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By Julia Ioffe
I began to feel ill of health on the night of Sunday, August 16. He had spent the past week suffering from excruciating neck pain, the origins of which he could not explain. My mother, a doctor who prides herself on her super diagnostic skills, was sure this was the first outbreak of a COVID infection. I waved to him, insisting that I had probably tried too hard on the abdominal workout. But on Sunday night, it was clear that something was wrong. I controlled myself slightly to do the shopping and had to lie down a couple of times while making dinner. In the morning, she had chills, a runny nose, and a sore throat. Something told me that my mother was right. I called my number one attending physician’s workplace in Washington, DC, and went downtown to his verification site. A quick nose swab produced negative effects two days later. I was delighted. I didn’t feel bad, just a little bad, and now the check has shown what I was looking to hear: I didn’t have COVID-19. But my mother and sister, a doctor who cared for COVID patients at the height of the pandemic, insisted that I had to stay home and quarantine for two weeks.
Gradually, the symptoms reappeared, although they never really left, they came in waves. I spent most of the day feeling good, just to get a temperature spike while wrapping myself in layers of clothes and blankets to fight the cold. In an hour or two, I’ll feel perfectly fine again. My sense of taste and smell began to improve. It may no longer smell my cat’s mess and the ice cream may taste cold. Then my sense of taste returned, but some things, like sweets, had an intolerably intense taste. A mental fog settled in and I discovered myself. constantly searching for undeniable words. It was the first time I felt that way of speaking English than a foreign language.
I was becoming more and more convinced that I had COVID, so I tried not to forget everyone I had noticed in the two weeks before my illness to warn them that by coming into contact with me, they may have simply been exposed. I told them via text message that I had tested negative for COVID, suspected I was inflamed, and encouraged them to get checked. My friends’ responses surprised me: the vast majority said they felt smart and didn’t feel like getting checked because my own test result had been negative. In their minds, they may not have been exposed if it had tested negative, not to mention the symptoms it was displaying. There wasn’t much I could do to convince them, so I made the decision to take the check again. This time, I went to one of the walk-in screening sites that the Washington, DC government had set up in the city. I finished the questionnaire: “Did you have any of the following symptoms?” List COVID symptoms: cough, sore throat, body aches, chills, loss of taste, loss of smell, shortness of breath. I checked almost all the boxes. A quick nasal swab and I was home, where 48 hours later I got some other negative result.
Meanwhile, the reflux intensified and intensified. Every time I thought I was feeling better, a new wave of discomfort covered me. I’d have a smart day, just to sleep 16 hours next time and I’d feel totally unable to move unless I also took a 3-hour nap. Shit, I guess, convinced I was getting sick more and more, to feel smart the next day.
Nearly halfway through my third week of illness, an oppression has gripped my chest. I felt as if someone had seized my traffic and reinforced their grip. I went from shaking to sweating and coming back. My mom and sister were convinced it was COVID. However, how can it be if I was negative twice?Friends coming to me were becoming more and more confident: two negative tests meant I didn’t have COVID. “Girl, ” a friend sent me, “stop telling other people you have a COVID when you only have one cold!”
But he didn’t look like an embedded man. In fact, it didn’t look like anything I’d had before. No disbeliever or even the flu had been so wobbly. Not even the monkey or flirtatious cough had been a roller coaster. They were all simple, linear diseases, and none of them produced questioned my sense of reality. I felt like I was entering a kind of viral purgatory, with no end in sight. However, two negative COVID tests seemed quite definitive.
This made me wonder: was it imaginable to have COVID-19 and still have negative control for SARS-CoV-2, the virus that causes it, twice?And if false negatives were imaginable, how often were they imaginable?He had read stories about false negatives in the spring, and had heard anecdotes from friends running in New York hospitals who did not fully accept the controls as true after having to place seriously ill patients in fans, even though patients had tested negative on several occasions. the new coronavirus. A friend’s elderly grandmother had tested negative four times, but was still being treated on the COVID grounds of her Florida hospital. And I remembered my mother, who had been sick for a month and had tested negative twice for COVID, despite sharing a space with my father, who was in poor health and had tested positive for coronavirus, but my impression was that the controls had come a long way since.
In addition, compared to the early days of the pandemic, the controls ended up meaning something different for many other people and would become the key to bringing something close to life to something close to it in the absence of a vaccine. Throughout the summer, other people I knew were checking their friends in beach houses or visiting a circle of family if the result was negative, but now I wondered if it was imaginable that a user inflamed by the virus had negative control – and given the politicization of CDC control rules – if we had become too confident in controlling and in our ability to locate and isolate other inflamed people?
I started calling the administrators of the main laboratories, interviewing the doctors who had treated patients with coronavirus and asked them: what is the probability of a false negative?, and contracted COVID?Meanwhile, I felt worse and worse, tiredness and mental confusion were overwhelming, chest oppression did not decrease and a dry, roaring cough prevented me from falling asleep. a control site in DC and, as I suspected the nasal swabs might lack something, I asked the guy administering the control if he could go past the nostril, to do the brain tingling he had read. he told me, we don’t do that here, we just take nasal samples. He showed me the little medical cotton swab before gently caressing the inside of each of the nostrils.
On Saturday morning of Labor Day weekend, after 3 weeks of illness, I gained an email informing me that I had tested negative again, but at night, it has become increasingly difficult to breathe. I had measured the degrees of oxygen in my blood. with an oximeter, a device that squeezes into your index finger. Given the rate at which some patients would possibly get worse without even knowing that their oxygen levels are decreasing, doctors have stated that oximeters are useful for COVID patients at home. weeks I was sick, my oxygen grades remained stable. This weekend, as it became harder to breathe, the grades began to drop. On Sunday morning, my oxygen point was at 89 – incredibly low. I called my PCP, obviously I have COVID,” he says, ignoring my 3 now negative tests. He told me to get to the hospital right away.
How did I get so sick and the evidence failed?And was it imaginable that I had COVID after 3 negative tests?
The answer, I realized, incredibly complicated.
“Just because I’ve scored negative twice doesn’t mean I don’t have it,” Geoffrey Baird, M. D. , Ph. D. told me after my negative check moment. Baird runs the University of Washington lab, which took care of COVID’s first access point in the United States, and I had written about his team’s herculous efforts to expand his own control of the new coronavirus. what’s going on with me and whether I’m an atypical case. “His story is unusual,” Baird said, “but it’s not unique. “
At the peak of the pandemic in the spring, Baird told me that it was not unusual for doctors treating patients at the University of Washington hospital to call their lab, through the COVID control effects they had just received. . In front of them would be a patient with a fever and severe respiratory symptoms, but laboratory effects would say that the patient was negative for the coronavirus. The two tests, what the doctor saw and what the check said, seemed to contradict each other. Resolving this contradiction, and doing it temporarily, was not just a matter of life and death, but also of containing the pandemic. If a patient who came to the emergency room with COVID-like symptoms tested negative for SARS-CoV-2 and was in fact not inflamed with the virus, which is called a true negative, then the action plan of a doctor would be very different. than someone who has actually had COVID-19. They can even finish the patient’s house to recover without telling him to self-quarantine. But what if it was a false negative? In other words, what if the patient actually had SARS-CoV-2 in their system, but for some explanation why it wasn’t showing up on the check? If doctors relied solely on the check and this patient was discharged or placed in a normal wing of the hospital, they may end up infecting others with this highly contagious and fatal new virus.
Part of the challenge is the controls themselves. At the beginning of the pandemic, the U. S. governmentHe used a control kit, made to be obtained through the CDC, which turned out to be defective. Infections in the United States soared and the FDA eventually allowed hospitals, college labs and personal brands to create their own checks. The ad hoc technique helped fill the US check gap. However, as a result, there is no popular gold for coronavirus control. Each of the check marks they implemented to the FDA for emergency approval to create a check, and there are 165, they had to submit their own knowledge to see if the checks were running correctly.
Some checks were very accurate, but others were not. A review of the checks to be performed revealed that the probability of them generating a false negative can range from 2% to 29%. Another found that up to 30% of checks can simply spit out a false negative. Other doctors gave me a 10 to 20% diversity. A faster check, the Abbott ID NOW, which President Trump promoted at a press conference in Rose Garden, turned out to be only 51% delicate. In other words, this exclusive check was probably enough to give you a false negative as to give you an exact result: not much bigger than a draw. (Public debate has now shifted to faster antigenic verification, which uses a different strategy than recently used PCR checks. PCR controls. The chances of getting a false negative are, on average, around 30%, in some controls they can succeed in 50 or even 70%).
And while PCR tests have become much more sensitive – meaning less likely to produce a false negative – they are still not 100 percent accurate. They are also much more likely to produce a false negative than a false positive. “” The best test, “Baird tells me. ” The ones we have lately are 80 to 90% sensitive. That’s really good, but it means there is a one in five chance of having a false negative. “
In fact, when I looked again at the effects of my checks, the warnings were there, in black and white. Just below my first negative control result, for example, was the following warning: “When diagnostic control is negative, the option of a false negative result should be considered as in the context of a patient’s recent exposures and the presence of clinical symptoms and symptoms consistent with COVID-19. In other words, if you checked negative for coronavirus but still have symptoms of COVID, you may have had a false negative. You may also have COVID.
And that’s just the probability of error built into the check itself. There is a total diversity of other points that have the possibility of compromising the accuracy of verification.
The popular COVID control is performed through the nasopharyngeal swab, which takes the back of the nasal passage and throat. But this sampling technique, very sensitive, is not the best either. “The virus enters through the nose, but it does it a lot in the lungs,” Baird says. The further you move away from your lungs, the less virus there is. “Baird, along with the doctors I spoke to in New York, San Francisco, and Atlanta, told me that I had noticed several cases of patients who had tested negative for swabs but whose lung fluid was filled with coronavirus. You need to be ill enough (hospitalized and intubated) to have your lung fluid checked. If you only have mild symptoms, as I did at first, no one will get into your lungs.
In contrast, the control may also lose COVID infection, according to studies, if you clean it too soon after you have been exposed.
Also, if there is something express in the way it is built, about the physical arrangement of your nose, for example, or if, for some reason, when the virus hit you, it was to your lungs, repeating a COVID test does not do it. will give you a more accurate result. Here, probability legislation is a component of its express physiology. “If there’s something in your nose or in your illness that makes control harder to detect,” Baird says, “the false negative is more likely to be repeated because everything about your nose or illness is also true the moment you do a check. “
Then there is the consultation of the quality of a pattern received through the swab. Nasopharyngeal swabs (nasopharyngeal swabs that pass so far in the nose that they feel as if they are coming out of the back of the head) are more sensitive. that undeniable nasal swabs that only come into contact with the inside of their nostrils. But the city of Washington, D. C. , for example, performs COVID checks only nasal patterns. When I called the city’s public fitness branch to ask why the city had opted for nasal patterns rather than more delicate brain tickles, a spokesman told me it was “mainly based on supply availability. “In the early days of the pandemic, when there was a shortage of control equipment, the city opted for what it was going to be had and stayed.
Even when done correctly, “there is no best test,” said David Hirschwerk, MD, vice president of infectious diseases at Northwell, one of the largest personal fitness care networks in the New York area. He and his team performed an exam in which they wiped the patient clean with two more swabs. “We saw a mismatch,” he told me. In other words, the same patient tested negative and positive at the same time.
The scale of the pandemic, and the volume of controls, means that there are many more false negatives than we think. ‘Even if a control were 98% delicate and 99% specific,’ a recent article in the New England Journal of Medicine warns. , ‘it would still produce a false negative result in 2 out of 100 inflamed people. If we review five million Americans daily and only 1% of them have COVID-19, a total of 100 positive cases will be lost, expanding the threat of spread. “And as we know, a lost infection, and the false sense of accepting as true created through a false negative, can create a chain of transmission that traps dozens of people.
So what does a doctor deserve?And what was he meant to do?
“I would probably tell you that you still have COVID and that you quarantine and act like you have COVID,” Neda Frayha, MD, a phD in internal medicine who teaches medicine at the University of Maryland, told me. ‘If someone has symptoms that look like COVID but the result is negative, we want to treat them as if they were cOVID’.
A young doctor, who treated the weight of COVID patients when his New York hospital was hit in the spring, told me that at the time “we rely heavily on clinical diagnoses. “At the time, he said: “If the image matches COVID, then it is COVID unless you can convince us otherwise. Ultimately, COVID control is very useful when positive, however, there were patients who obviously had COVID, based on things like x-rays, lab tests and symptoms. (This doctor asked to remain anonymous as it is not legal to speak to the press. )
Although a false negative is much less likely when the virus is not spreading in your community, “if you have symptoms consistent with COVID, and this is the time of year when there is not much flu,” Hirschwerk said, referring to August, when I was sick, “there is a very clever chance that Array, regardless of the test, will have a COVID.
“If you have symptoms of COVID, are serious and have the classic presentation, you’re still in danger of COVID,” Baird said. “Using only the check is a beginner’s mistake,” he said, comparing such a resolution to using blood sugar to diagnose something as complex as diabetes. “That’s why we have doctors, not robots. “
Why do these doctors think they can cancel my negative COVID checks?The answer is in something called the Bayes theorem and its concept of probability of prior control. Since the beginning of the pandemic, medical journals have published articles reminiscent of doctors using the Bayes theorem. , which encourages a doctor to incorporate all the evidence in front of them, be it the check and what tells them its clinical significance. According to the Bayes theorem, if a patient’s pre-check chance is higher, has all COVID symptoms, for example, or had close contact with a patient who showed COVID: getting a positive test result drags their 100 percent chance of having coronavirus, but getting a negative check doesn’t return them to 0. “moving a dot on a continuum between 0 and 100, ” said Baird. “With a negative check, we reduced the probability, but it still wouldn’t be 0. “
James Crawford, MD, who runs the diagnostic labs in Northwell, has put this even more bluntly: “When the probability of a previous test is high, you’re going to forget about the test,” he said. “Yes, there are transparent diagnoses in medicine, however, you spend a lot of time as a doctor doing probabilistic medicine and looking to get things right with your patient. “
In my case, I had all the cardinal symptoms of COVID (including loss of taste and smell), I live in a Washington domain with some of the highest COVID rates in town, and I was given poor health at the height of the summer, which makes the flu much less likely. My chance of prior control, according to Frayha, was very high. “It’s the fact that you have symptoms and they feel and sound a lot like COVID,” he says. , according to the Bayes theorem and a recent study published in the BMJ (originally the British Medical Journal), the likelihood that I will have a COVID is not negligible; in fact, it’s high. “For a 90% chance of pre-verification, a user with a negative check has a 74% chance of having COVID-19,” the authors wrote. “With two negative checks, this threat remains about 47%. “
When Frayha and I spoke, I asked him if it made sense that everything he had was so internal and external, and I felt so different from everything I had before. At the time, I had been in poor health for almost 3 weeks and had had two negative tests, and I was tired of friends who were not doctors wondering if it was actually COVID, there was a component in development in me that I feared was right. , even when I was spending more and more power trying to prove to them, and myself, that I wasn’t crazy.
“I’ll have to look absolutely crazy,” I said to Frayha, “I’ll have to feel like I’m making this up. “
“In fact, it reminds me more of COVID than anything else, ” he answered. “Other upper breathing viruses are very linear. This virus is very unpredictable and there is still a lot of mystery. But other people know when they’re passing is different from what they’ve experienced before. When my patients tell me, “This is different from everything I’ve experienced,” I pay attention to that. These problems of non-public reminiscence are very vital in interpreting what is happening. People know when something is going on and it’s very important to pay attention to it. This will be stimulating, even more than a lab says. Listen to your body. “
On Monday, September 14th, I had another COVID test. This time it was a brain tingle, and this time it was in the emergency room. After my concern for Labor Day, I was prescribed steroids, which recent studies have shown to be effective in controlling the fact that coronavirus sends the over-multiplied immune formula, infrequently with a fatal effect. Steroids worked magically. No more coughing, more fatigue and I might breathe without having to think about it or fight for the air, but then the remedy ran out, the steroids left my formula, and on Monday afternoon I was sitting on my couch, pale and sudorosa. and breathless. My oxygen grades began to wobble again.
In the emergency room, I told the staff that I had tested negative for COVID three times, but the nurse who took care of me repeated what I had heard from all the doctors I had interviewed when I was still well enough to work. as if it were a COVID unless you can convince us otherwise,” he said.
A few hours later the doctor arrived who was taking care of me to talk about the effects of the checks they were going to do to me, I had no blood clots or pneumonia, but the X-ray showed that I had bibasilar atelecasia, partially deflated lungs. A few days later, in the pneumologist’s office, I was informed that I also had what is called a reactive respiratory disease, a vicious cycle of postvial inflammation that affects cough, cough and shortness of breath (“Of course, this looks like COVID,” the pneumologist said. ) I also discovered that my last COVID control, the fourth, had come back negative. The emergency doctor had warned me that this could happen. Most other people so complex in their disease: five weeks in my case, were no longer positive for coronavirus. Besides, he added, “the controls aren’t perfect. It’s only about 80%. “
He made me wonder, “Am I still contagious?” I asked the emergency room doctor.
“I don’t know,” he said, explaining that science had not yet reached a verdict. But that was his well-informed assumption. ” The CDC has rules about this,” he told me sadly, “but I no longer accept it as true with the CDC. “
“You’re not crazy, you’re not alone,” a doctor I spoke to, just like the other doctors who treated me. However, my case is an atypical case. PCR testing is often very good,” said Caitlin Rivers, Ph. D. , epidemiologist at Johns Hopkins. “It’s very imaginable to get a false positive or a false negative, but I suspect the number is very small,” he told me. Although other people like me infrequently fall into the trap, he added, “At the level of public aptitude, the tests are accurate enough to, on average, fulfill our desires to involve the epidemic. At the population level, the tests work. “
Baird and Crawford, who run giant diagnostic laboratories that were once COVID’s hot spots concentrate, are also pretty confident in verification. Crawford estimates that the verification he uses in Northwell is 98% sensitive. It’s not 100%, but it’s close. . They also point out that this is why it is vital to control the spread of the virus: the less the virus circulates in your community, the lower your chance of pre-check and the more you can accept it as true with a negative COVID check to mean that you are in fact free of the virus.
The other message is darker: checking is important, but it’s not the solution. The habit is. Being checked before meeting friends in a beach space would possibly not protect you; social distance and willingness to wear a mask. Getting checked before you don’t save you from getting the virus along the way; don’t go on a trip. The tests, Baird reminded me, “are not healing or protective, but they are complementary to everything else we do. “He continued: “The transparent answer is that if not all regulations are met, it will continue to spread. There is an explanation as to why the COVID pandemic is mapped on the electoral map. It’s not a check or a lack of therapy, it’s a selection and a habit. It’s an incredibly disappointing message to send, but COVID is genuine and completely ruthless. The virus will immediately punish us for doing what we shouldn’t be doing. “
Julia Ioffe is a GQ correspondent.
Since 1957, GQ has encouraged men to look sharper and live smarter thanks to its unheard-of politics of style, culture and more. From award-winning writing and photography to ready-to-use videos and live electrical events, GQ meets trendy men where they live, creating moments that generate conversations.
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