The bombshell news that New England Patriots cornerback Stephon Gilmore tested positive for COVID-19 and continued fallout from the White House outbreak underscore what scientists have been warning for some time: the virus takes a while to incubate, so a negative test doesn’t necessarily mean you’re clear. And if you pop positive or have close contact with an infected person, it’s crucial that you isolate for at least two weeks.
Take the case of Gilmore, the reigning NFL Defensive Player of the Year, who played in the team’s Monday night loss to the Kansas City Chiefs. All of the tests the team took before flying to Kansas City on Monday morning came back negative, but Gilmore tested positive Tuesday.
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That’s certainly not unheard of, according to the US Centers for Disease Control and Prevention’s online guidelines, which state in part, “If you test negative, you probably were not infected at the time your sample was collected. The test result only means that you did not have COVID-19 at the time of testing. Continue to take steps to protect yourself.”
Note the key word regarding a negative test — probably.
Three members of the Patriots organization have now been directly affected by the coronavirus: Starting quarterback Cam Newton tested positive Friday and rookie practice squad defensive tackle Bill Murray was placed on the COVID-19 injured reserve list on Tuesday, meaning he either tested positive or was exposed to someone who had tested positive. Gilmore’s positive test came back on Tuesday.
A negative reading, the CDC says, “does not mean you will not get get sick. It is possible that you were very early in your infection when your sample was collected and that you could test positive later.”
The CDC adds that even “if you test negative for COVID-19 or feel healthy, you should stay home (quarantine) since symptoms may appear 2 to 14 days after exposure to the virus.” Elsewhere on the site, the CDC says flatly, “Stay home for 14 days after your last contact with a person who has COVID-19.”
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The incubation period for the virus, according to the CDC, “is thought to extend to 14 days, with a median time of 4-5 days from exposure to symptoms onset. One study reported that 97.5% of persons with COVID-19 who develop symptoms will do so within 11.5 days of SARS-CoV-2 infection.”
That means if you get tested within two or three days of contracting the virus, you could very well get a false negative reading.
Dr. Dani Zander, who chairs the the pathology department at the University of Cincinnati College of Medicine, elaborates on false negatives in a helpful video primer posted to the UC Health website.
“A false negative test can happen if one has a very low viral load, which can happen in the first couple of days after infection,” Zander says in a video clip posted to the UC Health website. “Or [it] can happen at the end of the course of the infection. And so, in both of those situations you can get a negative test result, even though you’ve been infected with COVID-19.”
Early in a patient’s infection, she says, “you may have very little viral RNA, and so it may be below the limit of detection of the [testing] instrument. And then that viral load will go up as the infection progresses, and then it’ll come down again as one develops immunity to the infection. And so if you are sampled at different points in that timeline, you may end up with a positive at one point, a negative at another, or vice versa.”
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One study authored by Tak‐kwan Kong, a specialist in geriatric medicine who works in the Department of Medicine and Therapeutics at Prince of Wales Hospital in Hong Kong, found the incubation period can be longer for older patients.
The study, published in May in the journal Aging Medicine, looked at 136 COVID-19 patients who had traveled to the Chinese province of Hubei — whose capital city Wuhan has been identified as the place where the virus first surfaced — between Jan. 5 and Jan. 31.
All 136 people had stayed in Hubei for two calendar days or less before returning home, where symptom onset came between Jan. 10 and Feb. 6, the study said. And of that group, 22 patients were age 65 or older. The median incubation period for the whole group was 8.3 days, 7.6 days for younger adults, and 11.2 days for older adults, the study said.
“Knowledge that an older adult can have a longer COVID‐19 incubation period will minimize underdiagnosis,” Kong wrote, while cautioning that “the distribution of COVID‐19 incubation period for older adults in this study had a wide variation.” He conceded there’s “uncertainty if the wide variation observed arose from heterogeneity in the fitness‐frailty spectrum, a hallmark of aging, or because of the relatively small number of older adults sampled.”
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It’s unclear precisely where or when Trump, 74, contracted the virus, making it difficult to pin down his incubation period. But this much we do know: he was hospitalized with the virus Friday at Walter Reed Medical Center, where a team of doctors constantly monitored his symptoms and attacked the contagion with a battery of experimental treatments and steroids, prompting him to return to the White House on Monday evening.
His doctors said at the time of his release that he met the discharge criteria but wasn’t yet out of the woods.
On Wednesday, his lead physician, Sean Conley, said in a White House statement that Trump told him earlier in the day, “I feel great!”
“He’s now been fever-free for more than four days, symptom-free for over 24 hours, and has not needed nor received any supplemental oxygen since initial hospitalization,” Conley said.
But despite the positive prognosis, Trump has come under blistering criticism for his behavior in the days leading up to his positive test, including holding a Sept. 26 Rose Garden event with more than 100 largely unmasked guests in close quarters. That event has resulted in a number of Trump’s top aides and political allies coming down with the virus.
On Wednesday, Dr. Dara Kass, an associate clinical professor of emergency medicine at Columbia University, said the White House outbreak could have damaging ripple effects.
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“The spread from the WH will contribute to the rise of cases in the entire Northeast,” she tweeted Wednesday. “It was nice having school for a few days. Don’t forget to stock up on toilet paper.”
Her words were echoed by Dr. Atul Gawande, a prominent surgeon and author.
“The White House’s unwillingness to fight the virus, even when it has hit its own staff and supporters, is insanity,” Gawande tweeted. “Actual insanity. The GOP opposition to a national test, trace, and mask strategy is catastrophic. There is nothing partisan about going on offense against the virus.”
Material from Globe wire services and prior Globe stories was used in this report.
Travis Andersen can be reached at travis.andersen@globe.com. Follow him on Twitter @TAGlobe.
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