Glenwood Man’s Health Battle Highlights Danger of ‘False Negative’ in COVID Fight

The fever lasted over two weeks.

Then there was the constant throb of a body ache. Any movement, even breathing, was labored and painful.

The tremors and shivering brought on by the fever made his jaws ache. Any appetite for food was non-existent.
Shawn Koehler had COVID- 19.

He was 100 percent, absolutely sure of it.

Except, he didn’t.

Not according to two nasal swab tests administered in Council Bluffs. And not according to the serology blood swab test that Koehler, 40, took that found no trace of COVID-19 antibodies in his blood stream.

Every test Koehler has taken that would have told him what laid him up for more than two weeks and took three more to fully recover from has come up negative for the coronavirus.

Koehler’s battle with an ailment that still can’t be called COVID-19 looks and feels like a textbook case of a “false negative,” a test result that indicates that a person does not have a specific disease or condition when the person actually does have the disease or condition. It’s the reason doctors and public health experts are telling people “If you have the symptoms, assume you have the virus.”

But the idea of ignoring a test result raises a thorny question on the accuracy of COVID-19 testing. Tests for the virus are largely accurate, most health experts agree, but they aren’t perfect. There’s a margin for error that leaves open doubt, even a slim one.

Lori Greiner, director of nursing at Mills County Public Health, agrees no COVID-19 testing method is 100 percent accurate but TestIowa.com has shown 95 percent accuracy for determining positive cases and 99.7 percent accuracy for negatives since ramping up the site’s statewide testing initiative more than a month ago.

“They’ve been highly vetted but it can be confusing for those in the community who go to the Test Iowa site and go through that symptom checklist and you check all those boxes and it’s easy to think you have COVID-19,” she said. “But you may not. You may be highly symptomatic but the testing has determined you don’t have it.”

Koehler has heard the statistics. He doesn’t doubt them. He guesses that means he either didn’t have COVID-19 or he did but didn’t have the antibodies in his blood yet.

“Every test has a certain percentage of inaccuracy,” Koehler said. “How many times you take it might matter. There were people who took the COVID-19 nasal swab test four or five times until they finally had a positive result and you can still take antibody tests two or three times before you get a positive test and then there’s false negatives and false positives.”

While Koehler may not know if he had the virus that has killed more than 120,000 Americans and infected more than 9 million worldwide in a global pandemic, he’s certain the hellish experience he had is one he wishes on no one and hopes to never repeat.

He first started to feel sick in late April while working outside on his family’s acreage just north of Glenwood. It was 50 degrees out and he was in a T-shirt, soaked through with sweat.

By the next morning he knew something was wrong.

The fever and aches took over and confined him to his bed for a week. “I think I streamed every Netflix and Amazon show I could think of,” he said.

When he first got sick, considering the timing and symptoms of it, Koehler was convinced he had COVID-19. The only thing he was missing were any respiratory symptoms associated with the virus. His lungs stayed clear throughout the illness.

On May 4, and two straight weeks of a fever over 100 degrees, Koehler went to the Jennie Edmundson Hospital Emergency Department. His fever, which peaked at 103.4, wouldn’t break.
“That was the worst day,” he said. “I was on full Tylenol and Ibuprofen and it would not come down. I bet I took 10 or 12 showers a day just to regulate my body temperature a little bit that day. It was a bad day.”
But a battery of tests concluded no official diagnosis. The doctors agreed he had a presumptive case of COVID-19 but did not administer a test at that time. Doctors told him a positive test would not change his treatment plan. He was sent home after a few hours and subsequently took the two nasal swab tests that both came back negative.
Koehler too

the serology test hoping for confirmation. He was as surprised as anyone at the negative results.
It was five weeks from his symptoms to finally feeling like he was back to his old self.

“It was a pretty wild ride, there’s no doubt about it,” he said. “It was a little scary at the time. I’m not going to lie. But looking back, we did everything right. My wife is a freaking saint. To take care of me through that was enough but she had to be nervous for herself and the kids and she took care of everything and she was amazing. It all worked out.”
If there is a bright spot, Koehler sees in not having (or having) the virus is the fact neither his wife, Kelly, nor four children ages 7, 9, 12 and 14, never got sick.

Greiner has heard the conversations about false negatives and false positives but the testing, overall, has been reliable for tracking and  preventing the spread of the virus.

“We encourage testing because the more you know, the better you can react and trace,” she said. “If you know you’re COVID-positive then you know you’re to self-quarantine. If you don’t know you’re positive then you don’t take the necessary steps to protect those around you. So we always encourage testing if you have the symptoms.”

There’s no doubt a false negative could bring a false sense of security. That’s especially troubling as the state continues to relax social distancing guidelines and re-open businesses and public spaces. The number of cases in Iowa and nearly every other state continues to rise. Mills County alone saw its cases jump from 24 to 31 cases in the last seven days. A rumored “second wave” could come in the fall with colder temperatures. Knowing who has or had and who has potentially been exposed will be critical in further tracking of community spread.

For nearly two decades Koehler has worked as a crop division manager for German pharmaceutical giant Bayer. He has a degree in agronomy with a heavy background in biology and chemistry. He’s tried to look at the virus and the public health response to it like a scientist. Masks, social distancing, good science and being cautious are all highly effective tools to combat the virus.

“Yeah its possible there could be people out there with a false negative out and about but the real concern for me is someone working in a long term care facility or a hospital or something like that,” he said. “That’s my concern. But for me, general public wise, if we’re following the rules, washing hands and social distancing and a face mask, then there’s still not a lot of concern.”

So, after his experience and feeling the “worst he’s ever felt,” does Koehler feel like he had COVID-19?
He’s still not sure.

And that’s not the definitive answer he hoped he’d have two months after first getting sick.

“There’s the scientist part of me that says I didn’t have it and there’s also part of me that says with everything happening, forget the data and the statistics, I probably did. I’m really torn.”