In some ways, we’ve come a long way since we wrote our first blog post Coronavirus: What You Need to Know & How to Stay Safe back in late February of 2020. In other ways, it feels like there is still so much that is unknown and so many questions that remain unanswered.
The most important question still looms: When and how will this pandemic end? When will life feel “normal” again?
When we wrote the blog post COVID-19 Testing: Availability, Accuracy & Interpretation in April of 2020, we were first able to test our family for COVID. At that time, testing was just emerging and not incredibly accurate. Like many other families we’ve spoken to, we believed that four of the five of us may have had COVID back in February 2020, but our April antibody testing did not confirm that.
Thankfully, all of us have remained free of symptoms, so it was only Dr. Roy who continued to test, about every three months, out of a combination of curiosity and precaution.
We are both fairly “risk averse” by nature and that’s how we’ve been during this pandemic. We shared in our blog post Can We Send Our Kids Back to School During a Pandemic? the many factors that have gone into our decision to remain conservative, most importantly our desire to have Debbie’s parents (67 and 70 years old) in our daily lives while keeping them safe.
Dr. Roy has been working largely through Telemedicine and seeing only healthy young children in-person. On top of that, he has worked around infectious disease for more than twenty years and we have excellent precautions in place at the office.
Debbie has worked from home since last March, our kids have been in home-learning, we mostly get grocery delivery and do curbside pick-ups and we have a very small circle of friends, who we mainly see outdoors.
So, as you can probably imagine, our first shock came when we learned that Debbie had COVID-19 antibodies. It’s not that we thought that we were being so careful, we know that we were!
But then further testing revealed contradicting results from different labs, leaving us feeling even more confused.
Our next big shock came when we tested more of our family and learned which of us had had COVID—and which family members had not.
The one person, Dr. Roy, who had developed a perplexing symptom that prompted our most recent testing, was the one who was negative!
We are sharing this story with you here, as a small case study of our own family, to help you understand what we have learned in this process and what we still do not know.
Before we dive into any specifics, it feels important to acknowledge how fortunate our family is and appreciate how grateful we feel. It appears that our family had COVID, and for the most part, everyone was relatively free of symptoms.
We know that some of you reading this may have been hit hard by COVID—and some may even be experiencing its lingering after-effects weeks or months later.
So many people have lost their lives and their loved ones in this pandemic.
We feel anxious when we think about what could have happened—and immensely grateful for what did not.
COVID-19 Testing & the Phases of Infection
Active Infection: Viral RNA & Antigen
When you contract COVID, the virus begins to multiply in your body. As it continues to multiply, viral genetic material (RNA) levels will generally peak at 1-week and then begin to fall off in the next week. This process occurs in individuals with and without COVID symptoms. This is also when people are most infectious.
There are two types of tests that can help diagnose an active infection. Both methods test infected body fluids, most commonly from a nasal swab.
The first test detects Viral RNA and is known as PCR Testing. PCR testing is currently the most accurate and reliable, but often takes 24-72 hours to get results.
The second test, called Antigen Testing, detects other proteins that COVID produces. The advantage of Rapid Antigen Testing is that it is quick. You can get results in minutes to hours. The down side is that it has a much higher rate of false negatives, especially in asymptomatic individuals.
Both PCR and Antigen test results are qualitative, meaning a positive or negative result is provided.
Current or Recent Infection: IgM
For most people, as your body starts to fight off the infection, your immune system will produce Immunoglobulin M (IgM) antibodies. IgM can be detected in the blood for approximately 1-8 weeks after the infection began. After that point, IgM is generally no longer detectable.
Because IgM can last from 1-8 weeks, positive IgM antibodies can be detected in both currently infected and recently recovered individuals. Therefore, IgM is not used to verify an active infection and does not help us know if you are still contagious.
Past Infection: IgG
As your body continues to fight off the infection, another antibody called Immunoglobulin G (IgG) becomes detectable in the blood. This antibody can take several weeks to develop and will generally remain positive for an extended period of months. It is these IgG antibodies that generally give us long term, protective immunity to infections.
With some diseases, such as chicken pox, IgG antibodies can remain for a lifetime. In other illness, such as the Flu, IgG antibodies may remain for a few weeks or months. It is not known for how long COVID IgG antibodies will remain.
IgG testing is generally useful in determining whether or not someone had a past COVID infection. These antibodies can be detected in both those individuals who experienced COVID symptoms and those who did not.
For symptomatic individuals, it is recommended to wait at least four weeks from the time of symptom onset before testing IgG. For those who have been asymptomatic, IgG testing is also an option for determining whether they unknowingly had the virus.
We do, however, recommend ordering both an IgM and IgG for a more complete picture, especially if you have not experienced any COVID-19 symptoms.
Our Family’s Test Results & Symptoms
Until just a few weeks ago if you asked us if it were possible that we had been infected with COVID-19, we would have told you there was no way. The main reason that we recently tested was because Dr. Roy has been experiencing one very strange symptom that we could not make any sense of. Plus, we are total data nerds and we like to run tests on ourselves!
Dr. Roy’s Strange Symptom
About 6-8 weeks ago Dr. Roy started experiencing what would best be described as “restless tongue and burning mouth syndrome”. It initially started with a tight jaw, which he attributed to the discomfort of wearing a mask and the stress of this year. Then he cracked a filling in his tooth and his tongue became accustomed to “messing with” the crack by constantly running his tongue over it.
But then a few weeks later, his mouth started burning. His palate and all his teeth started hurting and his tongue started feeling too large for his mouth. After this, he started noticing a strange metallic taste.
He had no other symptoms: no fever, no aches, no cough, no fatigue, no loss of taste or smell…nothing. Although there was no information that he could find on this (until this week!) it turns out that a new syndrome called “COVID Tongue” is now being discovered. And thankfully, Dr. Roy believes that his mouth symptoms are now starting to resolve.
Dr. Roy & Debbie’s Vibrant America Antibody Testing
As you can see, Dr. Roy’s results are completely negative while Debbie’s test indicate that she already had COVID. The presence of all her IgG antibodies indicate that she was past the infection already. As we mentioned earlier, IgM antibodies (which she had one positive) can linger for several weeks.
However, out of an abundance of caution, we both went for a nasal PCR testing and both of our results came back negative.
After seeing our results, we joked that our tests were switched because Dr. Roy had a strange symptom—and Debbie’s car battery has literally died twice from lack of going anywhere!
So, we repeated an IgG antibody test on Debbie, just five days after her first test, using another lab (LabCorp) and that result came back negative!
Now we were even more confused. Had Debbie had COVID or not?
We decided to test more members of our family to see if a clearer picture would emerge and we were shocked by the results!
It turns out that our daughter, Mia, and Debbie’s Step Dad were also positive. Testing indicated they also had COVID at some point as well, most likely in the last 1-2 months.
We also tested Debbie’s mom, who had received one dose of the vaccine three weeks prior. She was both IgM and IgG positive. We need more information to fully interpret her results and will be consulting with a scientist at Vibrant America Labs.
However, Debbie’s brother (who was in town the week we tested but had not been with us since October) as well as three of our friends (who we only socialize with outdoors) all tested negative.
A Clearer Picture
Let’s start by saying that nothing with COVID is “clear”! But now we had tests showing that Debbie, Mia, Debbie’s Step Dad and likely Debbie’s mom all had COVID. Even knowing that studies indicate that a significant number of people will be asymptomatic for COVID, it was hard to wrap our heads around.
Mia has had absolutely no symptoms. Debbie and her mom both had a 1-2 day period of acute gastrointestinal distress (but a month apart from one another)—and if you know Debbie’s family, that could happen any month in any year…ha! Debbie’s Step Dad remembers a very mild cough for a day or two that he attributed to the change in Colorado weather.
But What About Debbie’s Negative LabCorp IgG Results?
As we talked with more people in infectious disease, we learned that LabCorp’s test is a combination of the Spike 1 & 2 proteins, both of which Debbie was positive for with Vibrant America’s test.
However, LabCorp’s test only provides a positive or negative result. Let’s say, for argument sake, that the threshold is 3 for a positive test and Debbie’s results came back at 2.7. Then all she would see is a negative, even though she was clearly approaching what would be positive.
As Debbie’s body eventually stops making IgM antibodies and continues to make more IgG over these next weeks, it is possible that her IgG test may then be positive with LabCorp as well. We will likely repeat this test on her again.
We are also testing our two older kids, who were skiing the day we tested the rest of the family, and we will see how their results confirm or confuse this emerging picture!
How is it that the only one of us that had any real, ongoing symptom had a negative antibody test?
As we began to do some research as to why some people do not produce protective antibodies despite a COVID infection, we came across some interesting theories.
Antibodies are not the immune systems most efficient way to fight an early infection because it takes some time for the immune system to identify a pathogen and then create antibodies to kill that pathogen.
Our immune system has what is called innate protection as well. These are cells that directly kill pathogens without needing to make antibodies. It is a less specific but more efficient system.
It appears that people who are exposed to high levels of infectious disease, like those living in the developing world (India, Africa)—and possibly even pediatricians—have a stronger innate immune system and therefore may fight off a COVID infection before producing any detectable antibodies.
The second fascinating observation being made is that people who received the BCG vaccine for Tuberculosis may also have some degree of protection against COVID due to the vaccines effect on the innate immune system. (See information here and here)
It is known that the BCG vaccine does encourage greater protection against some other viruses and even makes the Flu vaccine more effective.
The BCG vaccine is not given in the United States but Dr. Roy was born in Israel. All children born in Israel from 1956 through 1979 received the BCG vaccine as infants. Dr. Roy was born and given the BCG vaccine in 1972.
Could this explain Dr. Roy’s negative antibody test results?
Could this mean that Dr. Roy did have COVID but we will not see it in his IgG antibodies?
Other Emerging Tests
T cell Testing
Part of the innate immune system is made up of T cells. While these tests for COVID-19 are just starting to come to market now, there is some good research to show they may have a higher detection rate than antibody testing.
We are getting Dr. Roy tested with a newly available T cell test this week.
IgA is a specific antibody that is produced in our mucus membranes: the mouth, nose, gut, and vagina. IgA is often the first line defense of our immune system since these mucus membranes are also the port of entry into our bodies.
IgA antibody testing for COVID has been shown to be reliable in those people who have predominantly digestive symptoms. It now seems that up to 20% of those with COVID may only experience gastrointestinal symptoms only and this testing (which can be done via serum and stool) may diagnose those individuals better.
Do IgG Antibodies Give You COVID Immunity?
So what do these results mean for our family? If you have IgG antibodies do you have immunity against COVID?
The CDC, and virtually all authoritative agencies, are stating that we do not know if having IgG antibodies is protective. Because COVID is a novel (new) virus there is no way to know this for sure and we should still be very careful, even if we have IgG antibodies.
The CDC states: “Having antibodies to the virus that causes COVID-19 may provide protection from getting infected with the virus again. But even if it does, we do not know how much protection the antibodies may provide or how long this protection may last. Confirmed and suspected cases of reinfection have been reported, but remain rare.”
However, based on what we know about viral infections in general, it is likely that IgG antibodies will have some protective effect.
We hope that sharing this small case study of our family helps you to understand what we know about testing—as well as its current limitations. As human beings who feel more comfort in certainty, it’s hard to make sense of a virus that can cause no or minimal symptoms in one person and can be so devastating in another.
In the early weeks of this pandemic, Roy’s childhood best friend in NYC suffered a stroke at 47 years old that left him paralyzed along the left side of his body. He tested negative to approximately 10 PCR tests—in addition to having a negative antibody test later on. He experienced altered taste at this time. Over these months he has made remarkable progress. Was his stroke caused by COVID-19? We still don’t have the answer.
In some ways COVID has challenged much of what we thought we knew about infectious disease. Several times Debbie has mentioned the blog post she wrote a few winters ago titled How I Avoided the Flu Three Times. In hindsight, we now offer up the question: could she have had the Flu?
Maybe, like COVID, Debbie was asymptomatic and, if we had actually tested her, we could have seen that? We simply don’t have all these answers at this time and are certainly not suggesting that this would be the way to proceed going forward either.
Your Options for Antibody Testing
By no means are we writing this post to suggest that every family get antibody testing. We have invested a lot of money in this and that may not make sense for some families.
However, we know that some of you reading will be interested, so we want to provide you with the information.
As already mentioned, we tested our family with the Vibrant America COVID-19 test and given what we have learned about antibody testing, this is what we would recommend right now.
The test costs $119 and has a sensitivity of 98.1% and a specificity of 98.6%.
Our office charges a small administrative fee ($55 for the first person, $15 for each additional family member) for our time ordering the test and returning the results.
Lori Anderson of ABO Labs will be at our office the following dates/times to draw blood for these tests*. Her regular draw fee is $45 per person but she will be charging $25 per person as a courtesy to our patients.
- Friday February 5th: 1:30-4:30 pm (FULL!)
- Friday February 19th: 1:30-3:00 pm
Please call our office at 303.318.4102 if this interests you and we can get you scheduled.
* Please remember: As we stated above, this testing is only suitable for healthy individuals who are interested in learning if they had a past COVID-19 infection.
If you have made it this far, thank you for taking the time to read all of this. It’s been quite a journey!
We welcome your questions or comments below. Also, if you found this post useful, please let us know that below and we will consider posting again as we gather more information.