This Virus of Great Uncertainty
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Image: Jim Cooke
“I know this is going to sound dramatic, but I’m not coming home this weekend,” I told my sister through the phone. It was the Thursday before the first weekend in March, and I had what I thought was a cold—but what kept me in Brooklyn was the suspicion that it might actually be something else. I just wasn’t sure.
The first confirmed case of covid-19 in New York had been reported just days prior, which meant this looming illness that had once been easy to brush off was now maybe knocking at the door. I had been planning to visit my family in South Jersey, as I hadn’t since Christmas. My sister was hosting a preview tasting for her restaurant’s upcoming summer seasonal offerings. Hers is the rare spot that offers healthier alternatives and vegan food on the pizza- and french fry-dominated boardwalk in my hometown, where she still lives. I was sad to miss it and felt a little silly about my decision to do so, but I knew that in the off chance that I was infected, I’d have a terrible time forgiving myself for possibly exposing my parents to this mysterious illness.
Really, I felt fine. For all I knew, I had something milder than a cold, just allergies. That seemed plausible in our unseasonably warm late winter. All I knew of the symptoms of covid-19, which most of us were just calling coronavirus at the time, were fever and a dry cough, with some secondary effects like soreness and fatigue. I felt fairly confident that my sickness was in a lesser class. Coughing up phlegm relieved not just my congestion, but also my anxiety. If it were coronavirus my cough would be dry, right?
So many have labeled what we’re living through “a time of great uncertainty.” It is. And that’s true on a molecular level. The vast majority of us have no idea if we were, are, or will be sick. In the absence of any verifiable information, there’s nothing to do besides live with the knowledge that every action is possibly flawed and potentially fatal.
So just in case, I was staying put. My sister said she understood. There was a whole summer season ahead of us, during which I could eat at her spot several times, performing my own tasting over the course of my regular trips home (hailing from a beach town, I visit home more in the summer than any other season). I was sure I’d be traveling home a lot this summer. I always do.
By the time I woke up on Saturday, I felt better. I went to the gym and worked and spent time thinking and cleaned my apartment and did all of the things I do on a normal weekend day. My only bit of residual weirdness was the development of an ache in my right ear that ensuing discharge (first in the form of liquid and then crust) suggested was an infection. I had ear infections a lot as a kid. I had tubes surgically inserted at one point to keep my ears irrigated. But I hadn’t had a full-on ear infection for at least 20 years. The timing could have been coincidental, but maybe not. I Googled whether an ear infection was a known symptom of coronavirus and discovered that it was, according to provider Intermountain Healthcare’s website. That page, however, has since been revised to indicate that it refers to seasonal coronavirus, and not covid-19. Today, ear infections have not been widely reported as a symptom of covid-19.
I saw a doctor. He confirmed my ear infection and prescribed antibiotic drops. My irritation with having to endure 10 minutes of an ear full of liquid notwithstanding—like a wet willy suspended in time every day for a week—life became increasingly comfortable and then back to normal.
Normal, that is, besides the invisible threat surrounding us that kept us away from our workplace and friends, threw off our daily routines, plummeted the economy into an anxiety-inducing collapse, rapidly sent people to the hospital and grave, and more or less hypnotized me into thinking about the viral culprit of all this unrest about every waking moment. But otherwise, I felt fine.
And then, three Saturdays after the weekend that I was supposed to visit home, I lost my sense of taste. By then, it was late March and I had ordered pizza, a weekly custom I adopted at the beginning of lockdown for its ability to soothe. Like earaches, pizza delivered to my door isn’t something I’ve experienced regularly in decades—if I’m going to eat pizza, among the most decadent of cheat meals, I’d rather just grab a few slices and not have leftovers to guilt me.
I took a bite of the pizza, an astoundingly tasty pie from a place near me that has totally renewed my faith in New York pizza’s ability to be casually excellent without a single frill, and realized I could barely taste it. It was like an echo on my tongue. I tried some of the Caesar salad I ordered and that, too, was barely there, despite filling my mouth.
“I really can’t taste any of this,” I said to my boyfriend, almost laughing because it was so weird to be chewing on something that was giving me almost nothing in return. “Oh no,” he said.
By dinner the next night, my taste was completely gone. On Monday, all of my previous symptoms returned and were worse than they were three weeks prior. More phlegm, a crustier ear infection. In addition to the loss of taste and smell, I experienced a set of new symptoms. My body was sore in weird places that I hadn’t worked out recently. I had diarrhea and I felt kind of high, en route delirium. I was surer than ever that I was infected with coronavirus and now scared that my boyfriend would be, as well. He’s an off-and-on smoker and I worried that his lungs might be decimated by this virus. (At a later point, some data suggested that nicotine might actually protect against the virus’s progression, but that has since been debunked. For now.)
I took my temperature regularly that day. Fine, fine, fine. And then: Holy shit. Around 12:30 am, right before I went to sleep, the thermometer read 99.7. I felt more out of it than ever and I knew, I just knew I would wake up with a fever that would commence my coronavirus nightmare.
What does nothingness look like? I wish I didn’t know. And now I know how it tastes.
I was wrong. I woke up feeling better and my temperature was back in the 98 range. I felt a bit woozy and like my head was 20 pounds heavier than usual, but I had faith I would be okay. I hadn’t read any accounts of people’s symptoms fluctuating—it seemed like people infected with covid-19 felt worse and worse until they felt better. Straight up and downward trajectories. I felt confident that I was on the right side of the crudely drawn mountain.
Within days almost all my symptoms had cleared, though my taste and smell were in no rush to come back. The experience of living without those senses was low-key torture. Once quarantine began, I abandoned my aspirations of regimented eating. I embraced the notion of comfort food wholesale: Seamless several times a week, the aforementioned Saturday pizza deliveries, boxed mac and cheese, packaged ramen noodles. In this pandemic, few things were more reliable than the pleasures of foods that I’d feel guilty about eating during normal circumstances. Imagine, then, what it was like to have that taken away. Texture just turned around in my mouth like a body in a coffin. Eating was like chewing a plate of gum that had lost its flavor and then swallowing all of it. A week in, I wanted to throw my salad across the room. My nose was not congested, but it felt altered. The closest thing I’ve experienced that I can compare it to is the respiratory burden I have felt after cleaning with bleach in enclosed spaces like bathrooms. It probably most resembles what it’s like to have someone take a blowtorch to your nose, but that hasn’t happened to me yet so I can’t be sure.
This stretched on for two weeks. Outside my city whined with seemingly uninterrupted sirens, but inside my apartment, I had changed. While nothing could be certain about covid-19’s effects given its newness, I knew that some sort of immunity was likely based on the body’s response to viral respiratory infections like SARS, MERS, and the flu. I didn’t stop social distancing or abandon my mask (in fact, I had just started wearing one since the messaging on whether or not they were necessary had been mixed until the CDC announced on April 3 its recommendation that they be worn in public). But I did drop the obsessive behavior I had adopted in the wake of the virus. No longer would I bring in food deliveries, put them on the floor, wash my hands, grab a wipe, wonder if the wipes container had the virus on it, start wiping down my food, wondering if virus that might have already been on it that had now transferred back to my just-washed hands that were transferring it back to my just-wiped-down food. I stopped leaping across the street when I saw someone coming toward me on the sidewalk from yards away. I felt like I could exhale, albeit in a tempered, potentially fatal manner if I were in fact shedding virus.
About 10 days into my tastelessness, I read Jack Holmes’s Esquire piece on anosmia (the loss of smell) and covid-19. It was as thorough and accessible an article on the phenomenon as I could find. The doctor Holmes had interviewed for that piece, Clare Hopkins, recommended “smell training” to those who had lost their sense in an attempt to stimulate nerves and sort of manually repair yourself. I sprayed my favorite cologne on my shirt, pulled my collar up to my nose, and inhaled deeply, repeatedly. I thought maybe I detected it faintly? Hard to be sure of anything, really. Later that day, or maybe the next, I came home from my daily walk and when I went into the bathroom to wash my hands, I could faintly smell its prior use. “Were you just in here?” I called to my boyfriend. “Oh yeah, sorry I didn’t spray after I flushed,” he said. There was nothing to be sorry about—my nose had detected his presence. I’ve never been so happy to smell butt in my life.
Living through a time of great uncertainty is unnerving. So great is the uncertainty that not only do we not yet know the extent of the pandemic’s effects on a societal and economical level, a lot of us don’t even know if we had it. Or have it. During my anosmia days, I had scheduled an appointment to be tested for covid-19. I contacted ProHEALTH, which was offering drive-through tests on Long Island. I figured I’d get a Zipcar and head over, though the nurse on the phone told me that the drive-through testing in my immediate area was for previous patients of ProHEALTH’s practice. There was, though, an urgent-care spot in Chelsea that could test me that day—did I want to schedule that? I did.
Almost immediately after scheduling the appointment, I talked to my friend in public health who told me I should cancel it. At the time, there was a shortage of PPE in the city. Such equipment, he told me, should be used only on people who really needed it. I was feeling (mostly) fine, so it’s not like a positive test result would be useful in treating me. I didn’t need to be treated. There was no treatment to be had but time. I only wanted whatever semblance of peace of mind that a positive result would give me, and possibly infecting the person taking my test was not a fair trade for that. I canceled the appointment but kept my Zipcar and drove through the city, just to see what it would be like, just because I missed driving a car. Manhattan was dead and brown and covered in graffiti. It looked like Abel Ferrara’s vision of an apocalypse.
A few weeks later, I received an email from LabCorp announcing that antibodies testing was available. I go to one of their facilities every three months to get the blood work done to test for STDs and my kidney levels, in order to maintain my PrEP prescription. I guess being a loyal customer landed me on their mailing list. The information on their website was somewhat confusing, but I was finally able to confirm that antibodies testing was available at all of their sites with a doctor’s order. I talked to my healthcare provider—he’s actually a physician assistant at the practice that I go to who has been available virtually on the fly for remote appointments—and he read through a list of symptoms to determine if I was eligible for the test. This was a formality—I’d already discussed my symptoms with him previously when he treated my ear infection. He sent me a PDF and I made an appointment with a LabCorp in Queens.
I’ve never been in and out of a testing facility so fast. I walked in, handed the woman at the desk my order, she directed me past a door and back to sit in one of the facility’s stations. She stuck a needle in my arm, took a vial of blood, and that was it. I was out of there in five minutes.
The blood was drawn on a Friday. On Monday afternoon, the PA called me with my results: The test results indicated the presence of antibodies. That meant it seemed that I had the virus when I exhibited symptoms, and the existence of antibodies very possibly means that I now have some sort of immunity to covid-19. The test that LabCorp used is the Abbott SARS-CoV-2 IgG assay, which the PA explained had been approved by the FDA through their Emergency Use Authority, a different and less rigorous process than usual, given the urgency of our current situation. That test, per the FDA’s website, has a sensitivity of 100 percent (which indicates a yield of low false negatives) and a specificity of 99.6 percent (indicating low false positives).
In an email, a LabCorp representative told me that their tests are accurate. But there’s a but: “Results from serological antibody tests are neither the sole basis for a diagnosis nor assurance of immunity. Confirmation of infection with COVID-19 must be made through a combination of clinical evaluation and other applicable tests.” I wrote back to ask how a test could be both accurate and inconclusive but I did not receive a response. I showed LabCorp’s statement to my PA, saying it looked like they were hedging so as to mitigate liability in the face of a virus that is still so unknowable. He confirmed he suspected as much, given covid-19’s multifaceted symptom presentation. He said this messaging is confusing for clinicians as well.
Last week I read about the base rate fallacy, which alters the assigned probability of accuracy based on the percentage of the population that’s actually infected. I wasn’t familiar with this concept previously, but it basically means that the sensitivity of a test is a number that reflects trial results and cannot necessarily be extrapolated to represent the general public given the high number of people in the general public who have not been infected with covid-19. This only complicates these things further.
I reached out to several doctors and experts for more clarity here—many of whom I’ve talked to for previous pieces—and heard back from none. People are busy with more important things to do than getting on the horn to help me sort out how relaxed I should be (even if it, hopefully, will impart some sense of the reality to readers), but mostly I assume people aren’t talking because we just don’t yet know enough about this young virus.
I don’t know for absolute sure that I had covid-19. I don’t know what To Do With This Information.
My sense of security is about as developed as my returned sense of taste: around 75 percent. The promise of antibodies “remains elusive,” the New York Times printed earlier this month. A few days later, the Times ran a piece reporting results of a study indicating that virtually everyone who has had covid-19 creates antibodies. “This is very good news,” responded Angela Rasmussen, a virologist at Columbia University in New York, though the article warned that it was unclear how long antibody-bought protection might last. Regarding antibodies yielding immunity, Mount Sinai’s Florian Krammer, who developed the antibodies test used in the study, said, “I’m fairly confident about this.” Last week, Science cited two studies that showed infected people’s T cells targeting the virus. Columbia University’s Angela Rasmussen said the results constituted “encouraging data.”
This tempered amount of expert confidence is what we have in the place of assurance. I am almost certainly not shedding the virus and I’m probably immune to some extent, whatever that might mean. Long-term effects are impossible to know. We just haven’t gotten there yet. The relative, woozy relief of having antibodies now could mean living with a chronic infection for the rest of my life. I was happy to read about data suggesting that a group of people in South Korea previously suspected of being reinfected, in fact, were not. I was less happy to see a World Health Organization spokesperson say, “It seems they these patients are expelling leftover materials from their lungs, as part of the recovery phase.” What does that mean? What will it mean?
Parallels have been drawn between coronavirus and HIV. For one thing, both arrived shrouded in mystery in terms of transmission and effects. Part of what makes the coronavirus terrifying to spectators is its wide range of symptoms and manifest differently in different people, though according to an University of Iowa immunologist Stanley Perlman, this perception may be a result of the intense scrutiny on covid-19. “He postulates that if influenza were looked at with equal intensity, it might also be shown to manifest in other ways—as a mild winter stomach infection, for example,” reads The Economist’s summary of Perlman’s idea.
Nonetheless, the bodily uncertainty that lingers even after a fairly certain diagnosis reminds me of the days before PrEP, when no one who was sexually active could be absolutely sure they didn’t have HIV. The window period of HIV, the time between infection and the production of antibodies to yield a positive test result, is now understood to be three weeks. That means you could test negative in that time even if you’ve been infected. Until PrEP, the only sexually active people who could be sure about their serostatus were positive.
And then PrEP changed that. With regular administration of antiretroviral drugs as a prophylaxis, people who were HIV negative could be sure that they would remain so. (Within the hundreds of thousands of PrEP users, only a handful have tested positive while supposedly adhering to the daily regimen. Its efficacy is basically as close to being 100 percent as possible without actually being 100 percent.) Tim Murphy captured what this meant to the psyche of a vulnerable group—men who sleep with men—in a 2014 New York magazine cover story titled “Sex Without Fear.” PrEP was a massive relief. I could be as sure as sure could be that I’d remain HIV negative. Granted, there is a litany of other biological invaders that could have already been infecting me. They still might be and have yet to reveal themselves. I could have cancer or imminent lung problems given the seven years I spent chain-smoking in my teens and early 20s. The sense of security PrEP gave me was by no means false (I remain negative), but I suppose, incomplete. And yet, it was enough to calm me in the short term.
And now, I just don’t know. I don’t know for absolute sure that I had covid-19. A friend of mine whose house I’d visited the day before I canceled my trip to New Jersey just got back her antibodies test results. They were negative. We were in such close quarters that it just wouldn’t make sense for her to have avoided contracting it. So, did I not have it the first time, then? Did I even have it at all?
I don’t know what my positive test result means for my health or the health of others. I don’t know what I’m supposed to do with this information. I don’t know if it means that I can, for example, start hanging out with people who have also tested positive for antibodies (assuming their results are also accurate). The picture of my health is hardly complete. My symptoms and test just tinkered with its resolution, and what these newly visible details mean is as yet impossible to interpret. So, like the rest of us, I remain in limbo sure only of this: Uncertainty is among the cruelest of infections.