By: Bill Rice, Jr.
A post made by an “anonymous” emergency room physician in New Orleans that quickly went “viral” on social media provides a gripping and detailed summary of lessons learned from this city’s COVID-19 outbreak in late March.
The dispatch seems to confirm that numerous elements conspicuous in Tim McCain’s medical drama were also seen in critical-care COVID-19 patients at this New Orleans hospital … approximately 11 weeks after Tim’s medical emergency began.
Brandie McCain says she was “blown away” by the parallels between her husband’s case and the doctor’s experiences and observations.
“…. Every one of my colleagues have now seen several hundred COVID-19 patients and this is what I think I know,” the report begins. It should be emphasized that in late December and early January, doctors in both Sylacauga and Birmingham had no idea that Tim McCain might be a COVID-19 patient.
Excerpts from the doctor’s report:
- The physician’s dispatch warns colleagues to “not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.” Comment: Tim McCain was given a steroid shot and received a pack of steroid pills on December 27th when he visited a local urgent care facility complaining of lower back pain.
- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.” Comment: Tim received IV fluids on his first trip to the emergency room on January 1st. Tim’s wife rushed him to the hospital again early on January 4th. The next day he was placed on a ventilator at a Birmingham hospital.
- Per the doctor’s dispatch, “back pain” was a “common” symptom of the critical-care COVID-19 patients in New Orleans. Comment: Tim McCain – plus his wife and his wife’s boss – all developed terrible back pain at roughly the same time.
- “Day 5 of symptoms- increased SOB (shortness of breath), and bilateral viral pneumonia from direct viral damage to lung parenchyma.” Comment: Tim McCain began to experience “flu-like” symptoms December 26. By January 1st – five days later – his shortness of breath was becoming acute. He also soon developed bilateral pneumonia.
- “Day 10 – Cytokine storm leading to acute ARDS and multi-organ failure. You can literally watch it happen in a matter of hours.” Comment: By Jan. 4th, Tim had developed ARDS – exactly 10 days after the onset of his first “flu-like” symptoms on December 26th. On January 6, he was placed on the ECMO machine because of fears that his organs were beginning to fail.
- X-Rays also seem to show that something dramatic was occurring with Tim’s lungs, and that this deterioration happened quickly. Tim received a chest X-Ray at his local hospital the evening of January 1st. These X-Rays were fairly normal. Approximately 54 hours later he received another set of X-Rays which showed “a mass of white … you couldn’t even tell he had lungs,” says his wife.
- “Patients are coming in hypoxic (even 75%).” Comment: Hypoxia – low oxygen in the blood and tissues – is diagnosed when blood oxygen levels fall below 92 percent. Tim’s level early on January 4th was 84. His wife remembers Tim’s blood-oxygen levels later falling “into the 70s.” The fact Tim could even walk and talk would also seem to indicate Tim had “silent hypoxia,” another signature symptom of some critical COVID-19 patients.
- “Seen three positive flu swabs in 2 weeks and all three had COVID-19 as well.” Comment: Several days prior to being rushed to the hospital, Tim tested positive for Influenza Type A. (Note: Tim’s wife, who also has COVID-19 antibodies, tested negative for influenza. Other studies have proven that patients can be “coinfected” with influenza and COVID-19.)
- “Do not give these patients standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation.” Comment: Tim also developed sepsis and probably received this same “fluid” treatment, the McCains believe. (A March 11th article in the medical journal The Lancet, “… found that more than half of patients developed sepsis. Sepsis was a common complication, which might be directly caused by SARS-CoV-2 infection …”)
- “We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.” Comment: Brandie McCain says she was told by Tim’s Grandview caregivers that Tim, by himself, exhausted the hospital’s supply of all or some of these medications.
- “Worldwide 86% of COVID-19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.” Comment: Tim also was incubated and placed on a ventilator 10 days after the onset of common COVID symptoms. Today, the McCains aren’t sure if the ventilator helped save Tim’s life, or, perhaps, exacerbated his condition. Brandie McCain is quick to praise the skill of the doctors and nurses who treated her husband and the degree of care her husband received. She says her
experiences watching Tim’s care made her appreciate how important it is that highly-trained specialists oversee patients on a ventilator. She suspects that many critical COVID-19 patients who were subsequently placed on vents did not receive the same level of expert care as her husband. She believes that ventilators almost certainly contributed to at least some or perhaps many deaths of critical COVID-19 patients.
- “Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.” Comment: Tim also received Bipap treatment. Note: A press spokesperson at Grandview Medical Center has not responded to an emailed question that asked if any of Tim’s care-givers later developed COVID-19 or COVID-19-like symptoms.
Other Clinical Details Support COVID-19 Diagnoses
- Prior to his medical emergency, Tim suffered from high blood pressure (hypertension). He would also have been considered overweight. (As of January 1st, he weighed 304 pounds per his medical records). Obesity is a well-known “risk factor” of critical COVID-19 patients. In a hospital stay of 24 days, Tim lost 80 pounds, according to his wife. Such rapid and extreme weight loss has also been seen in other critical COVID-19 patients.
- When Tim emerged from his medically-induced coma he was suffering from “ICU psychosis.” In a story in Kaiser Medical News, ICU units treating COVID-19 patients were labelled as “delirium factories.” When Tim emerged from his coma, he was convinced he was on a military medical ship and that his legs had been blown off while he was flying a fighter plane defending Pearl Harbor from Japanese attack.
- Several of Tim’s lab results from his January 4th trip to Coosa Valley Medical Center in Sylacauga on January 4th also seem to support a COVID-19 diagnosis. For example, Tim’s “D-Dimer” numbers – which are used to diagnose possible thrombosis and provide information on blood coagulation – were extremely high (3.88 mg/LFEU where the “normal range” is 0.00 – 0.49) and were flagged as “abnormal.” According to one study, “D-dimer values were considerably higher in those with severe disease than those whose disease was not severe.” Note: At this writing, Tim and Brandie McCain had just requested Tim’s medical records from his his 24-day hospital stay at Grandview Medical Center. Per Brandie, she was told that after filling out some paperwork they could expect to receive these records soon.
- The CDC lists at least eight common COVID-19 symptoms, including fever, cough, shortness of breath, loss of taste or smell, muscle pain, headache, sore throat and chills. Loss of appetite, extreme fatigue and gastrointestinal issues are three other common symptoms. Both Timmy McCain and his wife say that Timmy experienced every one of these 11 symptoms.
More than six months after the onset of their fist symptoms, Brandie McCain and her daughter are still experiencing an altered sense of taste and smell. “I have to force myself to eat and drink,” says Brandie, mentioning that water has some kind of odd lemony taste and that she has lost at least 20 pounds since she and Timmy have been back home. Both Brandie and Tim still have a lingering cough and Brandie recently made an appointment with a pulmonologist to investigate what she believes are on-going issues with her lungs. “Even today, I don’t feel like I did before all this happened,” she says, adding that she wished infectious disease experts would follow-up with her, Timmy and her daughter to
investigate possible long-term effects of COVID-19 exposure.
Bill Rice, Jr. is a freelance writer in Troy, Alabama. He can be reached by email at: