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.
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.