One of our favorite things at GeekWire is to try something new on our beats and write about it. We call these GeekWire Adventures, and the best are the ones we do as a team. A few years back, we all raced across Seattle at rush hour in different modes of transportation. A couple of years ago, we even spent a month in Pittsburgh — in winter! — for our GeekWire HQ2 project.
This was not supposed to be one of those adventures, but it turned into one.
Back in mid-February of this year, I started to feel just really yucky. It evolved from a tickle in my throat to congestion and a bad cough, body aches, chills, and fatigue. I was short of breath. It was the worst that I can ever remember being sick.
I did not mean to share this adventure with somebody else, but I think I did.
“There you were sniffling not far from me, and coughing, and just looking gray,” recalls my colleague, GeekWire reporter Kurt Schlosser, who got sick not long after that. “I was like, ‘I’m not going to catch whatever he’s got, am I?’ So, thanks, Todd.”
Yes, this was mid-February …. so was it COVID? On the Season 5 premiere of the GeekWire Health Tech Podcast, we revisit the early days of the pandemic in an effort to figure out this mysterious illness, and come away with a deeper understanding of the nuances of testing, and insights into the future of healthcare.
Listen above, subscribe to GeekWire Health Tech in any podcast app, and continue reading for a summary.
I don’t know where I got my mysterious illness, but there was one very public place that I went in the days right before I started feeling sick, and it provides an ironic twist at the outset of our story. One afternoon in mid-February, I went to the Washington State Convention Center in downtown Seattle, I waited in a big crowd outside the auditorium and spent an hour in a packed audience to cover Bill Gates at the American Association for the Advancement of Science annual meeting
Gates addressed COVID-19 during part of his talk, but it wasn’t the main focus, and at that point it still seemed in some ways like a very distant problem.
That weekend is when I started to feel sick. I initially convinced myself that it was just seasonal allergies, as one does, but soon it was obvious that it was a lot more than that. Being the moderately responsible sick person that I am, I went to the doctor and got a flu test. It came back negative for flu types A and B. So I asked the doctor about COVID-19.
But as you probably remember, COVID tests were not really available at the time in the United States. So I was prescribed Tamiflu, bedrest and lots of fluid.
And since I did not have a fever, I was reassured by the doctor that I was not contagious. But still, I stayed home from work, mostly. The rest of my family was fortunately out of town for the week so I was effectively quarantined — with the exception of a couple of days that I did go into the office for just a few hours, to take care of things that I felt at the time required me to be there.
Of course, it was a mistake.
“I got really sick. I missed five days of work, I was in bed with a fever for four days, lost a bunch of weight,” my colleague Kurt Schlosser recalls. “And I didn’t start to blame you until a few months after.”
He wasn’t able to get tested at the time either, so he also doesn’t know if he had COVID-19. He and I are not alone in looking back to a bad illness in the first few months of 2020 and wondering if it might have been COVID-19.
Moderating a panel at the GeekWire Summit in October, Christina Farr, the CNBC health tech reporter recently turned investor, raised the same question about her own illness from January. In retrospect, she asked, when exactly did COVID-19 reach the United States?
Speaking on the panel, Dr. Trevor Bedford of the Fred Hutchinson Cancer Research Center in Seattle said his research group and others went back to specimens that had been taken for flu tests in December and January, took them out of the freezer, and tested them for COVID-19.
“You basically see that none of those are COVID in January,” said Bedford, who studies the spread and evolution of viruses. “That doesn’t mean there wasn’t anything in January, but it means the average respiratory virus infection in January was very unlikely to be COVID.”
My ears perked up when I heard Bedford’s comment about going back and retesting samples originally taken for flu tests to determine whether people actually had COVID-19. I checked though and my medical provider did not retain my sample. That may be common in research studies, but it’s not realistic in the real world.
But I was able to take a different type of test — and that’s where things got really interesting.
Looking for answers in antibodies
A couple of months after I got sick, antibody testing started to become more widely available in the Seattle region. These tests are designed to detect the presence of the antibodies produced by the body’s immune system to ward off the virus that causes COVID-19. It’s a way of learning after the fact whether you had it.
The results came back in three emails for different stages of the test, and each one said the same thing: “This sample does not contain detectable SARS-CoV-2 antibodies.”
I’ve never been more disappointed to be told that I was not sick.
The tests are highly accurate in detecting antibodies, explained Dr. Erik Vanderlip, the chief medical officer at ZoomCare, the on-demand primary care provider where I got my antibody test. However, he explained, the question of whether there’s a presence of antibodies to COVID-19 “is a different question than whether or not you actually had it, because it’s possible that you may not have mounted a meaningful antibody response” to the virus.
That’s just one of the current vagaries of antibody testing. It’s also not clear how much protection against COVID-19 is provided by different levels of antibodies, and how long that protection lasts.
“People are looking to these antibody tests to understand what’s going to happen to them over the next year or two years,” said Dr. Alex Greninger, an Assistant Professor in the Department of Laboratory Medicine and Pathology at University of Washington Medicine. “They want to know, ‘Am I going to get the virus nine months from now?’ it just takes time to figure that out.”
Greninger is also assistant director in the University of Washington Medicine Clinical Biology Lab. He played a key role early on in getting FDA approval to process COVID-19 tests at the university lab, and he was part of a research team that evaluated an antibody test from healthcare giant Abbott, finding it highly sensitive to COVID-19 antibodies, and also very specific, meaning that the tests didn’t confuse them with antibodies for other viruses.
“The question really is, what’s the critical threshold that you need to have protection?” he said. “And we don’t totally know that. That’s another thing that’s really maddening about this.”
The measured doses provided in vaccine trials will help to answer these questions over time, he said.
Another challenge with antibody testing: While the results are often presented to patients as a binary answer, positive or negative, the test actually produces an underlying number, and the determination of the result is based on whether that number exceeds a specified threshold.
“In the first paper we put out on antibody testing, we actually proposed an indeterminate range,” Greninger explained. “In an ideal test, you have this perfect population of negatives and perfect populations of positives, and you can park a truck between them in terms of the values you’re getting. There’s no overlap. You look at the cutoff values on this test, it is just one long continuum.”
While labs have the ability to test for many different types of viruses, testing has been limited in part by a lack of treatment, plus a lack of insurance reimbursements for those extra tests, Greninger said. There’s a reluctance to test for a virus that can’t be treated.
‘Golden era’ for treatments and testing
That’s changing with the massive focus on COVID-19.
“We’re really in a golden era of respiratory virus treatments over the next decade,” Greninger said. “And I think it’s going to follow in the diagnostic space, as well. So there really is a renaissance in the testing for these. It will be interesting to see what comes out of that. And that goes to the antibody testing too.”
After talking with Dr. Greninger, my hunch is that I had not COVID-19 but rather RSV, respiratory syncytial virus, a common virus that infects the lungs and breathing passages. But that’s just a hunch. I still don’t know for sure. This is frustrating, given all the effort I’ve made. I went to multiple doctors when I was sick, and I’ve been trying for literally months now to figure out what I had.
So I couldn’t help but ask Dr. Vanderlip, the ZoomCare chief medical officer, if it would be too extreme to say the system failed me.
“Nope,” he acknowledged, expressing his personal view that the U.S. healthcare system and government, writ large, have “bungled this whole approach to COVID.”
ZoomCare and other U.S. healthcare providers didn’t have access to widespread testing in the early days of the pandemic. They faced restrictive CDC rules and the thread of FDA sanctions if they were to go rogue and try to solve the problem themselves, he said.
“We are part and parcel of the larger ecosystem of healthcare delivery system in the United States,” Vanderlip said. “And at that point in time, early on in this outbreak, one of the learnings that we had from a macro perspective was that if we get too far ahead of the standard of care for what everybody else is doing, or conversely too far behind, it’s not good.”
ZoomCare did get experimental, piloting a saliva-based coronavirus test but ultimately moving on when it didn’t prove as reliable as standard PCR (polymerase chain reaction) tests for SARS-CoV-2, the virus that caused COVID-19. (It is now offering PCR tests to its patients.)
“We’d like to do what’s right, what we think is scientifically valid,” Vanderlip said.
To bring closure to my own story, while I did not end up solving the mystery of my illness, I did make a point of closing the loop and apologizing to the person I accidentally shared this adventure with, my colleague Kurt Schlosser. He hasn’t worked regularly in the office since he got sick, since we’ve all been working from home. He’s a traditionalist who uses a paper calendar, and the last day crossed off on his desk is March 3.
I told him that I hoped he could find it in his heart to forgive me someday.
“Yeah,” he said with a laugh. “See you in 2022.”
