One nearly died, the other recovered from afar. How a California couple survived coronavirus
Darin and Sonia Vigil were relishing a week’s memories of Egyptian pyramids and a Nile River cruise as their flight neared Sacramento on Feb. 29.
Darin wasn’t feeling quite right, though. Probably jet lag and a bug.
“We’ve been around a thousand people. I probably have some cold symptoms, maybe a slight flu,” he thought.
Darin, 53, was unaware that Sacramento County had been heaved into the national spotlight as the coronavirus pandemic began spreading through the country. Health officials on Feb. 26 had confirmed what was the first known case of the new coronavirus in the Sacramento community.
At home in Fair Oaks, Darin’s symptoms worsened as he unpacked his bags. Fever. Weakness. And a growing sense of dread — that Saturday, Feb. 29, authorities in Seattle announced the first confirmed U.S. death linked to community transmission of COVID-19. Later, health officials would discover other such deaths had occurred weeks earlier in the Bay Area.
As the nation felt a chapter turn, Darin’s condition deteriorated. He went to see his primary care doctor three days after his flight touched down. Health care workers took his temperature, listened to his lungs, and told him to return home to rest while they processed some tests.
The next day, they called to tell him he had pneumonia in both his lungs.
What a way to end a trip, he thought. But before he could pick up his medication, Darin started having trouble breathing and chest pain unlike any he’d ever had.
His wife, a registered nurse, rushed him to the emergency department at Mercy San Juan Medical Center in Carmichael. At that time, no more than 100 people in the United States had been diagnosed with COVID-19.
A test revealed Darin would be listed among them.
Hours later, his every breath was being meted out by a ventilation machine.
Darin wouldn’t leave the facility for 23 days, his life consumed by feverish dreams and experimental drugs as doctors worked to stop the virus from ravaging his lungs and starving his body of oxygen. When he finally woke from the heavy sedation doctors administered to stop him from ripping out the breathing tubes, Darin found a lonely life that barely resembled the one he knew before.
Through it all, his wife couldn’t visit because he and many other COVID-19 patients had been placed in isolation. Business and government offices, churches and nonprofits, schools and colleges around the state had shut down. The nation was coming to terms with a pandemic.
“When I started coming out of it,” Darin said, “they had already canceled the basketball season. They already had postponed the Olympics. Then I got to where I didn’t want to watch the news anymore because of all the deaths that they were reporting.”
About a week after Darin’s March 27 release from the hospital, the couple sat together on a chair in their dining room, and on a video-conference call with The Sacramento Bee, to share details of Darin’s near-fatal brush with COVID-19. Dr. Parimal Bharucha, one of the ICU doctors who treated Darin, joined the call, providing rare medical insight into how a patient won the fight against a nearly fatal infection.
The Vigils’ harrowing experience illustrates the puzzling extremes of COVID-19. The couple — both middle-aged and, before the coronavirus, relatively healthy — survived a worldwide pandemic through vigilant medical care, an experimental drug, and perseverance.
Sonia also tested positive for COVID-19 but recovered after only a few days of relatively mild symptoms. On the opposite extreme, Darin survived only after feeding tubes, talk of brain damage and fear of acute rehabilitation.
In essence, Bharucha said, he “won the jackpot.”
Isolated and confused
A nurse for 35 years with Dignity Health, Sonia took charge the Wednesday night they walked into the emergency room. That was March 4.
It was full, Sonia remembered, and the nurse who greeted them wore a mask.
“I looked at her and I told her, ‘My husband has a fever. He’s been diagnosed with pneumonia, and we were out of the country. I don’t think you want him sitting in the emergency room.’ ”
After waiting a couple minutes, the Vigils went into an exam room where a doctor assessed Darin and then told the couple that he would be tested for COVID-19. Deep down, Darin said, he already thought he had been infected. He can’t remember much beyond that.
Facing sharp criticism, the federal government earlier in the week had announced it would ease guidelines and allow more people to be tested for COVID-19. Testing gaffes were already roiling the health care industry, and that would continue as counties and states failed to meet demand and the virus spread from person to person, undetected.
They tested Darin, put him in a private ER space, and, within hours, moved them both to an isolation room.
Sonia, 57, donned a face mask and other personal protective equipment and slept in the room with her husband for two and a half days, watching as his lungs slowly lost their ability to pump out enough oxygen to his limbs and organs. With just three confirmed cases, Sacramento County declared a public health emergency the next day.
On Saturday, March 7, after four days of waiting, the test came back. It was positive, forcing Sonia to retreat to the couple’s home to self-isolate. She kept in contact with the nurse caring for her husband, whose breathing strained more by the hour.
“He was struggling,” Sonia said. “We were needing to increase the oxygen. He needed to go to the ICU.”
Bharucha said they typically attempt to increase the patient’s oxygen levels by inserting nasal cannula, lightweight tubes that go into the patients’ nostrils to pump in a mixture of air and oxygen.
If the patient still isn’t getting enough oxygen, they step up to a mask with a bag attached, similar to the ones that drop down on airplanes in emergencies. With the cannula, Bharucha said, they could deliver up to 6 liters of oxygen; with the mask, up to 30 liters.
The protocols and equipment continue to evolve as more is learned about COVID-19 and physicians have to regularly revise their treatment plans, Bharucha said.
Before Sonia retreated to her own isolation at home, Darin had asked her what might come next, if he wasn’t able to get enough oxygen. Sonia told him: ‘If you cannot breathe well, honey, they’re going to end up putting a breathing tube down you and put you on the ventilator.”
That first weekend in March, vast areas of Italy’s northern region, home to 16 million residents, began shutting down. The world watched as cases overwhelmed hospitals, and confirmed case counts globally ticked past 100,000.
Closer to home, a Grand Princess cruise ship with infected passengers waited in limbo off the San Francisco coast. School administrators in Elk Grove announced the first district-wide closure. California had 114 positive cases.
The state had yet to record a death linked to COVID-19.
CART teams keep airways open
Because COVID-19 patients can crash quickly and require ventilation, Bharucha said, Mercy San Juan had created two-person teams — one anesthesiologist and one registered nurse — to ensure that the intubation process went smoothly each time.
They refer to the teams as CART — COVID Anesthesia Resuscitation Team — and one of these teams was called to put Darin on a breathing tube rather than wait for him to crash.
“These patients have the potential to decline very fast. Their oxygen can drop down very fast. We want to take an extra precaution,” Bharucha said. “In a sense, we are trying to buy some time by giving them more oxygen to see if their process can stabilize.”
In retrospect, Bharucha said, the decision to move Darin to ICU on March 7 proved to be wise. His need for oxygen increased. He complained about worsening shortness of breath and chest pain. His fever could not be abated.
And shortly after Darin was hooked up to the ventilator, he crashed.
The medical team almost lost his pulse. They called a Code Blue, triggering the team to scramble to their places in case Darin went into cardiac arrest. That wasn’t necessary though, thanks to a dose of epinephrine, Bharucha said.
Sonia got a call at home to tell her what happened. Fear washed over her.
“At that point, it was introduced that he could be having some cardiac issues related to inflammation of the heart,” she said. “That was a really scary time.”
She had been married to Darin for three years, sharing her life with him for 10. In her 14 years as an ICU nurse, she’d seen how precious seconds without oxygen could affect a patient’s condition.
Sonia wanted to meet in person with Bharucha to discuss what the medical team should do if this happened again. But a March 10 test had revealed Sonia had also been infected with the new coronavirus.
“As a nurse, you think you’re prepared and you know what that’s going to be like,” Sonia said, “but when it’s your husband who’s 53 years old, and it’s your husband who you know is a healthy guy.”
She wasn’t ready to tell doctors not to try to save him.
Experimental treatment
Soon after Darin got to the ICU, doctors and staff sent an appeal to biotech giant Gilead’s headquarters in Foster City, asking for approval to get its antiviral drug remdesivir for Darin. Developed as a treatment for Ebola virus, remdesivir has shown promise in the treatment of COVID-19 and is being evaluated in a number of clinical trials.
Although Mercy San Juan sent their application to participate in trials after the close of the business day, Bharucha said, the company had approved them by the next morning. Bharucha said he was impressed with the turnaround, given the number of requests the company was likely getting.
After getting the OK from Gilead, the Mercy staff then applied for approval from the U.S. Food and Drug Administration and the medical center’s independent review board. IRB’s consider the rights and welfare of human test subjects. Both the FDA and the IRB gave the green light.
Chinese researchers have said remdesivir appeared to do a good job of inhibiting the new coronavirus. Doctors at UC Davis Medical Center also used the drug as part of a regimen that helped cure the Solano County woman who had the nation’s first community-transmitted case of COVID-19.
While waiting on approval for remdesivir, Bharucha said, the Mercy San Juan medical team administered the anti-malarial drug hydroxychloroquine to Darin.
President Donald Trump had touted the drug as a potential treatment, but like remdesivir, its efficacy is still being tested. In a French study released April 10, doctors examined health outcomes for 181 patients treated for COVID-19. About half were given hydroxychloroquine, and the other half were not. There was little difference between the two groups in the number of patients who died or were later admitted to the hospital’s ICU.
However, eight patients did develop abnormal heart rhythms after taking the drug.
Along with remdesivir, the Mercy San Juan medical team also gave Darin an immunosuppressant called tocilizumab. Developed in a laboratory, the biopharmaceutical treatment contains antibodies that inhibit inflammatory storms that can damage the lungs or other organs.
The trial drugs weren’t the only things in the slurry some have referred to as a COVID cocktail.
Darin was on a breathing tube for 14 days, so they gave him two or three medicines to keep him sleeping and one to keep him paralyzed. They laid him prone on his stomach for about 16 hours a day, Bharucha said, to reduce the pressure on the alveoli in his lungs, improving the tiny air sacs’ ability to absorb oxygen.
The medical team used drugs to stabilize his blood pressure when it dropped dangerously low. They fed him through a tube and used a catheter to measure how much urine he produced.
“His kidneys were supported, his breathing was supported,” Bharucha said. “His nutrition was supported, his blood pressure was supported.”
‘I wanted to be there’
Stuck outside the hospital, Sonia could put none of the skills she’d amassed over years of nursing to use. After Darin’s diagnosis, public health officials advised her to check her temperature. When she did, she was surprised to see she had a fever.
Then she recalled she’d had a headache and some mild body aches and pains.
She reported all the symptoms to the Dignity Health employee nurse.
By the time she received a coronavirus test March 10, her symptoms had disappeared, but she remained in self-isolation for the prescribed seven-day period following cessation of symptoms.
All told, she spent 19 days away from Darin, receiving updates only by telephone.
She watched as the world changed around her.
Limited gathering sizes. And then no gatherings at all.
A national emergency.
A statewide shelter-in-place order.
“Emotionally I cannot tell you how difficult it was, extremely difficult, especially being a nurse, I wanted to be there, be able to help him through it. But I couldn’t do that,” she said. “I had to be at home, be the one who was the strong point person for the whole family.”
She knew it was the right thing to do.
In those mid-March days, hospitals across Sacramento were scrambling for medical equipment, with some rationing masks and others reporting critically low supplies to the state.
She couldn’t risk becoming another patient. And she was still worried she might infect others.
Bharucha knew Darin would pull through as his oxygen levels improved, his lungs cleared, and finally, he pulled out his own breathing tube.
Later, as the effect of the sedatives wore off, Darin also pulled out his arterial line in his confusion, so Bharucha had to apply pressure to keep him from bleeding until nurses could come to help.
Darin said he can’t thank enough the nurses, doctors, respiratory therapists and other staff who worked to help him recover. He was groggy for a few days and thought he was hospitalized in South Lake Tahoe.
As he regained his strength in the ICU, he watched TV news and tried to catch up with the cascade of events that even well-informed people not sedated for three weeks struggled to comprehend.
Newscasters dwelled on the case counts and the hundreds of people who’d died while Darin slept. By then, new prediction models warned hundreds of thousands of people could die from coronavirus complications, with the pandemic slated to linger for months, even years.
It was overwhelming.
“That hit really close to home,” Darin said. “I stopped watching the news.”
‘Fighting monsters’
Darin returned to his Fair Oaks home on March 27. The day before, the U.S. had emerged as the country with the most confirmed cases of COVID-19 in the world and hours before the federal government issued a travel advisory to people leaving New York City.
He couldn’t believe how grim things had become, and the virus continued to shadow him. One of his last memories before being hospitalized was spending the night of Feb. 28 at a hotel near John F. Kennedy International Airport. Now, airports there were shuttered, hotels emptied and that city was being referred to as ground zero for the worst pandemic in a generation.
“When I got home and I started asking questions about what was going on in the world,” he said, “my wife started telling me, ‘Hey, the state’s on a lockdown. They don’t want people to go out unless it’s absolutely necessary. Tax deadlines have been extended. All sports events have been shut down.’”
“That’s when I started realizing what’s going on,” he said. “It’s still a lot to absorb.”
Darin needed to strengthen his lungs and learn how to fully breathe again. He worked to retrain his leg muscles so they could carry him around the block after atrophying during three weeks in bed.
That’s nothing compared with the mental exercises he now needs. While in the ICU, Sonia said, he dreamed of “fighting monsters” and trying to protect his grandkids. He had dramatic visions wrought by his near-death delirium. It’s not uncommon for sedated ICU patients, Bharucha said.
It can be a haunting and a particularly difficult part of recovery. Plus, some of the real-life events that transpired while Darin was sedated seem just as unreal to him as some of his drug-induced memories.
So, as they watch the daily developments and stay-at-home orders, he occasionally turns to Sonia with a common question these days.
“Did this really happen?”
The world he re-entered has made the river cruise and pyramid tours seem like ancient history.
This story was originally published April 27, 2020 at 5:00 AM with the headline "One nearly died, the other recovered from afar. How a California couple survived coronavirus."
