believed it. She started agitating for our group four of families to begin socializing together again, going to the lake house we often shared. We had to say no.

A month ago, word came out that labs in Austin were offering SARS-CoV-2 antibody tests. After a couple of weeks of waiting and debating, our curiosity got the better of us and we went in. The tests were not cheap, but we are fortunate to both still be working, and decided it would be worth the price to know.

I did the math. Based on my understanding of the tests that were offered and the prevalence in Travis county, I reckoned the positive predictive value of the test at about 93%. That is, if I got a positive test result, I had a 93% chance of actually having antibodies. By itself, I’m not sure if that’s enough to change my behavior. But if my wife and I both got positive tests, given that we’d both been sick at the same time with similar symptoms, then I reckoned the chance of two false positives to be pretty low.

We donned our masks and went to the lab. The desolate, dystopic waiting room had a dozen empty chairs spaced six feet apart facing an automated check-in kiosk. An iPad on a stand scanned the QR code in my confirmation email and added my name just below my wife’s on screen in the corner of the room. We laughed as we sat, masked and separated from each other, the only souls in the room. The phebotomist, suited and masked, took us each in turn. I asked him a few questions about how to get more information about the antibody tests and their false positive and negative rates. He just suggested I call customer service.

Back home, we waited. On Memorial Day weekend our results might not come before Tuesday. But the next morning I had an email. My results were in.

Negative. Hers came two days later: Negative.

Well, so much for that theory. Whatever we had in January, it wasn’t COVID-19.

But that’s the problem and the danger in hoping that that illness you had was it and now you’re safe. The odds were always low. Serology studies of antibody prevalence are showing that even in the hardest-hit places — like New York — only perhaps 20% of people have been infected. In Sweden, where they’ve followed only the loosest of restrictions to mitigate the spread, a study showed only 7% antibody prevalence in Stockholm. In Austin, I suspect the total prevalence was no more than 5% by Memorial Day. Combine that low prevalence with the very early date at which we would have had to be infected, and there was never much of a chance.

People say we were foolish to get our hopes up. But it makes sense to hope, especially to hope that we might have already been through this thing. Because let’s be clear, the endgame of COVID-19 can only play out two ways: either we get a vaccine or, in the fullness of time, we will all be infected. The virus will not magically go away. No amount of social distancing, no amount of lockdown, will eliminate the virus from all seven billion people on Earth. Even the sparsely populated island nations that seem to have eliminated the virus will have to open their borders eventually, and when they do, it will return. Given this future, it’s not unreasonable to hope that my wife and I, and maybe even our kid, had already been inoculated.

As for those who are saying that there’s no evidence that infection results in immunity, there are two responses.

First, this statement assumes a strange and frankly nonsensical definition of “evidence”. Where are all the reinfected people? All these months after the first people got sick, the absence of a significant population of reinfected people is strong evidence that infection confers immunity. How long that immunity lasts is a separate question.

Second, and maybe more important, if indeed it’s true that infection doesn’t confer immunity, the future is bleak indeed. If infection doesn’t confer immunity, then hopes for a vaccine are dim — if the full-strength, live virus doesn’t confer immunity, then how can we expect dead or deactivated viruses to do so? Without some kind of conferred immunity, no amount of social distancing or lockdown will stop it from finding us all in time.

I’m rooting for immunity.

Postscript, December 2020

Since first writing this story we’ve learned some new things about the disease that might cast the story in a different light

fiction author • computer scientist • sometime ai researcher • rock guitarist •

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