The Scarlet “C”
The Corona Chronicles, Part 1 Artwork for "The Scarlet C" created by Dr. Saira Rahman
Writer's block had been plaguing me. I knew I wanted to write about the worldwide coronavirus pandemic for the March 2020 issue of Physician Outlook magazine but I did not know where to begin, what to pen that wouldn't become obsolete within minutes of writing it. Never in my lifetime, nor in my 3 decades as a practicing physician, has medical information changed so rapidly. Because Physician Outlook is both an online AND a print magazine I did not want to write something that would become “old news” by the time the magazine hit the presses.
Little did I know that my family and I would be making “front-page news” because of COVID-19, and that I would have a first-person story to recount. An experience that nearly turned my daughter and I into modern-day Hester Prynnes. One in which I uncharacteristically made unwise choices (both as a mom and a physician), and one which has somewhat defiled the ethical, evidence-based way I have practiced medicine throughout my career.
I gave my blessing to my daughter to board an international flight to London, England on March 7, 2020, at a time when I knew that the World Health Organization (WHO) and Center for Disease Control (CDC) were recommending the now all too familiar 2020 verb called “social distancing.” I knew that the situation with this virus had escalated and it was running rampant through Northern Italy. The UK had closed its borders to China early on in the epidemic, and was one of the countries that was reporting the fewest cases. More and more cases were being reported in the United States. I really thought of this like influenza, which had already caused more than 30000 deaths in the US when we first heard about coronavirus, but the media wasn’t hyping that up.
The risk of traveling to the UK seemed one that was worth taking. In fact, I was pretty sure that I myself had already been exposed to coronavirus on U.S. soil at the end of January and in early February when I treated a student that had spent her winter break in southern China who returned to campus with a fever and cough days after landing in the US (more about that later, but the CDC refused to test because of the lack of travel to the Hubei province). My personal hypothesis is that this student (who continued to cough for weeks) likely passed it on to several others on campus. I had a cluster of student patients with influenza-like illnesses who had negative flu swabs (it is important to note, however, that my hypothesis may indeed be incorrect, as to date there have been NO identified positive cases by that county).
With the benefit of hindsight, I know that I did not make the right decision to sanction and bless my daughter’s trip to London for her spring break with her college girlfriends. On March 20, 2020 she earned the dubious honor of being the first patient in our small rural county to be diagnosed with the dreaded novel coronavirus known as SARS-CoV2 which causes the COVID-19 disease.
My husband and I had some very blunt discussions with our daughter prior to the trip about the risk she was taking. A group of 4 friends was supposed to travel together to the UK, but at the last minute one of the girls canceled, deciding that the risk of being exposed was too great. That friend’s decision to opt out did not make us back down. Looking back at my reasoning, the only explanation must be that I selfishly wanted our daughter to “live life” and enjoy her spring break in a country that I have never ventured to. I knew there was a risk of her getting sick but I guess it didn’t seem “real” at the time. My brain would switch into the completely opposite mode... I’m embarrassed to admit this, but part of the reason I think I was OK with her going was because I sensed deep down inside that the world and freedom as we knew it was coming to a screeching halt. We were in the throes of “End of Days” and she deserved to experience one “last” normal life experience and a bit of fun before Armageddon was upon us.
It is too soon to tell, but it certainly feels that my sense of foreboding is not off the mark. We are currently days away from a probable mandate to “shelter in place” nation-wide as the horror that has happened in other countries is upon us now. The U.S. Intensive care units are getting filled with sick patients, and in some hospitals care is not even being offered to octogenarians because there are not enough resources. Worse yet, my fellow physician colleagues (and nurses, respiratory therapists and other front line healthcare workers) are in harm’s way because there is not enough Personal Protective Equipment (PPE) to keep them from getting showered with patients’ virus-laden secretions. Exposure of the middleman problem - Mafia-like Group Purchasing Organizations (GPOs) and Pharmaceutical Benefit Managers (PBMs) that control the U.S. healthcare system’s supply chain - is one of the main reasons that I founded Physician Outlook. People need to understand that U.S. healthcare is so expensive and shortages so abundant because they are ENGINEERED to be this way. We need to join together as a nation to repeal the perverse Safe Harbor protections that help to perpetuate the current equipment and drug supply predicaments we are currently in. I read in horror today that an anesthesiologist had to intubate patients with a plastic bag over his head because his hospital is out of face shields. Overnight we have become worse than the socialized country of Venezuela! This is the stuff of bad Hollywood horror movies. This shouldn’t be happening in the most developed country in the world.
It was not until my daughter was in the throes of violent coughing spells and became hypoxemic on her 2nd day home from London that I stopped to question how irresponsible I had been. Trips can wait. Fun can be had in the future, even if that fun has to be fabricated in a new post COVID-19 world. Is it truly more important to “live in the moment” than to protect the public good? She was upset with me, but on her first night home I completely forbid her from even having casual contact with her boyfriend, who she was dying to see. I had to put it in crude terms: if you see him, and his grandmother or grandfather end up in the ICU or dying, that is not going to be on YOUR or MY conscience. She thought I was overreacting that her minor illness was just from jet lag or lack of sleep. My daughter then realized the potential of being positive for Covid-19 and how she would never want to spread the virus to the community she knows and loves.
I can make myself feel somewhat better by remembering that “we make our decisions based on the best information we have at the moment.” At the time she left for England, the risk did not feel that great. Probably the only great decision I have made in the past few weeks was to completely opt out of all interactions with the outside world. As soon as she got home I gave her a great big hug, relieved that she was back in my arms. But the second I heard “the cough” (one that I feel I have been hearing in my student patients for the past few months on campus) I quarantined her.
Intellectually I knew there were risks inherent to traveling in the midst of a worldwide pandemic. Emotionally I was more afraid of her getting furloughed away from us indefinitely in a foreign country as the virus spread and borders closed.
As a physician, I knew better. I am held to a higher standard than most people. The community looks to me for leadership and advice. I was starting to counsel others to socially distance (but not all, interestingly...I told a dear friend to go ahead and take her chronically ill son to Disney at the same time that my daughter went to London, and they were one of the last people to visit before the parks closed). Her family was adamantly opposed, and were probably upset with me for going against every bit of advice that they had gotten from others. They had a blast at Disney, and they have come home and been in strict isolation. So far so good, no one has gotten sick. That mom and I both discussed prior to the trip that if his grandmother were to contract the virus from him she would not survive it. It was a calculated risk we were both willing to take for our children so that they could experience joy and make memories, even if it was an irresponsible thing to do.
I have behaved similarly in the past when I have had patients with cancer...I once sent a young girl with a recurrent metastatic Wilms tumor to a germ-laden dangerous water park with her family days before she was to re-start chemotherapy and have surgery. I knew she would be at higher risk for contracting infections but I didn’t care, I wanted her to enjoy her last little bit of fun before “the end,” even if it meant that her chances of survival were lessened because it compromised her immune system.
The hardest part of my daughter’s illness for me, however, was not her gut-wrenching cough or fever. I am a doctor, I know how to heal and care for the physical symptoms. I made sure she got started on albuterol to open up her lungs. She was taking acetaminophen instead of ibuprofen. She was not taking any elderberry products. She started Zinc 50mg, Vitamin C and I made sure she got enough Vitamin D. I had her check her pulse oximetry and temperature on a regular basis. I made regular calls to her pediatrician and to the Department of Health. I even made the difficult decision to start her on a medication that is not normally given to anyone unless they are going on safari and need to prevent malaria. I had heard about hydroxychloroquine way back in February, and I myself had uncharacteristically taken a 400mg dose as prophylaxis upon the advice of one of my “tin-foil hat wearing” alarmist physician friends (he had recommended early on that every physician take a loading dose and start a weekly pill “just in case this thing kept going viral.”)
The dichotomy of my life at the time was not lost upon me. On the one hand, I had let my daughter go galavanting around the world at the same time that I was worried about needing to take a potential “antidote” for the poisonous virus that was slowly creeping into daily life.
The social implications of being the brunt of rumors and having to experience the ugliness that being “the first” with a feared disease brought upon my daughter in our small rural, one-horse town was almost worse than her cough. I was powerless to stop it. Because we live in a small town where everyone knew that she and her best friend/college roommate had gone overseas together, she became the unwitting central player of a perverse version of the “telephone game” (also ironically also known as “Chinese Whispers”). In the traditional children’s game, the first player comes up with a message which is whispered into the ear of a second player, who then whispers it to a third player, and so on. In the game version, the last player usually repeats a hilarious version of the initial message. The original message was the standard Pennsylvania Department of Health report (without any identifying information) that our county had its first COVID19 case, but it didn’t take long before the whispered rumors started flying in person and on social media. Errors accumulated, and many friends were getting back to us, reporting what people were gossiping about. In one telling, I was implicated as being contagious and “spreading corona through the local hospital’s newborn nursery” (when in reality I haven’t worked at our local hospital since June of 2018). My daughter was reportedly sighted out shortly after her return from London playing basketball (when she hasn’t played the game since having an ACL repair many years ago after hurting her knee), nor had she left the house. In one particularly hilarious version one of us reportedly was “caught” spitting at the McDonald’s drive-through cashier.
The ostracization she felt from the whispered rumors, the many cars driving slowly by our house on our usually desolate road, the mean-ness that so many before her have experienced when they were diagnosed with stigmatizing diseases was so upsetting to her that until she finally made the difficult decision to “out herself” publicly.
She posted the following on her social media account, and it has gone “viral,” with >1000 shares, likes and comments. Not exactly the way to become a modern day “ influencer.” It brought joy to my heart that the majority of the comments and re-shares are overwhelmingly positive and supportive, and we are feeling blessed that we are part of this very tight-knit loving community. My husband and I both tested negative (the fact that the 3 of us were tested when others are being denied testing has been another source of hate mail and gossip, and unkind comments).
It will be a while before any of us leave the confines of our home, because we want to make sure that there is no doubt in ANYONE’s mind that we are not responsible for the illness and death that is surely to soon infect our little town.
Editor’s Note: Potter County’s first case of COVID-19 was diagnosed late last week. The victim, who had recently returned from London, England, has shared her story. It follows.
I am sure some of you have heard that I have tested positive for Covid-19. As far as we can piece together, this is the timeline.
The first appearance of my symptoms occurred only two days after being outside of the country in London, England. At the time of my trip, there were more cases in the United States than in the United Kingdom, so I decided to go and continue to experience new things and new places.
So, that being said, I could have contracted the virus in the U.S. up to two weeks prior to my trip abroad. Nobody knows, and there is no way for anyone to know.
Upon returning from my trip on March 14, my mother (who is a physician) immediately put me into a quarantine inside my own home. At this point, I only had a dry cough and very mild cold symptoms that I took as a side effect of jet lag.
I thought it was an overreaction, but I abided anyway, because I am not an ignorant human being and knew it was the right thing to do. I have not left my house since I returned on March 14 and have not been in contact with anyone else since I returned to Coudersport.
This virus has made me feel like death, but I am on the mend. I would never wish this upon anyone and would never want to risk spreading it to anyone else.
The frightening aspect of this pandemic is that the coronavirus (Covid-19) can appear as a multitude of symptoms or no symptoms at all. Many could be carriers and not even know it.
Honestly, none of this was anyone’s business to know that I tested positive, as it is my patient privacy. As a 19-year-old girl, it is tough living in a small town where it feels like everyone is against you. They never ask how you are and always just spread rumors, similar to the exponential growth of the virus.
So as well as flattening the curve of the rumors, I would also like everyone to do his or her part in flattening the curve of the virus. Please stay home.
I am not the only one who comes and goes to Potter County. I love my community, and I would never want to put anyone at risk. I just want everyone to stay safe and remain healthy.
As far as for myself, I plan on staying in my house until I am fully recovered and healthy.