Being Positive

Sheila was a thirty six year old woman that was new to our practice.

She was uninsured, but wanted to be tested for the COVID-19 antibody.

She was convinced that she contracted it, as she had all the classic symptoms. She was coughing nonstop two weeks ago andad developed an inability to smell her food. She also had developed an exhaustion that did not compare to anything she had experienced in her life. She works with nurses and healthcare providers that recommended that she self isolate. Since she had no insurance and was not “sick” enough to be tested, she did as they said and self isolated from her kids and everyone else in the house. As she recounted her history to me, she appeared anxious to know. Had she exposed her kids? Her parents? What about her coworkers?

The COVID-19 antibody or serology test has just recently been made available through commercial labs. The test tells us three things about a patient. It tells us if a patient has been 1. exposed, 2.

infected, and 3. recovered from COVID. The test is a blood test, so unlike the test for the antigen, which is done via nasal swab, it does not depend on items in short supply like reagents and nasal kits. What this means is that this test is readily available and can be done in much higher volume than the antigen test. What the antibody test will not tell us is if a patient has an active infection. In other words, if a person has a cough, fever, difficulty with taste and smell, fatigue or shortness of breath, this is not the test for them. This test tells us about the past, not the present. It tells us if a person has recovered, not if they are actively sick.

Some may ask why bother if this is the case? This is an important test for several reasons, but I’ll only give you three. First, it’s important for contact tracing. If we can determine the spread and breadth of the infection, we can find who is most likely to catch it next and possibly stop its movement. Second, it’s important for the economy. If we know who has recovered from the virus and those who possibly carry immunity to it, we can develop a strategy to safely open the economy instead of doing so blindly, putting our healthy population at risk a second time. Not to mention that people that carry the antibody are also possibly plasma donors that can help those that are in critical condition with the virus. And third, it’s important for peace of mind. If we want to go out to a restaurant without fear of contracting COVID, having extra assurance of the people handling the food is crucial. The ER doctor or nurse that fears he may be an asymptomatic carrier spreading it to his family and patients can have peace of mind. Because there are asymptomatic carriers out there that can potentially spread this virus, a person can test positive for this antibody without ever having any symptoms whatsoever. It can be for all the other Sheila’s out there that fear they may have had it, but aren’t quite sure, so they live in constant fear of it still.

To be clear, COVID-19 is still being studied. While having the antibody to this particular virus may confer some immunity from it, I cannot assure people of this. In other iterations of coronavirus, immunity is conferred. In other types of viruses, like the flu, immunity is typically conferred. The point of vaccines is to confer immunity via antibody, and that is the desperate hope of a COVID-19 vaccine. There are reported cases of people testing positive for

COVID-19 after recovery, which is the reason for my reluctance to plainly state that patients are immune. I will say, however, that in those cases, it is possibly an issue of the antigen testing as opposed to an actual reinfection. Regardless, practicing safe physical distancing is the only assured way of remaining safe from the spread of COVID.

Sheila’s test did come back positive. She evidently did get exposed, infected, and now recovered from COVID. I asked her to try to reach out to anyone that she may have exposed to it going back about one week prior to when she actually did develop symptoms so that they may also be tested. She immediately made an appointment to have her kids and parents tested as well. She breathed in a big sigh of relief and thanked me profusely. Being on the other side of COVID-19 is an amazing feeling. I hope that one day, we can all feel it.

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