The seriousness of the coronavirus pandemic finally hit home when one of my colleagues, a 30-year-old healthy neurological intensive care unit (ICU) nurse, was admitted to the Covid isolation unit on a ventilator.
The first case of Covid-19 caused by SARS-CoV-2 in the United States was reported in Seattle in late January 2020 and the first fatality occurred on February 26 at my hospital, where I am a chief resident in neurosurgery. Seattle, along with California and New York, is at the centre of the pandemic in the United States. In the state of Washington, where Seattle is situated, as of March 23, there are now 2 221 confirmed cases and 110 deaths.
Developments in the past month have been surreal. It felt like the movie Contagion, except that we were in it. In late January and early February, we read about what was happening in Wuhan.
However, perhaps taking cue from Donald Trump’s blustery rhetoric, no one was concerned. In fact, the only negative impact of the disease was the fact that my exchange rotation to a neurosurgery unit in China was cancelled. I rationalised that this was a blessing in disguise. My schedule was full, with research deadlines approaching, and I was due to take my final neurosurgery board exam on March 13. However, this was to be followed by a beach holiday in Mexico and a conference in Boston in April. I was looking forward to the end of an awful Seattle winter and too busy to care about this viral inconvenience.
By late February, an outbreak of Covid-19 was discovered at a nursing facility in Kirkland, a city within the greater Seattle metropole. Of the 120 residents, most elderly, 81 patients have tested positive and 34 have died. A number of healthcare workers at the nursing facility were also infected.
By the first week of March, there were the first signs that all was not going to be okay. The virus from the new cases in the nursing facility in March shared identical genetic sequence with the virus from the first patient identified in January. This suggests that the virus had made its way from the first patient in January through the community to reach the nursing home. In other words, the virus had been spreading in the community undetected for four to six weeks. Based on mathematical modelling, it was estimated that there were between 500 and 1 500 cases in Seattle, at least 10 times the number of confirmed cases at the time.
Over the next days and weeks, the exponential growth of the disease came to the fore. Schools and universities closed, along with restaurants and bars. Exams and meetings were cancelled. Major sporting events were postponed with a ban on public gatherings of more than 10 people. Each day, there were new restrictions, along with sharp falls in the stock market. We witnessed hoarding behaviour, inexplicably of water and toilet paper. Supermarket shelves were emptied of basic supplies; something I had only previously seen in Zimbabwe. This all culminated in the “shelter-in-place” protocol instituted this week, which is similar to the one that has been implemented in South Africa.
At my hospital, which is a safety-net hospital and the only level one trauma centre serving five states in the Pacific Northwest, all elective surgeries have been cancelled and there is a moratorium on leave of absence. My call roster now has first and second back-up persons in the event someone becomes sick. We have been warned of the likely need to reconfigure all services to deal with a surge in Covid-19 in the upcoming weeks. There is real fear and anxiety among healthcare workers about the wave that is yet to come. My American colleagues have never experienced the rationing of healthcare. What we are forced to practise in our South African public hospitals daily is unimaginable in America. One of the more challenging discussions taking place now is how to triage and allocate ventilators should supply overwhelm need.
As a doctor from South Africa and having worked at Chris Hani Baragwanath Hospital in Soweto and various day hospitals on the Cape Flats, I am no stranger to infectious diseases. On the back of the HIV/Aids pandemic, TB and other opportunistic infections are rife and afflicted patients are probably the sickest I have ever encountered. However, with HIV/Aids, there is usually a stepwise progression, even a sense of predictability in the inevitability. With Covid, though, it feels different. Indeed, a few of the older physicians recall this is what it felt like during the first panic-stricken days of HIV in the 1980s. It’s that fear of the unknown.
Rationally, as a scientist and physician, I know Covid will pass. Aggressive strategies in Taiwan, Korea and Singapore are examples of how to tackle the disease with success, while Italy serves as an example of how bad things can become. Based on available data, only one in five people who contract the disease will develop symptoms requiring hospitalisation, and overall mortality is very low (at 1-2%) with a disproportionate effect on those over the age of 70.
Yet, as I look at the boarded-up section of our neuro ICU, which has been converted into the Covid isolation unit, these numbers are hollow and not reassuring. Beyond that hastily erected containment structure lies my friend, a vivacious young woman, fighting for her life in the very unit where she has dedicated much of her youth to caring for the infirm.
Dr Christopher Young MBChB (UCT) DPhil (Oxon) is a former Rhodes Scholar and a graduate of the University of Cape Town medical school. He is currently a chief resident in neurosurgery at the University of Washington in Seattle