Like many in my profession of medicine, I have always tacitly acknowledged the inherent risk of my job. Needle sticks, accidental exposures, violent patients—each a potential obstacle in the day of the life of anyone involved in the spectrum of emergency medicine. I understand these risks, and in some ways can mentally prepare for these challenges and have an understanding of the potential outcomes. My infection with the novel coronavirus changed all that, melting away the fundamental protective barriers I have developed during my life in medicine.
I began my career in medicine as a volunteer EMT in a small rescue squad in Rockland County, New York, now near the epicenter of the coronavirus pandemic. Like many of you, I developed a love for the medicine, the thrill of prehospital care. I spent time as a paramedic for Rockland Paramedic Services before medical school and eventually went on to become a pediatric emergency medicine (PEM) physician. After completing my pediatric emergency medicine fellowship, I had an opportunity to rediscover my passion for prehospital care, becoming one of the first PEM physicians in the country to complete a fellowship in Emergency Medical Services and Disaster Medicine with the New Jersey EMS Fellowship (now part of MD1). At each step of this journey, I developed new tools to understand pathology and treatments and the confidence to work in the chaotic and unpredictable worlds of the pediatric emergency department and prehospital setting. I was a S.W.A.T physician, a flight physician and an EMS physician. I felt in control.
This all changed in early March of 2020.
It began as an influenza-like illness. A dry cough, followed by fever of 102.7F, chills and myalgias like I had not experienced before. In any other time, I would have taken a gram of Tylenol and moved on with my day, but this was somehow different. I was approaching work when I really began to notice my symptoms and worried about the potential threat I could be to my colleagues and patients if infected with the novel coronavirus. I turned around quickly and called in sick for the first time in nearly two years. I tested negative on our hospital’s viral panel which includes a number of common viruses and bacteria. Early in the pandemic, there was no local COVID-19 testing within my healthcare system. As a frontline healthcare worker, I was referred to the Colorado Department of Public Health & Environment who arranged for me to go to one of the nation’s first drive-through testing sites in the suburbs of Denver. I was swabbed early on a Thursday morning, and then, I waited. Four days; each passed slower than the next. Call after nervous call to my contact in the Department of Health generated only more questions without answers. I continued to be febrile each day with a degree of fatigue I had never experienced before. I’ve had influenza in the past, as well as pneumonia, but this felt different. I was worried; we knew so little about this virus that had seemingly only been infecting the elderly and those with significant medical issues—it was yet to impact healthy young adults in the United States. I worried for my wife, my kids. Would they get sick?
Over the following days, I began to feel better. In fact, when I finally received the call from the Department of Health early on a Sunday morning confirming that I did in fact test positive for the novel coronavirus, I was physically feeling better. With the diagnosis came a slew of questions. How long did I have to isolate? When could I hug my children? When could I get back to work? As infectious disease epidemiologists struggled to better understand where Denver sat on the brink of this pandemic, it was clear that straight answers would be difficult to find.
I consider myself well-informed. I read frequently and I am a news addict. Lying enclosed in our home’s small office, this became my entire life. CNN. NPR. The New York Times. Even Fox. Twenty-four hours of tragedy, of ill-preparedness. I watched as colleagues in New York City wore trash bags for personal protective equipment (PPE), where resident physicians, nurses and first responders fell sick while fighting on the front lines. It surely wasn’t the respite I needed, but it was the reality I was facing.
It was on the seventh day of my illness that I realized steps were becoming harder to climb, that speaking on the phone made me short of breath. I was tachycardic, even when I wasn’t febrile. I tried to seek comfort in the fact that my pulse oximeter showed that my saturation was 91%, which was “okay, but just okay.” I had read that some patients with COVID-19 infections followed a biphasic course. They could quickly and without warning, rapidly deteriorate after a brief period of recovery. I went to sleep that night nervous.
At 4 a.m. I woke up with shaking chills. I found it difficult to breathe and my pulse oximeter read 84% on room air. While I was struggling with the idea that I was worsening, it was time to go to the hospital. I woke up my wife, who is also a physician, and cried to her. Something was wrong. I wanted to kiss my children, but the fear of getting them sick was paralyzing. I realized that so much of my anxiety and fear arose from the fact that I had lost control, and as someone who speaks to patients and parents about prognosis with such confidence for the past few years, I had no idea how this would turn out. Would walking downstairs be the last time I saw my children? Didn’t I just see this story on the news? It didn’t end well.
The emergency department in the large academic hospital near my home was phenomenal. I had called ahead to let them know I was COVID-19 positive—my scarlet C. I was met at the door by nurses in full PPE and within minutes I was placed in a room, IV access was obtained, labs were drawn, and I was placed on supplemental oxygen. It was not until that moment that I realized just how air-hungry I had been. I felt like my lungs were on fire. I was met by the hospital’s COVID team. My chest film showed evidence of infiltrates at the bilateral bases, and labs showed a low white blood cell count and low platelet count. These findings all fit the clinical picture of COVID, though we were first beginning to understand the prognostic value of any of these tests. I was admitted for hypoxia and dehydration.
The next 12 hours, in retrospect, were some of the hardest moments in my life. Alone in an isolation room overlooking the snow-capped mountains beyond Denver, I found myself lost in a sea of thoughts. The emotional side of my brain was a tornado. I should call my parents. I haven’t been a good enough father or husband. There is so much I want to do. I want to watch my kids grow up. I wrote a will. I recorded messages for my children. I spoke with my father, an intensivist, about where I wanted to be buried if this didn’t go well. The scientific side of my brain struggled with the constant stream of “unknowns.” Should I be placed on hydroxychloroquine or azithromycin? Would I qualify for compassionate use with Remdesivir? An extraordinarily well-meaning member of the care team recognized my anxiety, and in an attempt to comfort me said, “It’s understandable you’re upset. You’re admitted to the hospital with a disease few have had before, in an age group that isn’t supposed to get sick.” He meant well.
I follow the literature. I practice evidence-based medicine and I believe in science. “Right now, Matt, there really isn’t evidence that any of these medications are effective.” So I was just supposed to sit there and breathe. During my four-day hospitalization I was never afebrile. My labs and imaging remained stable and slowly I forced myself to walk, drink and focus on getting better. After four days, I was discharged home, to recover in our small office, still isolated from my children and wife.
Slowly, I did get better. After 14 days, my fever finally broke, and as my symptoms gradually improved, the Department of Health cleared me from isolation. I’m surprised I didn’t leave marks on my children from hugging them so hard. A week later, I returned to work after 22 days. I returned to see the caring faces of my co-workers, though now hidden behind plastic shields, and carefully, but appropriately, rationed PPE. Everything was different, and it was abundantly clear that “different” would become the new normal.
Another week would pass until I was asked by a friend if I would donate plasma to a patient in the adult intensive care unit. Antibodies from my blood could be a beneficial therapeutic intervention for patients in the most acute stages of infection with the novel coronavirus. Days later, watching blood move through the 16-gauge catheter in my arm into the apheresis machine, and for the first time in nearly a month, I realized that despite the emotional and physical chaos that COVID wreaked on my life, I had officially regained control.
In the twenty years I have been involved in medicine as an EMT, a paramedic, a pediatrician, a pediatric emergency medicine attending and as an EMS physician, nothing has been so profound an experience as my illness during this pandemic. I imagine this will prove to be the defining moment in the careers of many in EMS and on the front lines of this pandemic.
Matthew Harris is a pediatric emergency medicine attending physician at Children’ Hospital Colorado and an Assistant Professor of Pediatrics (Emergency Medicine) at the University of Colorado. Dr. Harris is the Vice Chair of the Pediatrics Committee for the National Association of EMS Physicians. He is triple-board certified in Pediatric, Pediatric Emergency Medicine, and EMS.