The last thing Myra Ramirez of the Northwestern Memorial Hospital in Chicago remembers is calling her family to say she had a Kovid, was going to have a ventilator, and needed a mother to make medical decisions for her.
Ms. Ramirez, 28, did not wake up for more than six weeks. And then she learned that on June 5, she became the first Covid patient in the United States to receive a bilateral lung transplant.
On Wednesday, she went home from the hospital.
Ms. Ramirez is one of a small but growing number of patients whose lungs have been destroyed by the coronavirus, and the only hope for survival is a lung transplant.
“I’m pretty sure that if I had been in another center, they would have just finished the care and allowed me to die,” she said in an interview Wednesday.
Her surgeon, Dr. Ankit Bharat, performed a similar operation on July 5 on another patient, Kovid, a 62-year-old man.
Surgery is considered a desperate measure reserved for people with fatal, irreversible lung damage. Doctors do not want to remove a person’s lungs if they are likely to heal. In total, about 2,700 lung transplants were performed in the United States last year alone.
Patients must be sick enough to need a transplant, and strong enough to survive surgery, recover, and get back on their feet. With a new disease such as Covid-19, doctors are still learning how to achieve this balance.
“This is a paradigm shift,” Dr. Bharat said. “Lung transplantation was not considered an option for treating an infectious disease, so people need to get a little more comfort.”
Two more patients in the Northwest are awaiting transplantation, one from Chicago and one from Washington, D.C., said Dr. Bharat, who is the head of thoracic surgery at Northwestern University’s Feinberg School of Medicine and the surgical director of Northwest’s lung medicine transplant program. which includes the Northwest Memorial Hospital.
Dr. Bharat said the patient should arrive from Seattle next week, and the Northwest team is consulting with another medical team in Washington on the case. Other transplant centers are considering similar operations.
Last Friday, a Covid-19 patient underwent a double lung transplant at Shads Health Shands Hospital in Gainesville, Dr. Thiago Machuca said.
While other centers tried to refer cases, most patients had other serious medical problems that ruled them out, he said.
In some cases, Dr. Bharat said, hospitals seemed to wait too long to recommend a transplant. One patient who was referred to his center seemed like a good candidate, but then he had heavy bleeding in his lungs as well as kidney failure, and surgery was impossible.
“I think people should recognize this option sooner and just start talking about it before it gets to that point,” Dr. Bharat said.
In some cases, he said, insurers’ reluctance to cover the operation or pay for travel to transfer patients led to delays.
“It’s so new to our industry,” Dr. Machuka said. “The task for doctors will be to determine which patients are really candidates and what are the deadlines. We don’t want to do it too early when the patient can still recover from Covid’s lung disease and recover with a good quality of life, but also you don’t want to miss the boat and have the patient where it’s useless, the patient is too sick. “
He noted that in some cases, extensive rehabilitation led to the recovery of Covid patients who were considered possible candidates for transplantation.
Because severe lung damage in Covid patients makes transplant surgery particularly difficult, most patients will be referred to large transplant centers that are best equipped to perform risky surgeries and provide the intensive post-dispensary care patients need, surgeons said.
Before she became ill, Ms. Ramirez, a legal counsel for an immigration law firm, worked from home and delivered her products. She was in good health but had an autoimmune condition, neuromyelitis optics, and was taking medications that suppressed her immune system and possibly made her more vulnerable to coronavirus infection.
She was ill for about two weeks, and consulted the Covid hotline about her symptoms. One day she went to the hospital, but then came back without going. She was afraid of the idea of acceptance and told herself that she was recovering.
But on April 26, her temperature reached 105 degrees Fahrenheit, and she was so weak that she fell when she tried to walk. A friend drove her to the hospital. When the doctors told her she needed a fan, she had no idea what they meant. She thought it meant some fan, like the word in Spanish.
“I thought I’d just be there for a couple of days, Max, and get back to my normal life,” she said.
But she spent six weeks on a ventilator and also needed a machine to supply oxygen directly to her blood.
“I had nightmares all the time,” she said.
Many nightmares included drowning, her family said goodbye, and doctors told her she would die.
Frequently Asked Questions
Updated July 27, 2020
Is it worth refinancing a mortgage?
- This may be a good idea, as mortgage rates have never been lower. Refinancing applications have pushed mortgage applications to some of the highest levels since 2008, so be prepared to comply. But defaults are also increased, so if you are thinking of buying a home, remember that some lenders have tightened their standards.
What does the school look like in September?
- It is unlikely that much of the fall will return to its normal schedule this fall, requiring continued demarcation on the Internet, prompt childcare and delayed working days. California’s two largest public schools, Los Angeles and San Diego, said July 13 that education would be distanced only in the fall, citing concerns that an increase in coronavirus infections in their areas posed too great a risk to students and faculty. Together, the two districts enroll about 825,000 students. They are the largest in the country so far abandoned plans to even partially physically return to classrooms when they reopen in August. For other areas, the solution will not be an “all or nothing” approach. Many systems, including the largest in the country, New York, are developing hybrid plans that involve spending several days in classrooms and other days online. There is no national policy on this issue yet, so check your municipal school system regularly to see what is happening in your community.
Is the coronavirus in the air?
- Coronavirus can stay in the air for hours in tiny droplets of stagnant air, infecting people when they inhale, according to scientific data. This risk is highest in crowded rooms with poor ventilation, and can help explain the extremely common events reported at meat plants, churches, and restaurants. It’s unclear how often the virus spreads with these tiny droplets or aerosols, compared to the larger droplets that are expelled when a sick person coughs or sneezes or is transmitted by contact with contaminated surfaces, said Lincy Marr, an aerosol expert at Virginia Tech. According to Dr. Marr and more than 200 other experts, who presented the data in an open letter to the World Health Organization, aerosols are released even when a person without symptoms exhales, talks or sings.
What are the symptoms of coronavirus?
Is Covid-19 asymptomatic?
- So far, the evidence seems to show that this is the case. A widely cited paper published in April found that people became most infected about two days before coronavirus symptoms appeared, and estimated that 44 percent of new infections were the result of transmission from people who had not yet shown symptoms. A top World Health Organization expert recently said that transmitting coronavirus to asymptomatic people was “very rare,” but she later declined.
The disease was relentless. Bacterial infections are fixed, which scare away her lungs and eat holes in them. The lung damage caused circulatory problems that began to affect her liver and heart.
Doctors told her family in North Carolina that it might be time to come to Chicago to say goodbye, and her mother and two sisters went on a trip.
But Ms. Ramirez held on, cleared the coronavirus of her body and was included in the transplant list. Two days later, on June 5, she underwent a grueling 10-hour operation.
She woke up with scars, bruises, desperately thirsty and unable to speak, “when all these tubes came out of me, and I just could not recognize my own body.”
The nurses asked if she knew the date. She guessed in early May. It was mid-June.
She was not told that she had had a lung transplant until a few days after she woke up.
“I couldn’t handle it,” she said. “I was just trying to breathe and thirsty. Only a few weeks later could I be grateful and think there was a family out there that lost someone.”
Before the illness, she worked full time and enjoyed running and playing with two small shirt dogs. Now she is still short of breath, can only walk a short distance and needs help taking a shower and getting up from a chair. The dogs were happy with her return home, but their energy was low. Her mother, who lives in North Carolina, took time off from work at a meat plant and went to Chicago to help her recover.
Ms. Ramirez said she is learning to use her new lungs and is getting stronger every day.
She is looking forward to returning to work, but still has a way. Her family is helping her, and a friend has launched a GoFundMe page to help pay the bills.
“I probably feel I have a goal,” Ms. Ramirez said. “Maybe help other people going through the same situation as me, maybe even just share my story and help young people realize that if it happened to me, it could happen to them, and protect themselves and protect others around and motivate and help other centers around the world realize that lung transplantation is an option for terminally ill Covid patients. “
Ms. Ramirez’s prognosis is good, Dr. Bharat said, because she is young and healthy. She will be on rejection medication for life. He said the transplanted lungs could still be rejected, but he had observed the last 20 years. And patients may be able to get a second transplant.
“I think from now on it will continue to grow stronger and stronger,” he said. “She asked if she could go down with a parachute. We’ll probably get to her in a few months.”