We cannot definitely say someone is not infected: COVID-19 Nightmares

“We don’t have a test that can definitely say someone is not infected,” said Dr. John Swartzberg, a specialist in infectious disease and clinical professor emeritus at UC Berkeley’s School of Public Health. (Source)

I am listening to my neighbor who is standing outdoors below, outside my upstairs bedroom window, coughing his lungs out. I am wondering if his Coronavirus test came back negative like mine, and if I ought shut my window.

On Tuesday, March 24, 2020, I was able to do more physically than I have in two weeks. I stood upright for an hour. After my eldest son delivered Trader Joe’s groceries to our doorstep (in Olympia, Washington, U.S.A), I disinfected several bags of food items and restocked our refrigerator. Although, I was somewhat breathless following the task, I was pleased with the productivity outcome. At least I’d accomplished something beyond blogging about my anxiety, watching the start of dozens of Netflix shows, and deciphering patterns in consumer-trend buying at Amazon Pantry. (FYI: Yesterday, you could still find noodles by searching for Lotus Foods.)

This morning I was also semi-productive. I put in a few hours of remote-work at Ultranauts Inc. I am finding that I get tired from work about 75% faster than I have historically, even as I am sitting upright in bed, working from my laptop, and not having to host any meetings or calls.

Fortunately, my approximate sixteen days of house isolation are passing fast. Nights are a different story, with much tossing and turning and scary dreams. Since I’ve always had nightmares, they aren’t anything new. Even so, there is one primary difference: the scary dreams are leaning more toward current events. It probably doesn’t help that I weep most nights before sleep, thinking on the masses of people suffering as a result of the global health crisis

I began this hailing day in the Pacific Northwest remembering my SARS-CoV-2  (the virus causing COVID-19) test was negative. I reassured myself with these findings. It was a similar reassurance to this recollection, a burrito incident at the age of eight:

I recall standing in the heat of the light that was shining through the open kitchen window, when I took a ginormous bite of my Taco Bell burrito. It was a second after I had finished bite one that I realized I’d accidentally swallowed a smidgen of the tinfoil wrapping. The moment was intense. Upon recognition of the tinfoil entering my digestive system, I experienced an intense rush of panic. The blood surged up from my chest to my throat, and all the way to the tip of my head. As my cheeks flamed, my first thought was: Don’t worry. The government would not allow Taco Bell to poison you. Tinfoil must to be safe to eat. They wouldn’t wrap your food in anything unsafe. From there, the temperature of my face moved from hot to mild, the tight knot in my gut released, and I proceeded to devour the burrito. (Redwood City, California, U.S.A)

Since the age of eight, I’ve grown some in the ways of the world. I tried to keep comforting myself. But after a brief bout of coughing and chest pain and shortness of breath, I began to reconsider. It’s something my partner David has mentioned to me a couple times: His disbelief that what I am experiencing isn’t the Coronavirus, or to remove the double-negative:

His belief that I am experiencing SARS-oV-2.

This new mindset was upsetting. To ease my anxiety I went on a ‘false-negative-test-result scavenger hunt. It didn’t take long to find some evidence in this Mercury News article: Coronavirus false test results: With the push to screen come questions of accuracy

• As testing increases, so do reports of inconclusive test results.
• After testing negative, a Stanford student learned that he tested positive.
• “It is important to note that the test is not validated for use in asymptomatic individuals, and testing those without symptoms may give falsely reassuring negative results and lead to missed infections or inaccurate safety recommendations.” (Santa Clara County’s Department of Public Health)

I went on to read more articles, while questioning why false-negative test results don’t appear at the top of our news feeds:

• “Here’s a big, discomforting fact about the current coronavirus outbreak in the United States: We have no idea how large it is” reported in The CDC’s rocky effort to get Americans tested for coronavirus, explained.
• It is unclear why quality control did not detect this issue’: Early CDC tests couldn’t distinguish between the coronavirus and water
• New York’s state health department received a faulty CDC test kit on Feb. 8 for 800 patient specimens, an amount that’s consistent with other states (Source)
• Lack of a reliable tests prevented officials from taking a crucial first step in coping with a possible outbreak (Source).
• “Testing of specimens from multiple sites may improve the sensitivity and reduce false-negative test results.” (Source)
• “Reports suggest some people test negative up to six times even though they are infected with the virus, according to the BBC and Chinese media.” (Source)
• In Seattle researchers were so exasperated by the CDC’s initial faulty test that they came up with their own. (Source)
• “RT-PCR tests may produce false negatives due to laboratory error or insufficient amount of viral material collected from the patient. Samples that are stored or handled improperly also result in false negatives.” (Source)
• “Tests may result in false negatives if the patient is tested too early in the course of infection and there is insufficient amount of virus to be detected. Improper sampling may result in a false negative.” (Same source as above)
  

  Mark Pandori, the director of the Nevada State Public Health Laboratory, revealed, “A lot of people look at lab tests like they are magic. But when you run lab tests, the more chances you have for getting false answers.” (Source)

Anecdotal evidence: A Facebook friend from South Africa wrote to me: “There are stories here of people getting different results with 2 simultaneous tests. They’re still learning how this virus works.”

See video below at 57-minute mark for further evidence.

We know that there are many individuals who have the COVID-19 who are not being tested. Some experts state for every one person who tests positive, there are ten other individuals who haven’t had the test, who are active carriers of the virus. When we factor in the false-negative tests, how many more infections of the virus in total are we talking about?

From What Went Wrong with Coronavirus Testing in the U.S.:

“False diagnostic tests can lead to significant adverse health consequences—not only serious implications for individual patient care but also serious implications for the analyses of disease progression and for public health decision making.”

With a false negative test result, a person with COVID-19 is released back into the world to expose otherwise healthy people to the virus (Source) This could mean hospital and medical clinical staff, tested too early in their incubation period of the virus, or not tested enough, who remain in close contact with high-risk patients and clients, or moms and dads and grandparents who think they are in the clear and don’t take precautionary measures under home isolation with their family.

On the bright side, the number of false-negative folks floating about their day (or suffering without knowing why), like asymptomatic citizens who aren’t tested (or anyone who isn’t tested) would automatically lower the fatality-rate percentage. On the dark side, the false-negative test results might lead to an increase number of individuals being infected, which leads to more hospital beds and ventilators occupied, which leads to less room for the sick. Which leads to more fatalities.

From video below: Some patients have 7 tests that test negative in hospital before they test positive for COVID-19. In China they kept testing patients every 48 hours. Sometimes 12 to 14 times. Normally 7 to 8 times to check for recovery. Well spoken Doctor from China offers sound and calm medical advise to professionals and explain his experience. (Negative Test discussion at 57 minutes)

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