Six Negative PCR Nasal Swabs. Four Antibody Tests Negative. Still COVID19 Positive?

I am going to try and be nonjudgmental here. In this WSJ article, they describe a woman who in March had “a postnasal drip, shortness of breath and diarrhea. Over time, her symptoms have multiplied and gotten worse, including continued shortness of breath, lung and back pain, cognitive issues, a racing heart beat, facial numbness, and a bout of pneumonia.” Her husband did test positive for CV19. She did not….SIX TIMES by nasal swab. And she has had 4 negative antibody tests.

I feel for this lady:

Before getting sick in March, Ms. Berz was an avid Peloton bike rider with mild asthma. Now she says she is unable to do any physical activity without feeling completely depleted. “I can’t walk for 10 minutes without being in bed for days after,” she says. “I would love to be able to walk my dog again.”

So, I am open to a discussion on this. My issue is there has to be some type of positive test because the floodgates of CV19 disability is going to crush our country. Do I think she is malingering? I have no evidence of that. Do I think others will malinger? Hell yeah.

Your thoughts?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]

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11 Responses

  1. Jay Cooperman says:

    I’ve seen very few patients with positive antibodies despite suggestive symptoms. It is possible that humoral immunity in this population isn’t as good an indication of exposure or immunity as T cell immunity.

  2. Gary J. Pearce says:

    She lives in a flowery backyard. Any deer in that area? Deer ticks have been found in every state except Hawaii. Just tell me she does not live there. Do you really want to do titers? Not every patient is diagnosable. It is a lot easier to prove someone has a disease than to prove they don’t.
    And yes, while we are figuring all the COVID health care costs, let’s include PTSD and long-term disability due to nonspecific undiagnosable subjective symptoms like “brain fog” and “fatigue”. They may be psychogenic, but does that make it any less of a disability. Do we need a psychiatric evaluation of all these cases? Psychiatrists do not make enough money for the kind of work they do, but please let’s keep it in the medical field. And of course all these patients will need a complete medical workup- brain MRI included… will our health care system go bankrupt??? i think so.

    • Eleni says:

      My daughter in law is an ER doc, my son is a neurologist. All had covid symptoms, none were hospitalized. Neurologist and 2 year old tested positive, none isolated timely and she was heavily involved in taking care of the germ vector often known as a toddler. She had an antibody test prior to the worst symptoms, she also had a nasopharyngeal swab test and weeks later another antibody test….all negative. Did she have it, or did she not?

  3. Bill Ameen, MD says:

    Might be the tip of the iceberg, Dr. Doug…the Chronic Fatigue Syndrome/Fibromyalgia/Lyme Disease of the 2020’s. Only an effective vaccine might curtail the post-COVID epidemic of disability.

    • Pat says:

      Our government reacts to popular whim, then passes laws to assert and amplify the same in a never-ending reflex entitlement cycle. As has been demonstrated before (eg the disability industry, core measures, MOC, the “trans” lunacy) medicine has been so easily co-opted by government and media into emotional stances during this viral clench, that we will certainly be part of a new entitlement even before it is formalized. Flattening curves wasn’t enough, nor will a vaccine be. We will remain harnessed to validate whatever nonsense we are fed, reflecting the public rather than leading it.

  4. Steven Zeitzew says:

    She also needs more of a diagnostic evaluation. There are other things besides COVID-19 that can cause symptoms like these.

  5. Joyce Mauk says:

    There are lots of other diseases that existed before COVID. Her doctor should pursue another diagnosis. She is using up all our testing supplies! She will end up with another autoimmune diagnosis.

  6. Sir Lance-a-lot says:

    Bottom line: “There are more things on Heaven and Earth than exist in your philosophy.”

    Unfortunately, this is a weird disease, and we still don’t know all that much about it.

    What we do know is that our tests suck (all of them) and that this disease does odd shit and leaves a whole bunch more outliers, in all directions, than most (No symptoms? Sure! 1-day incubation? Sure! 2-week incubation? Sure! Young, healthy, and dead? Sure! Elderly, debilitated, and asymptomatic? Sure! Only a single atypical symptom from the cluster? Sure!)

    What we also know (last time I looked) is that the definitive test appears to be a CT. So I’d CT her.

    I had a pt. in April who came back with an incidental finding of COVID in the visualized lung bases on a CT for RLQ pain. He worked in a prison and, when I asked him, said that all the guys he worked with had gotten sicker than they’d ever been in JANUARY (4 months before), but then they all got better and he’d felt great since then. This crap sticks around.

    I’m also convinced my wife had it in March and April – I felt like crap for 2 days, several days after exposure to a couple of very likely pts (fatigue, general shittiness, chills, none of the things we were required to report at the time, like cough, fever, or SOB), then I felt fine. She got sock a few days later, felt just wiped out, had a cough, chills without fever, SOB on mild exertion, sleeping excessively, unable to do normal things. I felt fine throughout. It took her 2 months to feel close to better, and she’s still not 100%. I’ve been exposed to innumerable Positive and likely Positive Corona pts since then, with “PPE Theater” that’s a sad joke, and haven’t had a sniffle.
    We both had Negative Ab tests.
    What do I think? I think we both had it and got better.
    But I may never be sure.

    As for this lady, I suspect she had it too. She needs a CT and some more rest, and she will probably be fine. We ain’t got nothin’ else we can do anyway.

    • Gary Pearce says:

      Can you please email me when you find a test you can rely on? I am in Florida and i do not believe anything around here. Our hospital had had all us surgeons do a test beginning of May when they opened the OP’s, then they sent us all a letter a week later saying that the tests were discarded- and this is the big AdventHealth System!!! Does Governor Cuomo have different test in new York? I too think I had it already….I was febrile for 2 days right after the lockdown- and I am almost never sick. Also my wife had some strange illness a couple of years ago after visiting bat infested caves in Scotland- she had a recurrent pulmonary problem, given many different diagnoses, many Dosepacks, went through a bunch of inhalers, got a bunch of very expensive inhaled pulmonary drugs. I finally took her to an allergist who diagnosed esphageal reflux causing asthma like symptoms. And she got better and she does not use any meds. I surmise it was a zoonotic infection…just a guess. a lot of medicine is guesswork.

  7. Steven Mussey says:

    Great post!

    My experience with nasal swabs is terrible. The false negative rate appears to be absurd. Hospitalists on the front lines that I’ve spoken with are in agreement on this.

    On the other hand, when the issue has been important, such as work related, the antibodies are coming back positive (weeks later) at reputable labs.

    We are seeing a lot of patients many weeks and now months after a documented Covid-19 infection that are profoundly disabled with dyspnea and fatigue, even in the face of Chest CT’s that are dramatically better or resolved.

    Our nasal swab testing appears to be terrible. We know the false negative rate is high. Who knows what the false positive rate is? Meanwhile, the antibodies clear in just a couple months. If you miss them, they are gone.

    The problem is some of our patients are working in Nursing Homes. They get sick with Covid-19 type symptoms and they test negative. It becomes a mess!

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