From Cough to Clearance: Every Last Detail of My COVID-19 Journey

By the time I confirmed that I had coronavirus, it had been 13 days since I started experiencing symptoms. Between my first fever and my positive test result, I saw multiple doctors, took multiple unrelated tests, and learned first-hand the incoherence of the coronavirus testing and tracking process.

Within the span of three days, University President Lawrence S. Bacow and his wife experienced symptoms, got tested, and got their results. I wish them well. I know how awful it is to get the novel coronavirus, and I imagine only more so with Bacow’s autoimmune condition. But my story is much longer than his, and I hope its details reveal the institutional shortcomings in the initial response to the outbreak.

It took me nine days of illness to get tested and 13 days to find out it was COVID-19, and I had to do that outside of Harvard University Health Services. Our cases run parallel in that we presented similar symptoms and likely contracted the virus through community spread, but the divergence in our timelines raises questions about how testing is distributed and reflects the deeper inequalities in our society’s healthcare system laid bare by this pandemic.

THE FIGHT TO NAME AN ILLNESS

I started feeling ill on March 8. It started with back pain and a massive headache, but I thought little of it, believing that it was related to bad posture and stress. My body told me otherwise. During the first two nights, I woke up every two to three hours drenched in sweat.

On the morning of March 10, I went to Urgent Care at HUHS because I realized that I had been in contact with someone who worked at Biogen, the company whose conference was an initial source of the outbreak in Boston. The person did not immediately respond to my text message when I asked if they had attended the conference, so I was concerned that I might have been exposed.

By that time, I had a persistent fever of 100 degrees or higher, chills, muscle aches, and an occasional dry cough. I relayed my concerns to the attending doctor at Urgent Care. Since I did not travel on an airplane from a country with a Level 3 travel warning (then Italy, Iran, South Korea, and China) and/or had not been in contact with a confirmed positive, I did not qualify for a COVID-19 test. Instead, the doctor gave me a flu test and his personal number in the event that my Biogen friend had attended the conference and been exposed. When it turned out that this was not the case, I texted the doctor. He said it was great news: It meant my chance of having contracted COVID-19 was low. I felt some relief from that message, but I was still nervous, because medical experts on the news were already warning of community transmission and I still did not have an official diagnosis to name what was happening to my body. For that reason, I decided to begin self-quarantining, but as a graduate student worker at the University, I continued to virtually attend classes and fulfill my teaching fellow duties amid the tumult of transitioning to online classes as best I could.

But when my flu test came back negative, panic arose. My landlord, who lives downstairs in my shared house, had a heart attack last year. One of the housemates who lives upstairs is 75 years old. If I had COVID-19 and gave it to either of them, it could potentially be fatal. So on March 12 I went back to HUHS to try to figure out why I was still sick. I relayed my concerns to the nurse. She empathized, but said that I still did not qualify for a COVID-19 test. Instead, I was given a chest x-ray and urine test. I called back on Saturday to get my results, but they were not ready. My stoicism broke, and I spent the entire day in bed crying.

On Monday, March 16, the urine results came back normal. By that time my symptoms had remained unchanged for eight days. Even Tylenol bottles warn that you should consult a doctor if a fever gets worse or lasts for more than three days. Given that previous medical tests eliminated the possibility of other illnesses, the likelihood that I had COVID-19 seemed to be increasing, so I called HUHS again. They said there was nothing they could do, but that if the fever persisted, I should come back on March 19 for another chest x-ray.

Luckily, the following day, I received a tip from a friend that Somerville Hospital was beginning drive-through testing on Wednesday. I called to see if I could qualify. Fortunately, the doctor said I could go in that day to get tested, and so I high-tailed it to the hospital. They gave me a nasopharyngeal swab, and then prescribed medicine for the fever and the loss of appetite. By then, I had been sick for nine days, but there was hope. There is a power and relief in being able to put a name to an illness.

THE POSITIVE TEST

On the morning of March 21, at around 8:30 a.m., I got a call from the hospital that I tested positive for COVID-19. I immediately called HUHS to inform them of the diagnosis, concerned that I might have endangered the healthcare workers during my visits there. Then I texted all of my housemates. One had developed cold symptoms and a bad cough the weekend prior. I gave them the phone numbers for Somerville Hospital and HUHS. An hour after I called HUHS to update them, they sent an email asking whether I had a physical copy of the results that I could share. But when I got the call from the hospital that I was positive, my first thought was who I might have exposed, not whether they had proof.

HUHS public guidance on contact tracing refers University affiliates to the Department of Health, and the Department of Health only tracks people who I would have been in contact with after symptoms presented, which I had managed to limit to my housemates. When I tested positive, I did not have any legal obligation to inform anyone of my diagnosis. While the average incubation period is around five days, as many as 14 days can pass between being infected with COVID-19 and feeling sick. Scientists believe that one can still be contagious during that time. Knowing this, I spent the next several hours messaging all of my classes, my department, relevant institutions, and my friends on and off Facebook about the situation and urged them to get tested if necessary. Doing so, I felt, was an ethical imperative, not merely a courtesy.

There is a debate to be had over balancing privacy considerations and public health, and I do not claim to have a good answer. However, it strikes me as unsettling that in a pandemic, mass information dissemination about potential exposure is not an institutional prerogative, but instead relies on individual choice.

Despite fitting the criteria, such as presenting with symptoms and being in contact with someone who tested positive, the housemate with the cold found it somewhat difficult to get tested. Somerville Hospital was no longer accepting walk-in cases like mine, requiring permission from a primary care physician. HUHS Urgent Care wanted to speak with me before granting permission to my housemate, asking for a timeline of my illness and how I got tested. My housemate was finally tested that afternoon. My name was added to an internal database, but I have not heard from HUHS since, not even to check on the status of my health.

On the other hand, I received daily phone calls from the Cambridge Department of Health to monitor my symptoms and check on my wellbeing. My housemates received the same call daily too since they were at risk of exposure. A positive diagnosis requires self-isolation, which entails separation from the household. I was not to leave my room. If I stepped into common spaces, I had to wear a mask and gloves. Anything I was near had to be sanitized. If I wanted food, I needed to ask a housemate to leave it at my door. Due to potential exposure, my housemates were also impacted, and had to begin self-quarantine.

To be cleared, the housemate with the cold had to test negative, and I had to have no symptoms for at least three continuous days without the use of medicine. The other method of clearance was for me to have two negative COVID-19 tests taken 24 hours apart, but given the shortage, this was not an option. Five days after my housemate got tested, the result came back negative. I was cleared on March 27.

THE PRICE OF LUCK

I am incredibly lucky that I was able to get tested when I did, even though it was nine days into my illness. If I had a serious pre-existing condition or if I was much older, that 13-day period between getting sick and hearing my test results might have been fatal. But that word conveying gratitude — lucky — also masks the emotional toll this process took. Throughout this ordeal, I was constantly anxious that I could be responsible for someone’s hospitalization or death. After confirmation of COVID-19, I constantly wondered if I had done everything I could to make sure that I reduced the possibility of making a colleague, a housemate, or a stranger sick during the previous 12 days of uncertainty. The counterfactual haunts me. Since the coronavirus was never presented as a possibility until I got tested, what if I had subsequently attended classes on campus, acting in good faith but endangering lives?

As I watched the news in horror at the rising death toll and the dire situation in hospitals, I often felt guilty about my insistence on naming my illness, because I might have taken away a test from someone who needed it more. But I have also realized that naming the illness provided much-needed clarity. The symptoms were no longer incoherent and recovering became my priority, rather than pushing through and completing work. More importantly, the diagnosis also forced those around me to confront the dangers to personal and public health and respond accordingly. I shouldn’t have to feel guilty about receiving a necessary test; systemic failures should not be a psychological burden to individual patients in need of care.

This clarity both concealed and revealed emotional pain. Given the reports of increasing vitriol against Asians and Asian Americans, I feared that people would approach me with stigma or hatefulness because I tested positive. While I projected calm in my daily phone calls with my parents in California and Taiwan, my heart ached for them. Since I became sick, my mom frequently thought about the reality of COVID-19 patients dying alone. Might that have been me, her daughter? This knowledge, coupled with the fact that she lives with my cousin, an EMT, compelled my mom to tell my sister and me that she loves us and that we had to continue living should the worst-case scenario happen to her.

It would be convenient to blame individual doctors or nurses for my experience, but the reality is that this is a consequence of structural faults in our society and our healthcare system. There is something wrong when ordinary people find it difficult to get care, when they must sleuth and fight their way to a diagnosis while the wealthy, powerful, and connected have an easier time. While the federal government bears the biggest responsibility for the failures to adequately prepare for and respond to the crisis we are living through, healthcare institutions also need to make efforts to re-evaluate their administrative policies to ensure that inequalities are not being exacerbated and public health is not being endangered — especially when the lack of resources is taxing and threatening our healthcare workers. Harvard, unfortunately, is another microcosm of this larger systemic problem. These inequalities, across the institutional scales of our lives, should be the target of our anger and efforts to call for policy change.

In terms of combatting this pandemic, I would encourage anyone who has recovered from COVID-19 to consider donating plasma for antibody research or for compassionate treatment. The National COVID-19 Convalescent Plasma Project, established by physicians and scientists from 34 institutions, hosts a platform to register and match potential donors.

We have an obligation to help ease the pressures for our doctors and nurses wherever we can. We will get through this together, and hopefully through our actions, both collective and individual, build a more benevolent and egalitarian world.

Catherine Tsai is a fifth-year graduate student in the Graduate School of Arts and Sciences.