Three days after he was put on a mechanical ventilator, Richard Pritsky awakened to see members of his care team assembled around his bed at UVM Medical Center, the unmistakable look of relief in their eyes. He had been successfully extubated, brought out of deep sedation, and was breathing on his own.
At 74, Pritsky realized he would survive the severe case of COVID-19 that had taken him by surprise. “They got me through, it’s pretty amazing,” he says. “This is a crazy disease. Anyone who says it’s like the flu – this is nothing like any bad flu I’ve ever had.”
The symptoms started around March 19, and were mild at first. “I was feeling a little weird,” he recalls. “I thought maybe I was coming down with my usual spring sinus infection.” In the mornings, his nose was a bit stuffy, he felt slightly feverish and he was a tad short of breath. But by afternoon, he felt fine. This went on for 10 days, and it never crossed his mind he’d been infected with the new coronavirus – he had not traveled or been in close contact with anyone who was sick.
Everything changed on March 29. “I woke up and it was like I’d dropped off the end of a cliff. Suddenly, I could barely breathe,” says Pritsky, an IBM retiree who leads an active lifestyle cycling, taking dance lessons and acting in community theater. “And then I made a stupid decision and drove myself to urgent care.” In retrospect, he says, he should have followed the guidelines for people experiencing severe respiratory distress and called 911.
At Fanny Allen Urgent Care, the providers who examined Pritsky were dressed in full personal protective equipment. They told him his oxygen saturation level was dangerously low, less than 80 percent. They tested him for COVID-19 and put him in an ambulance bound for UVM Medical Center.
“It became pretty obvious pretty quickly that something was really wrong,” says Pritsky. “I’d read the articles and knew how bad it could get. I thought, ‘I have no control – what happens, happens.’”
Soon after he arrived at the hospital, Pritsky was taken to the intensive care unit. He had developed Acute Respiratory Distress Syndrome (ARDS), and the non-invasive forms of delivering supplemental oxygen were not doing the job. He was told he would need to be intubated, meaning that a tube connected to a ventilator would be inserted through his mouth and into his windpipe so that oxygen could be pumped into, and air full of carbon dioxide out of, his stiffened lungs. “I wasn’t in any condition to feel worried at that point. I told them, ‘Do whatever you have to do.’”
A sense of relief
Zechariah Gardner, MD, the physician who managed Pritsky’s care after he transitioned from the ICU, says not every patient who is taken off the ventilator progresses so quickly, or at all.
“It’s never a done deal that they will recover at that point. There’s still a risk of them developing another pneumonia and other patients have had to be intubated again,” says Dr. Gardner, adding that Pritsky also suffered a pneumothorax, or collapsed lung, while on the ventilator and required a chest tube.
ICU Director Mary Ellen Antkowiak says there is still a lot to learn about this new disease, there is no proven effective treatment, and guidelines have been variable about treatment approaches to try. “We haven’t found that there’s one magical thing we’re doing that helps more than others,” she explains. “But it’s really important to be able to look at each patient and see how they’re responding to a certain mode or therapy, and then be able to adapt.
Dr. Antkowiak adds: “We’ve been really fortunate that the people of Vermont have listened and abided by social distancing, and because of that we have been able to focus our care on fewer patients.”
While in the ICU, Pritsky was treated with steroids and, antibiotics. He was also given the antimalarial drug hydroxychloroquine, which may help reduce inflammation in certain patients, Dr. Gardner says. He was also given blood thinners to prevent clotting.
After the ICU, he was put on a relatively high level of nasal cannula oxygen support, which was ratcheted down over the five or six days he was on the COVID-19 step-down unit under Dr. Gardner’s care. As his mobility improved, Pritsky was able to stop taking the blood thinners.
“Mr. Pritsky was the first really sick patient that I’ve been able to discharge to go home,” Dr. Gardner continues. “My initial experience treating these patients was demoralizing, we lost several patients early on. We’ve since had a handful of patients who have been on a ventilator that have come off and recovered. Seeing really sick patients get better, it provides a sense of relief.”
Taste buds spring to life
As Pritsky was preparing for discharge from the hospital, he was asked to demonstrate that he could walk. Often, patients with severe illness and long hospital stays require care at a rehabilitation facility. But Pritsky did a little jig, and returned home from the hospital on Friday, April 10. The next morning, his housemate cooked him breakfast. Like some other COVID-19 patients, Pritsky had lost his sense of taste. But that Saturday, “My taste buds started springing to life. It was amazing, like a switch turned on,” he says. “The coffee was an elixir and the scrambled eggs were divine.”
Rosy Hill, MD, Pritsky’s geriatrician at Williston Adult Primary Care, is delighted by her patient’s steady progress. In fact, although it’s not unusual for people who are infected to go “from really fine to really sick really quickly,” she says she wouldn’t have predicted that Pritsky would be one of them. “He really had no risk factors other than his age, and he is in excellent condition.”
Who will be the most severely affected by COVID-19, and why, is one of the most important mysteries still to be solved about the disease, she says. The long-term effects of serious cases of COVID-19 are not yet known, but Dr. Hill does expect Pritsky to make a full recovery because of his overall good health. For now, he is still using a low dosage of supplemental oxygen when needed and is doing physical therapy to strengthen his respiratory function and gain muscle mass – he lost 20 pounds during his illness.
Dr. Gardner says he hopes people continue to practice physical distancing despite the promising trend showing a reduction in infections in Vermont. “I’ve been impressed by how we’ve been prepared for a worst-case scenario and I’m certainly glad we haven’t seen it,” he says. “But we’re still at risk. I hope we all can continue to do what we need to do to slow the spread, so we don’t see a second peak.”
Because no one knows for sure whether he is now immune, Pritsky is still practicing social distancing. His many friends are leaving soups, desserts, homemade masks and flowers on his front porch for him to pick up after they leave. “It’s been tough not to give someone a hug,” he says. “But we need to stick with this routine until we know where we are. Thinking we can go back to normal right away is naïve and deadly.”