I thought I might have had a mild case of COVID-19.
In late March, about three weeks after my family hunkered down at home, I felt a pressure, a heaviness, on my chest. I didn’t have a fever or a cough and I could breathe just fine, but the feeling stuck around.
At the time, people were just starting to mention chest pressure as a possible symptom of the coronavirus.
“My chest felt as if there were an anvil sitting on top of it,” one infected writer wrote.
Today, the Centers for Disease Control and Prevention (CDC) recommends emergency treatment for those who have “persistent pain or pressure in the chest,” but at the time, it wasn’t listed as a symptom.
My doctor told me not to worry during a March 30 telehealth appointment.
A few days later, the pressure was gone.
But the nagging question remained. Did I have a mild case?
The weeks passed and I monitored the availability of antibody testing, and when I saw a local urgent care office had the goods, I made an appointment.
It was for May 11, exactly six weeks after my telehealth appointment.
If I tested positive, what would it really mean?
“All that you’ve learned from this test is that you were infected 10 to 14 days ago or longer and you developed an immune response,” Daniel Varga, chief physician executive for Hackensack Meridian Health, later told me. “It’s not a passport for immunity.”
When my time came, I pulled into the urgent care’s parking lot and called the office.
They took my insurance information and details about my past symptoms over the phone, and said a nurse would shortly call me in.
To prepare to go inside, I readied my mask, which I cover with a scarf for a little extra protection.
In five minutes, the nurse told me to drive to the back of the building, park and she would meet me outside.
And there she was, fully dressed in PPE, by the door, which was propped up so no one would have to touch it. She took my insurance card to scan it and then returned it. No need for the credit card. The office would bill me, she said.
On the way to the exam room, we passed half a dozen face shields hanging on a wall. Gowns hung on another, probably on hooks that would be for employee winter coats in normal times.
I didn’t see any other patients.
The next person appeared about three minutes later with a surgical mask and gloves but no gown. Scrubs. I signed a release that included my email and cell phone so they could send the results. I used their pen — normally I would bring my own but I wasn’t expecting to sign anything.
“We try to keep them clean as we can but no guarantee,” she said, pointing to the sanitizer.
I asked a few questions as she prepared for the blood draw.
How accurate is the test? We don’t know, she said.
How long will it take for results? Three to five days, she said.
The blood draw took less than two minutes. A quick needle prick and a quick collection, and then I was on my way.
Back at my car, I used the sanitizer I always leave open in my cup holder on my hands and my steering wheel.
I headed home with two unanswered questions: How accurate was my test, and how would the results affect my actions during the shutdown?
HOW ACCURATE ARE ANTIBODY TESTS?
There are two main antibody tests run by most of the big labs. They look for what’s called IgG or IgM. Some tests look for both and other antibodies, too.
The IgM antibody, or Immunoglobulin M, is the first responder of the immune system, said Varga of Hackensack Meridian Health.
It’s the antibody that’s found immediately after exposure to a virus, he said, and it dissipates once the IgG antibody develops. In this case, the test is measuring coronavirus exposure.
The IgG antibody, short for Immunoglobulin G, tends to develop 10 to 14 days after infection, he said.
“IgG is the test you want,” Varga said, noting that Hackensack uses the Quest IgG test, which happens to be the exact test I took.
Varga said IgG is the antibody that tends to give long-term immunity, but for the coronavirus, we don’t yet know how long immunity might last.
“If you have developed an IgG response and you’re asymptomatic, it doesn’t mean that you’re not going to be able to get infected with the virus,” Varga said. “But what most virologists think is that it would be highly unlikely you would get really, really sick if you get exposed to COVID-19 again.”
A test is only as good as its accuracy. If someone has a false positive, they may be emboldened to change their behavior and pay less attention to social distancing, masking and other protective actions like hand washing. A person could then expose themselves to the virus because of a wrong belief that they have some protection, or even be asymptomatic and unknowingly spread the virus to others.
A false negative, in comparison, could cause a person who has some protections to remain strict with distancing and cleaning rules.
Varga called the Quest test and similar tests made by LabCorp and BioReference, among others, “very, very accurate.”
We asked Varga to translate what Quest says about its test’s accuracy.
On false positives, he said that because the test has a high degree of specificity — it was analyzed against other coronaviruses like SARS and MERS — it means “if you have a positive, it’s almost certainly a true positive.”
Consumers should ask at what lab the test will be performed and what instrument the lab is using to make sure the test has been reviewed by the Food and Drug Administration (FDA) under Emergency Use Authorization, said Paul Simon, laboratory medical director for the CentraState Health Care System.
Then you can look it up on the FDA website, he said.
“People, especially asymptomatic people, should get tested because we will learn a lot about not only disease prevalence, but test reliability,” Simon said, adding that testing helps with data collection.
“Everyone can play a part in that regard,” he said. “More importantly, people with antibodies are potential COVID convalescent plasma donors and can contribute to the pool of this therapeutic product.”
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So what does it mean if someone tests positive for the IgG antibody?
We are too early in this pandemic too know what it means, Varga said. It’s just another data point.
He said a positive antibody test doesn’t mean you still don’t have the active virus. He said he’s had patients test positive for IgG and also test positive for the virus with a nasal swab. Unless you test negative for the virus itself, you could still be infectious, Varga said.
Plus, he said, it’s too soon to know how long any immunity could last.
He recommends people with positive antibody tests not change their behavior when it comes to social distancing, masks and hand-washing.
MY RESULTS, MY DECISION
For me, the hope for a positive test wasn’t about hitting the boardwalk or eating in a restaurant.
I figured if I tested positive, my husband and teens would probably be positive, too. We wouldn’t visit grandma and grandpa yet and the kids wouldn’t have sleepovers or other hangouts, but it would give us some level of confidence that we wouldn’t get sick.
Having antibodies would give small comfort when I go out and run errands, even when I’m masked up and fully sanitized. I would worry less when schools and offices reopen and even feel more comfortable about a trip to the grocery store.
I got my result four days later when I wasn’t thinking about it: while listening to the Department of Labor’s commissioner speak at Gov. Murphy’s daily briefing.
My text beeped and I thought it was my editor.
“Negative antibodies,” the text said, followed by a one-page report.
I really expected it to be positive. I really wanted it to be positive.
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Karin Price Mueller may be reached at firstname.lastname@example.org.