A Little Context on Coronavirus For At-Risk Patients

By DAN STONE, MD

Joe, a semi-retired 81-year-old, never expected his Italy guys’ trip to thrust him into the front ranks of COVID-19 patients. Joe’s story goes against the grain of news about the coronavirus now gripping the world and providing epidemiologists and public health experts with the challenge of their professional lives.

Joe is a patient of a medical colleague, and he and his wife gave me permission to tell their story. It started with a ski vacation for 14 friends, united by their connections to the real estate industry, who flew from Sweden, San Francisco and Los Angeles to a rendezvous in Munich. From Germany they traveled to Selva di Val Gardena, a ski resort in the Dolomite mountains of northern Italy. Arriving on Feb. 21, they began their usual regimen of morning ski runs and afternoon lounging.

Before long, they could tell something was off. Joe’s friend Peter was the first to develop a cough and general malaise. Some of the others soon noted more shortness of breath than usual on the slopes. In the evening, normally robust appetites faded. By the time the trip ended, Peter was seriously ill with a cough and fever. He was hospitalized in Munich with pneumonia. Although Joe felt unwell, he was able to continue to Los Angeles.

By the time Joe arrived at LAX on March 1, he realized that he might have been exposed to COVID-19. He called Dr. Jonathan Weiner, his primary care doctor, from the airport. Weiner, aware of the public health implications of a potentially infectious patient in a public setting, directed Joe to head home and arranged follow-up care there with the Los Angeles County Department of Public Health.

Joe tested positive for COVID-19 as have all the other trip participants. He has no idea how they could have been exposed, although he thinks back to a crowded tram ride. Since testing positive, Joe has been isolated from all direct interpersonal contact. Confined to a bedroom at home, he communicates with his wife, Barbara, by cellphone, text and Facetime. Barbara is quarantined too. Because test kits and lab time remain limited, and because she exhibits no symptoms, she hasn’t been tested and she won’t be unless she develops a fever or cough.

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