On Tuesday, my housemate Laura heard she’d tested positive for COVID-19. I was sitting with her girlfriend, Caroline, at the dining room table when Laura, over on the couch, got the call. We didn’t try to hide our eavesdropping. Afterward, we all stared at each other for a moment, then proceeded to call and message everyone we know with what for us still feels like relatively remarkable news: We now had firsthand experience with a confirmed case of the disease caused by the novel coronavirus.
Laura started exhibiting symptoms of COVID-19 nearly three weeks ago: coughing and an on-again, off-again low-grade fever. My Brooklyn household of twentysomethings (Laura, Caroline, our friend Jackie, and me) started conducting ourselves as if we’d already been infected, going out only for walks or the occasional grocery store run. The disease is highly contagious, so by the time Laura got her first fever, we assumed that it was already too late for the rest of us to quarantine ourselves in different parts of the apartment; her doctor didn’t even suggest it. (Mind you, this was the week of March 10 — a lifetime ago — when practicing even light social distancing measures still seemed like paranoia to a lot of people, and we were all getting mixed messages from our doctors and from the government. Since then, and since we've become symptomatic, we've followed CDC guidelines for more stringent self-isolation.)
As soon as she started exhibiting symptoms, Laura called both the city and state departments of health, who advised her to consult with her primary care physician. Since she (like many New Yorkers) doesn’t have one, she called the urgent care clinic CityMD. A representative told her that the clinic didn’t have access to COVID-19 tests at the time, because the tests were being reserved for hospitalized patients, or anyone who’d been exposed to a confirmed cluster, but she could come in to get tested for flu and strep. She did — and tested negative for both.
Nine days later, when Laura was having bad chest pains and her shortness of breath had gotten worse, she went back to CityMD at Caroline’s urging (though she says she’s not sure she’d have felt comfortable returning if the urgent care weren’t within walking distance). As always, she wore a mask, which she’d been doing since the onset of her symptoms every time she walked the dog, though by day 10 she no longer stuck out quite so much. More mask-wearers have shown up on our block every day.
At her second appointment, Laura received an EKG and a lung X-ray, which thankfully didn’t reveal anything troubling. But this time, her doctor also offered her a COVID-19 test, if she wanted it.
Laura had to make an uncomfortable choice. She knew that tests were in short supply. But since she’d been sick for nearly two weeks, both she and the doctor thought she merited one. And five days after that, we knew.
I’ve struggled to differentiate these symptoms from the psychosomatic effects of anxiety, since I’m also a world-class worrier.
It’s not like any of us were surprised, exactly, by Laura’s results. In addition to the coughing and fever, her whole body ached; she struggled for air whenever she walked up and down the stairs, or stood for too long doing dishes. Soon enough Caroline was coughing too, and had to pull out the asthma inhaler she hadn’t used in years. Just a couple days before Laura got her results back, Jackie — who’d had some milder symptoms but seemingly rounded a bend last week — took a sudden turn for the worse, struggling to breathe. She said she felt like she’d eaten a pack of cigarettes. Her doctor prescribed her an inhaler and tested her for COVID-19; we’ll get her results in another few days.
For Jackie, who’s been working from home, a positive test might help her employer actually believe that she’s sick, and afford her the sick days and lesser workload she needs right now. But it would also give her the peace of mind that should she develop long-term health issues down the road, like potential permanent damage to her lungs, she could point to a concrete diagnosis to receive resources and care. “I want to be counted,” she said.
So where did all this leave me? I thought that if I hadn’t managed to avoid infection, I might have just been one of many asymptomatic cases. But sure enough, a few days ago I started coughing; my body feels like it’s been dropped down a garbage chute; my chest is tight as a drum. I’ve struggled to differentiate these symptoms from the psychosomatic effects of anxiety, since I’m also a world-class worrier. When I reached out to my doctor, though, he told me that if one of my roommates had tested positive, the symptoms Jackie and I are both experiencing “are likely COVID-19-related as well.”
He also relayed what I’d already learned: According to the New York City Health Department, Brooklyn residents experiencing mild symptoms right now should not go see their health care providers in person and shouldn’t expect to get tested for anything short of hospitalization. If I become short of breath or start to have trouble breathing, like Laura and Jackie did, I could follow up — but for now, all I need to do is sit tight and wait it out.
I know I don’t need a test. Even before Laura got her results back, we all assumed we had COVID-19 anyway. My own symptoms are mild, though my chest tightness does worry me (and my worrying, of course, only makes it worse). And I’m lucky enough to be able to work from home and that my boss doesn’t need me to prove how sick I am for me to take sick days — and paid ones, at that, which are unfortunately still a luxury in this country. So why do I still find myself wishing I could get tested?
Through my employer I have free (“free”) access to One Medical, a boutique membership-based primary care franchise, which Molly Osberg at Jezebel recently diagnosed as less of a clinic than evidence of US health care’s caste system. Though many US providers, including One Medical, have set up designated testing centers for COVID-19 specimen collection, the capacity to process the tests is still dependent on the CDC and private laboratories. More tests have been administered in New York City over the last week than had been previously, but the numbers still aren’t great; exposed doctors aren’t even able to get tested here. If I didn’t care l about potentially infecting others and putting unnecessary strain on the city’s medical resources right now, though, I suspect I could pretty easily use my unearned privilege to elbow my way into a sense of certainty.
Because that’s what Laura’s results offered us, in this mind-meltingly surreal time: a moment of rare, biting clarity. Even though it’s hard to escape the realities of this pandemic — we’re quarantined in our home and doom-scrolling through the news of job loss, death, and despair every day — it feels so gigantic, so overwhelmingly complex, that its specificity can still astound. Individual people we know and love can and will get sick; some of them already are. Many of them, even. But recognizing on an intellectual level that 40% to 70% of Americans are likely to be infected — that expressing telltale symptoms likely means you yourself are infected — remains incredibly difficult to wrap one’s mind around. A test is the only sure thing.
As soon as Laura started sharing her news, she was shocked at how shocked everybody else was — the sudden onslaught of questions and comments on social media, the spike in concern from family and friends. She’d already been telling everyone she surely had it for weeks! But without that concrete confirmation, even the reality of her increasingly frightening symptoms had been mere abstractions.
Recognizing on an intellectual level that 40% to 70% of Americans are likely to be infected — that expressing telltale symptoms likely means you yourself are infected — remains incredibly difficult to wrap one’s mind around.
Laura hasn’t had a fever in a few days now, and though she’s still experiencing some symptoms, she no longer feels like a “total sick blob.” Caroline was even well enough to go on a run today. As the first (basically) recovered member of our household, she’s reached out to Mount Sinai hospital and Rockefeller University about donating her blood to be tested for antibodies. (Earlier this week, the FDA approved the use of plasma from recovered patients to help treat severe cases, and New York Gov. Andrew Cuomo announced that the state would be the first in the nation to test serum derived from the recovered.) We’re tentatively hopeful that our house might become an immunity cell relatively early on in the pandemic and that we would be able to help support our neighbors and the city’s health care providers as the crisis worsens.
But it’s still unclear whether those with mild symptoms will generate a strong enough response to remain immune to the virus before a vaccine becomes available, which can only be revealed by further tests — and early antibody testing is still far from being applied on a mass scale. At the very least, though, scientists expect that anyone who becomes reinfected would likely experience a much milder bout of COVID-19 than their first. A test, then, would let me know that my worst-case scenario is the one right before me.
It’s an understandably human impulse to assume that the great big bad stuff going on in the world is always happening to somebody somewhere else. One of the reasons many different communities in the US were slow to adopt social distancing — besides criminally mixed messages from the federal government — is that same impulse: to just keep living, to refuse to give in to fear, to take certain risks and hope for the best. We all need to accept a certain level of cognitive dissonance if we’re going to get out of bed every morning.
Neither the agoraphobe nor the clueless spring breaker offer us the best path forward out of all this. In the past few weeks, it quickly became clear that we all need to adopt the mentality that we’re all already contagious, in order to protect other people — especially in New York City, which is on track to become the global epicenter of this virus. But it’s a big ask to expect everyone to trust in an abstract truth, in lieu of the certainty offered by widespread testing. Not even symptoms — real, scary, painful symptoms — can offer us that.
Personally, I’m not used to trusting my body. There’s my anxiety disorder, for one thing, which screws with my breathing and makes my muscles go haywire. And even when I do trust myself enough to think a symptom might not be attributable to anxiety alone, I’m used to doctors brushing me off or chalking up my concerns to paranoia (something that’s common for women patients, whose concerns are frequently downplayed by health care professionals; it’s even more common for black women).
I also grew up in an environment where sickness was perceived as a kind of weakness. We didn’t always have the money for copays, and it was easier, I think, for my family to treat people who took sick days from school or work as privileged, attention-seeking whiners rather than consider the reality that sometimes our bodies would fail us, too. My dad lived in pain for years because he couldn’t afford to get the surgeries that eventually saved his life. Because the truth of his conditions’ severity was so emotionally difficult to bear, he’d tried convincing himself that he wasn’t really that sick after all.
It’s easier to imagine we’re really the masters of our own destiny than consider the fact that our well-being might be largely outside of our control.
Downplaying potential vulnerabilities is also, of course, a particularly American phenomenon. We’re proud workaholics who value our seemingly endless ability to push through the pain, to sacrifice our time, energy, health, and sanity at the altar of capital. It’s easier to imagine we’re really the masters of our own destiny than consider the fact that our well-being might be largely outside of our control. But a pandemic makes devastatingly clear that our output has always had limits.
In Ed Yong’s excellent and sweeping report for the Atlantic about how this pandemic will end, he writes that “perhaps the nation will learn that preparedness isn’t just about masks, vaccines, and tests, but also about fair labor policies and a stable and equal health-care system. Perhaps it will appreciate that health-care workers and public-health specialists compose America’s social immune system, and that this system has been suppressed.”
Maybe someday it will also get a little easier for us to trust our own bodies — and trust that our health is inextricably connected with society’s health — without needing the confirmation of a test to tell us that yes, this is all really happening. We really are this fragile. We really do rely on one another.
But for now, especially before the death toll in the US starts to skyrocket in earnest, positive results are incredibly powerful. Even as testing ramps up throughout the country, there are in all likelihood far more actual coronavirus cases in the US than those currently confirmed by the CDC; doctors and nurses told BuzzFeed News that COVID-19 deaths have been “grossly underreported,” too. While we wait for different spots in the US hit their various peaks in hospitalizations, which, according to projections, are still weeks away, most of us who aren’t frontline workers are still suspended in a horrible sort of Before zone, when knowing someone personally who’s tested positive is still a novelty.
That marker will keep changing, and it will become so much more gruesome. Today, I can still shock the other attendees of a Zoom happy hour with the news of my roommate’s diagnosis. But someday soon, a diagnosis will become almost meaningless, because more and more of us will know people who have actually died. And I don’t think any number of test results could possibly prepare us for that. ●
The post has been updated to reflect the most recent CDC guidelines for those who test positive for COVID-19.