Now that my
family are nearly over our personal bout with COVID-19, I am compelled to
reflect as we brace for the crisis at hand, hopefully to give information, a
ray of hope, and a warning.
First,
after training in plastic, hand, general, and critical care surgery, I have seen
my share of disasters — from the 1992 Pope Air Force Base plane crash in North Carolina
to the recent Thomas Fire and mudflow. I've been tracking the COVID-19 pandemic
since early February through social media with colleagues overseas and in
Washington and New York.
We had
started to implement screening in our office and had removed chairs for
distancing. We were ahead with contact precautions, frequent hand washing, and
hand-sanitizer use. Yet four of us contracted COVID-19, and our symptoms varied
widely.
While I
still traveled, I was very careful to follow the strictest recommendations. I
used hand sanitizer, washed frequently, didn’t touch community coffee or
condiments, and kept a distance as well as I could.
We had a
family trip to Disneyland on March 1. I flew via LAX to Vail/Beaver Creek March
3-7, and back to Los Angeles for a medical seminar March 7-8 in Beverly Hills.
On
Thursday March 12, while in surgery I had sudden nausea, chills, and fatigue.
By that night I was exhausted, which is unusual for me. I usually sleep five
hours a night, workout a couple of times per day, and help with two young
children. My wife and I both work.
The
following day I wore a mask and gloves while seeing clinic patients. At the end
of the day I was told that a staff member and doctor nearby were sick with flu
symptoms, and they had been tested. We were never near each other directly that
week, but we had some shared common work areas. I sent an oropharyngeal swab as
the feeling of malaise — an unfocused bodily discomfort and weakness— continued
that evening. Our medical facility was allotted five tests. It took six days to
get the result back.
Varying Symptoms
Over the
weekend, the malaise wore on, and I had mild diarrhea. Maybe I had contracted a
gastrointestinal virus from my son, I wondered, after he vomited that Friday
night.
I had an
emergency surgery while on call and two more cases on Monday before we shut
down completely. I never had cough, fever, or the “standard” screening signs of
COVID-19.
By late on Monday we found out that a relative visiting one of our staff members had tested positive. The individual had received test results within 30 hours because they'd been tested at home, which was out of state. Over the next week I was confirmed positive along with one of my staff. Others had a myriad of symptoms ranging from mild sinus congestion to severe nausea and weight loss. We tested our entire staff, and luckily all were negative except one, who had mild symptoms.
I never
had a fever or cough. Just nausea, diarrhea, severe malaise, and body chills
for eight days; I felt like I'd been run over by a truck. My wife and kids had
a progressively worsening dry cough over the week. The day after I was
confirmed, my wife who is in her forties, a health-care professional, and a
healthy runner, became dizzy and short of breath. My wife and kids had a low-grade
fever of 100.5. Our wonderful pediatrician sent tests on all three. We rode it
out. My wife was confirmed with COVID-19. Our children were negative.
I spent two
days on the phone with the public health department. I called 35 patients,
including five who had surgery, to tell them about potential exposure. Some had
family with chronic conditions and others worked in the public sector. One of
our staff members has a child with leukemia. Fortunately, now that three weeks
have passed, none have shown any signs of this virus.
Now I have been released from quarantine, and we are all on the mend. I still don’t know where I contracted it. Vail? Patients? The office? Airport? Denver and Vail have a massive outbreak. Multiple TSA workers have it. It is already in our community. Our hospitals are attempting to gear up for it. We are lucky that Santa Barbara is small but has a robust health system and a very supportive hospital.
My wife
and I have lost the sense of smell and taste; we had vice-grip pleuritic chest
pain that started to subside after two weeks. The effects and symptoms of COVID-19
vary widely, from a dry cough or fever, to gastrointestinal symptoms and
respiratory failure. The 64-year-old musician playing at Pepe’s restaurant
where we ate in Vail has since passed away from COVID-19. He had other health
conditions but was an avid skier.
What We've Learned So Far
• Covid-19 is not as lethal as other recent
pandemic viruses like SARS, H1N1, or MERS, but it is insidiously extremely
contagious. Everyone will get it.
• Symptoms are variable. About 80 percent will
have vague mild symptoms like malaise, headache, nausea. Fever is only present
in 40-60 percent. Nausea, anorexia, and diarrhea symptoms occur in 30-40
percent. “Flu symptoms” at this time should warrant a high suspicion of COVID-19
and quarantine, especially if common influenza has been ruled out.
• This is not the flu or a cold. Dry
nonproductive coughs are common. Loss of taste or smell seems to be a common
symptom, both early and late.
• Testing is very slow and needs to be improved
to get a handle on the pandemic. Testing is only 70 percent sensitive, so
clinical suspicion should supersede a negative test. A new faster test might be
available soon.
• Severe manifestations of respiratory failure
occur in less than 5 percent, seem to progress rapidly, and might only be
averted with early intervention. This can occur at any age.
• Health-care workers are at extreme risk of
contracting COVID-19 and must be protected at all costs, including frequent
testing, adequate protective personal equipment (PPE), and early use of trial
medication for confirmed or suspected cases.
• Airborne and contact spread seem impossible
to prevent, and everything in public is contaminated — glass, plastic, metal,
and cardboard. Surfaces can harbor COVID-19 for 72 hours.
• If strict social distancing is relaxed in
less than several months, this disease could overwhelm even the U.S. health
system.
• While ships were the vector for worldwide
spread of the Spanish Flu 100 years ago, airline travel appears to be a major
cause for the rapid spread of COVID-19.
• Social media has been a great worldwide resource for clinicians to rapidly compare notes and learn about this disease.
With intelligence, a short-term sacrifice, public compliance, and determination, we can withstand this onslaught and return to normal life in a few months. Without social distancing, the U.S. could experience the breakdown of regional and national health-care networks and a much worse impact on human life and the economy for years to come.
Wesley G. Schooler, MD, FACS, is a plastic surgeon in Santa
Barbara, California, and a professor of surgery at the Keck School of Medicine
at the University of Southern California.