NYC Doctor Recounts His Own Battle With Coronavirus

UPPER EAST SIDE, NY — Lenox Hill Hospital pulmonologist Dr. Jonathan Raskin is usually treating patients with respiratory distress, but for nearly two weeks the roles were reversed after he contracted the new coronavirus and needed to be hospitalized.

The night that Dr. Raskin was admitted to the Upper East Side hospital, his fever spiked and his health crashed. The doctor's oxygen levels and blood pressure dropped. Luckily, Raskin said, doctors were able to pull him through the crash without having to place him on a ventilator.

It's a story that Raskin says isn't rare in New York these days. As of Thursday, April 9, 159,937 New Yorkers had tested positive and 7,067 lost their lives to COVID-19, state officials said. New Yorkers make up one third of the 432,596 confirmed COVID-19 cases in the U.S. and nearly half of the 14,696 who have died, according to Johns Hopkins and Centers for Disease Control and Prevention data.

Raskin spoke with Patch about his experience in the hospital, his thoughts on the coronavirus as a pulmonologist and the steps New York will need to take to recover from its outbreak. The following interview was edited for clarity.

Patch: When did you start feeling sick, and how did you know you needed to go to the hospital?

Raskin: I was documented to be COVID positive in early March, and probably acquired it in the community. I've tried to go back and see how I came to acquire it but I've had no luck and I believe it was already in the community unbeknownst to most of us.

Being a pulmonologist, I was on the frontlines caring for people with respiratory disease. I came down with it and began getting sick around the seventh of March and presented to the hospital after four days with refractory fevers to 102.8. As a pulmonologist, I own an oximeter and my oxygen levels were beginning to decrease and I knew I needed to be evaluated.

Patch: Describe your stay in the hospital.

Raskin: I was really grateful and lucky I went over that day because that night I had a bad event. I crashed and had my blood pressure drop, and oxygen levels go down. They resuscitated me — it wasn't CPR but they pulled me through it — and then the next day the infectious disease consultant decided I would be observed because at that point in time all their information was coming from China, and they really didn't know what medications to offer.

For a couple of days, I was having really hectic fevers and then had a bad episode again, and they realized they had to begin therapy. And three drugs, Plaquenyl, Kaletra and Actemra were given.
Once the therapies were begun I began to get better and I'm very grateful. It was really touch and go for a while and I'm happy to be on the other side of it.

I was also undergoing cytokine storm, which is an associated reality in very serious illnesses.

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Patch: What is cytokine storm, and how does it affect people?

Raskin: It is usually experienced by people suffering from other illnesses, which are usually real catastrophes, like sepsis, a blood borne infection with adult respiratory distress syndrome, or severe burns or major emergency surgery — these are really sort of medical catastrophes. When you are confronted with a really challenging medical moment there's tremendous dysregulation of cytokines — chemicals produced by the body — and they are elaborated in ways that are actually problematic for the body.

In this instance, I was discussing with my doctor whether I was in cytokine storm, not even really knowing what to look for and think about but I realized upon reflection that it was because of the all the visceral issues I was having, which included bad headaches, severe nausea, profound muscle and bone pains and, of course, I was simultaneously struggling with the pneumonia.
We don't usually get to discuss [cytokine storm]. People are on ventilators or people are terribly sick and it's just not a moment that we end up talking about.

Patch: You were treated at Lenox Hill, where you are also on staff. How does the current situation at the hospital compare to before the coronavirus outbreak?

Raskin: The hospital has changed substantially. For the last three weeks I've been in touch with friends who are there, and they're seeing primarily coronavirus. Everyone's been hunkering down and staying at home, and so the character of admissions to the hospital has changed dramatically. Sadly more recent admissions seem to favor the elderly and nursing home patients.
The latest news from Governor Cuomo is that the admissions are beginning to plateau and perhaps even to change trajectory, but at the moment most of the facilities in New York are dealing with Coronavirus. Not exclusively, of course… other illnesses go on, but floors have been changed, ICUs expanded. Right now we are in the peak of the illness, so that's no surprise.

Patch: What is your advice to people who think they may be sick?

Raskin: When somebody has a fever, our first effort is to understand the source of the presumed infection. In this day and age when I can't identify why someone is febrile, Coronavirus must be considered. Given its prevalence that's quite reasonable.
I have sent people to the ER and have kept people at home based on their signs and symptoms of disease. So my advice is speak to a physician or other health care authority and develop a plan and understanding. Given the current state of affairs we are trying not to overwhelm emergency departments.

In the situation where people have fever and they're beginning to have respiratory symptoms, then it becomes a little more compelling. Certainly any version of shortness of breath with or without exertion would probably push somebody to go to the emergency room.

Patch: You're a pulmonologist, meaning you specialize in respiratory conditions. How does coronavirus compare to some other similar illnesses such as SARS, MERS and the flu?

Raskin: I think people have to remember this current virus is a mutation. Mutation means change. As a result of that, each one of these Coronaviruses is unique and has its own characteristics. This mutation is different from previous Coronavirus infections such as SARS and MERS and seems far more consequential. The use of the term “novel” is appropriate. For instance, it seems that women are more capable of handling this illness compared to men as mortality data indicates fewer deaths in women throughout all decades of life. No such observations were made of SARS or MERS.

When you think about the fact that we're only six to eight weeks into this ordeal, and if you look at past pandemics such as HIV, one gets some insight as to our level of ignorance. I think that's important to say out loud, that we're really learning as we go at this stage.

Patch: Moving forward, what will be most important for society to recover from this outbreak?

Raskin: We really need not only to have testing kits for the acute illness but also need to have antibody testing so that we understand who has acquired immunity and can return safely to the workplace.

Yet the whole question of antibodies is also a compelling issue because we do not know how long the antibodies last, we don't know whether or not there's a threshold level above which antibodies do confirm immunity and then there's a daunting question of whether Coronavirus is really just one genotype or whether there are other versions of the current virus that have different antigenicity and virulence.

At the moment, everyone should be wearing masks and be conscious of social distancing. As we return to getting back to normal, whatever that will look like, we must be respectful of each other. I do hope this understanding becomes a part of our ethic at least in the short run until vaccines are available.

Sadly, we really don't know the prevalence of illness as we are unable to test the population at large. We will have a lot more insight into this illness and how to proceed safely once we can test for the acute illness as well as subsequently test for antibodies. We must establish a way to not be afraid of one another as we return to our community.

I anticipate when antibody testing becomes commercially available there will be a line of people outside my door with their sleeves rolled up.

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