How Much Should the Public Know About Who Has the Coronavirus? – The New York Times

michael barbaro

From The New York Times, Im 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 from the first confirmed case in New Jersey.

Its Monday, March 30.

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 OK, could you maybe find some time to talk? And he said, sure, call me now. Im in isolation, in other words, and I have time.

Hello? [COUGHING]

Are you there?

Yes. [COUGHING]

OK.

And what was the story that he told you?

So James lives and works in New York City.

So my name is James Cai, and Im 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 P.A.

He came to this country when he was about 16 from Shanghai. And hes 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 of my grandparents. They are doctors. My grandfather is an anesthesiologist in Shanghai. And when I was young, I 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 doesnt work in a hospital. And because he works in private practice, I think he probably imagined he might be working remotely with telemedicine.

I actually heard about coronavirus many months ago when China had outbreak. But I always followed the disease.

But because of the 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 end of February, I started to pile up all the food, like canned foods, 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 thats right.

So you werent sure at what point you would start doing that, but you felt youd know when it was time?

Yes.

But, you know, hes 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 all sorts of conferences and events. And the same was true of James. So like everybody else, hes 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 conference.

On the fourth day of the conference, Monday, March 2, he comes down with a cough. And he starts to realize hes actually getting sick.

I start to cough and a fever and tired.

So he leaves and texts his wife that hes going to go to New Jersey, where his mom has a house. His moms away. And he doesnt want to come home and get his wife and the baby sick.

Because of my daughter, when I went home, she always hugged me and kissed me. And she will catch it.

And whats 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 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 didnt 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 didnt 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 or

Yes. Certainly more serious than the flu.

So after, I went direct to the Hackensack emergency room.

So the doctor sends him to the E.R. at the Hackensack University Medical Center, which is not far from that doctors office.

And in the emergency room, they asked me questions. Asked me if I cough. I said, I do, 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 hes 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 havent seen any coronavirus patients. So they dont 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. Thats where he spends the night, texting his friends and his wife and getting increasingly unnerved and feeling quite ill.

I was nervous. And at the same time, since Im in the hospital, Im going to check everything. Make sure Im OK and then I go home.

So then on Tuesday, March 3, which is the second day in the hospital

They decide 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 hes going to have to wait a few days for the result, but he shouldnt worry, hes young and healthy. At the same time, hes wildly Googling symptoms for Covid-19 and realizing that he has almost every one of them.

I had maybe lied to myself, was like, trying to calm myself down. I dont have the Covid-19, I shouldnt have it.

And so, its day three for James in the hospital. Its Wednesday, March 4. Hes still waiting for the results in his tiny little room with a TV. And

[SOUND OF LOCAL NEWS THEME]

a local news report comes on.

We 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 thirties is hospitalized in Bergen County.

Theres a guy in his thirties in Bergen County, which is where he is, whos tested positive for coronavirus. Its the first case in New Jersey.

Governor Murphy saying

Theres 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, saying, is this me? And the doctors saying, no, your test is not back yet.

And of course, he hasnt heard anything about the results of his test yet?

No, he has not heard anything.

Wow. So you found out from the news from the governor of New Jersey?

Yes. On TV. And I asked the doctor. The doctor say, 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.

Lets hope so.

And how does the hospital react in this moment?

So hes really scared. But the hospital is telling him that he really has nothing to worry about. Hes a 32-year-old guy. Hes got no preexisting conditions.

Even Dr. [INAUDIBLE] was telling me, oh youre so young. Its like a flu.

In fact, one doctor even told him

If its not because everybody is talking about corona, you can go home already.

You know, if it werent for all this attention about the coronavirus, youd 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 mean, that day, I was so depressed.

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.

America is not ready.

It also dawns on him that he is the first person in this hospital to be treated for coronavirus.

I feel like, Im in real trouble. Why I come to this hospital? Because I feel they dont know how to treat this disease, and they dont have deep understanding about this 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. Hes the first person, and thats a very frightening position to be in.

Well be right back.

So Sue, James is newly diagnosed. Hes in isolation at this hospital in Hackensack, New Jersey. Hes 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?

I would say 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.

Its like Im in the water.

Tell me more about that.

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How Much Should the Public Know About Who Has the Coronavirus? - The New York Times