What H1N1 Taught Our Family about COVID-19
By: Rachel Kats Cooper
The world is changing right now. Everyday there is news of more deaths, increasing infected areas, and devastating business closings. The economy is evolving and there is so much uncertainty surrounding the future, but one thing is for sure is the United States public needs to get more serious about what this virus (COVID-19) really is and its effects. I have seen an increasing number of people say that these decisions to close schools and businesses and to basically shut down the public are an “overreaction” and that there is nothing to worry about.
In 2009, a lot of people said the same thing, that “there was nothing to worry about”. In April 2009, Swine Flu (H1N1) swept across the world with over a billion cases and northwards 500,000 deaths worldwide (according to the CDC). One of those casualties was my dad, Leon Kats. The Swine Flu killed my dad. Pandemics like the one sweeping the world right now (COVID-19) bring up so many emotions for me and my family.
What is H1N1?
In early April 2009, H1N1 was first detected in the United States. According to the CDC’s historical archive, “This virus was a unique combination of influenza virus genes never previously identified in either animals or people. The virus genes were a combination of genes most closely related to North American swine-lineage H1N1 and Eurasian lineage swine-origin H1N1 influenza viruses.” Upon further research little evidence was found relating the virus to pig herds. Like most flu strains H1N1 moved fast, but by mass majority it was moving fast among children and young adults, much different than what we see with most viruses. In just 10 days after the first reported US case (which was a 10 year old patient in California) the Director General of WHO declared H1N1 a “Public Health Emergency of International Concern.” This virus moved fast! On June 11, 2009, WHO declared H1N1 an official worldwide pandemic. This would be the first worldwide pandemic since the Spanish Flu in 1918 which killed over 50 million people. Making COVID-19 the 3rd worldwide pandemic in history (this status is not declared lightly). The FDA approved the vaccine for the H1N1 September 15, 2009, but was released on a minimal scale. By December 2009, the vaccine had reached all 50 states. Since then the vaccine is included with the seasonal flu shot and has remained controlled.
Mortality Rate:
H1N1 took my dad. A worldwide pandemic killed my dad. The mortality rate of H1N1 was 0.02–0.08% while COVID-19 mortality rate stands at 3.4% and is as high as 11% depending on age of patient. That is an astounding difference and proves how much more serious COVID-19 is compared to H1N1. So, why do you care? You are healthy, right? How does a pandemic affect you or your family? Why is it so serious?
Daddy’s Background:
To fully explain the magnitude of what a pandemic can cause, I first have to tell you the story of my dad. He was a decorated retired Air Force Master Sergeant who, after his retirement, could have been in a number of high dollar careers. Instead, he chose to use his GI-Bill and get his masters degree in education. He went on to teach middle school math. Of all the things he was good at and all careers he could have chosen, he chose to teach kids. It still baffles me to this day that he chose that, but, dang, he was amazing at it! He loved teaching, he loved Camden Middle School, and he loved his students. However, it was his career choice that ultimately proved to be his end.
H1N1’s Attack: On Friday, October 23rd, 2009, Daddy came home from school and told Momma that half the students in his class were home sick with the flu. The next morning he woke up with a “tickle” in his throat that wouldn’t go away. Of course, with everyone getting the flu the concern in Momma started to grow, especially when Sunday he broke out in a high fever and admitted that he would not be going to work the next day. That was so rare for him. He NEVER missed work.
The First Hospital Visit: Monday morning, Momma went to work and Daddy attempted to drive himself to the doctor, but he almost drove into a ditch twice because of the delirium from the fever. He was able to make it to Momma’s office (a few miles from the house) and she drove him to Moncrief Army Hospital located on Fort Jackson Army Base. That is where we always went when we were sick and where Daddy’s PCP (Primary Care Physician) was, so why would this time be any different? Once they arrived, he saw a NP (Nurse Practitioner) who listened to his chest and checked his temperature which was a little over 100 degrees. She did not want to do the flu test, but Daddy insisted (since half of his students were out sick). Reluctantly, the NP did a nose swab culture and a rapid test to determine if he had the flu. They were told the rapid test results would be back in an hour and they could wait in the waiting room. They decided to go wait in the car where Daddy fell asleep shortly after they sat down. After waiting two hours for the results, Momma went back to the doctor’s office and she was told that he tested negative for the flu. They told her that Daddy had a virus and did not need an antibiotic. No chest X-Ray and no blood work were done. The only test was the nasal flu swab. There was no follow-up, no medication for his symptoms, no suggestion to get an external lab test. Just sent home.
Later the same night Daddy’s fever rose to 103 degrees. Momma called Moncrief, but because it was after hours she was transferred to the Urgent Clinic. A doctor was called and a nurse relayed that fever was a good thing because his body was fighting off the infection. Momma and Daddy opted to not go back in at that time.
Tuesday, October 26th he stayed home from school. Temperature began to normalize and Momma went back to work. It seemed to everyone like he was on the mend. Momma was working a 12 hour day and Daddy called her around 9:30 that night and said that his fever was back up. He said that he was going to go back to Moncrief Urgent Care. He also said that if they didn’t satisfy him that he would go to Providence NE ER.
The Second Hospital Visit: He ended up calling home around 11:30 that night and told her that the strep test was negative and they had done a chest X-Ray and they were about to do a CT scan of his chest. Early in the morning, Momma tried calling him on his cell, but got no answer.
Admission to the Hospital: Finally, on Wednesday morning around 6:50 he called her and said he was diagnosed with pneumonia. He was being admitted to Moncrief. Apparently, they also saw something on one of his scans that showed a bowel obstruction and was put on a liquid diet because of it. He relayed to Momma that at some point during the night they put a tube down his throat. He explained it as a horrific experience and he had no idea why they were doing it. No one explained it to him or walked him through the process. He explained that he was nauseated the whole time, so they gave him Phenergan and then later, Zofran. Through this trauma he developed a horrible headache. No questions were asked and they gave him a Vicodin for the headache.
I remember visiting him that night after I got out of classes (I was at Midlands Technical College taking 8 classes that semester). I remember him seeing me and moving to the edge of the bed to sit up. I sat down next to him and cried. He put his arm around me, rubbed my shoulder, and said, “It’s going to be ok.” I told him of a few good grades that I had gotten back that day. I could tell he was proud. I could also tell that he didn’t want to talk about how sick he was. I made him promise me that he was going to get better. He promised. He promised… I left that night with a knot in my stomach, but comforted that Daddy promised he would get better. Little did I know that would be the last time I ever talked to him.
Please transfer hospitals! Over the next several hours it was more of the same and his condition was worsening. Momma suggested that he be transferred to another hospital that could take better care of him since his condition seemed to be rapidly declining. He said he was content to stay there.
Walking into the Light: Around 11:00 Friday morning Daddy called Momma and said he was really sick and was starting to get worried. He told her that they repeated the chest x-ray earlier that morning (mind you, the first one done since Tuesday, on a pneumonia patient). Momma rushed to be by his side. Several hours after she arrived a doctor came into the room to give the results from the morning chest x-ray. The doctor stated that the pneumonia was worse and they were going to transfer him to another hospital. They asked the doctor why, but no real reason was given. They opted for Palmetto Health Richland.
EMT’s arrived around 6:00pm to transport him to the 9th floor (regular bed) at Palmetto Health Richland. Momma remembers him sitting up on the gurney talking, gave her a smile, and she waved goodbye (she needed to go home to my little sister, who was 9 at the time). Around 10:00 that night he called her and said that he was settled into his new room. They had taken his IV out, put him on solid foods (which they confirmed that there was never a bowel obstruction), and were planning to repeat the CT scan soon. It seemed that, once again, he was on the mend. Everyone was wrong. Should he have been put in a regular bed to begin with?
A Turn for the Worse: On Halloween, the day after his transfer, things changed. Momma got a call at 5:30am, expecting it to be Daddy. It wasn’t, it was an RN, who was sharing the news that Daddy had gotten worse throughout the night. They talked for a while and the nurse explained that Daddy was on 3 antibiotics and was being moved to a step-down unit (one step down from ICU). About an hour later, Daddy’s doctor called her and said they had intubated him and were moving him to ICU. She rushed to the hospital and it all became a blur after that.
Saturday a lot was happening. Doctors were trying everything they could. His BP was up, then it was down. His fever spiked to 105 and then to 106.5. He was heavily sedated on Propofol.
Sunday, November 1st: Around 9:00 am, at the scheduled visitation time, as Momma walked towards his room, she saw all the staff rushing to Daddy’s room. They asked her to wait outside. Later, she found out that he had awakened from the sedation, had gotten his hands free of the restraints, and had pulled his breathing tube out, so they had to replace it. Earlier that morning, Daddy had asked one of the nurses for a pen and paper so that he could write. He wrote, “Tube out.”
Monday, November 2nd: The ventilator was not good enough anymore, so they switched Daddy to a respiratory oscillator, which delivers very small breaths at a very high rate. However, this made his saturations even worse, so they had to switch him back to the ventilator. Out of options, they suggested one more thing, to begin “proning” him, which meant 6 hours on his back and 6 hours on his stomach. There is a special bed that allows for this, but they were unable to locate one, so they had to make it work with what they had. They flipped him manually. Around this time his kidneys also started failing, so they started him on hemodialysis, in an effort to draw the fluid off. Momma was told that he was the sickest patient in the hospital.
On Tuesday, he was no worse/no better and was given the hemodialysis treatment again. I remember my visit to him after classes that day. I went in and whispered to him, “You promised. You promised me that you would get better. We need you.” I squeezed his hand and when I did a tear rolled down his cheek.
The Fifth Day: Daddy’s fifth day at Richland would be his last. November 4th, his dad’s birthday, was the day the bottom dropped out. The earth crashed around us. His BP became too low to tolerate hemodialysis anymore. They had to switch to continuous dialysis which was slower and pulled less fluid out at one time, so as to not affect his BP. Throughout the day his BP remained extremely low and he was now not responding to any medications. He was on Levophed and Epi drips and they still had to keep adding more on. They had 12 IV solutions infusing at the same time.
That afternoon Momma was very concerned about all the conflicting results she was told regarding the H1N1 testing that had happened at Moncrief and Richland. So, in the middle of Daddy’s decline, she called the doctor at Moncrief. She asked him for the culture results (the long test that takes up to 7 days for results), at which time he confirmed that it was positive. Livid, she asked him why the results were not provided to her or Richland Memorial. He didn’t answer. She asked when he got the results. He didn’t answer.
Between 5–6:00pm a nurse came to the waiting room and told her that his BP was very low again and it did not look good. Our family was able to come back to be with him. Shortly after this visit, Momma made the decision that if the dialysis equipment clotted off, they would not resume it and if his heart stopped they would not resuscitate.
Around 10:00pm I was sitting alone in a private room off the ICU waiting area. I just remember rocking back and forth thinking I was in a dream. A friend from church came in and handed me our family picture that had been hanging in Daddy’s room. He was coming to tell me that this was it and I needed to prepare myself. My brother came in to get me so that the two of us could go see Daddy again. I wasn’t prepared. I wasn’t prepared for what came next. We stood over Daddy. I think we prayed, but mostly we stared and listened to the whirling and pumping of the machines. At 10:45, my brother went to get Momma because Daddy’s BP was almost nothing. We all stood around as the nurses came in and one by one turned the machines off. At 10:55, Daddy took his last breath.
My Purpose: I tell this story in such detail, 10 years later, to show how fast the pneumonia, a symptom of H1N1, took the life of my dad. I tell this story to show how horrible he was treated, medically, in the beginning of all of this. I tell this story to show you that you can’t rely on testing to prove a diagnosis, especially during a frenzied worldwide pandemic. Could he have had a full recovery if he had chosen a different hospital? Could he have had a full recovery if he had been treated more aggressively for pneumonia?Could he have had a full recovery if all of his doctors had asked more questions? Could he have had a full recovery if the test results had been more accurate and had come back sooner? Could things have been different if he had followed his gut and gone elsewhere? I don’t know. What I do know is pneumonia is a killer and some hospitals are just not equipped to handle these pandemic patients. Be aware! Follow your gut! ASK QUESTIONS. DEMAND ANSWERS!
The NEW killer: I also tell this story to point out that pneumonia is also a leading symptom of COVID-19, only this time it is much worse. This time the virus ITSELF causes respiratory issues. A healthcare worker in Louisiana reflected on a young COVID-19 patient, “It first struck me how different it was when I saw my first coronavirus patient go bad. I was like, Holy shit, this is not the flu. Watching this relatively young guy, gasping for air, pink frothy secretions coming out of his tube and out of his mouth. The ventilator should have been doing the work of breathing, but he was still gasping for air, moving his mouth, moving his body, struggling. We had to restrain him. With all the coronavirus patients, we’ve had to restrain them. They really hyperventilate, really struggle to breathe. When you’re in that mindstate of struggling to breathe and delirious with fever, you don’t know when someone is trying to help you, so you’ll try to rip the breathing tube out because you feel it is choking you, but you are drowning.”
He continues, “When someone has an infection, I’m used to seeing the normal colors you’d associate with it: greens and yellows. The coronavirus patients with ARDS have been having a lot of secretions that are actually pink because they’re filled with blood cells that are leaking into their airways. They are essentially drowning in their own blood and fluids because their lungs are so full. So we’re constantly having to suction out the secretions every time we go into their rooms.”
“Before this, we were all joking. It’s grim humor. If you are exposed to the virus and test positive and go on quarantine, you get paid. We were all joking: I want to get the coronavirus because then I get a paid vacation from work. And once I saw these patients with it, I was like, Holy shit, I do not want to catch this and I don’t want anyone I know to catch this.”
The Reality we Live in: COVID-19 knows no age, race, color, creed or political party. While early numbers showed that seniors 65 and older were the highest risk, numbers have since shown that all ages are affected and all ages are at risk. Almost a third of all hospitalizations are in the age bracket of Millennials or Generation X (ages 20–44). According to the CDC, “As of March 16, a total of 4,226 COVID-19 cases had been reported in the United States, with reports increasing to 500 or more cases per day beginning March 14. Among 2,449 patients with known age, 6% were aged ≥85, 25% were aged 65–84 years, 18% each were aged 55–64 years and 45–54 years, and 29% were aged 20–44 years. Only 5% of cases occurred in persons aged 0–19 years.”
Why do you care? So, how are you affected? Because you and all of your loved one’s are at risk. If you don’t contract it or become symptomatic, your mom, dad, grandmother, or even your child may get COVID-19. You love them and you care for them. Let us all remember those in the higher risk categories, but let us not forget those that were at “no risk at all” and still succumbed to this virus.
In the beginning, I didn’t fear this illness for myself and I still don’t completely, but I do fear it for my family and friends that are at higher risk of dying from it, those with diabetes, cancer, or even just a history of respiratory problems (i.e. previous pneumonia patients or those with asthma), those with weakened immune systems, those 65 and older…ALL family and friends just like my dad. I have a concern for my community and that as they go about their daily lives as if nothing is wrong, there is a chance that everyone they come in contact with may be at risk. Is it worth it? Is it worth going to the driving range and potentially infecting all those around you? Is it worth sitting in a movie theater? Ask yourself every time you leave the house “is this trip worth the risk?”
Take all precautions advised by the CDC, but don’t think it’s silly and won’t affect you, because my family thought the same thing in 2009…
My song tribute to Daddy:
