A Physician’s Personal Experience with Coronavirus
Anything said in advance of a pandemic seems alarmist. After a pandemic begins, anything one has said or done is inadequate.
–Michael Leavitt, former US Secretary of Health
As news surrounding the coronavirus (COVID-19) pandemic continues to evolve at breakneck speed, I have watched firsthand via social media as my physician colleagues work tirelessly to prepare for outbreak, treat critically sick patients, and educate the public all while coping with the same fear and anxiety that the rest of our fellow citizens are experiencing. Testing rates are abysmally low. Personal protective equipment that is desperately needed to keep those on the frontlines safe is in short supply. Many find their health care organizations underprepared and unresponsive to their concerns. Given the rapid spread of the virus across the globe, evidence-based recommendations regarding treatment and quarantining practices are limited at best.
So what do we do when one of us falls sick or becomes aware of exposure to a patient known to be infected with the virus? How do we navigate the medical system for ourselves as patients? Do we stay home to ensure that we don’t expose our patients, knowing that the consequence of this may be that patients don’t get their much-needed medical care in our absence? There are no easy answers to these questions, and the following is an account of my experience over the past two weeks with likely coronavirus infection, quarantining, fear, anxiety, public perception, and barriers to testing.
Friday, March 6th
Return from my evening session of yoga teacher training with a sore throat. Could I be getting sick? We did a number of breathing exercises that night, maybe my throat is just dry. Plus, is sore throat even a symptom of coronavirus? By the time I wake up the next day, the sore throat is resolved.
Monday, March 9th
I develop a headache in the afternoon, and this along with mounting evidence indicating that the pandemic has spread to the US—confirming my fears of the prior week—leads me to reconsider whether I should forge ahead with my plans for the evening to celebrate a close friend’s birthday at a local bar. I decide that people will think I’m being crazy to cancel plans, and I don’t feel that bad, plus is headache even a symptom of coronavirus? Spend the night socializing and sipping margaritas with friends, most of whom are pediatric nurses at my local hospital.
Tuesday, March 10th
Wake up with continued headache, horrible pain along the length of my spine and neck, mild shortness of breath, and chest pain. I chalk the back and neck pain up to a long weekend of studying twisting poses in yoga teacher training. I’m still seeing most sources indicate that the main symptoms of COVID-19 disease are fever, cough, and shortness of breath. Since I only have one of the three, how likely is it that I have the disease? (Confession: I’m a doctor and I do not own a thermometer. So I can’t say with certainty that I did not have a fever, but I never felt like I did.)
As a lifelong asthmatic, I am intimately familiar with being short of breath, although when triggered by a virus, which is often the case for me, it is often preceded by symptoms of an upper respiratory infection, such as runny nose and congestion. Nonetheless, I do what is familiar to me and initiate treatment with albuterol and inhaled steroids. I pop some ibuprofen for the terrible back pain and decide that, given the current circumstances in the world, I will take a highly unusual step for a doctor and call out of work for the next day. My current clinical position does not include acute pediatric care but rather entails seeing children with special needs on an annual basis and ensuring their physical therapy, occupational therapy, and durable medical equipment needs are being met. While this is important work, it is not critical, and the idea that I may expose my particularly vulnerable patient population to my germs is reason enough to postpone these visits despite continued evidence that the virus rarely affects children.
Throughout the day, the shortness of breath continues and is worse with any exertion, and the chest pain moves locations. I opt not to tell my nonmedical husband about the chest pain, as I don’t want to alarm him, but I internally consider whether I should seek medical attention. These symptoms don’t really sound like what I’ve been hearing about coronavirus, but they do sound like the symptoms of a pulmonary embolism. My back hurts so much that I can’t get comfortable in any position, and this—along with my headache—doesn’t get any better with the ibuprofen I continue to take.
Throughout the day, the news through the physician social media community grows exponentially more anxious as we hear from colleagues in Italy about their devastating experiences rationing ventilators for patients. We see our own country on the same trajectory but feel the general public is not yet grasping the looming crisis. Coronavirus is becoming a prominent story in the mass media but is still overshadowed by politics. I decide the time has come to isolate myself at home, however, my husband continues his daily routine of working for his online running coaching business at the local coffee shop and working out at the gym.
Wednesday, March 11th
On my daily call with my best friend, who is also a pediatrician, she and her orthopedic surgeon husband convince me that I should look into being tested for coronavirus given my persistence of shortness of breath. I message my pulmonologist and inquire about this and am told just to stay home and not get tested.
Friday, March 13th
My shortness of breath and chest pain remain about the same, with some mild improvement in headaches and back pain. I check on my 75-year-old neighbor who lives alone to make sure he is ok (from a distance so I don’t potentially infect him), and he tells me that he was sick a few days ago. He had a cough and was so tired he slept for the better part of two days. He went to urgent care where he was tested for the flu, which was negative. and he was told, “You most likely have one of those other viruses that’s floating around this time of year.” He feels much better now. This sounds highly suspicious for coronavirus to me. I advise him to please stay in and to let my husband or me know if he needs groceries and we will get them delivered for him. He tells me, “No, I’m fine, I’m not gonna catch that virus.”
Saturday, March 14th
Mounting concern about the potential effects of the pandemic and calls for social distancing fully dominate the news cycle. The public is starting to see the stark reality of what physicians have seen coming for weeks play out in Washington state. On Facebook, the Santa Barbara County Public Health Department shares a post stating there are “no cases of coronavirus” in Santa Barbara County, California, where I live. When questioned by multiple respondents, they admit that they have only performed six tests. SIX. The population of our county is roughly 92,000 people. I emphatically comment that they are providing misleading information by claiming that there are no cases in our county, especially when only six tests have been performed, and they later change their wording to “no documented cases.” They continue to require contact with a known case in order to offer testing, leading to a now-familiar catch-22: how are you supposed to know if you’ve had contact with a known case if no one is being tested?
Meanwhile, on social media, physicians form groups to share experiences, information, and best practice considerations. A COVID-19 group on Facebook exclusively for physicians now has over 14,000 members, and a group for both physicians and other advanced practitioners such as nurse practitioners and physician assistants has over 104,000 members. As members share their own symptoms of illness and those of their patients, I realize that my symptoms are actually quite common for COVID-19. Many describe backaches, headaches, sore throat, and especially this strange chest pain that one person described as “my lungs hurt.” It really registers with me now just how highly likely it is that I have contracted coronavirus.
At this point I may have had symptoms for at least a week and we know that the virus can be spread days before one is actually symptomatic. That being said, what to do about quarantining myself from my husband? We live in a one-bedroom apartment with two dogs, so this is more or less logistically impossible. Should he leave and go to our condo in the mountains? Does it matter at this point? What if I get sicker and I need him? What if he gets sick up there where medical care is not as readily available? We decide to stay the course at home.
Sunday, March 15th
My symptoms remain about the same. Continued shortness of breath, intermittent chest pain, no known fever, and perhaps a mild cough, but who can tell because I have significant seasonal allergies and am often coughing at baseline. A group text message with some of my closest friends from medical school reveals that one is also sick with symptoms of cough and fever consistent with coronavirus after recently returning from vacation in Seattle. She is both concerned for her own health and especially worried about potentially needing to miss work, as she is one of the few abortion providers in Philadelphia. These friends also emphasize my need to be tested, which I have not further pursued since my pulmonologist stated that I did not need to be tested a few days before.
After talking with them I decide to call the hotline that Santa Barbara has set up and further inquire about testing. I am told that with updated testing recommendations that went into effect on Friday, I am now considered a Tier 1 candidate for testing, which means not only should I be tested, but my test should be fast-tracked for a 24-hour turnaround because I am a health care worker. I’m told to contact my primary care provider in the morning and she will know how to order testing, so I shoot her a quick note through the patient portal to let her know.
As stories of infected patients continue to develop online, the picture is grim. This disease was previously thought to be most risky for older patients and those with comorbid diseases, yet many are sharing stories of young, previously healthy patients who are now intubated in the ICU with COVID-19. The typical disease course is different from many others—patients are described as having relatively mild symptoms for about a week and then acutely decompensating on day 8–10 of illness. Debates continue about medications that may worsen the disease: Does ibuprofen lead worse outcomes? Steroids? I’ve been taking both of these for six days. Does vitamin C help? Vitamin E? Should I ask my husband to go to the pharmacy and get these? Between reading this, being stuck in the apartment for six days, and watching far too much news on TV, I lose it and break down crying, telling my husband that I feel like I’m just sitting at home waiting to die. But what can I do besides take my medications, go to bed, and wait?
Monday, March 16th
My primary care physician texts me at 10 am stating that she received my message and is currently on the phone with the Public Health Department to get my testing approved. I explain that the hotline made it sound like she would just be able to order it, and she tells me that her understanding is that the Tier 1 testing still requires approval because it needs to be run by the Public Health Department to get the 24-hour turnaround (as opposed to all other testing, which is now being done by commercial labs). After 30 minutes on hold, she is asked to leave a message to have a supervisor call her back.
When I don’t hear back from her in two hours, I call back the hotline to try and get some more information. They confirm that I meet testing requirements and state that they will also check with their supervisors and follow up with me later to ensure that I get tested. Shortly thereafter, my primary care physician calls me and says that she received a call back from the Public Health Department and they are out of the tests with a 24-hour turnaround time. Therefore, I will need to go to urgent care to be tested through a private lab with a five-day turnaround. She provides me with the number to call once I arrive at urgent care so they can meet me in the parking lot to perform testing. A quick text exchange with my friend in Philadelphia reveals that she too endured an entire morning on the phone before finally being tested in the ER of the hospital where she works. Her results are expected in two to three days.
I proceed to urgent care and am graciously met in the parking lot by a nurse in full protective gear, including mask, gown, and gloves, who takes my vital signs and performs a nasal swab for influenza. Luckily, my oxygen level is normal and I don’t have a fever, although I had taken acetaminophen (Tylenol) shortly before arriving. Following this, I am asked to park in the lot until they call me, and about 20 minutes later I receive a call stating that I can come into the building via a side door and am placed in a negative pressure isolation room. I am then evaluated by a physician who is wearing only a surgical mask with an eye shield—no gown or gloves—who performs my nasal swab for coronavirus. I come directly home and shower, as I am concerned that if I did not already have the virus (which I am almost certain that I do) that I may have caught it there secondary to the substandard personal protective equipment used by this physician.
On my drive home, I’m shocked to see the number of people out and about. In a town where wildfires are all too common, I have seen my fellow community members stay indoors for days to weeks at a time to avoid the lingering smoke in the air. However, today it is abundantly clear to me that with the current threat being invisible to the naked eye, people are woefully underestimating just how much more deadly this will be than the fires and mudslides they are accustomed to enduring.
Tuesday, March 17th
I feel less short of breath than I have in a week. However, my husband begins to complain of chest pain and fatigue, which leaves me immediately riddled with guilt at the idea that I could have exposed him to this disease. Nonetheless, we continue with our daily routine. I’ve now lost five pounds in one week of quarantining secondary to cutting back my portion sizes in order to conserve the food we have at home. As schools remain closed for the near future, all of my clinics, which are attached to schools, are not seeing patients for the time being, so the consideration of when I can return to work can thankfully be delayed for now. I am a contractor, so I have no paid sick time, however, my husband and I are abundantly lucky to be financially stable, unlike so many who are now going without pay. I additionally have nonclinical work that I do from home, including being the Pediatric Medical Editor for Rosh Review, so I am able to generate some income during these uncertain times, for which I am grateful.
Wednesday, March 18th
For now, we wait. My test results are expected on Friday. I’m feeling a bit better, as is my husband. I continually think about all of the places I went and people I saw in the week prior to getting sick. I went to the store (where I swear I only bought one package of toilet paper), multiple coffee shops, spin class, yoga teacher training, yoga class, and I saw patients, attended a Lakers game, went to a meeting at the hospital, had lunch with a friend, and attended the birthday celebration mentioned above. If my test is positive, should anyone I came in contact with even be quarantined, as it will be two weeks or more at that point since I saw any of them? If my test is negative do I even believe it, as the sensitivity of the test is questionable at this point? Could earlier testing and preventive measures have worked to prevent much of the spread of disease that we are now seeing? I think so, as this has been demonstrated by the far more aggressive response implemented in Singapore.
Medical professionals sharing their experiences online and treating patients on the ground certainly feel that the situation will get worse before it gets better. We fear that the ventilator rationing taking place in Italy will become a reality here, as the projections of those who will require them and the number currently available point in this direction. We are significantly concerned that the general public, as I describe above, are not taking social isolation recommendations seriously and that this will not allow us to “flatten the curve,” which means slowing the spread of the disease over a longer period of time so as to not overwhelm the already overburdened health care system all at once. But in the meantime, while I continue to quarantine at home, my very brave brothers and sisters on the frontlines in health care will continue to care for patients as we have always done, likely at significant risk to themselves and their families if personal protective equipment continues to be in low supply, which is likely.
I hope you take my experience to heart and rethink your day-to-day practices, if you haven’t already. I’ve compiled some insights and requests that I strongly encourage you to take seriously:
- Please take a moment to thank any nurses, doctors, respiratory therapists, EMTs, or other medical professionals in your life working extra hard in this time of crisis despite the personal risk.
- Heed the advice of these wise and educated professionals in the coming weeks and months, not just for your own sake, but also for the sake of those around you who may be at greater risk of having a bad outcome from the disease than you are.
- Check on your elderly friends and neighbors and those who live alone who may be struggling the most with social distancing and quarantining.
And most of all, please take care of yourselves and your loved ones during these tough times ahead.