A Tortola resident tested negative for Covid-19 last month, but she strongly suspects she had the disease because of the symptoms she and two co-workers suffered after interacting with passengers from cruise ships that were later connected to the spread of coronavirus in the region.
“I think I had it,” said “Jane Doe,” a tourism worker who spoke on condition of anonymity because she feared retaliation from her employer. “I’m not a medical practitioner, but if it wasn’t that, what in the heck was it? Influenza was negative; all the other tests for viruses that they can do were negative.”
Ms. Doe contacted this newspaper after noting similarities between her experience and an April 16 account by Beacon reporter Dana Kampa, who also tested negative after suffering many of the symptoms associated with Covid-19 starting on March 27.
Both women suspect their results might have been false negatives, which recent research abroad suggests may occur in nearly one in three negative Covid-19 tests. But health officials here did not warn them — or the wider public — about the possibility, and they did not respond to related questions for this article.
Ms. Doe, who is in her 40s, said her ordeal began around March 9 or 10, when she noticed that a co-worker appeared ill.
“We were outside, and she looked really unwell,” she recalled. “We were speaking about three feet away from each other. I was just concerned, and I convinced her to go see a doctor. She texted me later that day and said she wasn’t tested for anything, but [the doctor] definitely felt she had a virus and sent her home.”
They didn’t know it at the time, but two cruise ships that had visited the territory over the previous two weeks were already dealing with coronavirus concerns.
One was the Braemar, which had called in Road Town on Feb. 25. On March 10, four crew members and one passenger aboard the 929-passenger ship tested positive for Covid-19 in Curacao.
Though the ship had taken on a new set of passengers shortly after it left Tortola, the crew had not been replaced, according to Ellis Barker, a spokeswoman for Fred Olsen Cruise Lines, the United Kingdom-based company that operates the Braemar.
Two days later, two passengers from the Costa Magica, which had called in Road Town on March 1, tested positive in Martinique on March 12. Costa Cruises, the Italy-based operator of the 2,718-passenger ship, did not respond to queries, and neither did its parent company, Carnival Corp.
Though Ms. Doe and her co-worker didn’t know about the concerns aboard those ships at the time, they had been taking precautions to protect themselves, she said.
They were aware that some cruise ships calling here carried passengers from Europe, parts of which were experiencing severe outbreaks by then. But they also knew that preventive measures were in place, and that the VI government had turned away another Costa ship — the 3,780-passenger Costa Favolosa — on Feb. 26 after learning that three passengers on board had tested positive for an influenza virus.
However, on March 11 — the same day the World Health Organisation declared a coronavirus pandemic — the Favolosa was back, and it was allowed to dock in Road Town even though most of its passengers had come from Europe.
“We were all a little bit nervous with that ship calling into port, but we also were aware of the Maritime Declaration of Health and other measures that all the cruise lines indicated that they had put in place,” Ms. Doe recalled, adding, “So we felt a bit nervous about the Costa [Favolosa] call, but by the same token not to the point of saying, ‘Okay, we’re not going to work’ or whatever. You kind of just put it aside and get on with it.”
Shortly after the Favolosa’s visit, Ms. Doe came down with a bad headache and noticed a “weird feeling” in her throat.
“I brushed it off because I oftentimes have headaches or migraines, and at that time my particular work was very stressful because that’s when [the VI was] calling off the cruise ships,” she said.
The last cruise ship was allowed to dock in the VI on Friday, March 13, as cruise lines around the world suspended voyages and leaders here announced a moratorium on calls for at least 30 days.
The next day, health officials in Martinique announced that two Favolosa passengers had tested positive for Covid-19 and 426 were in “confinement.”
The following Monday, March 16, more news of the virus emerged, this time in the Dominican Republic, which the Favolosa had visited immediately before it came to the VI. The country’s minister of public health announced ten new cases of Covid-19, alleging that many of them were “linked” to the Favolosa.
No warning here
Here, VI officials didn’t explicitly warn the public about possible community exposure from the cases aboard the three cruise ships.
However, when Premier Andrew Fahie was asked about the Favolosa at a March 17 press conference, he said he was aware of reports about the Martinique cases but had not received official confirmation.
“We didn’t have any signs of it,” he said at the time. “We didn’t have … anything at all to alert us while the ship was here.”
No further announcement was issued in the VI, even as the three ships continued to make regional headlines.
After the cases were confirmed, each ship struggled to find a place to dock.
The Braemar was turned away from Barbados, where it was scheduled to end its trip on March 12, and then from its home port in the Bahamas. Eventually, it travelled to Cuba, where its passengers — most of whom came from the United Kingdom — were evacuated on four flights on March 18, according to Ms. Ellis, the Fred Olsen spokeswoman.
Meanwhile, news reports suggested that the Favolosa outbreak was much more extensive than previously reported. On March 21, Trinidad and Tobago’s health minister announced that 40 of his country’s nationals had tested positive for Covid-19 after returning home from the ship. The following week, seven more cases were added to that total.
By March 26, the Favolosa and the Magica had anchored in Miami to allow crew members experiencing serious respiratory symptoms to disembark and be taken to hospitals in the area. Six came from the Magica, seven from the Favolosa, according to The Miami Herald.
As these events were playing out abroad, Ms. Doe’s health was deteriorating by mid-March.
On Monday, March 16, she had developed a slight dry cough, but felt good enough to go to work. But the next day, she recalled, her symptoms included shortness of breath, fatigue and fever — all signs of Covid-19 as well as other illnesses.
“I started feeling terrible,” she said. “I decided to call the [VI’s Covid-19] hotline because I was getting concerned with going through all the symptoms and I was worried.”
When she reached the hotline, she was asked a series of questions.
“They were primarily focused on travel,” she said. “I had travelled in February, but they didn’t seem too concerned with the timeline, because at that time I’d been home for about three weeks. … I also mentioned where I worked and I mentioned that another one of my co-workers was not feeling well and had some similar symptoms, but I just felt — I don’t know — they didn’t seem concerned.”
She was advised to visit a doctor, but not warned to call ahead, she said, and she followed those instructions. The private doctor, however, didn’t yet advise her to get a Covid-19 test.
“I was … told there’s a lot of stuff going around,” she said. “I wasn’t tested for anything; just told to hydrate and rest and that kind of thing.”
Later that week, however, her doctor followed up and advised that she get tested along with her coworker and a third colleague who was experiencing symptoms by that time.
“They now had additional criteria for testing, and [my doctor] said, … ‘I now think that you guys need to be tested,’” Ms. Doe said, adding, “I didn’t sort of put it all together at the time, but she said to me that, ‘You need to go home; I want you to stay home and I’ll be in touch in terms of testing.’”
‘Ups and downs’
After that, Ms. Doe said, her symptoms continued to worsen.
“I kept getting these ups and downs. It was just bizarre. One day you’d wake up and think, ‘Oh, I’m good,’ and by the afternoon or the next day I couldn’t even walk up my flight of stairs,” she said. “I’m a runner. I exercise on a daily basis, but just walking from room to room or up the stairs, I would be exhausted.”
By March 20, her coughing got so bad that she decided to take further action.
“I called my private doctor and said, ‘I think I need an inhaler.’ She wrote a prescription and I got that. I also got my hands on a nebuliser, because the inhaler was not working, and it was pretty scary,” she said. “I was coughing to the point of not even being able to breathe. At that point, my boss was checking on us; he was very concerned, and he started calling as well to say, ‘Okay, look, we need to get these guys tested.’ All of us were starting to feel a bit worse.”
She also called the Covid-19 hotline again to follow up.
“They indicated that I was on the list to be tested, but if my breathing got worse that I needed to notify them and go to the hospital,” she said.
Within about three days of her follow-up call — she wasn’t sure of the exact timeline — a team came to her home and administered a nasal test, she said.
“I did ask the individual that came to our house to test, ‘Why did it take so long?’” she recalled, adding, “He just said, ‘We are overwhelmed,’ and in my mind, I was like, ‘Oh, wow. Really? Already?’”
At the hospital
The day of the test, she felt better. But the next day, her symptoms worsened so much that she went to the Dr. Orlando Smith Hospital for treatment.
“The coughing was completely out of control,” she said. “I was out of breath.”
The hospital’s Covid-19 isolation units were being completed at the time, and she was taken instead to a designated room in the emergency ward. The hospital staff, she recalled, was very professional.
“That was all organised quite well,” she said. “I had to call first and then they set everything up and they contacted me and told me, ‘We are ready for you now.’ Because at this time they did know that I was one of the patients that had been tested, so they had to treat me as though I had the virus.”
At the hospital, she was given a mask and put on an I.V. Staff members carried out blood work, letting her know that she would be tested for illnesses including dengue and influenza, she recalled.
“One of the things they gave me was a cough medicine, and it really did work,” she said. “I was sent home after that and just told to monitor my symptoms and take cough medicine, and if the inhaler helped, to continue to do that.”
While she was at home waiting for her Covid-19 results, VI leaders confirmed the territory’s first two cases during a March 25 announcement broadcast on Facebook.
Both, they said, were “imported.” One was a 56-year-old male resident who had travelled from Europe on March 15; the other was a 32-year-old male resident who had recently travelled from New York City and came into contact with a person who had tested positive.
“The two patients’ infections were travel-related,” the premier explained that day. “However, the Ministry of Health and Social Development’s epidemiological unit is taking the necessary steps to prevent the risk of community spread.”
Since then, VI officials have not publicly confirmed community spread of coronavirus in the territory, in spite of discovering four more Covid-19 cases over the past month, one of which ended in death on April 18.
For her part, Ms. Doe never received documentation of her negative Covid-19 test result, she said.
Instead, she learned about it when government officials announced the results of a larger batch of tests on a live broadcast about a week after the testing team visited her home.
“We heard about it on the news,” she said. “That was it. And then I finally reached out because I felt that I needed to have something to show to my employer as well, because I was out before the lockdown happened. And then that’s when I finally received a letter from [the Ministry of Health and Social Development].”
That letter noted her 13-day quarantine period and stated that she was no longer a public health risk, but it didn’t mention her test result, she said.
She was officially released from quarantine the day after the results were publicly announced, and she said she was not warned about the possibility of a false negative. Though she was told verbally that her tests for influenza, dengue and other illnesses had also come back negative, she never received documentation of those results either, she said.
Ms. Kampa, the Beacon reporter, had a similar experience: She was not notified personally of her Covid-19 test result, and she was officially released from quarantine the same day it was announced on a live Facebook broadcast as part of a larger batch. Like Ms. Doe, she received no warning about a possible false negative.
Ms. Doe said, “I want to believe it was all done properly, but, by the same token, how it was announced first publicly, nobody came back to us as individuals; reading [Ms. Kampa’s] story; all of the symptoms that my … colleagues and I felt — it just seems so very odd.”
A false-negative test result, however, may not be so odd after all. Recent research out of China suggests that the false-negative rate for nasal tests may be around 30 percent. And, although officials here have not addressed the issue publicly, experts abroad have raised related concerns.
“If you have had likely exposures and symptoms suggest Covid-19 infection, you probably have it — even if your test is negative,” Dr. Harlan Krumholz, a professor of medicine at Yale, wrote in The New York Times on April 1, adding, “Increasingly, and disturbingly, I hear a growing number of anecdotal stories from my fellow doctors of patients testing negative for coronavirus and then testing positive — or people who are almost certainly infected who are testing negative.”
BVI Health Services Authority CEO Dr. Ronald Georges did not answer questions about how the health system handles the possibility of false negatives, and Chief Information Officer Desiree Smith, Communications Director Arliene Penn and health information officer Adrianna Soverall did not respond to requests for information.
Now, Ms. Doe and her co-workers — who she said also tested negative — have fully recovered from their symptoms. And aside from a family member who suffered a headache for a day, she doesn’t know of any other contacts who felt ill.
“I stayed home, but didn’t separate myself from my husband,” she said. “He didn’t get anything. So those are the things you’re looking at. But at the same time, we now know that there are so many people [with Covid-19] who are asymptomatic. Whenever any of our kids have had the flu, I’ve always been the parent that also got sick, and he never did. So, to me, I feel like he has a really strong immune system, and I just don’t.”
Initially, she was reluctant to share her story. But after reading about Ms. Kampa’s experience, she felt that the public needed to hear it.
“I’ve had flu over the years, but I have never felt so awful, so tired,” she said. “I mean, the tiredness, just the weakness; not being to walk up a flight of stairs and you’re a runner? That’s not normal.”
Overall, she said, her experience with the territory’s Covid-19 response system was mixed.
“There were some interactions that seemed to contradict what they were advising the public, but there were also some very positive ones with the health team as well,” she said, adding, “For me, personally, I also feel if we’re not testing a lot of people in the community, we probably don’t have a true picture of what’s going on.”