The Calm Before the Storm
And so it begins...
Folks from New Orleans and along the Gulf Coast are used to the ramblings of pundits that predict the oncoming horrors of brewing storms. Unfortunately, there is an unhealthy skepticism born of many ‘near misses.’ One could even say that the threat of annual hurricanes had been a generational concern in that a really bad storm only seems to come around about once a generation. Hurricane Katrina changed this, but collective memories fade. Suddenly, apathy takes over and the dire warnings of weathermen take on a less menacing tone. Or, at least, that is how we interpret them. It is just another hurricane, we can weather the storm.
I first posted personal musings on social media about an interesting Chinese viral illness that appeared to be affecting the elderly toward the end of January of 2020. As an ER doctor I am fascinated by the waves of disease that have been crashing at the gates with a medical fascination and a keen personal interest. So news out of Wuhan China piqued my interest. SARS had come, and SARS had gone. MERS had sputtered but had seemingly retreated with the simoom. Ebola had roared but then had gone back down its mouse hole. UN workers brought cholera to Haiti. And the true killer malaria remained on foreign soils away from this backyard. As with the tapestries of the Middle Ages, our daily tapestry appeared to have the face of death looming in the background while we lucky souls seemed to weave around its steely grip. Carry on and “laissez les bons temps rouler.”
As reports surfaced of hospitals filled with Chinese elderly gasping for breath, I was planning to dive into the annual Mardi Gras festivities with a passion. I would ride in the Krewe of Hermes and throw trinkets to the children lining St. Charles Avenue. The band would play to the revelers until shrove Tuesday whereupon we would sacrifice our worldly pleasures and take up the mantle of penance through fasting. Little did I know that the fasting would take on many new twists in the quarantines to come.
As carnivals go, the Mardi Gras of 2020 stood out for atypical reasons. The revelry was tempered with an unusual sobriety. Perhaps there was little to burn off from the year before. The season was marked by several tragedies. Several rides had been involved with pedestrian deaths resulting in the cancellation of rides. During one ride someone opted to dart between the floats, slipped and fell. Foreboding perhaps. Overall, the party came and went. Life was proceeding along as usual.
Death don’t have no mercy. Just three weeks before Mardi Gras the World Health Organization had finally pulled its ostrich head out of the proverbial pit of despair and declared the COVID-19 scourge a pandemic on January 30th. The storm was on the horizon, but seemed to be isolated to a city in China. A city more populous than New York City, and a city whose job was to spread goods worldwide fueling the wealth of China’s industrial might. President Trump restricted flights from China on January 31st, but the US already had its first case by then (a patient presented to an urgent care facility in Snohomish Washington and was hospitalized because he had returned from Wuhan to develop a fever and cold symptoms).
In the weeks before Mardi Gras the New Orleans mood was festive, but along the Gulf Coast there was apprehension. The Carnival cruise line vessels based out of New Orleans, Louisiana and Mobile, Alabama had been relocated to Gulfport, Mississippi and loomed large on the horizon not far from the hospital where I worked. Several of the crew members were reported sick but remained isolated aboard ship. My last shift before the Mardi Gras ride fell on a Wednesday. February 19th would be an easy shift in Medical 2, a step down pod for the emergency department. Theoretically, M2 was supposed to be a fast track or urgent care wing of the emergency department but since its inception had really been a spill over for the incessant tide of patients flooding the overtaxed ER.
Our shift commenced around 10 in the morning on a bright sunny day. Around 2 o’clock I entered a room to see a patient complaining of fever and cough. He sat waiting with his wife to be seen and had an infrequent cough. He did not appear ill so the triage nurse sent him to my side of the ER. But as I sat talking with him taking his history, the hairs on the nape of my neck stood up every time he coughed. I excused myself and left the room to notify the nurses to institute isolation precautions.
As patients go, he was patient despite his illness and disarmingly pleasant. He was an otherwise healthy male my own age. He had been away on a trip to the Holy Land for several weeks and had commuted via Atlanta and Heathrow. In between he had more than probably been exposed to other international travelers, but the likelihood of crossing paths with a traveler from Wuhan seemed remote. Regardless, I printed out a form from the CDC, a sort of checklist for whether or not to send a sample to the CDC to test for the novel coronavirus. I was perplexed that the CDC would not accept any samples unless the patient had had direct or some indirect exposure to Wuhan, China. In my mind, the illness had been ongoing for at least 2 months such that any travel could quite potentially be risky.
The patient had disembarked in Gulfport and had only been home an hour when he presented to the hospital suffering with refractory shortness of breath. He was breathing but felt ‘air starved.’ His respiration’s felt inadequate. His initial vital signs revealed a low grade fever and mild hypoxia. In medicine there is an expression: when making a diagnosis, if you hear hoof beats, it is more than likely those of a horse rather than those of a zebra. So, it was more than likely that he either suffered with a pulmonary embolus secondary to the prolonged travel, or he indeed had a simple case of pneumonia. I still wish that he had been swabbed for the novel coronavirus. The stripes on this case still haunt me. He met criteria for admission for pneumonia and would spend the next couple of days in the hospital.
The next day I departed for several days in New Orleans to revel with my fellow Hermes Krewe members. I returned from New Orleans to the news that my patient had died after several days in the hospital. And one of the elderly Krewe members I had had lunch with in New Orleans was home with a cough. The calm before the storm ended with that last bead thrown from the float. The ride was over, the storm was upon us.