Double Uncertainty

During the early outbreak of the pandemic in the United States, David Hobbie received two false negative results for COVID-19 tests, showing the lack of preparedness of the country for what would become its most important health crisis in decades.

On March 11 de 2020, before a stay-at-home advisory was in effect in Massachusetts, David Hobbie decided that it was the last day he would go into the office until the pandemic was over. He is a middle-aged man with a history of mild asthma. His wife, Jeanne, is also middle-aged. They have a 17-year-old daughter. He could work from home and did not want to take any unnecessary risks.

His wife and his daughter did the grocery shopping. The only risky thing he did was see his parents from a safe distance at a nature preserve.

On March 28, Hobbie and his daughter started feeling sick. He had a fever of 101, and she had a fever of 103. Worried that they had contracted COVID-19, he called the local doctor’s office and asked if they should see a doctor. The nurse who answered said they should not come into the office because they were only experiencing one of the symptoms.

A few days later, Hobbie started experiencing chest congestion, shortness of breath and extreme fatigue. He called the doctor’s office again. The nurse agreed that he should come in, but was still hesitant to say that he should get tested, despite his severe symptoms.

Jeanne drove him to the doctor’s office because at that point, he was so sick that it would not be safe for him to drive. When he arrived, a nurse at the entrance directed them to the second floor that was dedicated to COVID-19 patients. It was empty.

After a few minutes, a nurse in full personal protective equipment came in and ushered him to a standard waiting room, where she took his blood pressure and oxygen levels. A nurse practitioner interviewed him about his symptoms through a video call on an iPad to minimize the time she needed to spend in the room with him. After mentioning that he had a history of asthma, she decided to test him for COVID-19.

“I thought it should be very easy to get a test, but it didn’t seem like it was,” he says. “I think the magic word for them was ‘asthma.’ Once I told them that, they were like ‘oh, yeah, we should get you a test.’”

At that time, it was still difficult to be tested for COVID-19 in any part of the country. However, according to a New York Times investigation into the subject, in late January, the Centers for Disease Control and Prevention (CDC) had already developed their own COVID-19 test. It was supposed to be more accurate than the test being used by the World Health Organization (WHO) because, while the WHO’s test had two genetic sequences that matched up to the genomes of the virus, known as “probes,” the CDC’s test had three. But researchers soon realized that the third probe in the CDC’s test gave inconclusive results.

Rather than use the WHO’s test, the CDC told labs to stop testing while they figured out the cause of the inconclusive results. By mid-February, the United States was only testing about 100 samples per day. On February 24, the CDC finally told labs that they should use the CDC’s original tests and leave out the third probe rather than wait for replacements.

While the CDC delayed the use of their own test, the Food and Drug Administration (FDA) did not loosen restrictions on other medical manufacturers attempting to produce COVID-19 tests. Rather than calling on them to continue making tests while the CDC was figuring out the problem with their own, the FDA continued to use the standard, strict approval process until early March. As a result, tests for COVID-19 were still not widely available in early April when Hobbie was tested.

Hobbie’s COVID-19 test came back negative two days later. But at that time, his wife was also experiencing similar symptoms, and Hobbie was feeling worse. He was feeling so sick that he called the doctor’s office almost every hour and spoke with a nurse practitioner to be sure that he was well enough to not go to the hospital. The nurse practitioner gave him a specific threshold of when to go to hospital, considering the risks that that would entail. He almost got to that threshold.

“If it had been a normal time, I would have definitely gone to the hospital, feeling as badly as I did,” he says.

Considering how his symptoms lined up with the typical COVID-19 case, he decided to go back to the doctor’s office to take yet another test. It also came back negative. But his doctor believed the test results were wrong.

“When I talked to my doctor then, she essentially sayd ‘yeah, you have COVID.’ Because all my symptoms lined up, the progression did, the fact that everyone in my family got sick within a day or two, the progression of their fevers, the timing of that, the timing of my fevers, the subsequent symptoms that I’d had and the extent of those. All of that was very consistent with COVID,” he says.

He received a reverse transcription polymerase chain reaction (RT-PCR) test, for which a swab is inserted deep in the patient’s nose. The sample is sent to a lab where it goes through a process that extracts the viral RNA and amplifies it if it is present. Fluorescent markers will then signal if the virus is there.

This process is referred to as the “gold standard” of virus testing, because it can detect even a small amount of the virus. Researchers at the Foundation for Innovative New Diagnostics in Geneva, Switzerland tested five COVID-19 RT-PCR tests, and they achieved 100 percent accuracy on positive samples.

The inaccurate results occur when the tests are taken in a clinical setting rather than a laboratory setting. According to a study published in the magazine Radiology, clinical uses of RT-PCR tests are not nearly as accurate, with false negative results occurring about 30 percent of the time. False negative results occur when the medical worker taking the sample does not insert swab far enough into the nose, the medical worker does not collect enough sample, the patient is tested too early or too late during infection or it takes too long for the sample to be tested after being collected.

Hobbie believes that when he was tested the first time, the nurse practitioner did not insert the swab far enough into his nose.

“The first time, it was only mildly uncomfortable. The second time, it was painful,” he says.

After taking two tests, it is not possible to take another one. The only other way for Hobbie to find out if he had COVID-19 is to take an antibody test, but his doctor told him that taking the test was not worth it.

“She said they’d been following the antibody test very closely and they didn’t think any of them were sufficiently reliable to warrant a test,” he explains.

Because he did not test positive for COVID-19, Hobbie will not be counted in the official number of cases in the United States, or in Massachusetts. He is far from being the only one with a presumptive case of COVID-19 who is not included in the statistics. As of May 17, official reports said that there were 86,010 total cases of COVID-19 in Massachusetts. But according to a study conducted by the Imperial College London’s COVID-19 Response Team, about 13 percent of Massachusetts residents, or nearly 900,000 people, had likely been infected by the virus by May 17.

Hobbie says that the presumably incorrect test result does not affect him personally because he is not doing anything differently, but he is frustrated at the United States’ response to the pandemic.

“This is the most urgent health care crisis that we’ve seen and hopefully are ever going to see, and they bollocksed this up in terms of the timing of the availability of the test,” he says. “It wasn’t easy to get. It’s ridiculous that they’re not testing all the people they should, and then the test is inaccurate, so that’s really frustrating.”

Hobbie’s symptoms did not wane until about 50 days after he had started feeling sick. On day 40, he tried to take his dogs out for a walk, but soon after leaving his front lawn, he began struggling to breathe and had to immediately go back home.

“I thought I was going to pass out. I was breathing really hard, and I just had to stop and hold onto the railing for a minute until my breathing slowed down again,” he says. “Now Jeanne walks the dogs.”

Despite his struggles, he feels grateful that his situation is not worse. His job allows him to have unlimited sick time, and both his wife and his daughter have recovered from their sickness.

“As a family, we’re able to manage. Not always easily, but we manage,” he says. •