Editors` Expressions: Fighting Fear With Facts

The first week of April I was feeling unusually fatigued; I chalked it up to late nights doing homework for grad school. When I felt chest tightness followed by a mild cough late at night Friday, April 3, I thought, No way. I was in the middle of a writing assignment for school and pushed away any thoughts of the worst-case scenario unfolding. Knowing I had a long weekend ahead of me dedicated to this assignment, I had to stay focused.

A week prior, I had volunteered at a COVID-19 testing site. I’d collected data from patients before directing them to get swabbed by providers donned in PPE from head to toe. My PPE consisted of a surgical mask and gloves—but I wasn’t touching patients, so that was enough, right? Did the guy who had a coughing fit from laughing at my co-volunteer’s joke turn away from his open window quickly enough? What did those reports say again about rate of transmission through aerosolized respiratory droplets? Of course, it’s impossible to know for certain the source of my infection, but this was the likeliest culprit as I’d been quarantining the last several weeks save for a grocery run and a trip on the subway to the testing site.

The following day, a stronger cough ensued, intensifying the chest pressure accompanied by radiating substernal pain that lit a small fire in my lungs with each inhalation. Still, I brushed it aside, stubbornly resolved to get through my work. I figured if I really had been infected with COVID-19, it would only worsen, so better to power through now and rest later. I started writing down my symptoms in case I needed to call my doctor after the weekend.

Later that evening, I felt warm despite having all my windows open. In hopes of allaying any concern of showing signs of infection, I took my temperature. The thermometer read 99.6. Okay, not quite the number I’d hoped for, but it wasn’t terribly high either. I recorded it so I could compare it to the next reading.

As a night owl, I’m comfortable working well past midnight, but around 12:30, feeling chilly and achy, I felt compelled to sleep. Within twenty minutes, I was shaking uncontrollably and went to bed under five blankets (including a weighted one!) that did little warming. I was woken around 3:30 am by severe myalgias in my legs, hips and low back, sending me hobbling to the kitchen for Tylenol. I wanted to take Advil since acetaminophen does little for me, but the case reports about ibuprofen causing complications in young COVID-positive patients was enough for me to avoid it out of an abundance of caution (in hindsight, with little evidence backing these claims, I wish I’d just taken it). Sleep found me for a few more hours before the dreadful body aches woke me again—this would continue for the next seven days. I was lucky to sleep through the nights, unlike some other COVID-positive people, but it was light and often interrupted by the aches driving constant restlessness.

By midday Sunday, my temperature reached 100.3, just short of a fever but high enough to raise some alarm bells. The body aches had me bedridden by this point, but even bedrest provided little relief. On Monday morning, I explained my situation to my physician, who told me to bypass a telemedicine appointment and call the Philadelphia Department of Public Health to request a COVID-19 test. Like many other areas, the city classifies EMS providers as healthcare workers, so I secured an appointment that afternoon at one of the city’s clinics. Only one other person stood in the waiting room, which I found strange considering the other site had seen over 150 people in just the one shift I worked. The intake process was systematic and somewhat tense; though the staff were calm and collected, their stress was palpable. When asked for my insurance and ID cards, I slid them under the glass divider, to which the staff member brusquely responded, “No, no, up to the glass.” I thought about how human behavior changes so intuitively to reflect the roles we’re assuming—just a week prior I was in this woman’s role having similar exchanges with patients to prevent the spread of infection, but still made the same mistake of the uninformed patient.

As fatigue set in more forcefully that evening, I took off from work the remainder of the week. The following day I woke up after a full night’s sleep, poor as it was, and worked for about two hours before crashing and returning to bed. I awoke seven hours later. I fixed myself a quick dinner, realizing I hadn’t eaten more than crackers the last few days. I had no appetite, not even for the life blood that is my morning coffee, but was insatiably parched and drank water and Pedialyte incessantly over the next two weeks.

I received a phone call from the DPH April 10 informing me I had tested positive for COVID-19. I wasn’t very surprised considering my symptoms, so I’d braced myself for this outcome. What I found most frustrating about this virus was how fluid its clinical presentation was. While I made general improvements over the course of the illness, each day was different from the last. Symptoms would come and go, leading me to believe I was improving, but one symptom was just subsiding to be replaced by another. Tuesday, for example, my cough and chest pain had diminished but were quickly substituted by a sore throat, congestion and constant sneezing. I slept through this day again. Day 6, the head cold symptoms had disappeared so the cough and chest tightness could take their throne once again. On day 7, my dry cough became productive, which came as a relief, allowing me to finally clear my lungs. The second week brought daily headaches that started every afternoon like clockwork. These symptoms persisted until day 12, which was the first day that I felt a marked improvement and back to full strength. The respiratory symptoms lingered well past two weeks, but at day 25 at the time of this writing, I’m nearly symptom-free with just a remnant of chest pain and an occasional cough.

Though I did tire easily performing regular tasks, and there were a handful of times that exercise in the later stages of the illness made me mildly tachypneic, I never had true shortness of breath, and counted my lucky stars for it. But I feared that would happen any given day. In the scattered pockets of my waking hours, I fervently researched case studies and the CDC’s reports on the average onset of respiratory issues. Dyspnea typically started between days 5–8. Okay, day 8 with no dyspnea—I was likely in the clear. But what about those reports of patients recovering and then rapidly deteriorating around day 7? As a young person with no comorbidities, I knew this was an unlikely scenario, but even still, the headlines of otherwise healthy twenty-somethings dying of COVID-19 scared me. With no roommates, I ran through action plans in the event of experiencing respiratory distress. Could I knock on my neighbors’ doors for help? No, wait, I don’t want to expose them to the virus. Would I have enough air movement to communicate my address to a dispatcher? Could I endure the five-block walk to Penn Medicine’s ED by myself? To stay sane, I consistently reminded myself of how improbable this scenario was for me, kept in frequent touch with friends and family, and distracted myself with Netflix before drifting to sleep each night.

Before contracting the virus, leaving my apartment was like walking through a minefield of people, door handles, and grocery store card reader keypads that were potential sources of infection. I felt like Pac-Man navigating a maze on the hunt for necessities while avoiding the coronavirus ghosts seeking to infect me. Now, I feel like one of Pac-Man’s ghosts, a danger to my fellow citizens—how long will I shed the virus and remain infectious? Is wearing gloves and a mask really enough to protect others from myself? Should I worry about reinfection, or am I immune for now? How is it that my friend, a nurse working regularly in a COVID-19 ward in New Jersey, hasn’t been infected but I contracted the virus my first day venturing into society in weeks? Are certain people just more genetically susceptible? We know more than we did a few months ago, but there is even more that we don’t yet know.

I’m fortunate to work in a field that keeps me apprised of the latest, evidence-based information, the reality of which can be overwhelming at times, but the truth is easier to accept than the mass of misinformation and conspiracy theories spreading out there. What will it take to stop the dissemination of such damaging content? When people reject science, poor, uninformed decisions are made, and others suffer for it. As a journalist, my only hope is that I can contribute to the provision of hard facts that help people make intelligent, informed choices.

Valerie Amato, NREMT is associate editor of EMS World. Reach her at vamato@emsworld.com or @ValerieAmato2 on twitter.