I’m Almost Positive I Had Coronavirus, But Don’t Know For Sure—Here’s Why That’s a Problem
Our best shot at a treatment for the very ill may rely on those who have recovered from coronavirus. But without tests, how will we know who has had Covid-19?
Courtesy Karla Walsh
In the middle of the afternoon on March 14, I was on my yoga mat, doing sun salutations to stretch out after teaching a morning spin class. My allergy symptoms, including a runny nose, itchy eyes, and post-nasal drip, had been picking up the week prior since spring was finally around the corner. But one symptom I’d never really had with my seasonal allergies? A cough. And my cough that Saturday would not quit. This was pre-Tom Hanks, pre-China travel ban, but we were starting to hear rumblings of this new coronavirus. As a freelance health and food writer, I had done enough initial research to realize that was one of the main symptoms of Covid-19, but still thought, “This can’t be it! I feel fine, well, mostly.”
Out of an abundance of caution and just in case, I canceled my dinner plans that night and decided to stay at home until my symptoms calmed down. The next few days, I went about my life, just not stepping foot outside of my one-bedroom apartment: Working from home as I normally do, cranking out at-home circuit workouts, cooking dinner, and chatting with friends and family on the phone.
Realizing I may have the coronavirus
On Tuesday, I was assigned a story I had pitched about what to do when you think you might have Covid-19. My sister is an emergency room doctor, and we decided to tell the story from her perspective to guide people through their safest course of action. To flesh out the story I’d write, “By Dr. Amy Walsh, as told to Karla,” we hopped on a call so I could pepper her with questions. Midway through, I tuned into my body and realized how heavy my chest and lungs seemed (and how my fever had been inching higher since Saturday). It hit me that I was talking about myself.
But the lucky/fascinating/frustrating thing was that my course of action those three days leading up to our call was exactly what I should (and honestly, all I could) do for the next two weeks. Hunker down as to not pass it along, drink lots of water, take it easy, get plenty of sleep, and let my healthy immune system do its job. That was the moral of the story my sister and I teamed up on, too. Unless your symptoms are bad enough that you’d need to be admitted to the hospital to treat them, say, you require breathing assistance or have a fever over 104° F, you should steer clear of the ER and just ride it out at home. Treat the symptoms with naproxen (Aleve, Anaprox) and guaifenesin (sold as Robitussin and Mucinex, for example) and call your doctor if things don’t improve within 14 days.
Who gets tested for coronavirus?
Because of a severe testing shortage, Iowa (the state I call home) did not have tests for anyone who doesn’t fall into one of these categories:
Working in the healthcare field or as a first responder
Over 60 years of age
Living in a group home
The more I talked to friends, co-workers, and family across the country, the more I realized there were dozens of people just in my circle who had similar mild to moderate symptoms in March.
Many people feel uncertainty during the coronavirus pandemic
I’m still not sure whether I had Covid-19, but I had some convincing evidence. The day of my highest fever, Amy and I were texting back and forth between her shifts and she asked, “Is this Day Eight, by chance? That seems to be the worst based on the initial research from China.” I flipped to my calendar and discovered it was Monday, eight days after those first coughs. Luckily, I had been following her advice and quarantining, acting like I had it even if I didn’t.
I’m feeling 99 percent better now, and thankfully am pretty sure I had practiced good hygiene before symptoms arose and caught it in time to not spread the virus to anyone else. But as I shelter in place and interview more and more epidemiologists, doctors, and scientists, I have discovered even more similar cases to mine. About 80 percent of those who noticed symptoms in that Wuhan, China study I mentioned had mild ones. And get this: Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases and a member of the president’s Coronavirus Task Force, estimates that 25 to 50 percent of people who have Covid-19 are completely asymptomatic. That means there are a lot of people walking around spreading the virus without even knowing—hence measures like social distancing and the new Centers for Disease Control and Prevention recommendation for all Americans to wear face masks in public places where social distancing is hard to maintain. (Here’s how to make a face mask to protect against coronavirus.)
“The idea of doing a broad screening, including asymptomatic people, is not a bad idea…it’s surveillance, but not the highest priority,” Fauci said during a CNN Town Hall event on March 20.
The more we discover about this virus, the way it spreads, and how we’re trying to fight it, the more I realized the best way out of this pandemic—with the least deaths along the way—might require testing our way out. Here’s why.
What testing can tell us
There are two types of tests related to the coronavirus:
A diagnostic test, which can tell you if you have it at the moment (you’ve likely seen reports about the drive-through nasal swab tests; we’re inching closer to at-home testing options)
An antibody test that can tell if you had it in the past (although antibody tests can be used in conjunction with other tests to diagnose the illness)
On April 2, the FDA approved its first antibody test, which is a blood test, for in-office use. These test a person’s blood to measure whether the body has created an immune response to fight off the virus.
“During a viral infection, the body’s immune system ramps up to control and kill the virus. Production of virus-specific proteins, or ‘antibodies,’ is one way the body is able to control and kill the virus. It takes the immune system weeks to generate these antibodies in adequate amounts to not only kill the virus, but to also protect the person from getting the virus again,” says Jill Weatherhead, MD, an assistant professor of adult and pediatric infectious diseases at Baylor College of Medicine in Houston, Texas.
Antibody testing will play a critical role in understanding Covid-19 disease progression. Having widely available antibody testing will offer a clearer picture of the number of people who have had Covid-19, the frequency of death, and how long immunity lasts after people recover, Dr. Weatherhead explains.
Experts are trying to find out whether antibodies created after you’re infected with Covid-19 protect you against getting re-infected. If they do, Dr. Weatherhead says, that information could lead to decisions to reopen businesses and ease stay-at-home orders.
The data also will come in handy during the development and testing of potential vaccines.
“Having available antibody testing will provide insight into the effectiveness of vaccines that are entering clinical trials because they could indicate if the vaccines are creating the correct immune response,” Dr. Weatherhead says. “Other tests are currently being developed, and several diagnostic tests including antibody tests have received Emergency Use Authorization (EUA) from the FDA.”
Until a vaccine is developed (which will probably be at least 12 months), the most successful treatment might lie inside those who have recovered from the virus. To tap into this treatment option, though, we must know who those people are.
Plasma and a potential treatment for the coronavirus
Convalescent plasma therapy has been used since the early 1900s to treat various illnesses, including cancers and infectious diseases. It involves taking donated blood from those who have recovered and spinning it in a centrifuge to separate the plasma (the part of the blood filled with antibodies that can fight off infections). After the plasma is screened for safety and tested for the number of antibodies, it’s pumped into those who are severely sick.
“The use of convalescent plasma that contains SARS-CoV2—the virus that causes Covid-19—specific antibodies as treatment for Covid-19 is currently being studied in several clinical trials globally,” Dr. Weatherhead says. “While there’s hope that convalescent antibody transfusion will be a therapeutic option for people with severe Covid-19, this has yet to be proven. Randomized control clinical trials are necessary to evaluate the safety and effectiveness.”
The future of antibody testing
We want testing and treatment options to be accurate and safe, so scientists are putting all of the above through their paces before making them widely available.
“At this time, there’s no FDA-approved test that can be done at home. Antibody tests will require collection of blood specimens, which may limit home availability. However, the FDA is currently examining other diagnostic strategies that are safe and accurate for home use,” Dr. Weatherhead says.
Until then, and until we know more about the way this virus works, our best course of action is to stay home as much as possible.
- The Lancet: Estimates of the Severity of Coronavirus Disease 2019: A Model-Based Analysis
- National Institutes of Allergy and Infectious Diseases: Anthony S. Fauci, MD
- White House: Statement from the Press Secretary Regarding the President's Coronavirus Task Force
- NPR: Fauci: Half of Those With Coronavirus May Have No Symptoms
- CNN: Dr. Fauci: Testing Asymptomatic Patients is Not the Highest Priority
- CDC: Social Distancing, Quarantine, and Isolation
- CDC: Use of Cloth Face Coverings to Help Slow the Spread of COVID-19
- FDA: Coronavirus (COVID-19) Update: Daily Roundup April 2, 2020
- Jill Weatherhead, MD, assistant professor of adult and pediatric infectious diseases at Baylor College of Medicine in Houston, Texas
- Johns Hopkins Medicine: New Coronavirus Vaccine in Development at Johns Hopkins
- Recent Patents on Anti-Infective Drug Discovery: An augmented passive immune therapy to treat fulminant bacterial infections