Did I or Didn’t I Have COVID-19? Blundering through Unknowable Truths

Coronavirus Testing Capacity Is Going Unused - WSJ

            Few things are more terrifying than the unknown, as we are discovering as we struggle to navigate, avoid and (if we fail) survive a mysterious new virus. That goes double when reliable information is hard to come by; it is unquantifiably worse without credible leadership.

            “Who ya gonna believe,” Chico Marx asked, “me or your own eyes?” More than other cultures of which I am aware, Americans are acculturated to ignore their instincts and the truth of their observations. A smoker might wake up coughing up phlegm every morning for decades yet he only begins to internalize that tobacco is dangerous to his health after a surgeon general he has never met issues a report. You might live in the same house years on end but discount your observation of the fact that it used to snow but now it doesn’t; global warming only becomes official when hundreds of climate scientists certify what you already knew.

            Sometimes you have to trust yourself.

            Even when you are mistaken about some details.

            I’m 90% sure that I had COVID-19. It was in November. I was in LA for several weeks. In March I blogged about my symptoms: “I had an incessant dry cough…I had a constant fever. My temperature ranged from about 101° during the day to closer to 103° at night. My chest was tight: it felt like a car was parked on it. I had absolutely no energy whatsoever. I was exhausted. Even walking half a block, I had to take a break. I would get back to my hotel after a meeting and be asleep by 6 PM. I would sleep 14 hours and wake up still wiped out. ‘What the hell,’ I would ask myself, ‘is going on?’”

            I tested negative for influenza. An x-ray revealed early-stage pneumonia. I was prescribed antibiotics and a nebulizer. Obviously I recovered; here I am writing this. But I’m still weak and tired.

            If I could prove I had the novel coronavirus in November, it might be a news story. Aside from a New Jersey mayor who says he is sure that he had COVID-19 in November and a 55-year-old Chinese man whom doctors say had the disease on November 17th, the scientific and journalistic consensus is that the coronavirus pandemic originated in Wuhan, China in December. Last week my physician administered a serology test to determine if I have antibodies consistent with past infection with SARS-CoV-2. It came back negative. I was puzzled. If I hadn’t had COVID-19, or the flu, what the hell was this horrible illness?

            I’m 56. I’ve had trouble with my lungs my entire life: asthma, lots of bronchitis, several cases of pneumonia, swine flu. My symptoms are remarkably consistent. My November experience was nothing like anything before. What bronchitis gives you fever for weeks at a time? What pneumonia?

            The day after my doctor called with the negative antibody test result, the FDA issued a statement essentially declaring such lab tests worthless for the purpose of figuring out whether you’ve ever had COVID-19. So even if it had come back positive, it wouldn’t have meant anything.

            Even if my test had been 100% reliable, and it had come back positive, all the test result would have proven is that I had COVID-19 at some point. It would not have evidenced that I contracted COVID-19 in November. I could have caught something else in November and COVID-19 asymptomatically, later.

            Further reducing my reliability as a possible COVID-19 Patient Zero is a failure of memory: in my blog, I wrote—because I believed it—that this happened in January. When I subsequently reviewed my records, I came across a photo selfie of me on the nebulizer in a West Hollywood urgent care clinic. It was dated November 15th and I had already been sick for a couple of weeks. You may be less surprised that I made such a mistake when I tell you that my mom was desperately ill at the time, and she died on February 7th after a year of hell. Whatever it was, COVID-19 or something else, definitely happened in November.

            Does it matter? Scientifically of course the answer is yes. Epidemiologists benefit when they can trace a viral pandemic to its roots. Personally, medically, probably. Though the experts remain officially uncertain whether someone can be reinfected by COVID-19, the evidence appears to say that COVID-19 survivors probably cannot get reinfected to a significant extent. It wouldn’t prompt me to go out in public without a mask or stop washing my hands. I know it’s selfish but I won’t deny it: I would love the peace of mind of knowing that this particular beast isn’t going to kill me. And I would like to donate blood for use as plasma in order to treat coronavirus victims.

            As it stands, most of my thoughts on this subject are a muddled rumination about the nature of humanity and the reliability of personal knowledge. If I were an animal, and had never heard of science, and had memory and self-awareness, I would know—know with the same certainty that I know I am typing this column—that I had COVID-19 and that I should probably worry about something else more than the possibility that I might get it again. But I am not an animal, I am an American filled with self-doubt, in awe of Science and the desire to document what can probably never be proven and that in fact might not be true at all.

(Ted Rall (Twitter: @tedrall), the political cartoonist, columnist and graphic novelist, is the author of the biography “Bernie,” updated and expanded for 2020. You can support Ted’s hard-hitting political cartoons and columns and see his work first by sponsoring his work on Patreon.)

4 thoughts on “Did I or Didn’t I Have COVID-19? Blundering through Unknowable Truths

  1. Ted,

    Assuming you did have COVID-19 in November 2019 and that antibodies were made, it is likely that by the end of May 2020 there would no longer be antibodies or their levels would be below the sensitivity of even validated, accurate tests.

    First, In general, the initial antibody reaction to a never-before encountered foreign micro-organism is relatively weak. It serves mainly to “prime” the immune system to react much more quickly and with much higher antibody levels upon subsequent encounters with that foreign micro-organism. This is the rationale on which vaccination is based.

    Second, antibodies like all other components of our bodies are not permanent and are eliminated gradually as their function is no longer needed (antibodies) or is impaired by molecular damage in the general case.

    Initial info I found suggests a half-life of 21-28 days for IgG, the class of antibody sought for treatment of COVID-19 patients. From 15 Nov19 to 22May20, is a span of 160 days. That is 5.7 to 7.6 half-lives, defined as the time period it takes for levels of antigens, in this case, to fall to half of what they were at the beginning of the period. So at the time of your test, you would have between 2^5.7 (i.e. “2 to the power of 5.7”) and 2^7.6 lower antibody levels than in Nov19. That is 0.7-2.0% of “original” levels – whatever they might have been.

    Of course, there is no way to know what “original” levels were nor, therefore, if the sensitivity of current approved, accurate tests could confidently detect 0.7-2.0% of it.

    Why don’t you treat yourself, and us, to the story of “Patient Zero” … without regard to his/her definitive identity?

  2. First of all, saddened to hear about your continuing health problems and here’s hoping that they will at least fade with time.

    It certainly never showed from your cartoons and articles which continued to be thoughtful and timely throughout – at a time when most commentary noticeably devolved into blind adherence to one camp or the other, no less.

    I’m certainly not qualified to perform a differential diagnosis of an atypical pneumonia from a distance ;-), but to make a positive suggestion:

    An x-ray revealed early-stage pneumonia

    Christian Drosten – whose Corona update podcast (unfortunately in German) has taught millions the basics of virology – mentioned that clinics would sometimes get quite severe cases that looked like CoVID-19 but tested negative (PCR test). This makes sense in so far as the test sample is usually obtained from the throat or nasal mucus and virus concentration reliably plummets there after a week or so (but the virus is now replicating in the lungs, hence the danger). Such patients would receive a “provisional” diagnosis based on specific patterns in the x-ray/CT scans of the lungs that diagnosticians have learned to associate with CoVID – until such time that a positive PCR test could be obtained, e.g. from a stool sample.

    So if you still have your x-rays, you could send them to a doctor who has in the meanwhile been familiarized with lung damage due to the novel corona virus… In the absence of more specific issues (such as temporary complete loss of taste) this could provide one more piece of the puzzle. It has the added benefit that the x-ray has a clear date stamped to it, unlike even an antibody test, as noted in the article.

    As I said before, I’m not a medical doctor but from how I read the science I would clearly caution against expecting yourself to be an early case, let alone a case before any other case has been established… Partly because of negative PCR tests of kept samples from the time period, partly because of the base rate fallacy Alex mentioned, and partly because of the precautionary principle.

    Politically, it would certainly be hilarious – if it weren’t so tragic – if you indeed had had some version of CoVID-19 already in November, in light of the apparent mainstream consensus that China-as-a-whole was secretive if not criminally negligent for failing to immediately declare a handful of cases of atypical pneumonia as a novel contagious disease 😉

  3. Well, the New York Post just added some potential evidence (https://nypost.com/2020/06/09/covid-19-may-have-been-spreading-in-china-since-last-august-study/).
    I was very sluggish for several weeks in early December. I thought it was for another reason, but possibly, I, too, had coronavirus. If it is true that it emerged in August, then four months is more than enough time for it to get to the U.S. I wonder if the initial wave of illness and death was simply dismissed as “natural” causes.
    In the past, I’d have said, “No, there are systems in place specifically to spot these things as they emerge, rather than when they’re in full-blown pandemic,” but the strategic stockpile of medical supplies didn’t even have the special swabs needed for sampling. And I note that the media seems wholly uninterested in pointing out that this “Swab Gap” isn’t just Trump’s fault. You don’t stockpile in a single year or administration. You do it over many years. Funny I don’t hear anyone screaming themselves hoarse about Obama, Cheney, Clinton, and GHW Bush’s failure to take care of this.
    One wonders if they have batteries in their smoke detectors at home, these ex-presidents of ours.
    So, sure, maybe the coronavirus has been around since August and no one spotted it. All too busy tweeting in outrage about what Trump just tweeted.

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