It looks like the November 2019 Florida outbreak just had another case.

The dog that didn't bark

Remember those Florida residents who began falling sick in November 2019, “haven’t been sick since” and tested positive for SARS-CoV-2 antibodies?

Peter Antevy @HandtevyMD

In January I got very sick (flu like illness but much worse), no sleep for 2 days and almost checked myself into the ED. Had no idea what it was. Today I checked my #COVID19 Antibody status......IgG+ Only (sign of past infection). Mixed emotions🙄. Will retest tomorrow.

Peter Antevy @HandtevyMD

Update: second test positive IgG again, however third and 4th tests were negative.

Peter Antevy @HandtevyMD

Here are the 2 other tests....both with 2 negative results. I’m back to square one. I now cannot confidently say I had this virus 🤔.

Peter Antevy @HandtevyMD

My serology saga continues. Just tested with a FDA EUA test and it shows IgG+. This is consistent with the first 2 tests I took. Next step for me is ELISA (quantitative Ab).

It looks like these Nov-Dec cases weren’t the last of the people in Florida that were sick before the first officially acknowledged case within the United States and then tested positive for SARS-CoV-2 antibodies once the tests have been made available.

https://www.linkedin.com/in/peter-antevy-md-a9b11726
"Peter Antevy, MD has served as the Medical Director for a number of EMS agencies throughout Broward, Palm Beach, and Dade Counties in Florida since 2010". However, it is unclear if he directly contacts any patients as
"The medical director organizes and coordinates physician services and services provided by other professionals as they relate to patient care. The medical director participates in the process to ensure the appropriateness and quality of medical care and medically related care."

It should also be noticed that while severe symptoms (ARDS/severe pneumonia manifestations) are rare in SARS-CoV-2 infections, more than 60% of all serologically confirmed SARS-CoV-2 infections are symptomatic, with an observed asymptomatic infection rate of only 34.9%. This means that if an infection happened, even though ascertainment through severe symptoms that are specific to severe pneumonia/ARDS is unlikely, more than half of those infected will become sick. Most of these symptoms involve fever.

As such, having the last onset of illness in November-December 2019, and then no more sickness afterward, all testing positive for antibodies prior to any second symptoms onset, within a tightly packed cluster that spans just two blocks of Delray Beach (a city within the Palm Beach county), with at least 4 people (and up to 11 which was the entire cluster where sickness occurred in Nov-Dec 2019 and where antibody test results at availability indicating positive results, where they “all told The Palm Beach Post the same thing”) that displayed no additional symptomatic illness after this first onset and prior to the antibody test, the chance that all of these cases were positive only due to a subsequent, later infection, is at most 1 in 2^4, which is 1 in 16.

Now with a medical director in Palm Beach that was also sick in January 2020, and then tested positive for antibodies (IgG only indicating long-term and non-recent antibodies) upon the availability of the tests, this makes this series of illnesses consistent with a localized outbreak of SARS-CoV-2 infection, with transmission first into the neighborhood, then into healthcare workers.

As of January 2020, officially registered cases of COVID-19 (that were then found to be positive when testing became available for their samples left within hospitals or have been found positive when they died and were then autopsied) were found to have begun showing symptoms according to the official records in Florida. This is also when the first Nationally registered “death involving COVID-19”) was recorded somewhere in the U.S.

We strongly suggest @HandtevyMD on Twitter provide more information on the date of symptoms onset for his January 200 illness, and to provide more information on antibody testing, particularly for samples of blood or serum banked in his hospitals from Dec 2019 to Jan 2020, as these may hold vital clue on the date of the first arrival of SARS-CoV-2 into Florida.