Personal experience, conversations with a post-COVID-19 patient, and some questions to think about

I’m writing this chapter in the month of June. Surprisingly, the quarantine has been lifted, and the economy is now “reopened.” There have been protests against the quarantine, and now, there are protests against the police that have turned to riots. Grocery stores all require sanitized carts; we’re using bottles of hand sanitizer after touching anything from gas station pumps, apartment lobby keypads, and elevator buttons. As I’m taking my younger sister grocery shopping with me, I see that the Sprouts Farmers Market we frequent has boarded up all its windows and doors in precaution against looters. I turn to her and say “Wow, we really are in an apocalypse.”

Some people had stocked up on toilet paper upon hearing the first rumors of quarantine, thinking that resources would be limited. In reality, the supply chain was not affected. Others stockpiled ammunition in fears of a necessary civil war since a curfew and quarantine apparently mean martial law. And here we are now: a curfew is enforced and the National Guard’s Humvees are parked at every entrance of the shopping malls, guarding them from looters. But how did we get to this point?

It seems to me that the people have been easily driven mad and we are just looking for some sense of solidarity. We’re all just looking for some purpose to get behind amidst the civil unrest, the economy’s uncertainty, and the pandemic’s threats that made us tremble, although it seems we have forgotten about the latter. These protests against the quarantine and the police force in the United States have led to the same types of mass gatherings we had worked so hard to prevent.

As I’m writing this in Tempe, Arizona, I’m reading news that Arizona’s infection rate is now more than three times higher than that of New York State. There have been more than 4400 new cases reported in the past 72 h. Arizona is now the number 1 state for coronavirus disease (COVID) cases, and it’s no surprise to me at all. Apart from these mass gatherings, all the bars are now open. I’ve seen pictures and videos on friends’ social media, and it really seems like everything is back to “normal.” It seems to me that our leaders are just “winging it.” It’s almost simply up to us to educate ourselves and propagate that information to our peers, since we lack so much guidance. I’m not sure that we can just expect the masses to take responsibility and be the ones to flatten the curve. If our leaders don’t set the example, if they don’t model the way, what are we expected to do? Clearly, we need more educated leadership. We need more competent leaders versed in these matters. It’s so concerning to me, and nearly obvious that there will definitely be a second wave, considering this is such a highly infectious virus.

I’m working on a Master’s Degree of Healthcare Management at the University of Arizona and I hope that what I’m working toward will be a stepping stone to becoming a leader in my field. I hope I can be a part of efforts to educate the masses, perhaps advise those in political positions and perhaps play an important role in managing aspects of national and even global health, as it is clearly necessary in times like these. I currently work as a nursing assistant, and when I’m in the hospital, I’m required to don full personal protective equipment: mask, goggles, apron, double gloves, and boot covers, just to come into brief contact with a post-COVID patient. The term “post-COVID” means that he/she has had the virus in the past and is now awaiting a confirmation of a negative test result. All this, for just a potential exposure to COVID 2019 (COVID-19), and what we have on the polar opposite side of the coin are crowded bars, clubs, restaurants, and mass gatherings.

I’ve been exposed to COVID-19 and have contracted the virus unfortunately as well. When I first suspected my infection, I had a shift at work the following morning. I had some symptoms like a runny nose, chills, sore throat, and what I consider the cardinal two: complete loss of taste and smell. I couldn’t smell the coffee I was drinking, or taste the cumin in my chicken. I knew my team needed me. I knew the consequences of not being on the hospital floor and forcing them to be understaffed. I knew that without my contribution, they would struggle. It was a difficult decision, but my conscience forced me to make the choice I did of calling off work that day. I couldn’t go to work and put the lives of my patients at risk. I didn’t know if I had the virus, but I wasn’t going to put the lives of the people I’m supposed to care for in danger simply due to my negligence. I phoned in to the hospital, called off my shift, and reported my possible infection. I know they really wanted me there. Apparently with a flu, you’re not considered contagious unless you actively have a fever. If I didn’t have a fever, I would have been “cleared” and considered fine to work. I was asked if I had one, and I lied saying yes, because I knew that even asymptomatic individuals could carry and pass on the virus.

The charge nurse told me I needed to get tested to confirm my exposure immediately, and that I would need a negative test result in order to return. That sounded to me like very effective protocol. I scheduled a test for the next day, and headed to bed. The next day, I woke up feeling extreme fatigue, muscle aches, and chills. I headed to the testing site and awaited my results, which I was informed would take another 2–5 days. Thankfully, they were prompt, and I received a result in 2 days: I was positive for COVID-19. I followed the recommended procedure by the Centers for Disease Control and Prevention (CDC) and stayed at home for the following 14 days. I was aware that the incubation period for the virus, or the time from exposure to symptom onset could have been anywhere from 3 to 6 days, so I wasn’t sure of when I might have contracted it. I tested again 8 days from my positive result and received a second positive.

I was feeling ok by this time, hoping for that negative result. I enjoy my work, and I’m sure no one likes being locked up in the house all day, so I was a little bit let down, but I had to follow through with my responsibility. If I ventured out of the house I may not be directly putting those I have contact with at risk, but I could be endangering the lives of their relatives, or other people they encounter. I had planned ahead from the beginning of the outbreak anyway. Before there was a mandatory lockdown, I purchased enough canned food and other items with a long shelf life to last me 3 weeks, so I wasn’t really in need of anything. I’m lucky to have people looking out for me as well. Some were very good friends, and everyone in my family called to check up on my condition. They offered to bring me anything I needed, which I really appreciated. Thankfully, my parents had already prepared my sister and I for the potential outbreak by sending us Sudafed and Sudagrip, which helped with the fever and chills, so I wasn’t in any need of medications either. Instead I offered my family some of my medication in case they were ever infected. The CFO and staff managers of the hospital I work at sent me text messages from their personal phones to ask how I was doing and if there was anything I needed. The gesture really meant a lot to me because it is reinforced the way I felt about the culture in the environment I work in. It’s a small hospital, and we’re all members of a health-care team. It taught me that the team effort to care for others goes beyond just the workplace.

I received another call from the charge nurse at the hospital on Friday of the second week of my self-quarantine. I was asked a couple of questions about my symptoms, and if I had a fever. I didn’t have a fever and was told that as long as I had been fever-free for at least 3 days, I could be cleared and be able to return to work. I was surprised by this and was on board with it. I would have liked to receive a negative result prior to returning to work, but I could only do so much, right? If those in management say that it is okay for me to go back, then I maybe I should be ok. I did what I could, and they’re the medical professionals after all. I may not necessarily agree with the situation but what more can I do? I would have fulfilled the 14 days of quarantine from the first day of my positive result by the time of my upcoming shift, according to CDC guidelines, so in the end, I did my part after all, and followed the guidelines I was supposed to. I said I was in agreement and was scheduled to work on Sunday, 3 days from the time of that phone call.

The very next day, I felt chills and muscle aches once more. My first fever actually started that night. It didn’t make any sense to me. How could I be getting a fever this late into the infection? I didn’t say anything to my team, hoping for the best the following day, but nothing changed. I still had the same symptoms, and this time they came with even more fatigue. I called in sick to work again. Another day passed and I noticed a slight discomfort in my throat. It felt as if I had swallowed something sharp, and it had scratched my esophagus on the way down. The pain was unbearable the following day. It hurt so much to swallow my own saliva. I was drooling and spitting from how much I was avoiding having to swallow. My doctor told me that I had contracted a throat infection by opportunistic bacteria possibly as a sequela due to the immunosuppression of having been infected with COVID-19. This infection lasted about 5 debilitatingly painful days, during which I tested for the virus a third time, and finally received the negative result I was hoping for. I was so glad to have had a negative result before returning to work.

My case was nowhere near as severe as what some others have experienced, however. I recognize my privilege and fortune to be young, healthy, and to have no preexisting conditions during this pandemic. The hospital I work at is a rehabilitation hospital. This means that patients in the process of recovering from accidents, falls, orthopedic surgery, stroke or traumatic brain injuries, etc. come to our facility to recuperate and engage in daily physical therapy. Some of these patients who had been previously diagnosed with the virus were recovering from having been put on a ventilator. I tried to be as sensitive as possible when asking my patients about their experiences.

“If you don’t mind me asking, what was your experience with COVID-19?” I asked one of my patients. He looked like he was in pretty good shape, and he was recovering well.

“What was my experience? Like what did I go through?” He asked me to clarify.

“Yes. How did you know you were infected?” I continued.

He began to explain, “I didn’t know I was infected.” He told me that he started having chills and muscle aches while he was at home, but he had no other symptoms. He went through a couple of days, like this before going to the hospital. “I wasn’t even planning to go to the doctor at all,” he confessed. “I have so much lapse in memory that I’m not exactly even sure what is a dream and what isn’t. It all feels surreal to me. I’m not even sure how lucid I am here in front of you today.” I gave him a look of concern as I kneeled in front of him to place anti-embolic stockings on his legs. “When I was at home I started having a slight cough. It was nothing crazy, just a small itch in my throat I felt I was trying to clear it up. All I know is that night when I went to bed I was having trouble breathing, and my wife suggested that we’d best go to the hospital before my condition got any worse.” I took a seat after having put his socks on and continued listening. “The next thing I remember is that I was seated in the emergency room. They told me I fainted there, and my next memory after that is being in a hospital bed while the paramedic asked me to sign some things. I wasn’t even sure what I was signing, and there I have another lapse in memory. I don’t know if this is the next day, or the same day, the next week or whatever; I just remember the doctors coming in and explaining the necessity for me to be put on a ventilator, and asking if I was in agreement with the procedure. I simply said ‘Whatever the doctor says is best.’ And they asked me to remove my ring so that the swelling in my hands wouldn’t cause me to lose a finger. I handed him my wedding ring, and that’s the last thing I remember. I don’t know how long I was under, and the next thing I know, I was awake again in the hospital and the next day they transferred me here.”

Due to the lack of oxygen, he suffered of neuronal and permanent lung damage. This is what was causing his lapses in memory, and was affecting his level of alertness and orientation. He was very weak upon standing. His physical therapists explained to me that they weren’t certain he’d be able to walk without an assistive device again. I know he’s lucky to be alive. I see patients in every shift that I consider fortunate. Some of them have to relearn how to use their entire bodies all over again because they’ve lost motor function in their arms and legs due to the lack of oxygen to their brains. Many haven’t been so fortunate and have lost their lives. Friends and family of mine have lost loved ones to this virus, and I’m grateful that the borders back home in Belize are closed. I give thanks to God for that every day. My father, who lives there, is receiving chemotherapy so this places him at risk.

As a health-care worker who constantly sees and hears cases like these, I understand the frustration that comes with this pandemic. There are human lives at stake, and there is a very demanding responsibility to do the best you can and play your part, but there are other consequences as well. Economists say, for example, that more than 40% of all job losses due to this pandemic are now permanent. Unemployment was perhaps at all-time lows before this pandemic, around 3.6%. Now, on the other hand, it could be anywhere from 10% to 25%. Experts are now linking unemployment in the United States to a death toll, explaining that every one percentage point increase could be equivalent to 40,000 deaths. With a rate of 10%–25%, I’m frightened to even do the math. The bitter truth is that this pandemic could have more consequences than those directly caused by the becoming infected with the virus itself.

Perhaps our leaders may be making the best decision after all. Are they? I truly want to believe that they are, but we are being faced such a difficult dilemma. Maybe this pandemic could have been handled differently from the start. Maybe it is too late now to remedy the problems we now have in front of us. If we take a look at the rates of infection in other countries, we can clearly see downtrends. Many countries like France, Spain, and even Italy which was once a “coronavirus hotspot” are now well under control. New Zealand did an excellent job of containing the infection rate. When we look at the United States, however, and it’s clear that we didn’t do a lot of things right.

Infection rates are rising even higher than the initial spike. I’m disappointed because it truly seems to me as if there is almost like a childish blame game being played by our leaders. Whether China underreported its cases or not, and whether they are responsible for a global outbreak because of their inability shut down international flights, shouldn’t matter. The problems we face should not be about whose fault they are; are we really going to wager lives here and play blame games? Are we performing human sacrifice simply to make a point? I understand that the laws of power are important, but where are our ethics?

I’m hearing news now, that Belize is opening its borders on August 15, and yes, Americans are welcome… Is it not our responsibility now not to continue to spread the virus to countries that rely so much on us? If China is responsible after all, it shouldn’t matter. Why don’t we do what we can to contain the problem, and then seek some form of accountability? Why must we play this spiteful game as if we’re saying to the world, “if they won’t take accountability, we won’t either”? We’re simply showing that we’re no better. France is now banning U.S. passports from entry to the country, and this is for a good reason. How do our actions look to the rest of the world? What impact on international relations could this have for the United States?

There’s one more thing I want us to think about before I conclude. I understand that people don’t like being told what to do. Perhaps we need a different approach. Who said a pandemic was going to be easy? There will always be conflict, no matter what decisions are made. If you ride the donkey into the city, people say you’re being abusive to the poor animal. If you don’t, they call you a fool for not utilizing it. The moral of The Man, the Boy, and the Donkey fable is that you can’t please everyone. If we’re going to “reopen the economy,” then so be it. I’m not saying I agree with that decision at all, but the truth is that no one really has the solid answers for handling this situation. There were no previous protocols in recorded history for a situation like this. Frankly, I think the United States did a terrible job when we were expected to be the leaders to this side of the globe. As for what can be done now, I do think, however, that more can be done to get our people on board with the decisions being made, or at least we need more education and transparent communication between our leaders and our people.

It’s a nuisance that people think you’re infringing their rights of freedom simply by telling them to wear a mask, for example. At first, I didn’t understand the cause for such resistance. It’s not such a hard price to pay for some sort of freedom to roam outside and carry on as if we’re not in the middle of a pandemic. In many Asian countries, people wear a mask when they have the flu or even just a cold, simply to do their best not to contaminate surfaces when coughing or sneezing, since the droplet particles will stick to surfaces. There is a culture of collectivism rather than the individualism we see here. Do we really lack the culture in this country to be considerate of others?

Admittedly, there could be some solid evidence that reusing a surgical mask could harbor mold or cause other problems. It is designed to be worn in a sterile environment after all. Wearing them outside in the dust with our constant humid breath behind them is not what they’re designed for, and yes, an N95 mask only filters air coming in, and not the air coming out. This is because it is vented to expel the air straight out of the mask without filtration, so it would defeat the purposed of wearing a mask in order to protect others from yourself. It is designed to be worn in contaminated environments, so there is no need to filter the breath of the person donning it. There is also the argument that cloth masks don’t even filter anything. In fact, these humid barriers could become mildew ridden overnight.

Okay, I get it. There is resistance. There are potentially valid points being raised, but please, let’s do some more research. The data supporting the donning of masks we’ve all seen on social media probably doesn’t account for the things I’ve stated above. But what is the alternative? Are we really going to suggest that it’s better that we don’t wear a mask at all? A healthy individual donning a mask is significantly lowering their risk of contracting the virus. The positive effect on transmission rates is even further increased when a carrier of the virus or infected person dons a mask. Now, if everyone wears one and the rate of transmission from carriers to healthy individuals is even lower. Instead of being so combative and resistant to do anything we’re told, why can we not just follow through at least with that? If there’s really so much concern over the masks like the arguments above then there are simple solutions. Let’s change the disposable surgical masks daily. Let’s not wear N95, and I assumed everyone was already doing so, but how about we wash out cloth masks daily? Most importantly, however, how about we just wear them? Is this really so hard to do or must we really behave like rebellious teenagers?

There will always be people who are drawn to conspiracy theories. Let’s face it. I have friends that I feel bad for, who eat these sorts of things up. They’re constantly complaining about social media not allowing them to propagate false information because their posts have been “fact checked.” Their accounts get flagged, and their response to this is, “they are censoring us.”

I don’t agree, but I can understand their points of view and their frustrations. Maybe we shouldn’t be removing their posts, “infringing their freedom of speech,” but how do you pull people out of that line of thinking and get them to just face the scientific facts? Maybe we shouldn’t censor them because in so doing, we may only pushing them to hold on to these ideas more strongly. They say this virus could have been engineered in a laboratory somewhere and that it has something to do with 5G towers. Perhaps COVID-19 isn’t even real, and “the media” is really just distracting us from other things going on behind the scenes. I get it. Those in power will do anything to keep the current systems in place in order to sustain that power. There will always be distractions for the masses while more sinister things take place in the background. There might never be true transparency in the world we live in, but the message all of this communicates to me is that people simply don’t trust their leaders. Given history of our country, frankly, I don’t blame them.

I do want to, however, do what I can to lay these concerns to rest. I hope there are readers who can change their minds, or maybe you, the reader, can use the following thought exercise to try to knock someone out of those “conspiracy theorist” lines of thinking. Sometimes what I really want to ask these people are: “So you don’t trust the government thinking that they could be using surgical masks to control us? We are literally carrying tracking devices in our pockets everywhere we go. The National Security Agency possibly has a record of every message or phone conversation you’ve had for the past 10 years. We’re all forced to register our property and pay taxes under a social security number given to us at birth for the sole purpose of keeping track of our contributions to society. You have a social security number, a driver’s license number, a passport number, license plate number, and house number. They know everything about us, and already have the power to control us, but are we really going to believe they’re using the masks, of all things, to control us?”

Millennials and the COVID-19 pandemic