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The Doctor’s Symptoms Weren’t Typical. Was She Sick Enough to Stay Home? The Doctor’s Symptoms Weren’t Typical. Was She Sick Enough to Stay Home?
(2 months later)
“I don’t know what you’re feeling,” the supervising doctor said over the phone, his voice calm and reassuring. “But based on the text you sent me, you shouldn’t go to work.” The 29-year-old woman, an anesthesiology resident in her second year of training, breathed a sigh of relief. “Now,” the training-program director continued, “tell me what’s going on.”“I don’t know what you’re feeling,” the supervising doctor said over the phone, his voice calm and reassuring. “But based on the text you sent me, you shouldn’t go to work.” The 29-year-old woman, an anesthesiology resident in her second year of training, breathed a sigh of relief. “Now,” the training-program director continued, “tell me what’s going on.”
Two days earlier, on March 14, the young doctor finished her sixth straight day of 12-hour shifts in the surgical intensive care unit in her hospital in Boston. She was exhausted, but that wasn’t unusual. Yet when she woke up the next day, her only day off, she didn’t feel well. It wasn’t much — a queasy stomach, a little headache and brain fog. Her muscles were sore, as if she had lifted weights the day before. And when she took a deep breath, her chest felt strangely tight. She figured that she was just recovering from what had been a really tough week.Two days earlier, on March 14, the young doctor finished her sixth straight day of 12-hour shifts in the surgical intensive care unit in her hospital in Boston. She was exhausted, but that wasn’t unusual. Yet when she woke up the next day, her only day off, she didn’t feel well. It wasn’t much — a queasy stomach, a little headache and brain fog. Her muscles were sore, as if she had lifted weights the day before. And when she took a deep breath, her chest felt strangely tight. She figured that she was just recovering from what had been a really tough week.
The following day, she felt fine when her alarm went off at 5 a.m. She got to the hospital by 6, but before the day started, she was told she wasn’t needed. All elective surgery had been postponed because of the Covid-19 pandemic, and so there weren’t many patients in the surgical I.C.U. She and her co-resident made a deal: Her colleague would care for their patients that day, and she’d take over the next.The following day, she felt fine when her alarm went off at 5 a.m. She got to the hospital by 6, but before the day started, she was told she wasn’t needed. All elective surgery had been postponed because of the Covid-19 pandemic, and so there weren’t many patients in the surgical I.C.U. She and her co-resident made a deal: Her colleague would care for their patients that day, and she’d take over the next.
Later that day, the subtle symptoms from the day before worsened. She didn’t feel sick exactly, just not like herself. She had been training for the Boston Marathon, before it was rescheduled for September, and she decided to go for a run. She finished her six-mile loop with no trouble, but she still felt a little off. Was she getting sick? Her husband, a doctor at the same hospital, didn’t feel sick, either, but for the past couple of days, he had a cough. Could this be Covid-19, the respiratory infection caused by the novel coronavirus SARS-CoV-2 — the virus that was sweeping across the United States and much of the rest of the world?Later that day, the subtle symptoms from the day before worsened. She didn’t feel sick exactly, just not like herself. She had been training for the Boston Marathon, before it was rescheduled for September, and she decided to go for a run. She finished her six-mile loop with no trouble, but she still felt a little off. Was she getting sick? Her husband, a doctor at the same hospital, didn’t feel sick, either, but for the past couple of days, he had a cough. Could this be Covid-19, the respiratory infection caused by the novel coronavirus SARS-CoV-2 — the virus that was sweeping across the United States and much of the rest of the world?
From what she had read, that infection usually caused a fever, cough and shortness of breath. The young doctor had none of those. She had a bit of chest tightness, but it didn’t make her feel out of breath. She fretted about it all afternoon and deep into the evening. When she came across a story online about an emergency-room doctor who had symptoms like hers and tested positive for Covid-19, she made her decision and texted the director of her residency program. He called her right back.From what she had read, that infection usually caused a fever, cough and shortness of breath. The young doctor had none of those. She had a bit of chest tightness, but it didn’t make her feel out of breath. She fretted about it all afternoon and deep into the evening. When she came across a story online about an emergency-room doctor who had symptoms like hers and tested positive for Covid-19, she made her decision and texted the director of her residency program. He called her right back.
“Stay home, and get tested,” he told her. The next day, she was tested. By then, her headache was a little worse. Her muscles ached a little more. She spent much of the day in bed. Her husband’s symptoms didn’t change; he still had the same dry cough. Neither of them had a fever. Two days later, she felt fine; not 100 percent but close. She went for her usual run.“Stay home, and get tested,” he told her. The next day, she was tested. By then, her headache was a little worse. Her muscles ached a little more. She spent much of the day in bed. Her husband’s symptoms didn’t change; he still had the same dry cough. Neither of them had a fever. Two days later, she felt fine; not 100 percent but close. She went for her usual run.
Given how well she now felt, the young doctor wondered: Had she called in sick for a headache, unnecessarily increasing the workload on her fellow residents? There’s an informal motto that says a doctor should either “round or be rounded on.” You are well enough to work until you are sick enough to be in the hospital as a patient. A doctor should put patient care above everything else. A 2012 study found that more than half of all residents surveyed admitted to going to work when they were sick with flulike symptoms.Given how well she now felt, the young doctor wondered: Had she called in sick for a headache, unnecessarily increasing the workload on her fellow residents? There’s an informal motto that says a doctor should either “round or be rounded on.” You are well enough to work until you are sick enough to be in the hospital as a patient. A doctor should put patient care above everything else. A 2012 study found that more than half of all residents surveyed admitted to going to work when they were sick with flulike symptoms.
And yet she knew that to go to work with even the slightest chance of a Covid-19 infection would be irresponsible. She hoped that the test would be positive — that she was right to call in sick even though she wasn’t very sick.And yet she knew that to go to work with even the slightest chance of a Covid-19 infection would be irresponsible. She hoped that the test would be positive — that she was right to call in sick even though she wasn’t very sick.
It took four days for the results to come back. A nurse from her hospital called to let her know: She’d tested positive for Covid-19. Her husband, who hadn’t been tested, probably had the virus as well. Both of them would need to stay home for at least one week after the start of their symptoms, the nurse instructed. And before going back to work, both would have to have a negative test result.It took four days for the results to come back. A nurse from her hospital called to let her know: She’d tested positive for Covid-19. Her husband, who hadn’t been tested, probably had the virus as well. Both of them would need to stay home for at least one week after the start of their symptoms, the nurse instructed. And before going back to work, both would have to have a negative test result.
After the phone call, the young woman was overwhelmed with relief. Later that morning, the head of her residency program called. How would she feel about letting her colleagues know about her diagnosis? This way they might feel better about calling in sick if they had symptoms that didn’t seem that bad. Remembering how important the story about the E.R. doctor had been in her own decision, she immediately agreed. She’d already called the people she interacted with on her last morning at work.After the phone call, the young woman was overwhelmed with relief. Later that morning, the head of her residency program called. How would she feel about letting her colleagues know about her diagnosis? This way they might feel better about calling in sick if they had symptoms that didn’t seem that bad. Remembering how important the story about the E.R. doctor had been in her own decision, she immediately agreed. She’d already called the people she interacted with on her last morning at work.
In an email, she described her symptoms and the anxiety she had about calling in sick. “It can be tough to stay home, especially at a time like this, but it’s the best thing that we can do to keep our patients, families and each other safe,” she wrote. Once she hit send, she felt a sense of satisfaction, she told me. But that night, although she believed she was done with this virus, she found that it wasn’t done with her.In an email, she described her symptoms and the anxiety she had about calling in sick. “It can be tough to stay home, especially at a time like this, but it’s the best thing that we can do to keep our patients, families and each other safe,” she wrote. Once she hit send, she felt a sense of satisfaction, she told me. But that night, although she believed she was done with this virus, she found that it wasn’t done with her.
On March 21, a week after her first symptoms, the young resident was reading a book when suddenly she felt as if her chest was squeezed tight, as if there was a band restricting the expansion of her ribs and lungs. She’d never felt anything like it before, and it scared her. She stood and felt lightheaded. “I don’t feel good,” she said to her husband. “I can’t breathe.” The suddenness with which this came on argued against its being a pneumonia. Could this be a panic attack? She tried taking deep breaths and relaxing. It didn’t help. She needed to go to the E.R., she told him. She put on a face mask, and the couple headed to the hospital where they worked. The woman fought against a rising sense of panic. Every stoplight seemed torture. There were reports of this virus causing sudden death. Was she dying? Would it just keep getting harder to breathe?On March 21, a week after her first symptoms, the young resident was reading a book when suddenly she felt as if her chest was squeezed tight, as if there was a band restricting the expansion of her ribs and lungs. She’d never felt anything like it before, and it scared her. She stood and felt lightheaded. “I don’t feel good,” she said to her husband. “I can’t breathe.” The suddenness with which this came on argued against its being a pneumonia. Could this be a panic attack? She tried taking deep breaths and relaxing. It didn’t help. She needed to go to the E.R., she told him. She put on a face mask, and the couple headed to the hospital where they worked. The woman fought against a rising sense of panic. Every stoplight seemed torture. There were reports of this virus causing sudden death. Was she dying? Would it just keep getting harder to breathe?
Updated June 2, 2020
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
In the emergency room, her heart was beating faster than normal, and she was breathing rapidly, but her oxygen level was fine. “Don’t leave me alone,” she pleaded with her husband and the nurse who took her to a negative-pressure room.In the emergency room, her heart was beating faster than normal, and she was breathing rapidly, but her oxygen level was fine. “Don’t leave me alone,” she pleaded with her husband and the nurse who took her to a negative-pressure room.
Over the course of the next couple of hours, blood tests were done, and an EKG and X-ray were performed. Her doctors wanted to make sure she didn’t have something on top of her known viral infection. One blood test looked for an increase in white blood cells in her circulation — a sign of a possible bacterial infection. It was normal. The other tests were equally unrevealing. The EKG showed no evidence of heart damage. The chest X-ray showed no sign of a pneumonia. The weight on the young woman’s chest didn’t get better, but it got no worse. Early reports of Covid-19 cases in China showed that some patients who already had serious symptoms suddenly got worse a week or more into their illness, a so-called second-week crash. It’s still not clear exactly what might be causing this late exacerbation. After promising the doctors she’d come back if she felt any worse, the young doctor and her husband went home.Over the course of the next couple of hours, blood tests were done, and an EKG and X-ray were performed. Her doctors wanted to make sure she didn’t have something on top of her known viral infection. One blood test looked for an increase in white blood cells in her circulation — a sign of a possible bacterial infection. It was normal. The other tests were equally unrevealing. The EKG showed no evidence of heart damage. The chest X-ray showed no sign of a pneumonia. The weight on the young woman’s chest didn’t get better, but it got no worse. Early reports of Covid-19 cases in China showed that some patients who already had serious symptoms suddenly got worse a week or more into their illness, a so-called second-week crash. It’s still not clear exactly what might be causing this late exacerbation. After promising the doctors she’d come back if she felt any worse, the young doctor and her husband went home.
I spoke with the patient on March 26, and she told me she was feeling better. She gets a little out of breath when she climbs the four flights of stairs to her apartment, but even that is improving.I spoke with the patient on March 26, and she told me she was feeling better. She gets a little out of breath when she climbs the four flights of stairs to her apartment, but even that is improving.
Right now, she’s focused on going back to work — she recently tested negative. Although no one knows for certain if getting the infection provides long-term immunity, current thinking is that she is probably immune to the virus for now. She is eager to return to the fight and, given the proper equipment, is ready to take her place at the very front lines of this war.Right now, she’s focused on going back to work — she recently tested negative. Although no one knows for certain if getting the infection provides long-term immunity, current thinking is that she is probably immune to the virus for now. She is eager to return to the fight and, given the proper equipment, is ready to take her place at the very front lines of this war.