My wife and I were skiing in Montana well before the worldwide pandemic had been officially declared to be what it is. At that time, the virus was targeting the elderly and medically compromised in urban population centers, while we were outdoors in a remote part of the country, breathing fresh mountain air, thinking that nowhere could be safer from the advancing pestilence. That thinking was flawed.
Our exposure was almost certainly very brief, but ski resorts are a nexus for people from all around the world, and SARS-CoV-2 needs only a brief running start to make a 6-foot jump. We had few options when the ski resorts shut down, so we decided that the risk of flying home was worth the benefit of proximity to our sophisticated medical centers if we became ill along with everyone else. That thinking was sound.
My wife became ill first, with relatively mild and short-lived symptoms. My symptoms developed a few days later and significantly worsened over the next 8 days. There were intense shaking chills, though not as bad as the break bone fever I had from Dengue back in the 80′s. There were paroxysms of cough productive of frothy sputum indicating pulmonary edema. Traffic at one end of my GI tract completely reversed direction, while traffic at the other end became a bloody race to escape the terror replicating inside of me. The worst symptom – the one precluding any hope of sleep – was disabling myalgias. They became so severe that I had to brace for the pain of every breath.
En route to the emergency room with a positive SARS-CoV-2 PCR result in hand, I knew what I needed, but was not sure that the staff in a battle-hardened urban emergency room would comply. Fortunately, a brave, clear headed, and surprisingly calm resident, knowing that I had been in his position 35 years earlier, listened to my cogent rationale for needing one of the oldest of drugs, despite its dark role in a concurrent iatrogenic epidemic. I have never enjoyed the effects of narcotics; my opioid receptors do not produce any kind of euphoria when stimulated. Within a minute, however, morphine relieved my pain to the point where I could take a deep breath and cough effectively instead of continuously.
Over the course of 8 days in the hospital, I was moderately lymphopenic, but my D-dimer levels were also low. I refused hydroxychloroquine (that was a thing at the time), and enoxaparin (on account of my hematochezia). Colleagues in my clinical division of Infectious Diseases gave me remdesivir, acetaminophen, ondansetron, and IV fluids in addition to my opioid lifeline. Colleagues from around the country called me with messages ranging from “physician, heal thyself”, to more well-considered ones such as “it’s time to let someone other than yourself be your doctor”. Angelic nursing staff bravely gowned up and ventured into my virus-saturated room every four hours as my temperature stabilized, and GI output subsided. In between visits, they watched my telemetric oxygen saturation monitor and called in by intercom to alert me on the frequent occasions when I would desaturate into the 70s. To call me a “happy” hypoxic patient would be mischaracterizing my actual mood, but those nurses undoubtedly saved me from downward spiraling episodes of hypoxia of which I was oblivious. Only upon discharge, 8 days after admission and 16 days after the onset of symptoms, did I realize that my wife had not completely recovered from her illness that had onset before mine. We both had profound fatigue and slept up to 18 hrs/day over the following 6 weeks. Fortunately, neither of us now seems to have any long-term sequelae.
The principal irony in this story is that we – two medical professionals and even an infectious diseases specialist – are the only ones in our circle of family, friends, and neighbors who have gotten sick. Our decision to travel in early March is wide open to criticism, but getting out of a densely populated city and spending most of our time outdoors in a remote part of the country seemed like a good idea at the time.
What lessons can be learned from this irony?
PPE is effective!
It is heartening to learn that the seroconversion rate among the staff that took care of me and other SARS-CoV-2 patients in our hospital has been vanishingly small. They were well supplied with personal protective equipment, and observers were assigned to make sure that strict don & doff training was followed. But thousands of health care workers elsewhere have fallen sick, and hundreds have died – which did not have to happen if we had a better system to produce, distribute, and use PPE.
Social distancing is effective!
Although I would like to take some credit for raising awareness among our family, friends, and neighbors about the seriousness of this illness, they deserve the real credit for having ears to hear, and the discipline to act on what they hear. They have forsaken their former and familiar ways for months of a much more limited and confined life. If everyone followed their example for a few weeks, this pandemic would be over. We have always been our neighbor’s keeper, whether we know it or not, whether we accept it or not.
This virus is different!
Care must be taken to not over extrapolate from our experience with other respiratory viruses in a rush to develop a vaccine. The highly variable clinical course of SARS-CoV-2 infection includes otherwise healthy people such as myself who develop incapacitating symptoms of immune-mediated pathology, suggesting that antibody-mediated enhancement of viral pathology and “cytokine storm” are real potential risks of vaccination. Doing a vaccine right takes time, and shortcuts can be costly.
Old drugs can still be great drugs!
A fear of perpetuating the epidemic of opioid abuse does not justify any reluctance to administer opioids to people in real acute pain. As with most drugs, there is both art and science to prescribing them safely and effectively.
Health insurance is vital!
The ability to enter an emergency room without fear of an overwhelming cost is an invaluable freedom. Yet, emergency rooms and hospitals must have a reasonable expectation of payment for the services they render, or we are all at risk of losing that freedom.
Science education needs redirection!
The mantle of skepticism has become a fashionable proxy for scientific thinking, and that skepticism has been misdirected outward – at the existence of this virus, its virulence, the effectiveness of masks and social isolation, the motivation behind vaccination, and even at science itself. Skepticism must be redirected inward, towards our own individual assumptions and conclusions. True scientific thinking does not endlessly raise unanswerable questions, nor does it become paralyzed by nihilism. Scientific thinking raises well-formulated questions, gathering and evaluating data in a good-faith attempt to answer them.
Finally, antimicrobial agents are the second best drug
My students hear that statement every year, and I follow it up by challenging them to name the best drug. Despite knowing that the topic of my lecture is “Immunization”, it always surprises me how long it takes them to realize that prevention is better than cure. Life as we once knew it can only resume when a safe and effective vaccine for SARS-CoV-2 becomes widely available, and widely used.
Declaration of Competing Interest
The author declares that he has no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.