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 Tests both for the virus itself and for the antibodies the immune
system produces to fight the infection are becoming more widely
available, but they are not perfect. The tests can come back with
false positives, false negatives or confoundingly ambiguous results.
Doctors cannot always offer definitive explanations.
For Maree Johnson-Baruch, her husband, Jason Baruch, and their two
teenage daughters, their experience ran the gamut.
They all became sick around the same time with the same symptoms.
But each set of tests they subsequently took, whether for antibodies
or the virus, came back with conflicting results among family
members - some positive some negative. Eventually, after several
weeks and additional tests, they were able to confirm that all four
had indeed been infected.
"I feel a little bit like a science experiment," Johnson-Baruch
said. "But no one really knows how this virus is behaving."
Widespread testing is touted by many policymakers and public health
experts as a central tool for reopening closed economies and for
tamping down any future outbreaks of the virus. But these public
health experts have said that the limitations of tests must be
factored in, and that there must be time for more research into the
degree that antibodies, for example, confer immunity against future
infection.
Johnson-Baruch, an actress, began to feel ill shortly after she
finished her final performance in the pivotal supporting role of
Madame Giry in the Broadway musical "The Phantom of the Opera." It
was a Thursday matinee on March 12, the day New York City began
closing non-essential businesses to try to slow the spread of the
virus.
Over the weekend she had occasional aches but thought she was just
imagining symptoms. By Monday, she had a fever. One by one, her
husband and daughters fell sick over the following week.
Johnson-Baruch noticed she could not smell the pine-scented
disinfectant she was using to clean the family's apartment.
The family called the New York State Department of Health's
coronavirus hotline. The federal government had botched the rollout
of test kits, which then remained scarce - and limited in New York
mostly to only those sick enough to require hospitalization. The
family followed the advice to recuperate at home and by April
everyone felt recovered.
Soon after, Johnson-Baruch read about a new experimental therapy at
Manhattan's Mount Sinai Hospital in which the antibody-rich blood
plasma of patients who have recovered from COVID-19, the respiratory
disease caused by the virus, is donated to people hospitalized with
the illness.
In late April, she and her husband put on face masks and went to the
hospital, where healthcare workers decked in protective gear drew
blood.
"The strange thing was I tested positive and Jason tested negative,"
Johnson-Baruch said.
Such disparities do not surprise Dr. Ania Wajnberg, who oversees
Mount Sinai's antibody testing efforts.
The antibody test developed at Mount Sinai fails to detect
antibodies in about 6% of patients who actually have them. The
intensity and recentness of the original infection can also affect
whether antibodies are detected, Wajnberg said.
"I do think sometimes the results are surprising to people,"
Wajnberg said. "And, more than anything, I get tons of questions
about what the results mean, and we don't know exactly what they
mean."
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Although antibodies are thought to be likely to provide at least some immunity
for some period of time, it remains the subject of study.
"Overall, everyone understands that this is so new and that they are sort of
participating in the learning process," Wajnberg said.
'WE WERE SURPRISED'
About six weeks after calling the state health department, Johnson-Baruch heard
back from an official saying the family could finally get a test for the actual
virus that works by looking for distinctive parts of the pathogen's genetic
material, RNA, in a patient's sample.
"We were well over a month out of our symptoms by that point, so we were
surprised to get the call from them sort of out of the blue," Johnson-Baruch
said.
Johnson-Baruch noticed her eldest daughter particularly squirmed when healthcare
workers stuck swabs, one by one, deep into the back of their noses.
Once again, the results surprised them. Johnson-Baruch, her husband and their
youngest daughter all tested positive. Their eldest daughter tested negative.
What did it mean, the family wondered. Were they still in some sense sick? Could
they still infect others?
A health department official who called to relay the results was not much help.
"She was quite surprised to hear we were sick six weeks ago," Johnson-Baruch
said.
The tests used by the health department "cannot distinguish between RNA from
live or dead virus," Jonah Bruno, a department spokesman, wrote in an email.
"This persistent positive test result can continue long after a person has
recovered and does not necessarily indicate that a person continues to be
infectious."
Some 60 different RNA or antibody tests are now available after under emergency
use authorization by the U.S. Food and Drug Administration, but the makers of
those tests must continue to submit accuracy data to the regulatory agency
before final approval is given.
Dr. Danielle Ompad, an epidemiologist at New York University's School of Global
Public Health, said it was challenging to get the general public to accept the
limitations of tests.
"People are way more comfortable with 'yes' or 'no' than 'maybe,'" Ompad said.
"Unfortunately, that's where the science has us right now: we just don't know,
and it's much better to say that we don't know than to try to make predictions
without having the data there because that can be detrimental."
The Johnson-Baruch family members are not quite done with testing. The daughter
who had negative virus results has since tested positive for antibodies for the
virus after going to a walk-in clinic. Such facilities made testing more widely
available this month.
Jason Baruch, a lawyer for Broadway theaters, is also seeking a second antibody
test, this time hoping it comes back positive. A positive test would offer some
comfort that he may have some level of immunity.
"No one's really willing to put themselves on the line and say, 'Hey, you're
home free, you have antibodies,' or, 'You're still contagious,'" Baruch said.
"No one really wants to tell us - definitively - anything."
(Reporting by Jonathan Allen; Additional reporting by Mike Segar and Aleksandra
Michalska; Editing by Ross Colvin and Will Dunham)
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