On March 7, the rector of a Georgetown church became patient zero, the first known coronavirus case in the District, causing a flurry of concern for people who had been in recent contact with him.
On Feb. 16, a day after returning from a ski trip in northern Italy, the 54-year-old education researcher woke with a fever, chills, a headache and exhaustion. When the illness did not go away after a few days, she went to her doctor. Tests for flu and mononucleosis came out negative, but her doctor told her the flu test must have been a false negative.
It didn’t occur to them that it could be the coronavirus.
On Wednesday, Hughes, now recovered from her illness, went to a doctor in Fairfax who administered a finger-prick serology test. Within 10 minutes it came back positive for coronavirus antibodies. If the result was accurate, it would mean the virus was likely present in the District at least three weeks earlier than believed.
In that case, D.C. would join jurisdictions in California, Washington state and New York that have been revising their estimates of when the coronavirus began to spread through their communities, as evidence has grown that it was spreading much earlier than thought.
Unsure how to alert the city of her test results, Hughes emailed D.C. Council member Mary M. Cheh (D-Ward 3) on Sunday asking her to pass the information to the city’s health department. Cheh said she was sharing it with the department’s director and would bring it up in a call with the mayor’s office scheduled for Monday.
Cheh told The Washington Post that haphazard testing availability has resulted in a hazy understanding of the virus’s trajectory in the region. “The canvas of this has been so far pretty spotty,” she said. “We have no idea how many people have had it and were asymptomatic.” Cheh said she planned to ask the city whether there is someone responsible for tracking data or taking information from people who had symptoms but did not get tested.
A spokesperson from the District’s health department confirmed to The Post that the city’s first case was reported on March 7 but did not say whether the city has heard reports of earlier suspected cases and said she was awaiting information on plans for antibody testing.
Serology tests can determine whether the body has developed antibodies in response to the virus, and widespread antibody testing has been touted as a possible way to determine who can safely return to work.
However, it is still unclear whether recovery from covid-19 confers immunity, or if so for how long. In a brief issued Friday, the World Health Organization said, “There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.” It cautioned against the use of “immunity passports” for those with positive serology tests, saying they may “increase the risks of continued transmission.”
On Saturday, the organization added that it expects that most people who are infected with the virus will develop an antibody response that will provide some level of protection, but the level or length of protection is unknown. “So far, no studies have answered these important questions,” the organization tweeted.
Additionally, the reliability of the antibody tests is not a sure thing. Dozens have entered the market without the Food and Drug Administration's approval; only four had FDA authorization as of Friday, and even those are not 100 percent accurate.
Eileen West, the doctor who tested Hughes, is using a test awaiting FDA approval, manufactured by Hangzhou Biotest Biotech and distributed by Premier Biotech. The same test was used in a Stanford University trial published last week, West said, adding that it is considered to be “well over 90 percent accurate.”
West said she is about a third of the way through administering 360 tests as part of an initiative by Ms. Medicine, a women’s health-care network that is also offering 1,200 drive-through tests in Cincinnati.
Of 110 she has administered, five have been positive, she said, adding that two of the patients with antibodies had had household contact with confirmed coronavirus cases and one had been exposed to someone in the workplace who had it. Among them, only Hughes reported feeling ill as early as February, she said.
West said the Fairfax County Health Department told her it did not have a system in place for reporting antibody test results, and she had not yet tried the D.C. health department. “The antibody information is so new it isn’t clear they desire that information as yet,” she said.
The rate of positive tests in her study closely matches the 4 percent rate found in antibody tests in Santa Clara, Calif., West said, adding that serology information could help shed light on other potential early undiagnosed cases.
“There were quite a few patients who came in with symptoms in January and February, people who had pneumonia who don’t typically fall ill,” she said, adding, “We can’t have a good picture of what is happening in our community without understanding how many have been infected and what antibody presence means for immunity.”
That means identifying people who may have contracted the virus before it laid siege to hospitals and shut the country down, before many Americans were even thinking about covid-19.
In Hughes’s case, thinking she had the flu, she took it easy during the second half of February but did not self-quarantine. She and her husband were visited by their daughter and her boyfriend during a college break, and Hughes attended services at Citizen Heights Church in Tenleytown. At one point her husband lost his sense of taste and smell — symptoms now commonly associated the virus, though they did not know that at the time.
By the end of February, as the epidemic raged through northern Italy and Hughes still felt rotten, she began to wonder whether she might have it. On Feb. 28, she went to a second doctor.
“At that point, she saw my symptoms and where I had been, and she suspected it,” she recalled. Hughes said that doctor, who practices in the District and Maryland, called at least one local health department and was told that no testing was needed. “She was quite concerned and told me to have a chest X-ray,” Hughes said, adding that the X-ray was normal.
Since then, testing sites have been opening across the region, but only for people with a doctor’s referral, who then have to pass a screening put in place by the hospital or clinic doing the testing. Results take three to seven days to get.
On March 7, the day the rector tested positive, Hughes finally felt better. But the more she learned about covid-19, the more convinced she became that she had had it. When she heard West administering the serology tests to anyone who wanted one, she made an appointment.
Hughes tested positive for the antibodies; a separate test for the virus itself was negative, meaning that if she had it, it had cleared her system. Her husband, whose sense of smell and taste had returned, tested negative for the antibodies.
Although it is unclear whether she is immune, Hughes said the antibody test provided much-needed clarity. “We know that something happened to us, and we would like some kind of proof or understanding of what it was,” she said.
Hughes said she is still practicing social distancing, washing her hands frequently and wearing a mask, knowing that even if she is immune, it is possible to spread the virus by touching contaminated surfaces.
She feels fortunate, because her case resolved on its own and because it didn’t spark the intense fear and dread that now surround the presence of symptoms.
“I wasn’t fearful when I had it, because I didn’t know that I had it,” she said. “That was such a blessing, looking back.”