This article is from the source 'nytimes' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at https://www.nytimes.com/2020/04/13/us/coronavirus-doctor-kirkland-padgett.html

The article has changed 28 times. There is an RSS feed of changes available.

Version 7 Version 8
He Was a Doctor Who Never Got Sick. Then the Coronavirus Nearly Killed Him. He Was a Doctor Who Never Got Sick. Then the Coronavirus Nearly Killed Him.
(about 16 hours later)
SEATTLE — At the end of February, Dr. Ryan Padgett’s colleagues in the emergency room called him over to share some news: A patient who had died the previous day had tested positive for the coronavirus — the first known death in the United States.SEATTLE — At the end of February, Dr. Ryan Padgett’s colleagues in the emergency room called him over to share some news: A patient who had died the previous day had tested positive for the coronavirus — the first known death in the United States.
Everything, they knew, was about to change. Over the next several days, a parade of patients from a nearby nursing home was brought into the emergency room at EvergreenHealth in Kirkland, Wash., which emerged as the first center of the nation’s coronavirus outbreak.Everything, they knew, was about to change. Over the next several days, a parade of patients from a nearby nursing home was brought into the emergency room at EvergreenHealth in Kirkland, Wash., which emerged as the first center of the nation’s coronavirus outbreak.
The patients were in dire condition, struggling for air. But most of them were old, and some were already sick. Dr. Padgett did not worry much for himself. The 45-year-old physician kept in shape with gym visits and skiing trips. Back in college at Northwestern, he had been an All-Big Ten offensive guard, helping lead the team to the Rose Bowl after the 1995 season. In 21 years on the job, almost all at EvergreenHealth, he said he had taken only five sick days.The patients were in dire condition, struggling for air. But most of them were old, and some were already sick. Dr. Padgett did not worry much for himself. The 45-year-old physician kept in shape with gym visits and skiing trips. Back in college at Northwestern, he had been an All-Big Ten offensive guard, helping lead the team to the Rose Bowl after the 1995 season. In 21 years on the job, almost all at EvergreenHealth, he said he had taken only five sick days.
Then one day in early March, he felt a headache coming on, which was unusual for him. His muscles were sore. By March 9, he had a fever and a cough. Two days later, his breathing was so labored that he realized he was going to become a patient in his own hospital.Then one day in early March, he felt a headache coming on, which was unusual for him. His muscles were sore. By March 9, he had a fever and a cough. Two days later, his breathing was so labored that he realized he was going to become a patient in his own hospital.
“Either this thing is a beast or I’m just not used to being sick,” he texted a friend. “My Ironman immune system failed me.”“Either this thing is a beast or I’m just not used to being sick,” he texted a friend. “My Ironman immune system failed me.”
Dr. Padgett was one of the first two emergency room physicians in the country to be hospitalized in intensive care with the coronavirus. His case, which he shared publicly on Monday for the first time, offers a harrowing window into the risks faced by front-line medical workers and the devastating impacts that coronavirus can have on some people who are otherwise healthy.Dr. Padgett was one of the first two emergency room physicians in the country to be hospitalized in intensive care with the coronavirus. His case, which he shared publicly on Monday for the first time, offers a harrowing window into the risks faced by front-line medical workers and the devastating impacts that coronavirus can have on some people who are otherwise healthy.
For Dr. Padgett, who hovered at one point near death in a medically induced coma, it took medical teams at two hospitals to bring him back from the brink.For Dr. Padgett, who hovered at one point near death in a medically induced coma, it took medical teams at two hospitals to bring him back from the brink.
Back at his home in Seattle, still weak from his three-week ordeal, Dr. Padgett in a telephone interview described an illness that left him feeling as though he had, for the first time in his life, utterly lost control.Back at his home in Seattle, still weak from his three-week ordeal, Dr. Padgett in a telephone interview described an illness that left him feeling as though he had, for the first time in his life, utterly lost control.
Even before he learned he had the coronavirus, he said, he knew this was no ordinary case of the flu.Even before he learned he had the coronavirus, he said, he knew this was no ordinary case of the flu.
“You can’t lay flat, or you start gasping for air,” he said. “A couple of steps forward and all of a sudden it’s like you just ran three miles, which is pretty rare. I’m in pretty good shape. You knew something was up. You knew something was different.”“You can’t lay flat, or you start gasping for air,” he said. “A couple of steps forward and all of a sudden it’s like you just ran three miles, which is pretty rare. I’m in pretty good shape. You knew something was up. You knew something was different.”
The turnaround time for a coronavirus test at the time was at least several days. Assuming that he had the illness, Dr. Padgett stayed home with an oxygen monitor.The turnaround time for a coronavirus test at the time was at least several days. Assuming that he had the illness, Dr. Padgett stayed home with an oxygen monitor.
Even as his condition continued to worsen, Dr. Padgett said he was in a bit of denial, assuming that things would be fine.Even as his condition continued to worsen, Dr. Padgett said he was in a bit of denial, assuming that things would be fine.
His fiancée, whom he was set to marry in May, questioned him after his oxygen levels began dropping well below normal levels. He responded by saying that maybe the oxygen monitor, not as good as the ones in the hospital, was faulty.His fiancée, whom he was set to marry in May, questioned him after his oxygen levels began dropping well below normal levels. He responded by saying that maybe the oxygen monitor, not as good as the ones in the hospital, was faulty.
“She looks me in the eye and she said, ‘OK, I’m going to get ready to go to the hospital. We’re going to take one more measurement, and if it’s too low, we’re going,’” he said.“She looks me in the eye and she said, ‘OK, I’m going to get ready to go to the hospital. We’re going to take one more measurement, and if it’s too low, we’re going,’” he said.
Within hours, Dr. Padgett was on a ventilator.Within hours, Dr. Padgett was on a ventilator.
His colleagues at the hospital put him on the anti-malarial drug hydroxychloroquine, whose effectiveness for the coronavirus is still unknown, but Dr. Padgett’s condition continued to worsen.His colleagues at the hospital put him on the anti-malarial drug hydroxychloroquine, whose effectiveness for the coronavirus is still unknown, but Dr. Padgett’s condition continued to worsen.
By March 16, his heart was struggling, his kidneys were failing and his lungs were not providing enough oxygen to his body. The levels became so dire that he was on the verge of injuring his brain through oxygen starvation.By March 16, his heart was struggling, his kidneys were failing and his lungs were not providing enough oxygen to his body. The levels became so dire that he was on the verge of injuring his brain through oxygen starvation.
Dr. Padgett’s team at EvergreenHealth decided to transfer him to cardiac specialists at Swedish Health Services in Seattle. Dr. Matt Hartman, a cardiologist there, said it was clear that Dr. Padgett’s condition was rapidly worsening and that if they did not do something, he would not survive.Dr. Padgett’s team at EvergreenHealth decided to transfer him to cardiac specialists at Swedish Health Services in Seattle. Dr. Matt Hartman, a cardiologist there, said it was clear that Dr. Padgett’s condition was rapidly worsening and that if they did not do something, he would not survive.
“We didn’t know if this was someone who was just going to die no matter what we do,” he said. “We think with his age, and the fact that there’s no other major comorbidity or problem, that we should at least give it a try.”“We didn’t know if this was someone who was just going to die no matter what we do,” he said. “We think with his age, and the fact that there’s no other major comorbidity or problem, that we should at least give it a try.”
The team decided to hook Dr. Padgett up to a machine known as an ECMO that could essentially serve as both an artificial heart and lung, taking his blood out of his body, oxygenating it and returning it to him. While such procedures are most often done in the surgery suites, in this case it was all done in the intensive care unit, to prevent the spread of the coronavirus elsewhere in the hospital.The team decided to hook Dr. Padgett up to a machine known as an ECMO that could essentially serve as both an artificial heart and lung, taking his blood out of his body, oxygenating it and returning it to him. While such procedures are most often done in the surgery suites, in this case it was all done in the intensive care unit, to prevent the spread of the coronavirus elsewhere in the hospital.
“We brought the operating room to him,” said Dr. Samuel Youssef, a cardiac surgeon at Swedish.“We brought the operating room to him,” said Dr. Samuel Youssef, a cardiac surgeon at Swedish.
The team also began consulting with oncologists. Indicators of inflammation in Dr. Padgett’s body were “astonishingly high,” suggesting that he was potentially dealing with a “cytokine storm,” a dangerous phenomenon in which the immune systems of otherwise healthy people overreact in fighting the coronavirus.The team also began consulting with oncologists. Indicators of inflammation in Dr. Padgett’s body were “astonishingly high,” suggesting that he was potentially dealing with a “cytokine storm,” a dangerous phenomenon in which the immune systems of otherwise healthy people overreact in fighting the coronavirus.
The doctors administered the drug tocilizumab, often used for cancer patients who can have similar immune system reactions. They added high-dose vitamin C after seeing reports that it might be beneficial. These experimental treatments had also been tried on another patient, a 33-year-old woman, with some success.The doctors administered the drug tocilizumab, often used for cancer patients who can have similar immune system reactions. They added high-dose vitamin C after seeing reports that it might be beneficial. These experimental treatments had also been tried on another patient, a 33-year-old woman, with some success.
Over that week in mid-March, there were signs of improvement. As his inflammation numbers came down and his lungs started to provide more oxygen, the team began scaling back the ECMO machine, until they finally removed it on March 23.Over that week in mid-March, there were signs of improvement. As his inflammation numbers came down and his lungs started to provide more oxygen, the team began scaling back the ECMO machine, until they finally removed it on March 23.
Four days later, on March 27, the breathing tube was removed. Slowly, after two weeks in a sedated coma, Dr. Padgett began to wake up.Four days later, on March 27, the breathing tube was removed. Slowly, after two weeks in a sedated coma, Dr. Padgett began to wake up.
It took him a couple of days to begin gaining awareness. At first, he did not understand where he was. The unfamiliar view out his hospital window left him wondering if the top of the Space Needle had been turned into a Covid-19 unit.It took him a couple of days to begin gaining awareness. At first, he did not understand where he was. The unfamiliar view out his hospital window left him wondering if the top of the Space Needle had been turned into a Covid-19 unit.
Updated June 16, 2020Updated June 16, 2020
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
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.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.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
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.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.
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.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.
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.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.)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.)
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.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.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’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.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.
He had missed a lot. While he had been unconscious, government mandates to contain the coronavirus had altered life for everyone else.He had missed a lot. While he had been unconscious, government mandates to contain the coronavirus had altered life for everyone else.
“When I went to sleep, things were pretty normal, and you wake up and they say, ‘You know, people aren’t leaving their homes and everything is shut down,’” Dr. Padgett said. His wedding, he learned, might have to be rescheduled.“When I went to sleep, things were pretty normal, and you wake up and they say, ‘You know, people aren’t leaving their homes and everything is shut down,’” Dr. Padgett said. His wedding, he learned, might have to be rescheduled.
Dr. Padgett said he had been humbled by the care he received and alarmed at the destructive capabilities of the virus.Dr. Padgett said he had been humbled by the care he received and alarmed at the destructive capabilities of the virus.
“It goes from kind of initially feeling like this was a flulike illness where the vulnerable are the ones that are going to get sick, and now understanding that the vulnerable are getting sick and there’s going to be some young, healthy people that get cut down with this,” he said. “That’s the scary part. I think of my colleagues still on the front lines. That’s what I fear for them.”“It goes from kind of initially feeling like this was a flulike illness where the vulnerable are the ones that are going to get sick, and now understanding that the vulnerable are getting sick and there’s going to be some young, healthy people that get cut down with this,” he said. “That’s the scary part. I think of my colleagues still on the front lines. That’s what I fear for them.”
Dr. Padgett said he was still working to recover physically and mentally. He worried now about whether he would regain full cognitive function, noting moments of memory and attention problems. Still, he said, things have improved each day.Dr. Padgett said he was still working to recover physically and mentally. He worried now about whether he would regain full cognitive function, noting moments of memory and attention problems. Still, he said, things have improved each day.
Over the next two or three months, he will be doing physical and occupational therapy. After that, he plans to return to his job, despite a new perspective on the risks.Over the next two or three months, he will be doing physical and occupational therapy. After that, he plans to return to his job, despite a new perspective on the risks.
“As an emergency physician, you walk into every single room and take care of whatever is there,” Dr. Padgett said. “Going back, I don’t think that will change. I hope not.”“As an emergency physician, you walk into every single room and take care of whatever is there,” Dr. Padgett said. “Going back, I don’t think that will change. I hope not.”