After much internal debate, I decided to get the COVID-19 Antibody test in Houston. This was in the early days of May. I am an HR manager for Veritas Total Solutions. We have a strong presence in the Houston energy sector as well as with clients around the globe, so being vigilant and knowledgeable about the precautions employees and employers will need to take as businesses reopen is at the forefront of my mind. Like all businesses, the health and well-being of our employees and clients are paramount and information is empowering.
While there is still a lot of uncertainty around employer responsibilities, some employees may be interested in getting tested for COVID-19 Antibodies before returning to work. I wanted to share my experience to cast sunlight on what your experience could look like if you are also wondering if you have contracted COVID-19 and either recovered without hospitalization or were asymptomatic. Knowing if antibodies are present in your bloodstream could drive decisions for employees such as getting on an airplane or attending a conference, as we begin to reopen.
February: Showing symptoms, pre-COVID-19
My story begins in February 2020 when I went to Philadelphia with two coworkers on a business trip. Shortly after landing I was wracked with fever for three days; this is a rare occurrence for me. My chest hurt and even while walking around the city I felt exhausted and short of breath. You may recall that in mid-February, COVID-19 and its symptoms were not part of the public vernacular. I remarked repeatedly to my spouse that it hurt to breathe, and when asked if I had the flu, I kept complaining that the symptoms were completely different from the achy body and sore throat symptoms of cases of the flu that I have had in the past. I am a tough patient and rarely stop my life when I feel sick (remember this was pre-COVID-19) so I took 2 airline flights, walked all over the city of Philadelphia, ate out 3 meals a day, including with coworkers, and even visited the famous and packed Reading Food Court for a Philly cheesesteak. Not proud of this, just sharing the facts.
March: Quarantine begins, COVID-19 viral testing slowly becomes available
My symptoms resolved themselves within a week of my return to Houston and then we ushered in March 2020. Houston was shut down and the quarantine began with little left to do after working all day from home but exhaust ourselves on news. April came and went, and Houstonians were encouraged to hear that several random COVID-19 testing centers finally opened up in Houston.
Houston had been exceptionally slow to make wide-scale testing available prior to May. The public was still largely reluctant to test, confounded by reports that the test was less than 70% accurate. Hardly a reason to venture out. First-hand accounts from Houstonians reveal that people who did not have extreme and current symptoms were denied testing access and told it could take two weeks or more to get the results back. This did not help. The other disturbing fact was that the tests were producing a significant percentage of false negative results.
A recent NPR article raises questions about false negatives. “So that means if you had 100 patients that were positive, 15% of those patients would be falsely called negative. They'd be told that they're negative for COVID when they're really positive," Procop told NPR in an interview. "That's not too good."
April: COVID-19 Antibody tests become available
Finally, Houston announced in late April 2020, COVID-19 Antibody tests to detect the presence of Antibodies were now readily available. The COVID-19 Antibody tests are different than the viral tests. This was what prompted me. I wanted to look in the rear-view mirror to see if I had antibodies present which could ward off a future viral attack. I went on the Texas Testing Center website and entered my Harris County zip code. At the time, there were 4 sites that indicated that they offered this test (today there are 37). After calling the closest antibody testing center repeatedly, with hold times of up to an hour, I was finally able to reach an operator. She indicated that they did not offer the Antibody test after all and that she did not know who did! This was a local CDC rep. In my frustration, I asked to speak to her supervisor. He informed me that there were some antibody testing locations, but that the site he knew of was changing location every 4-5 days and was currently a 40-minute drive with extensive wait times.
That didn’t motivate me. On the drive to the grocery store with my husband later that day, he received a call from a client. The client mentioned informally that he had just taken the elusive Antibody test. I immediately interrupted my husband and asked him to find out where. We were told that the client had called his doctor and was given a lab requisition for Quest diagnostics where he had his blood test and received results within 24 hours.
I immediately reached out to my doctor and asked for the Antibody test. With no questions asked, she agreed and told me that her office would call in a lab request. The nurse called me back the next day to say that she was not able to find any labs in Houston that could help me with this. I told her about the call the day before and Quest lab. My doctor’s office investigated and promptly returned my call to say that Quest Diagnostics was now authorized to perform the Antibody test and that I could go to any of their lab locations to take it.
May: Scheduled a COVID-19 Antibody test appointment
After numerous calls I landed upon Quest Lab on Binz Street in the Med Center. This location was unique in that it allowed me to make an online appointment. Having an actual appointment was important to me, since this process had been so slow, frustrating, and fruitless until now. I did not especially want to go to the med center, since I imagined walking through corridors of sick COVID-19 patients. I arrived wearing gloves and a mask and parked at the adjacent parking garage. It was a relief to see only 3 other cars on the entire first floor. So far so good. This was May 5th, and there were even a few restaurants with outdoor seating that I passed on the way into my building that had customers and people who were socially distancing themselves and enjoying lunch. Houston had just launched Phase 1. I was pleased to see no sick people.
In the building’s main lobby, the first well-known lab that I passed filled me with dread. Patients were standing shoulder to shoulder to get testing of some sort. My thought was, “Ok, if Quest Lab looks like that, I’m leaving. I won’t even walk in.” As I rounded the corner to my lab’s entrance I was heartened by the lack of people, in fact I was the only person there! I keyed my data into the iPad at the check-in desk and waited no more than a minute before a nurse called me. I was immediately dropped into a chair and my blood was drawn. I personally never watch my own blood extraction, so I don’t know how many vials she took, but it did seem to take a long time. After I was given a hot pink bandage, I was told to expect the results for both the Antibody test and the COVID-19 test within 24 hours. I left really pleased by the safe, scheduled experience and was happy to know that I would receive both test results back, even though I only requested the Antibody test. The other silver lining was that the cost for the test was completely covered by my insurance company.
The results are in
Three business days later, and after a number of non-productive phone inquiries, my doctor’s nurse called to inform me that the Antibody test came back negative. “Terrific- how about the COVID-19 test?” “I have no idea what you mean”, the nurse replied. “I see nothing on your chart.”
Huge relief in the short term, skeptical longer term. After some research, it turns out that none of the Antibody tests on the market are FDA approved and can return almost 50% false positives. Was it worth it? I ultimately decided it was not.
Jump forward to May 21, 2020. On this date Texas was specifically called out by the CDC along with Pennsylvania and Georgia for comingling test data. In an article by Alexis C. Madrigal of The Atlantic entitled, “How Could the CDC Make That Mistake?” She reported that “the government’s disease-fighting agency was conflating viral and antibody tests, compromising a few crucial metrics that governors depend on to reopen their economies.”
She went on to point out: “The upshot is that the government’s disease-fighting agency is overstating the country’s ability to test people who are sick with COVID-19. The CDC confirmed to The Atlantic on Wednesday that it is mixing the results of viral and antibody tests, even though the two tests reveal different information and are used for different reasons. This is not merely a technical error. States have set quantitative guidelines for reopening their economies based on these flawed data points. The widespread use of the practice means that it remains difficult to know exactly how much the country’s ability to test people who are actively sick with COVID-19 has improved. “You’ve got to be kidding me,” Ashish Jha, the K. T. Li Professor of Global Health at Harvard and the director of the Harvard Global Health Institute, told us when we described what the CDC was doing. “How could the CDC make that mistake? This is a mess.”
“Viral tests, taken by nose swab or saliva sample, look for direct evidence of a coronavirus infection. They are considered the gold standard for diagnosing someone with COVID-19. Antibody tests, by contrast, use blood samples to look for biological signals that a person has been exposed to the virus in the past.”
A negative test result means something different for each test. If somebody tests negative on a COVID-19 viral test, a doctor can be relatively sure that they are not sick currently; if somebody tests negative on an Antibody test, they have probably never been infected with or exposed to the coronavirus. (Or they may have been given a false result—Antibody tests are notoriously less accurate on an individual level than viral tests.) The problem is that the CDC is clumping negative results from both tests together in its public reporting.
In Texas, the rate of new COVID-19 infections has stubbornly refused to fall. The Texas Observer first reported last week that the state was comingling viral and antibody results together. On Tuesday, Governor Greg Abbott denied that Texas was blending the results, but the Dallas Observer reports that it is still doing so.
Blending COVID-19 viral and Antibody test results: What does this mean for employees in Houston?
The long and short of it is that if you choose to take the Antibody test in Houston, you may not necessarily end up feeling like you have received the last word on this subject. In an admittedly small sample straw poll, I contacted the nurse who administered my COVID-19 Antibody test and asked her generically if she was getting a lot of positive test results for the Antibody test. She said that she did not recall seeing any so far. Could it be that no one in Houston’s med center area has any antibodies in their blood stream for this virus, or maybe it is just a poorly contrived test, too quickly released?
Houston - we just don’t know.
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