The last thing Mayra Ramírez remembers from the emergency room at Northwestern Memorial Hospital in Chicago is to call her family to tell her that she had Covid, was about to receive a ventilator, and needed her mother to make medical decisions for her.
Ms. Ramírez, 28, did not wake up for more than six weeks. And then she learned that on June 5, she had become the first Covid patient in the United States to receive a double lung transplant.
On Wednesday, she went home from the hospital.
Ms. Ramírez is one of a small but growing number of patients whose lungs have been destroyed by the coronavirus, and whose only hope for survival is a lung transplant.
“I am pretty sure that if I had been in another center, they would have finished the care and let me die,” she said in an interview on Wednesday.
Her surgeon, Dr. Ankit Bharat, performed a similar operation on a second Covid patient, a 62-year-old man, on July 5.
Surgery is considered a desperate measure reserved for people with fatal irreversible lung damage. Doctors do not want to remove a person’s lungs if there is any chance that they will heal. Overall, only about 2,700 lung transplants were performed in the United States last year.
Patients must be sick enough to need a transplant and yet strong enough to survive the operation, recover, and stand up again. With a new disease like Covid-19, doctors are still learning how to achieve that balance.
“It is a paradigm shift,” said Dr. Bharat. “Lung transplantation has not been considered a treatment option for an infectious disease, so people need a little more comfort.”
Two more patients at Northwestern are awaiting transplants, one from Chicago and the other from Washington, DC, said Dr. Bharat, who is chief of thoracic surgery at Northwestern University Feinberg School of Medicine and chief surgical officer of the lung transplant program. at Northwestern Medicine, which includes Northwestern Memorial Hospital.
Next week a patient will be taken from Seattle, and the Northwestern team is consulting another case with a medical group in Washington, DC. Other transplant centers are considering similar surgeries, said Dr. Bharat.
Last Friday, a Covid-19 patient underwent a double lung transplant at the University of Florida Health Health Hospital in Gainesville, Dr. Tiago Machuca said.
While other centers have tried to refer cases, most patients had other serious medical problems that ruled them out, he said.
In some cases, Dr. Bharat said, hospitals seemed to have waited too long to recommend a transplant. A patient who was referred to his center seemed like a good candidate, but then he had significant bleeding in the lungs as well as kidney failure, and surgery was no longer feasible.
“I think people need to recognize this option sooner and just start talking at least before it gets to that point,” said Dr. Bharat.
In some cases, he said, insurers’ reluctance to cover surgery or pay for the trip to transfer patients has caused delays.
“This is very new in our field,” said Dr. Machuca. “It will be a challenge for physicians to determine which patients really are candidates and what the time is. We don’t want to do it too early when the patient can still recover from Covid’s lung disease and resume a good quality of life, but he also doesn’t want to miss the boat and have a patient where it’s useless, the patient is very sick. “
He said that in some cases extensive rehabilitation has prompted recovery in Covid patients who were being considered as potential transplant candidates.
Because extensive lung damage in Covid patients makes transplant surgery especially difficult, most patients would be referred to major transplant centers that are better equipped to perform risky operations and provide the intensive care that patients need, surgeons said.
Before she got sick, Ms. Ramírez, a paralegal at an immigration law firm, worked from home and her food was delivered to her. She was in good health, but she had an autoimmune disease, neuromyelitis optica, and was taking medications that suppressed her immune system and could have made her more vulnerable to coronavirus infection.
She was ill for about two weeks and consulted with a Covid hotline about her symptoms. At one point, she made her way to the hospital, but then turned away without entering. She feared the idea of being admitted and told herself she would recover.
But on April 26, her temperature reached 105 degrees Fahrenheit, and she was so weak that she fell when she tried to walk. A friend took her to the hospital. When doctors told her she needed a fan, she had no idea what they meant. She thought it meant some kind of fanatic, like the Spanish word.
“I thought I would be there for a couple of days, at most, and go back to my normal life,” he said.
But he spent six weeks on the ventilator and also needed a machine to supply oxygen directly to the bloodstream.
“All the time I had nightmares,” he said.
Many of the nightmares involved drowning, her family said goodbye, doctors told her she was going to die.
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Frequent questions
Updated July 27, 2020
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Should I refinance my mortgage?
- It could be a good idea, because mortgage rates have never been lower. Refinancing applications have taken mortgage applications to some of the highest levels since 2008, so be ready to get online. But the defaults have increased, too, so if you’re thinking about buying a home, be aware that some lenders have tightened their standards.
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What will school be like in September?
- Many schools are unlikely to return to normal hours this fall, requiring the routine of online learning, impromptu child care, and delayed work days to continue. California’s two largest public school districts, Los Angeles and San Diego, said July 13 that instruction will be remote only in the fall, citing concerns that rising coronavirus infections in their areas pose too serious a risk to students and teachers. Together, the two districts enroll about 825,000 students. They are the largest in the country so far to abandon plans for a partial physical return to classrooms when they reopen in August. For other districts, the solution will not be an all-or-nothing approach. Many systems, including the country’s largest New York City, are developing hybrid plans that involve spending a few days in classrooms and other days online. There is no national policy on this yet, so check with your municipal school system regularly to see what’s going on in your community.
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Is the coronavirus in the air?
- Coronavirus can remain in the air for hours in tiny droplets in stagnant air, infecting people as they inhale, growing scientific evidence suggests. This risk is highest in crowded interior spaces with poor ventilation, and may help explain overcast events reported in meat packing plants, churches, and restaurants. It is unclear how often the virus is transmitted through these small droplets or sprays, compared to the larger droplets that are expelled when a sick person coughs or sneezes, or is transmitted through contact with contaminated surfaces, Linsey said. Marr, Virginia Tech aerosol expert. Aerosols are released even when a symptom-free person exhales, speaks or sings, according to Dr. Marr and more than 200 other experts, who have summarized the evidence in an open letter to the World Organization. Of the health.
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What are the symptoms of coronavirus?
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Does Covid-19 transmit asymptomatic?
- So far, the evidence seems to show that it does. A widely cited article published in April suggests that people are most infectious approximately two days before the onset of coronavirus symptoms, and estimated that 44 percent of new infections were the result of transmission from people who still had no symptoms. Recently, a senior expert from the World Health Organization stated that transmission of the coronavirus by people without symptoms was “very rare,” but later withdrew that claim.
The disease was relentless. Bacterial infections appeared, scarring his lungs and eating holes in them. The lung damage caused circulatory problems that began to affect his liver and heart.
Doctors told her family in North Carolina that it might be time to come to Chicago to say goodbye, and her mother and two sisters made the trip.
But Mrs. Ramírez endured, removed the coronavirus from her body, and was included in the transplant list. Two days later, on June 5, she underwent a grueling 10-hour operation.
He woke up scarred, bruised, desperately thirsty and unable to speak, “with all these tubes coming out of me, and I just couldn’t recognize my own body.”
The nurses asked him if he knew the date. Guessed in early May. It was in the middle of June.
He was not told that he had undergone a lung transplant until several days after he woke up.
“I couldn’t process it,” he said. “I was struggling to breathe and I was thirsty. It wasn’t until weeks later that I was able to be thankful and think that there was a family out there that had lost someone. “
Before his illness, he worked full time and enjoyed running and playing with his two lanky little dogs. Now, he still feels short of breath, can walk only a short distance, and needs help showering and getting up from a chair. The dogs were delighted with his return home, but his energy was too much. Her mother, who lives in North Carolina, took time from her job at a meatpacking plant and traveled to Chicago to help her recover.
Ms. Ramírez said that she was learning to use her new lungs and that she was getting stronger every day.
She is eager to return to work, but still has a way to go. Her family is helping her and a friend started a GoFundMe page to help pay the bills.
“I definitely feel like I have a purpose,” Ramírez said. “It may be to help other people who are going through the same situation as me, perhaps even sharing my story and helping young people realize that if this happened to me, it could happen to them, and protect themselves and protect others around them who are most vulnerable AND to motivate and help other centers around the world to realize that lung transplantation is an option for terminally ill Covid patients. “
The outlook for Ms. Ramírez is good, said Dr. Bharat, because she is young and healthy. She will take anti-rejection medications for the rest of her life. The transplanted lungs can still be rejected, he said, but he has seen some past 20 years. And patients can receive a second transplant.
“I think from now on it will continue to get stronger and stronger,” he said. “She asked if she could skydive. We’ll probably get her there in a few months.
