ASPS member details his bout with COVID-19, provides guidance

A note from ASPS/PSF Board Vice President of Membership Steven Williams, MD: During this difficult time, the ASPS message board has been an amazing resource for our members to provide support for each other, ask questions and find answers. There have been specific COVID-19 channels created for our members to discuss a variety of topics. Wesley Schooler, MD, Santa Barbara, Calif., shared his personal experience battling the coronavirus. I think that pieces like this all make us feel more connected to each other in these challenging times. Thank you, Dr. Schooler, for sharing this with all of us.

Now that my family and I are nearly over our personal bouts with COVID-19, I'm 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 had seen my share of disasters, from the 1994 Pope Air Force Base airplane crash in North Carolina to the recent Thomas fire and mudslide in California. I had been tracking the COVID-19 pandemic since early February through social media colleagues overseas and in Washington and New York. We had started to implement screening in the office, and I had been ahead with contact precautions.

Although I still traveled, I was very careful to follow the recommendations. I used hand sanitizer, washed frequently, didn't touch community coffee or condiments and kept distance from others as well as I could.

We took a family trip to Disneyland on March 1. I went to Vail/Beaver Creek, Colo., from March 3-7, and back to Los Angeles for a medical seminar March 7-8. On March 12, while in surgery, I had sudden nausea, chills and malaise. By that night I was exhausted. I usually sleep five hours per night and workout twice per day. 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 a doctor in an adjacent clinic were sick with flu symptoms and they had been tested. I sent an oropharyngeal swab due to continued malaise. It took six days to get results.

Over the weekend, I had malaise and diarrhea and thought I had perhaps contracted a gastrointestinal virus from my son, who had also vomited.

I had an emergent surgery on call and two more the following Monday before we shut down completely. By late Monday, we found out that a staff member's family member who flew back to the Midwest tested positive for COVID-19. Over the next week, I was also confirmed as having tested positive, along with one of my staff members. Several others were ill with symptoms ranging from minimal to profound fatigue, shortness of breath, malaise, profound weight loss and vomiting over the next two weeks.

I never had a fever or cough – just nausea, diarrhea, severe malaise and body chills for eight days. My wife and kids had a progressive, worsening cough over the course of that week. The day after I was confirmed, my wife, who is in her 40s, a CRNA and a healthy runner, became dizzy and her oxygen saturation was 89-90 percent on room air. My wife and kids had a low grade fever of 100.5. Our pediatrician sent tests on all three. We rode it out. My wife was confirmed positive for COVID-19. My son had another milder coronavirus – but kids' swabs weren't very reliable.

My wife and I took hydroxychloroquine for five days, and we saw rapid improvement. The kids took azithromycin. I spent two days on the phone with the public health department. I called 35 patients – including five who had undergone surgery – to tell them about potential exposure. Some had family with chronic conditions and others worked in the public sector. We have a staff member who has a child with leukemia. Luckily, they are fine.

Now, at day 14, 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 other doctor? It's already in our community. Denver and Vail have a massive outbreak. Multiple TSA workers have it. Our hospitals are attempting to gear up for it.

My wife and I lost the senses of smell and taste and had vice-grip pleuritic chest pain that is subsiding now after two weeks. A 30-year-old who contracted it only has a sinus headache. A 60+-year-old remains in the ICU. The 64-year-old bar musician (COPD/DM) at Pepe's where I ate in Vail has since passed away from complications stemming from COVID-19.

Takeaways

• COVID-19 is not as lethal as SARS, H1N1 or MERS, but it is insidiously, extremely contagious. Everyone will get it.
• Symptoms are variable. About 80 percent of patients will have vague, mild symptoms, such as malaise, headache and nausea. Fever is only present in 40-60 percent of those who contract it. Gastrointestinal symptoms occur in 30-40 percent. "Flu symptoms" at this time should warrant a high suspicion of COVID-19 and quarantine. Fatigue and malaise seem very common.
• This is not the flu or a cold. Dry, nonproductive coughs are common. Loss of taste/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.
• Severe manifestations of respiratory failure, cytokines storm and ARDS occur in less that 5 percent, seem to progress rapidly and might only be averted with early intervention. This can occur at any age.
• Healthcare workers are at extreme risk of contracting COVID-19 and must be protected at all costs – including frequent testing, adequate personal protective equipment 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 (e.g., glass, plastic, metal, cardboard).
• With a relaxation of strict social distancing in less than three months, this could overwhelm the U.S. healthcare system.
• Ships might have been the vector for worldwide spread of the Spanish Flu in 1918, but airline travel appears to be the culprit for rapid spread of COVID-19.
• Social medial 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, however, the United States could experience the breakdown of regional and national healthcare networks – and a much worse impact on human life and the economy for years to come.