63-day struggle to save British Covid-19 patient's life: the timeline

By Le Phuong   May 20, 2020 | 07:36 pm PT
Doctors and nurses at the HCMC Hospital for Tropical Diseases battled for two months to treat a British pilot with Covid-19 and failing lungs.

The doctors received the test results of the 43-year-old man, who was Vietnam's most critical case, on March 18.

They also received a warning from the laboratory staff: Be extra careful with the patient because his viral load is much higher than other patients.

Dr Nguyen Thanh Phong, head of the hospital’s Infectious Diseases Department, explained what that means: "The patient posed a major threat of spreading the infection to the medical staff treating him."

Designated as "Patient 91," he was the first case in the cluster of infections in Saigon associated with Buddha Bar & Grill. A few days after he was diagnosed, 18 others were also found infected.

On March 23, a 29-year-old doctor at the National Hospital of Tropical Diseases in Hanoi tested positive for the coronavirus, becoming the first health worker to be infected while treating patients.

As the head of a department where Covid-19 patients are treated, Phong was concerned, especially since the British man had a higher viral load than normal.

"We remained strong mentally, but could not help but be more cautious," he said.

He reminded his staff every day to be mindful about their protective gear and infection control because "a person not following the procedures is going to jeopardize the safety of everyone else."

"The patient was young, had no underlying conditions but obesity posed a risk to his recovery from Covid-19, we could not be reckless."

The pilot had a body mass index of more than 30 at the time of admission.

At the time the battle against the disease was still in its early stages. To put it in perspective, now, two months later, there are epidemiological factors that researchers are still struggling to decode.

When the patient first arrived at the hospital, he could walk around but refused to eat Vietnamese food.

The hospital had to contact his employer, Vietnam Airlines, to get food for him. A few days later his pneumonia worsened, and he had to be put on a nasal ventilator.

On March 25 he was put on a ventilator mask, and on April 5 on an invasive ventilator.

On April 6 he was put on a life support machine for extracorporeal membrane oxygenation (ECMO). The machine pumps blood out of the body and to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back.

The entire team of doctors and nurses has forgotten the notion of time since they began the battle to save him.

"Sometimes I don't know what day it is because almost everyone has to work overtime and stay on duty at the hospital, regardless of whether it is the weekend or night," doctor Phong said.

Doctor Nguyen Thanh Phong, Head of the Infectious Disease Department at HCMC Hospital for Tropical Diseases, puts on protective clothing before entering treatment area for Covid-19 patients, March 11, 2020. Photo by VnExpress/Huu Khoa.

Doctor Nguyen Thanh Phong, Head of the Infectious Disease Department at HCMC Hospital for Tropical Diseases, puts on protective clothing before entering treatment area for Covid-19 patients, March 11, 2020. Photo by VnExpress/Huu Khoa.

Dr Nguyen Van Vinh Chau, director of the hospital, said the patient's immune system overreacted when the virus attacked his body, releasing too many cytokines that damaged his organs.

His lungs were damaged by both the virus and the body's release of anti-inflammatory substances.

An online chat group was established to bring together leading experts in intensive care, infectious diseases, hematology, respiratory diseases, clinical microbiology, and clinical pharmacy to monitor and discuss the treatment of the patient.

They are from the hospital, Cho Ray Hospital and several other institutions. His condition is updated and discussed round the clock.

Though the group members do not directly treat the patient, they are the ones who make vital decisions.

While on ECMO, he has to take heparin, an anticoagulant. Then he developed coagulopathy, a condition in which the blood does not clot. He also developed heparin-induced thrombocytopenia (HIT), an immune complication from herapin therapy which could cause bleeding and is life threatening.

Choosing drugs for him and adjusting dosages became a daunting task.

The doctors decided to use intravenous anticoagulants on him.

The drugs, never used in Vietnam before, were imported by the Ministry of Health from Germany. During the 10-day wait for them to arrive, doctors used Xarelto to prevent thrombosis which can lead to blood clots in the lungs.

He was transferred from infections disease department to the intensive care unit where he was treated by four doctors and taken care of day and night by 16 nurses.

Cho Ray Hospital sent four of its doctors to join the team.

The patient's lungs continue to be solidified. A CT scan on May 12 showed fibrosis had scarred both lungs, and they were only working at around 10 percent capacity, meaning he couldn't be taken off the life support machine.

The ministry has said a lung transplant will be done to save his life.

A second CT scan six days later indicated a recovery of 20-30 percent of lung capacity.

On Wednesday the ministry announced that he is completely free of the virus after he tested negative five times in 10 days.

But he still has pleural infection meaning the transplant cannot be done yet. The infection is being treated.

Health ministry officials have decided to transfer the patient to Cho Ray Hospital for continuing treatment. The ministry also has plans to transport him to the U.K. when he's well enough.

‘Fulfilled mission of treating patient’

Luong Ngoc Khue, director of the Administration of Medical Examination and Treatment under the Health Ministry, said the HCMC Hospital for Tropical Diseases "fulfilled the mission of treating the British pilot patient."

He had spent a total of two months and two days at the hospital.

It was a period with non-stop working for the doctors there whose faces constantly bore the imprints of the protective mask.

Despite having lived through other major epidemics like severe acute respiratory syndrome (SARS) in 2002, swine flu H1N1 in 2009 and the Middle East respiratory syndrome (MERS) in 2015, doctors said the Covid-19 pandemic has put them in situations they have never experienced before.

"Despite the hardships, we never faltered, were never discouraged and were always ready as people on the frontlines," Phong said.

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