COVID-19: A personal and professional journey
Proper treatment and management of COVID-19 patients by primary care physicians can reduce hospitalizations and mitigate the strain on our health care delivery system
By Amer Shakil, MD
As a frontline, community family physician treating patients like my colleagues across the country, I became infected with the new coronavirus and contracted COVID-19. Fortunately, I am recovering and did not need to go to the ICU or be put on a ventilator, unlike far too many of our friends and neighbors.
I was taking care of a patient in the hospital who was immunocompromised, had heart failure, renal failure, and a history of renal transplant rejection. While in the hospital, he became sick again and again, and I tested him for COVID-19 several times. On the third episode after 10 days, his test came back positive. Although I was taking all the precautions and preventive measures, I believe I contracted the virus from him.
When he tested positive, I filled out an occupational health questionnaire and realized I had been having headaches and mild body aches for a few days. I thought this was simply the effects of working long hours in the hospital. I initially tested negative but was advised to quarantine anyway.
Over the course of next three to four days, I started experiencing severe myalgias, low-grade fever, and chills. Later I developed a sore throat, ear pain, and night sweats. I took Tylenol around-the-clock and I could not do much. After four days of worsening symptoms, my test came back positive. I was advised to get an infusion of monoclonal antibodies at UT Southwestern Medical Center.
I had started antibiotics and steroids when I initially experienced symptoms. I was not getting better so I called my infectious disease friend who doubled my dose of steroids and added few more medications. A day later I worsened, with significant difficulty breathing and my pulse oximetry reading dropped from 96 to 94. We both got scared and my treating physician referred me to the emergency room to get a CT scan. The scan showed typical findings for COVID-19 viral infection but likely no other complications, so I returned home. I also had a telemedicine visit with a pulmonologist who further changed my medication regimen, adding an even higher dose of steroids.
Again my condition worsened and I went back to the ER. I was diagnosed with pneumonia and sepsis, and I spent three more days in the hospital.
This illness is nothing but a great lesson and blessings for me. I have learned so much on both the professional and personal levels. I owe so much to the care, love, and support of my colleagues at UT Southwestern and the physicians in my community. They checked on me regularly and took care of all the work I was unable to do.
Similarly my family and community showed an outpouring of love and care. They have delivered food and groceries, and they have helped out with anything we needed. My mom and my family back in Pakistan showed similar support. Most importantly I am lucky to have a beautiful wife who is also physician. She not only took care of me, but she maintained our practice and our COVID testing site.
This is a very isolating illness; that was probably the hardest part of getting sick for me. In general, I have no trouble being alone and working away, but to be forced to stay quarantined and not to touch or feel your loved ones can be tough. However I consider myself as one of the positive stories of this pandemic. Although I was not sick enough to be admitted to the ICU or to need a ventilator — like some of my physician friends and patients — I still struggle with daily fatigue.
I have a strong faith and firmly believe that everything happens for a reason and for making you better and stronger. A few things bothered me during my fight with COVID. My elderly mother waits anxiously all year long to touch, hug, and kiss me for only a few days a year. She calls every morning to chat on FaceTime, but how would she feel if I were not there to answer?
I also thought about what it would mean for the love of my life, Yasmin, to lose her husband if I were to perish. I was able to feel the pain, isolation, and suffering of so many families who are faced with the devastating outcome of this disease and the harsh reality of losing a loved one.
While convalescing, I have had time to think about how we as primary care physicians can combat this pandemic. I believe we must commit to a three-step strategy: identification, isolation, and intervention. First we must identify every infected and exposed patient, regardless of age. This is very important to prevent the vicious circle of spread in outpatient settings. We must provide enough testing capacity to community physicians so they can identify these patients as early as possible and start the isolation and treatment process.
The second step is isolation. It has been my experience that in the community setting, families do not quarantine in the strictest sense. Particularly children and young adults do not quarantine appropriately when someone in the home is sick. Primary care physicians should provide proper education about this but this is difficult now, as many practices have had to close or curtail their business due to a lack of PPE, rapid testing modalities, and fear of spreading the disease.
The third step is intervention. I think this is the most important step that is missing in the current management of the COVID-19 pandemic in our country. As the disease burden has increased, the number of new positive cases and the number of patients becoming moderately to critically ill seem to be spinning out of control. Most cases can be identified in the early stages and should be aggressively treated to prevent further progression.
Many countries that do not have adequate resources have adapted to the situation using time-tested clinical strategies to mitigate the pandemic. For example, many of my family members and friends who became ill in Pakistan or India were treated. If patients there have significant symptoms, particularly respiratory system involvement, physicians will start them on anti-inflammatory high-dose steroids and antibiotics like Zithromax. Patients routinely get a chest X-ray to inform their treatment options and if their condition worsens, they will get a CT scan to make sure there are no further complications. Over the last 6 to 8 months, I have treated many patients on an outpatient basis not only here in America, but all the way back to my home country of Pakistan, and I have helped prevent numerous hospitalizations.
At the current rate the disease is spreading, we must maximize outpatient management, aggressively identifying and treating patients in a timely manner so we can prevent complications and the potential breakdown of our health care system. My worst nightmare is that this may be the assault experts have been predicting for decades that can cause our entire health care system to collapse. I am saddened to see that many of our outpatient physicians and other health care providers have not been considered a priority to receive the vaccine at this time. I strongly believe they should be a very high priority. If they are immunized, they can reopen their offices and help mitigate the pandemic.
Immunization is key for building long-term herd immunity. However, immunization of our entire nation will take time and will not be enough to curb the current rate of infection. New mutations of the virus and uncertainty over how long the vaccine will convey immunity further complicate our situation.
We must be strong, both in our resilience and commitment to defeat this pandemic and to fix our systemic health care delivery problems, which are the real reason we are losing this battle. We must commit to building a stronger foundation of primary care upon which the edifice of our health care system can stand firmly and not collapse under severe stress.
The United States has always been at the forefront of implementing the best systems, using the best technologies, and applying the best approach to overcome any challenge. With dedication and determination, we can build a more equitable and effective health care system, better equipped to handle the next pandemic while providing comprehensive, continuous care to all.