The last thing Mayra Ramirez remembers from the emergency room at Northwestern Memorial Hospital in Chicago is calling her family to say she had Covid, she was about to be put on a ventilator and needed her mother to make medical decisions for her.
Ms. Ramirez, 28, has not woken up for more than six weeks. And then she found out that on June 5, she had become the first Covid patient in the United States to receive a double 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 whose only hope of survival is a lung transplant.
“I’m pretty sure if I was in another center, they would have just finished treatment and let me die,” she said in an interview on Wednesday.
Her surgeon, Dr Ankit Bharat, performed a similar operation on the second patient Covid, a 62-year-old man, on 5 July.
Surgery is seen as a desperate measure reserved for people with fatal and irreversible lung damage. Doctors do not want to remove a person’s lungs if there is a chance that they will heal. In all, only about 2,700 lung transplants were performed in the United States last year.
Patients must be ill enough to need a transplant, and yet also have enough strength to survive in the operation, recover and get back on their feet. With a new disease like Covid-19, doctors are still learning how to find this balance.
“It’s such a paradigm shift,” Dr Bharat said. “Lung transplantation has not been considered a treatment option for an infectious disease, so people want to get a little more level of comfort with it.”
Two other patients in the Northwest are awaiting transplants, one from Chicago and another from Washington, DC, said Dr. Bharat, who is the head of thoracic surgery at Feinberg University School of Medicine Northwestern and the program’s surgical director. of lung transplants in Northwestern Medicine, which includes Northwestern Memorial Hospital.
A patient is due to fly out of Seattle next week, and the Northwest team is consulting on another case with a medical group in Washington, DC Other transplant centers are considering similar surgeries, Dr. Bharat said.
Last Friday, a Covid-19 patient underwent a double lung transplant at the Health Trends Hospital at the University of Florida in Gainesville, said Dr. Tiago Machuca.
While other centers sought to refer cases, most of the patients had other serious medical problems that ruled them out, he said.
In some cases, Dr Bharat said, hospitals seemed to have been waiting too long to recommend a transplant. One patient who was referred to his center appeared as a good candidate but then had severe bleeding in the lungs as well as kidney failure, and surgery was no longer feasible.
“I think people need to recognize this option earlier and start at least talking about it before it gets to that point,” Dr Bharat said.
In some cases, he said, the reluctance of insurers to cover the operation or to pay for travel for transferred patients has led to delays.
“This is so new to our field,” Dr. Machuca said. “It will be a challenge for doctors to determine which patients are really candidates and what the time is. We don’t want to do it too early when the patient is still able to recover from Covid’s lung disease and resume with quality. of a good life, but also don’t want to skip the boat and have a patient where it’s useless, the patient is too sick. ”
He said that, in some cases, extensive rehabilitation has brought recovery in Covid patients who were being considered possible candidates for transplants.
Because extensive lung damage in Covid patients makes transplant surgery especially difficult, most patients are referred to major transplant centers that are best equipped to perform risky operations and provide care. intensive care that patients need, the surgeons said.
Before she left, Ms. Ramirez, a paralegal for a law firm specializing in immigration, was working from home and was delivering her groceries. She was healthy, but had an autoimmune condition, optic neuromyelitis, and took medication that suppressed her immune system and may have made her more vulnerable to coronavirus infection.
She was ill for about two weeks and consulted with a helpline to Covid about her symptoms. At one point, she rushed to the hospital but then returned without entering. She feared the idea of being admitted, and told herself she would recover.
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 doctors told her she needed a ventilator, she had no idea what they meant. She thought it meant some kind of fan, like the word in Spanish.
“I thought I would only be there for a few days, max, and get back to my normal life,” she said.
But she spent six weeks on the ventilator, and also needed a machine that provides oxygen directly into her bloodstream.
“All the time, I had nightmares,” she said.
Most of the nightmares involved drowning, her family saying goodbye, doctors telling her she was going to die.
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Frequently Asked Questions
Updated July 27, 2020
Do I have to refinance my mortgage?
- It may be a good idea, because mortgage rates have never been lower. Refinancing demands have forced mortgage applications to some of the highest levels since 2008, so be prepared to comply. But the shortcomings are also high, so if you are thinking of buying a home, be aware that some lenders have tightened their standards.
What does school look like in September?
- Many schools are unlikely to return to a normal schedule this autumn, requiring the grinding of online learning, the care of children they do quickly and the restless working day. California’s two largest public school districts – Los Angeles and San Diego – said on July 13 that instruction will only be done remotely in the fall, and expressed concern that the increase of coronavirus infections in their areas can be a very difficult risk for students and teachers. Together, the two districts enroll about 825,000 students. They are the largest in the country so far to abandon plans for a partial physical return even in classes when they reopen in August. For other districts, the solution would not be an all or nothing approach. Many systems, including the largest nation, New York City, are drawing up hybrid plans that involve spending some days in classes and other days online. There is still no national policy on this, so check your municipal school system regularly to see what is happening in your community.
Is the coronavirus in the air?
- The coronavirus can sit aloft for hours in small drops in stagnant air, infecting people as they breathe, and suggests scientific evidence. This risk is highest in poorly ventilated crowded indoor spaces, and can help explain the super-widespread events reported in cardboard plants, churches and restaurants. It is unclear how often the virus spreads through these small droplets, or aerosols, compared to large droplets that are expelled when a sick person observes or sneezes, or is transmitted through contact with contaminated surfaces, he said. Linsey Marr, aerosol expert at Virginia Tech. Aerosols are released even when an asymptomatic person sneezes, talks or sings, according to Dr. Marr and more than 200 other experts, who drafted the evidence in an open letter to the World Health Organization.
What are the symptoms of coronavirus?
Does asymptomatic transmission of Covid-19 occur?
- So far, the evidence seems to show so. A highly-cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and an estimate that 44 percent of new infections were the result of transmission from people who have not yet been infected. did not show symptoms. Recently, a leading expert at the World Health Organization stated that transmission of coronavirus by asymptomatic people was “very rare,” but later reversed that statement.
The disease was relentless. Bacterial infections set in, scarring her lungs and eating holes in them. Lung damage caused circulatory problems that began to have an effect on her liver and heart.
Doctors told her family in North Carolina it might be time to come to Chicago to say goodbye, and her mother and two sisters made the trip.
But Ms. Ramirez caught it, cleared the coronavirus from her body and put it on the transplant list. Two days later, on 5 June, she underwent a ten-hour operation.
She raised a scar, bruised, thirsty desperate and unable to speak, “with all these tubes coming out of me, and I couldn’t recognize my own body.”
The nurses asked if she knew the date. I cut it in early May. It was mid-June.
She did not say she had a lung transplant until a few days after she woke up.
“I couldn’t process it,” she said. “I just had to struggle to breathe and I was thirsty. It wasn’t weeks later that I could be grateful, and I think there was a family out there that lost someone.”
Before her illness, she worked full time and had fun running and playing with her two scrappy little dogs. Now, she still feels short of breath, can only walk a short distance and needs help to take a shower and stand up from a chair. The dogs were thrilled with her start, but their energy was a bit. Her mother, who lives in North Carolina, took time away from her job at a meatpacking plant and traveled to Chicago to help her recover.
Ms Ramirez said she was learning to use her new lungs and get stronger every day.
She is looking forward to getting back to work, but she still has a way. Her family is assisting her, and a friend started a GoFundMe page to help her pay the bills.
“I definitely feel I have a purpose,” Ramirez said. “It could be helping other people go through the same situation that I am, maybe even sharing my story and helping young people realize that if it happened to me it could happen to them, and to protect themselves and others around them that they are more vulnerable. And to motivate and help other centers around the world to realize that lung transplants are an option for terminally ill Covid patients. “
The outlook for Ms Ramirez is good, Dr Bharat said, because she is young and strong. She will be on anti-rejection medications for the rest of her life. Lung transplants can still be denied, he said, but he has seen some in the last 20 years. And patients may be able to receive a second transplant.
“I think from now on she will continue to strengthen and increase,” he said. “I wondered if you could go parasites. We’ll probably get it there in a few months.”