Testing, and the tested

In Manhattan and Jersey City the government now offers tests to anybody who wants them. Only a few weeks ago, faced with shortages, municipalities were reluctant to test people who weren’t exhibiting symptoms. Some very sick people were sent away. Our friend never went to a clinic, but he certainly didn’t feel himself. His ears and eyes burned. At night, he’d sweat straight through his shirt and soak his sheets. He’d been out in city bars in early March, during a time when we know the virus was transmitting rapidly. He didn’t think he had it, except for the times he was sure he did.

Two days ago, he queued up to get tested. The antigen swab, he told us, was every bit as uncomfortable as he was told it would be — a stick so far up his nose that he felt it was probing the underside of his eyeball. The test for antibodies was easier to endure, but just as complicated to think about. Even a positive result, he told himself, would provide some clarity. A positive result on an antibody test might suggest that he had acquired some immunity to future waves of the coronavirus. A positive result on the antigen test would dispel the mystery of the symptoms that had been troubling him since late winter.

The doctor administering the test told our friend that his symptoms were consistent with coronavirus infection. The two-week period, he said, was just an educated guess, and one that no longer corresponds to facts on the ground: people are getting sick and staying sick, and might remain carriers for a long time. Our friend was warned not to see us, or anybody else who might be immunocompromised. Stay inside, keep calm, wait for a call in five to seven days.

I told him what I knew, and what I didn’t. Antibodies might confer immunity on those who have them, but then again, they might not. The World Health Organization warned us not to assume that seroconversion would be automatic, or lasting, or consequential. Recent studies from South Korea suggest that reinfection is unlikely, and that those who test positive weeks after coming down with symptoms are shedding inactive virus. Nevertheless, we all know people who can’t seem to kick the thing, and whose road to recovery has been a perilous zigzag. The early euphoria about antibodies — our belief that some of us would be able to return to normal activities with “immunity passports” in hand — has given way to a grim recognition that the long-term effects of coronavirus infection are consequential. That which appears asymptomatic could cause trouble down the road. Our best bet is still not to get it.

Fear of mutation nags at the city. We all know that viruses change from host to host; will this one shuffle its spike proteins so efficiently that our efforts to detect it, treat it, and immunize against it will prove useless? Will we recover from one strain only to be hit by another? All of that antibody manufacture wasted on a passé brand of coronavirus: a persistent worry in a town obsessed with fashion and the latest tech. If New York City was in the blast radius of a more explosive variant of virus than that which had reached Florida, that might account for the relative severity of the crisis we’ve faced.

It’s still too early to know for sure, but current opinions held by scientists ought to ease your mind. The coronavirus has mutated, as all viruses do, but it’s unlikely to change in a way that would allow it to evade its capture by antibodies. Should you fall ill and recover, your immune system ought to recognize the next coronavirus antigen you come across, no matter what its new ensemble is. The version of the virus we’re struggling with in America isn’t meaningfully different from the one that plagued Asia and other parts of the globe. If our outcomes are unlike theirs, I’m afraid that’s attributable to the way we’ve handled the crisis. Florida, like many other places, is underreporting. And our friend got a call from the city yesterday afternoon. He tested negative for the antigen and the antibodies. That may raise more questions than it answers, but it’s a relief nonetheless.