Last Tuesday morning, Isabelle and I were in the car headed north, planning to get our six-year-old granddaughter out of the house for a walk in the woods. We were just a few minutes away from her house when her mother — our daughter — called. A call instead of a text. When she calls, it signifies urgency, so Isabelle answered with veiled hesitancy in her voice.
Our daughter’s brother-in-law was not feeling well, and had tested positive. His son had symptoms, too. Her bubble against the virus, a bubble of hope and of some semblance of a normal social life, had melted away in the thin air of a pandemic year. The Covid had come.
The two couples — our daughter and her husband, his sister and her husband, had been seeing each other without masks, but only each other. They had celebrated Christmas eve together. They live in the same town, and the kids have adjacent birthdays. In each family, a girl of six and a boy of three.
When we see our daughter’s family, we all wear masks, inside and out. Still, I turned the car around. Our granddaughter would be disappointed, her chance for a special day stolen away by an invisible, inscrutable gremlin.
So began a week of waiting. Of holding up a lantern against the dark, its reservoir half full, and all of us squinting, hoping for a good way out.
And it does appear that the viral load is light. The brother-in-law is having the “fatigue” version of Covid. Both he and the boy are gradually improving.
So this can be chalked up more as a teaching moment than a frightening one. We could say that we have learned our lesson, that we can’t be too careful, that the virus is more contagious than we imagined. But we all stumbling over the answer to this question:
How was the brother-in-law infected?
The two little boys go to the same day care, but are not in the same classroom. Though the six-year-old girls wear masks all day when they are in class, the day care does not require the three-year-olds to wear them. It’s a lot to ask of the little ones: to have that thing across your face for 40 hours a week.
(Our grandson wears his mask when we visit. His energy takes hold of his mask and brings it nearly into his mouth. His breath blows hot against his face and his mask goes sopping wet. Most of the time he’s good about keeping it on, even though he wants nothing more than to tear if off.)
So we all assumed that the three-year-old cousin had brought the virus home from day care and infected his dad, who is so careful about protocol there was no other explanation.
But this is what happened with the testing: the dad was tested twice, both times while symptomatic. The first was a so-called “rapid” (Antigen) test, which came back negative — not surprising as these tests are less reliable and known to provide false negative results. A day or so later, a PCR test for him came back positive. Then the boy, also symptomatic, was PCR tested. The result: negative.
How could the boy test negative, when the only obvious way in for the virus was from the day care? We’re guessing that the boy’s result was a false negative.
How often does that happen? Well, it’s much more possible than I had realized.
Dr. Robert Shmerling, writing on the Harvard Medical School website, explains that the chance of a false negative PCR result is high early in the infection period. One study showed that if the test is performed five days after symptoms begin, the false negative rate can be as high as 20%. Earlier in the infection period than that, the false negative rate can go up to 100%!
Apparently, this is what happens when Emergency Use Authorization is applied. The usual testing and vetting for the PCR test itself have yet to be done. As Dr. Shmerling says, we're lucky to have the tests, but they should undergo rigorous vetting by the FDA as soon as possible.
After a discussion in his article of all the available tests for Covid-19, he even says this: “Unfortunately, it’s not clear exactly how accurate any of these tests are.”
I don’t want to leave the impression that I’m an anti-tester. All this does explain why multiple PCR tests are sometimes recommended, such as when college students want to leave or return to campus.
Finally, a recent study in Clinical Infectious Diseases concludes that even though children are unlikely to be the source of Covid-19 outbreaks in households, it is nevertheless possible. Some studies do show that children can shed the virus at levels similar to adults.
So… it looks like the virus did come from the day care school — but I don’t think we should blame it on them. No, actually, I think the responsibility lies with individual families.
The infection that’s hitting home for our extended family could be the aftermath of an irresponsible Thanksgiving, attended by someone, somewhere, who has a connection to the day care. The facility had announced guidelines, but all it takes is one family ignoring the guidelines to provoke a post-holiday cluster. Should we expect the day care to test the kids every day? Who would pay for that?
As we head into the new year, each of us will be called upon to continue to make those hard decisions. To care about each other — even those we do not know — and to be careful how we get together.
At this time of year I remember the hard-working Portuguese woman who used to take care of the building where we live when we’re in Paris. At the new year, we would give her the usual greeting, but she did not reply in kind. Instead, she would say, “Santé! Santé! Surtout, la santé!” Health! Health! Above all, health!
She understood, ages before the pandemic, that health and happiness go together.
We all wish you health and happiness in the new year.
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