The Daily - Back From the Brink

Episode Date: March 30, 2020

Across the United States, many hospitals are confronting their first cases of coronavirus. Today, we speak to New Jersey’s first confirmed coronavirus patient, a medical professional, about what having the virus was like for him, what he learned from the experience and why he thinks, “America is not ready.”Guests: Susan Dominus, a staff writer at The New York Times Magazine, spoke with James Cai, a physician assistant. For more information on today’s episode, visit nytimes.com/thedaily. Background reading: James Cai was told his test for coronavirus had not been completed. Then he heard from the governor on the news that he was the first confirmed case in New Jersey. Why states must ask knotty questions about how much to tell the public — and when.President Trump, listening to his health advisers, has said that the country should be practicing social distancing until at least the end of April. Here are the latest updates.

From The New York Times, I'm Michael Barbaro. This is The Daily. Today. As the pandemic quickly spreads across the U.S., hundreds of hospitals are now confronting their first serious cases of the coronavirus. Susan Dominus on the lessons of the first confirmed case in New Jersey.

It's Monday, March 30th. Sue, tell me how you first heard about James Cai. Well, a few weeks ago, I heard about this young guy, a 32-year-old physician assistant, who was the very first patient in all of New Jersey to test positive for COVID-19. And so I reached out to him while he was still at the hospital.

And I was sort of wondering, would it possibly be okay? Could you maybe find some time to talk? And he said, sure, call me now. I'm in isolation, in other words, and I have time. Hello? Are you there? Yes.

Okay. And what was the story that he told you? So James lives and works in New York City. Okay, so my name is James Kai, and I'm a physician assistant. And his mother and grandfather live in New Jersey, and so he spends quite a bit of time there as well. And I work as a primary care, urgent care, and nursing home PA. and nursing home PA. He came to this country when he was about 16 from Shanghai,

and he's married and has a 20-month-old daughter whom he adores. Why did you go into medicine in the first place? Why were you drawn to medicine? Oh, because my grandparents, they are doctors. My grandfather is an anesthesiologist in Shanghai. And when I was young, I was always sick. So I always went to his hospital. So I had a good impression. And as someone working in the medical field, was James expecting to interact with this epidemic, the coronavirus? Was he maybe even thinking he would end up treating coronavirus patients?

Well, he doesn't work in a hospital. And because he works in private practice, I think he probably imagined he might be working remotely with telemedicine. I heard about coronavirus many months ago when China have outbreak. But I always follow the disease. But because of his family background and because he does work in medicine, when news of the coronavirus did start coming out of Wuhan, he definitely understood how quickly the virus could spread.

And he definitely understood that the only way to guarantee that you could survive this was by not getting it in the first place. Around the end of February, I started to pile up all the food, like canned food, frozen vegetables, dumplings. So soon after the coronavirus landed on the West Coast, he and his family went to Costco and stocked up. Our family plan is to stay home for two months. For like two months worth of supplies. Right, so they were going to avoid any meaningful exposure to the virus.

Yeah. If there was communal spread and it had become widespread, their plan was to shelter in place. And well ahead of the rest of us. Yeah, I think that's right. So you weren't sure at what point you would start doing that, but you felt you'd know when it was time.

Yes. But, you know, he's felt you'd know when it was time. Yes. But, you know, he's stocking up at the end of February. You know, people in the U.S. were still flying all over the country. Kids were going to school. Bloomberg was in the race for president. People were planning vacations and weddings and, you know, all sorts of conferences and events. And the same was true of James. So, like everybody else, he's going about his life.

And around this time, without really too much concern about his health, he went to a medical conference in Times Square. So I changed diaper for my daughter and gave her morning milk and I kissed my wife and to go to the conference. On the fourth day of the conference, Monday, March 2nd, he comes down with a cough and he starts to realize he's actually getting sick. I started to cough and a fever and tired. So he leaves and texts his wife that he's going to go to New Jersey where his mom has a house. His mom's away, and he doesn't want to come home and get his wife and the baby sick. Because of my daughter, when I'm at home, she always, like, hugs me and kisses me,

and she will catch it. And what's running through his head at this moment? Is he thinking, I have a bad cough, I might have the flu? Is coronavirus even on his mind? Not really. I mean, there had not been a single case in all of New Jersey. He thought he probably had the flu. By then, he was mostly feeling he had this bad cough. He had an elevated heart rate. His eyes were really runny. He had diarrhea. He was not feeling well at all. But he also was not alarmed. You know, he decided to go to one of those drop-in centers to get a flu test because he wanted to be told he didn't have the flu so he could go home.

So the doctor gives him a strep test and a flu test. They discuss whether he should get a coronavirus test, in fact, but the doctor didn't have one. So they moved on and the results came back that although the strep and the flu tests were negative, his symptoms were consistent with something called a pulmonary embolism, which is a clot in your lung that can be fatal. So this could potentially be even more serious than just a seasonal flu? Yeah, certainly more serious than the flu. So after I went directly to the Hackensack emergency room. So the doctor sends him to the ER of the Hackensack University Medical Center, which is not far from that doctor's office. And in the emergency room, they asked me questions, asked me if I cough. I said,

I do have cough. I do have shortness of breath. So as called for, the doctors do a CT scan. And after they do, they realize that no, he does not have a pulmonary embolism, but that in fact, because of the symptoms he's having and the way his lungs look in the scan, they see a ground glass nodules. So this can be coronavirus. He might actually have coronavirus. And how do the doctors at this hospital react to that? Well, at this point, they haven't seen any coronavirus patients, so they don't seem to him terribly alarmed. That said, they do put him in a tiny isolation room, a windowless room on the floor of the emergency room.

isolation room, a windowless room on the floor of the emergency room. That's where he spends the night texting his friends and his wife and, you know, getting increasingly unnerved and feeling quite ill. I was nervous. And at the same time, since I'm in the hospital, I'm going to check everything, make sure I'm okay, then I go home. So then on Tuesday, March 3rd, which is his second day in the hospital. They decided to do a test on me. So the test takes about 24 hours or 48 hours. They do a COVID-19 test. And they tell him he's going to have to wait a few days for the result, but he shouldn't worry. He's young and healthy.

At the same time, he's wildly Googling symptoms for COVID-19 and realizing that he has almost every one of them. I said maybe lie to myself. I was like, try to calm myself down. I don't have the COVID-19. I shouldn't have it. And so it's day three for James in the hospital. It's Wednesday, March 4th. He's still waiting for the results in his tiny little room with a TV and a local news report comes on. But we begin tonight with breaking news regarding the coronavirus. Yeah, that virus arriving in the Garden State tonight. Governor Phil Murphy announcing the first presumptive positive case of the virus right here in New Jersey.

And the news report says a man in his 30s is hospitalized in Bergen County. There's a guy in his 30s in Bergen County, which is where he is, who's tested positive for coronavirus. It's the first case in New Jersey. Governor Murphy saying there's even a tweet from the governor of New Jersey confirming it. in New Jersey. Governor Murphy saying... There's even a tweet from the governor of New Jersey confirming it.

We take this situation very seriously and have been preparing for this for weeks. I urge residents to remain calm... And it occurs to James they really might be

talking about him. And then I asked the doctor, say, is this me? And the doctor said, no, your test is not back yet. And of course, he hasn't heard anything about the results of his test yet. No, he has not heard anything. Wes, you found out from the news from the governor of New Jersey?

Yes, on TV. And I asked the doctor, the doctor said, oh, the result is not back yet. And then the next day, his doctors come to him and say, yes, you have tested positive. And he is the first person in New Jersey to have tested positive for COVID-19. Right. And perhaps the first person in the history of the universe to find out he has a disease, not from his doctor, but from TV news. Let's hope so.

And how does the hospital react in this moment? So he's really scared, but the hospital is telling him that he really has nothing to worry about. He's a 32-year-old guy. He's got no pre-existing conditions. Even Dr. Balani was telling me, oh, you are so young. It's like a flu. In fact, one doctor even told him, You know, if it weren't for all this attention about the coronavirus, you'd be home right now just getting better in the comfort of your own bedroom. In other words, it would probably just self-resolve in somebody of his health. That was definitely the expectation. I think he

felt that as a medical professional, he actually, he knew that he was quite vulnerable, that nobody was invulnerable. And there was this disconnect between his own concerns and their own insistence that he was overly anxious. It also dawns on him that he is the first come to this hospital because I feel they don't know how to treat this disease and they don't have deep understanding about the disease. Nobody there has any experience. Nobody there can make good predictions. Nobody there has institutional knowledge about what happens when this goes wrong or something unexpected happens. He's the first person, and that's a very frightening position to be in.

We'll be right back. So, Sue, James is newly diagnosed. He's in isolation at this hospital in Hackensack, New Jersey. He's been there for about four days. Physically, how is he doing at this point? When you first got the results of the positive test, on a scale of 1 to 10, how bad did you feel physically, 10 being the worst? 9.10. Wow.

He is feeling worse by the day. Getting worse. So my heart is compensating, beating very fast. He definitely has that cough and he also is having real trouble breathing. It's like I'm in the water. Tell me more about that. It's like normally we can just take very deep breath in and out. He describes it as that feeling when you're underwater and you have to come up to gasp for breath, but you can't quite get that oxygen that you want.

And it's a very panicking feeling. It's a very scary feeling. So my lung is not allowing me to take deep breaths. And how is the hospital treating him now that he's officially tested positive? They move him to a room with certain protections in place, and they're keeping an eye on his numbers, and they're giving him oxygen when he needs it. And he's also keeping an eye on his numbers. And he's worried because he is not breathing well. And on Friday, March 6th, his fifth day in the hospital, he worries that he is desaturating to a dangerous level. And I desat.

He desats. He desaturates. And what does that mean to desaturate? It means that when you desaturate below a certain level, your blood is not getting enough oxygen from your lungs for you to function in a normal, healthy way. And this is really concerning to him. You have pneumonia. It's normal. Just use oxygen.

But he still has the sense that the hospital is telling him he's overreacting, that he's being too anxious. He's going to recover just fine. I was confused, and also I was worried because I think I'm not getting enough care. And my oxygen level dropped and they cannot even see it. And why do you think people in the hospital are saying that? And maybe more importantly, why are they thinking that? Why are they insisting on being so calm about what it would mean to have an infection like this? I would have to guess that it's because the widespread impression that people had was that young people were not going to be terribly affected by this virus and that it was going

to feel like a very, very bad flu and that he was going to recover just fine, just like the statistics supposedly said he was going to. And did you actually feel yourself having difficulty breathing at that point? I just feel tightness. Tightness in your chest? Yeah. I feel like I'm very scary, very scared, and I don't know what to do next. And James is all too aware that no one in that hospital has ever treated anyone with coronavirus. And he's really worried about his symptoms

because he knows he's feeling worse and worse every day. I told my cousin, I told everybody, and they did start searching. So he starts reaching out to friends of his who are plugged into the Chinese medical community, including his best friend, who's a physician, and whom he calls his cousin, and his boss. And they start making phone calls and trying to get information from experienced people who can maybe share what they've learned. Which is what? You know, there's advice that he should get high doses of vitamin C.

There's some discussion of whether he should get a steroid treatment. Things get worse. They say that maybe he wants to look into antiviral medication. They tell him he shouldn't wait too long before getting a second CT scan. But his doctors were really reluctant to do that. Why was that? They felt like they were giving him good care and that probably the results of the CT scan would not change that. So James is more or less beginning to advise his own doctors on how to treat him based on his research, based on his relationship with other medical professionals, which is pretty unusual.

Yes, very unusual. And then the evening of the 7th, he starts desaturating to a level that really scares him. He's concerned that if he desaturates to a certain degree, there could be no turning back. He'd have to be intubated, which definitely increases all of the risks of the illness. It would mean that a machine was going to be doing all the breathing for him.

It could lead to organ failure and in some cases, of course, death. And I mean, if I intubated at night, I probably would have just died by myself alone without seeing the loved ones. And his friends also, some of them friends said to me that he personally felt responsible for making sure that the doctors took James' case as seriously as possible. Here he is. He's the first health care worker in New Jersey also to come down with COVID-19. If he didn't make it, it was going to feel like the battle was over before it had even begun. it was going to feel like the battle was over before it had even begun. You always live in fear. You're never going to wake up.

And also in isolation. And nobody can see you. So it's very miserable. If people died, think about it. If People die and they cannot see their loved one. I mean, like, I feel like it's very tough, right? For somebody to die alone. So you were scared. I mean, you were probably too weak to really speak forcefully, but you were letting them know that you felt that your life was on the line at this point. Yeah.

life was on the line at this point. Yeah. And we don't exactly know why, but on the 8th, he did get that second CT scan. And he come back very bad. It's bad. He has, you know, pneumonia in both lungs.

30 to 40% of his lungs seem to be affected. That's astonishing that it would go from a small spot just a few days earlier to where it is now and if he had gotten that bad in three days or four days since the last ct scan how much worse was it going to be in another four days and now james starts to worry that he really might not survive this. I was praying to everybody, to God, to Buddha, to everybody, saying, don't let me die. When I know my oxygen levels keep desaturating, one of my requests is, can I see my mother and my wife or my daughter for the last time? Because that time when my chest actually shows so bad and my oxygen level every day is dropping, and I will tell myself to be strong, but I don't know how many days I can live.

And, but the good thing is after CT, they listened. When she saw second CT, she was like, okay, we have to treat you. have to treat you. I spoke to a doctor at the hospital who was part of the team overseeing his care, and he said they'd been looking at the whole clinical picture, had recognized that he was declining even before the CT scan. But from James's point of view, everything changed after the scan. He feels like now they're taking this very seriously and they're listening to him. They're coming around to seeing just how serious it is and also recognizing that, yes, even a young person can get very, very sick with coronavirus and they're willing to try something. And at this stage, what is he asking them to do?

And at this stage, what is he asking them to do? James wants a few different types of treatment. He's been advised that the doctors should try providing him a more intensive form of oxygen therapy. And he wants to go on three experimental antiviral medications, Kaletra, Chloroquine, and Remdesivir. And at this point, he and the doctors at Hackensack and all the other doctors he's working with are pretty much all on the same page. He finally gets the main things he's been asking for. And I think the next day, Dr. Balani came in.

He said, the medication's here. We're going to give it to you. And finally, after more than a week in the hospital, James starts to turn around. He does start to feel better. So after the first day, my fever finally dropped. And my oxygen stopped dropping. I'm getting better and better every day. So that's the whole thing.

getting better and better every day. So that's the whole thing. And does he have a sense, do you have a sense, do his doctors have a sense of which of these treatments was responsible for that? Not really. I mean, it might have been any one of the drugs or all of the drugs or the oxygen or some combination of that,

or he might have just gotten better on his own. We really don't know. And so I asked you how you felt on a scale of one to 10, being 10 being the worst when you first got the results of the test and you said that you were a 10. On a scale of one to 10, how do you feel now? I would say now maybe three. That's pretty good, huh? Yeah, because I feel like all the symptoms are gone. I mean, I will be maybe no worry if tests come back negative. Yeah, I know the virus is dead. Now I don't know if it's dead or not. It's now 1037 and I need you to get a good night's sleep.

So, I'm going to call you in the morning and see how your oxygen levels were. Is that okay? Okay. Thank you. Thanks, James. Bye. Good night. Bye-bye. Sue, it feels, correct me if I'm wrong, like a big reason why James survived was because he was such an aggressive advocate for himself

and he had this network of expertise that he could tap into. He himself was a medical professional, and that put him in a very strong position. But I wonder why the people around him in this hospital were not better prepared, given the stage of this pandemic, when he arrived in Hackensack? We don't really know what saved his life because these drugs are still in clinical trials. What we do know is that the entire story of coronavirus in this country is a story of lack of preparation. People did not believe that it simply was never going to be as bad here as it was in Wuhan or Milan. That is a universal story. It was hardly just these doctors at this hospital. I mean, part of it is that they are busy people. They are moving quickly. They are saving lives every day.

In fact, we all know that they're saving lives and putting their own lives on the line right now. But also, it is just hard to put yourself back in that moment, March 1st, March 2nd, or the end of February, and remember how unlikely we all still hoped and believed, against all evidence, that this wasn't going to be devastating here the way it was elsewhere. That said, to their credit, the doctors at this hospital were open-minded, and they were flexible, and hospital were open-minded and they were flexible and they were nimble and they were willing to try whatever they could that was safe when they realized that whatever they'd been doing definitely was not working and i know james certainly feels really appreciative ultimately you know he sent out a tweet that expressed his gratitude for the hospital's saving as he sees it his life.

So what do you think the lesson of this story is of James, his very unique situation in these early days of the pandemic in the United States and of what happened to him at this hospital? the United States and of what happened to him at this hospital? You know, one of the things that I'm hearing from doctors is that until you are in this moment and experiencing the onslaught of patients, it is very hard to imagine it. You can't really know until you're actually living it. And every hospital in this country is likely to have its James. It's going to have that first patient who comes in who is really ill. They're not exactly sure how to treat it. We still really don't know how best to treat this virus. That is the hard-cold truth of it. There are some protocols that we hope will help, that our thought might help, but it's unclear. It's so new. And it's going to be really hard for all those hospitals. And they're going to have to make difficult choices. They're going to have to make complicated ethical choices.

They're going to have to make decisions on the fly and build up their clinical experience. And it's not going to be easy for any of them. Sue, how is James doing at this point? I don't know when the last time it was that you spoke with him, but what did he tell you? He's home. He is still in quarantine. So he still has not been able to see his wife or daughter. And his lungs are still recovering. It's unclear just how fully they will recover.

You know, it's definitely a long road ahead of him. And at the same time, you know, he's reading the news and he is feeling so lucky. Lucky to be alive. To be alive. Thank you, Sue. Thank you, Sue. Thank you, Michael. Hello? Hi, James, it's Sue. How you doing? I'm good.

Are you actually in your own home? Yes. How does it feel? It feels great. I'm going to sleep on my own bed. Fantastic. Once I'm in the hospital, I feel like I'm alive. I feel like everything is so new to me the grass

trees, cars new people face the sky and the way I drive on the road I appreciate every building every people I see like I said I feel like it's a second chance to live again

to be alive. What is the first thing you're going to say to your daughter and wife when you finally get to see them in person? I know you're quarantining for almost two more weeks now. Yeah. So when I see my daughter and my wife, I definitely will give them big hugs. Try to don't let them go. I maybe will like have my daughter in my arm all the time. I will come home and spend every minute with my family. I appreciate every day living.

Alright. Good night. Have a great night's sleep. Thanks, James. Thank you for checking in on me. My pleasure. Bye. Bye. Bye. We'll be right back. To be continued... Here's what else you need to know today. In interviews on Sunday, members of the president's coronavirus task force sooner the states and the metro areas react and ensure that they've put in full mitigation at the same time understanding exactly

what their hospitals need, then we'll be able to move forward together and protect the most Americans. Speaking to NBC News, Dr. Deborah Birx said that the White House was asking every state to prepare for the kind of outbreak now occurring in New York, where there are about 60,000 infections. Well, Dr. Birx said yesterday, as you know, that she doesn't think any city will be spared from this virus. How many cases do you think the U.S. will reach? I mean, looking at what we're seeing now, you know, I would say between 100 and 200,000 cases, excuse me, deaths. But I just don't think that we really need to make a projection when it's such a moving target. On CNN, Dr. Anthony Fauci said that millions of Americans could eventually be infected and that between 100,000 and 200,000 could die.

What we do know, Jake, is that we've got a serious problem in New York. We have a serious problem in New Orleans, and we're going to be developing serious problems in other areas. On Sunday night, the president extended federal guidelines for social distancing through the end of April and backed away from his previous plan to open up much of the country by Easter. That's it for The Daily. I'm Michael Bavaro. See you tomorrow.