Our COVID Conundrum…Did We Have It or Not?

Setting: Beautiful small town, high up in the Colorado mountains, where we’ve been very much isolated and socially distanced in our home for several weeks…except that ONE day, six days earlier, when our older daughter and I had our “big outing”. After dropping off my husband at the small town airport, we made a quick Target run, ate lunch outside of a restaurant in another small town (sitting at an isolated table), and in the process, used two public restrooms, including the highly trafficked one at the airport. We wore cloth masks the whole time except while eating, and sanitized our hands constantly. Now, fast forward six days:

Day 1 (Friday): 23-year-old daughter awakens with a mild sore throat, assumes it’s allergies and takes an antihistamine. An hour later: “Mom, something’s REALLY not right with me. I feel awful.” Within a few hours, her temp is 101*, then shoots up to 103*, complete with nonstop, teeth-chattering shaking chills, intense body aches, headache, and no appetite. Nausea/vomiting visited in a couple brief random waves late that night, but resolved with prescription anti-nausea medication that we had on hand. She stayed hydrated (enough) by steadily sipping on water and sports drinks. Although her oxygen saturation (measured on a pulse oximeter) dropped several points, she had no cough, no shortness of breath, and no symptoms to indicate other issues (like kidney infection or stones, food poisoning, etc.) These high fevers and chills would only ease up for a few hours despite both Advil* & Tylenol* maxxed out. (Side note: I try not to “doctor” my own family, so we did phone consult with a local physician who felt this was most likely COVID, and we made a plan for watchful waiting with strict parameters of when to head to ER.) Sick kid was 100% isolated in her own bedroom/bathroom.

Day 2 (Sat): More of the same, totally miserable. Fever and aches only bumping down a notch (to 101*) for a couple hours with meds; fatigue intense. Unable to get rapid COVID test over the weekend unless admitted to the hospital, so more watchful waiting. No cough, no loss of smell/taste.

Day 3 (Sun): I wake up with muscle aches, moderate headache and fever…NOOO! Max temp 102, no shaking chills or sore throat, no nausea/vomiting, but every cell feels like it’s wearing a super-heavy lead blanket, so weighted down and deeply aching, and zero energy or appetite. Sick kid no longer having her teeth-chattering chills, but temp right back up to 103 about four hours after every dose of Tylenol* and Advil* and won’t eat. Thankfully, 21-year-old (who did not go on airport/Target outing) remains healthy and dutifully brings Gatorade, soup, bananas and crackers to leave outside each respective isolation room when texted (which is infrequent, as all we want to do is sleep.)

Day 4 (Mon): 8am-Called to schedule COVID drive through testing in nearby town, first appointment available is tomorrow afternoon (Tues). Sick kid still has no appetite, intense fatigue, but fevers staying down around 101, and I’m about the same. Both of us start to cough, but no shortness of breath. Pulse ox drops about 4 points below normal for this altitude, so keeping an eye on that, kind of scary. I talk with our doctors; plan remains the same. (Side note, I’ve been on plaquenil for 11 years, so I’m still taking that along with fever/pain meds. Did it keep me from getting worse? Maybe? My overactive immune system loves to ramp up every bodily response, and this drug’s very job is to mitigate that response.  Clearly it didn’t not keep me from catching COVID, however.)

Day 5 (Tues): No change in fevers, aches, headaches for both of us, and my cough is often coming in fits. Taking a shower, dressing and getting to the car leaves us short of breath with racing hearts. We drive to the next town and receive VERY thorough, bilateral nasopharyngeal swabs (thank goodness for the headrest keeping our heads still during the 16 seconds for each side- yes, I counted). Frankly, I’m relieved the guy did such a good job, because I didn’t want to end up with a false negative test from poor technique. During the swab test, we both had fevers above 101, active cough and aches- surely this will be positive. “When can we expect results?” I ask.  “5-7 business days, but we can’t promise that, because it depends on the volume of tests they receive at the state lab.” Um, okay. Not like we have a choice.

Days 6- 12- More of the same. Daughter finally began to eat (had forced herself to stay hydrated, sipped on soup, but ate almost nothing for 5 days.) No loss of smell, but both of us developed abnormal taste- hers metallic- lasted only a few days; mine got intensely salty/metallic and persisted for several weeks. (Initially I thought it was from the cough drops or zinc and even stopped those for a few days- but I’ve taken all of these for colds and the flu in the past and never had the weird taste.) Temps always better in the mornings, would go to normal range with fever meds, but later in the day, temp usually back to 101 despite meds. Lots of aches and fatigue, racing heart and shortness of breath with minimal movement, oxygen sats staying low but not dipping below our agreed upon cut-off. At this point I was coughing most of the day and night- maybe an hour without much, then absolutely nonstop for the next couple hours. Weirdly seems to turn on and off. Worse if I tried to talk. We start joking about developing awesome “COVID Abs” from being so sore after coughing. Daughter has way more fever but thankfully way less cough. My doctor starts me on a steroid inhaler. I’ve gone through bags of cough drops, and we both took everything that might help and is not harmful- Vit D, Vit C, plus a couple zinc lozenges every day.

Day 13- Results back! BUT: “Test processed out of hold time…recommend retesting.” WHAT? The swabs had been sent hours away to the state lab, then sat there waiting in line for days, followed by more delays when their server crashed for 24 hours and there was some other glitch with the test processing. Utimately, our very thorough nasopharyngeal swabs were useless. So. Darn. FRUSTRATING.

Days 14-28– Two steps forward, three steps back. Happy waves of increased energy, some days waking up feeling darn near normal in the morning, only to have deep body aches, low grade fevers, fatigue or headaches return later in the day, sometimes lasting a couple days. Other than my exhausting cough, the biggest challenge was cardiovascular, as we were suddenly so de-conditioned. Our Apple watches revealed pulses racing at least 40-60 beats per minute higher than our normal rates with minimal exertion, but we were relieved to be able to safely walk a slow mile on a flat street (with masks, VERY socially distanced from the few people we passed.) After much debate about proper timing and yield, we had antibody testing around day 15, which was negative.

6 Week Epilogue: There is always more to medical stories, and though I’m leaving out a bunch of details, I hope I’ve shared enough to keep this experience relatable and accurate. Ultimately, our symptoms have resolved except for some remnant cough, some persistent orthostatic symptoms (fleeting blackout with standing up) despite drinking tons of water, and a frustratingly slow return to cardiovascular fitness. Our primary care doc referred us to an Infectious Disease physician, who strongly suspected COVID and now has clinically confirmed COVID (meaning diagnosed using her best judgement given all info available) after ordering additional blood work to be sure she wasn’t missing another less common cause (like TB, typhus, Rocky Mountain Spotted Fever, Mono, etc.)- all of which were negative, including repeat COVID antibodies. FWIW, curbside consultation (discussing the details) with multiple primary care docs and a few more Infectious Disease experts yielded the same conclusion- this was COVID.

Bonus discussion points:
1. Why didn’t we get chest x-rays or CT scans?
Doctors try not to order tests that don’t change treatment, especially tests that involve radiation. Although one of these tests may have helped confirm the diagnosis, they would not have changed treatment (but would have added cost and risk.)

2. Why didn’t I just give our daughter some of my Plaquenil?
a. Intellectually, it was fairly easy not to- the current science was pretty clear that this drug doesn’t offer significant benefit, and may cause harm.
b. Emotionally- especially while pretty darn sick myself AND seeing our daughter feel so awful AND receiving zillions of texts asking about social media posts on this drug- it was honestly a bit tempting, which drove me to read every study I could find (when I could concentrate).
c. Again, I avoid “doctoring” our family with prescription medications, and her doctor did not recommend this (and yes, we discussed it.)
d. I have my own love/hate decade-plus-long relationship with this drug, especially some of the generic versions that give me wicked headaches, which I am now forced to take because of the unavailability of name brand due to the current increased demand. I am painfully clear about the side effects and knew the high doses being used (by those promoting the use and in clinical studies) were highly likely to worsen the headache and nausea she was already experiencing.
3. Do I really think we had COVID?
Without a doubt. Ruling out “weird stuff” was icing on the cake. Why? Frankly, there’s not much flu in July (only other common pathogen that would cause similar symptoms); timing was spot on from the only time we could have been exposed; we were infected by a bug strong/infectious enough to make us sick despite wearing masks; plus the bizarre salty/metallic taste distortion is pretty unique to COVID.
4. Did anyone else in your family get COVID?
The only other person with us was our younger daughter, and she never developed any symptoms. Asymptomatic testing was not available (so she was not tested.) She appropriately quarantined a full 14 days after possible exposure from us.
5. Any other thoughts?
I firmly believe if we had NOT been wearing cloth masks when we were presumably exposed, we would have ended up much sicker,  likely in the hospital (because it’s clear now that the volume of virus that initially infects you correlates strongly with the severity of your illness.) Take home message: Barriers and ventilation matter. I can’t help but wonder, though…was it the two girls in Target who surprised us when they turned around right in front of us and were not wearing masks? The heavily trafficked public bathroom at the airport with minimal ventilation? Our choice to eat outside of a restaurant? We’ll never know, but I can assure you, we remain vigilant.

6. The IRONY: No, the irony of dealing with COVID myself and within our family (as I continue to speak professionally about everything college students can do stay healthy) does not escape me! Meanwhile, if you’d like to hear more, I continue the discussion of negative COVID tests in the setting of positive COVID symptoms in my next blog: The COVID Conundrum: Did you have it or not? /

BOTTOM LINE: Our family’s COVID experience hit the middle ground- certainly not mild, but thankfully not severe enough to land us in the hospital hooked up to a ventilator. None-the-less, I don’t wish this on any of you! Let’s all do our part with masks, social distancing and hand washing. We’re in this together!

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