While helping patients with infectious diseases such as AIDS for years, epidemiologist Mike Saag, MD, director of the Division of Infectious Disease and the Center for AIDS Research at the University of Alabama at Birmingham, had never experienced a potentially deadly virus himself.
His experience with contracting—and subsequently recovering from—COVID-19 has given him a firsthand perspective on treating and researching the disease.
Saag reveals the details of his COVID-19 illness, along with the University of Alabama’s new research on the disease in an interview with Physician’s Practice.
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PP: How and when did you contract COVID-19?
Saag: My son and I were driving back from New York on March 12 and 13. The morning of the 13th, we stayed overnight because my son wasn’t feeling well. We took his temperature and it was 102. We said, “We know what you got; let’s go into quarantine.” I drove most of the way back to Birmingham and we went into our independent rooms. I stayed there for 23 days.
PP: What were your symptoms and experience with COVID-19?
My initial symptoms included not feeling well, malaise, headaches, a minor cough, a runny nose, and body aches. I tested positive for COVID-19. By the fifth day, my son had already gotten well, and I felt good. But, that evening, a fever started, which started a relentless recurrent pattern of fever, malaise, bad headaches, inability to think clearly, and a worsening cough.
I would feel good, and then the next afternoon/evening, it would come roaring back like Groundhog Day. I didn’t know how long it was going to go. The biggest psychological hurdle was the knowledge that, at any moment, I could get short of breath and have to go to hospital. When I was feeling that bad in the middle of the night, I would check the pulse oximeter and it didn’t drop below 90 percent.
PP: What kind of treatment did you seek?
After the second day of fever and the second Rod Serling [creator of Twilight Zone] night, the first hydroxycholoroquine report came out from France. Twenty people were treated. Some got hydroxychloroquine plus azythromycin (Zithromax, Zpack) and some got hydroxychloroquine only. The shedding of virus levels came down fast for the hydroxychloroquine group and even more so for those taking the two drugs together.
I checked with several colleagues who said, “Go ahead and try it [hydroxychloroquine plus azythromycin).” I don’t know if it helped, but it didn’t seem to hurt.
After my head was clear and I had a chance to read more of about it, I learned that the drug combination can cause fatal heart arrythmias. I was a little ashamed of myself. I understood after working with stage 4 cancer patients and AIDS patients in the early days that they are going to reach out for anything when they are experiencing that pain. I had never experienced that myself.
PP: Would you recommend other patients take hydroxychloroquine, with or without azithromycin?
I would recommend that patients take it as part of clinical trial. We didn’t have a study then, but we started a study [at the University of Alabama, Birmingham) on hydroxychloroquen plus azythromycin. It will be for patients with symptoms who are not requiring hospitalization—someone like me.
PP: Should antibody testing be universal before we re-open businesses?
Even more important than antibody testing is the ability to do case contact tracing for the virus. It’s what we should be establishing now, and a lot of states are heading towards that. That is exactly what we do with tuberculosis now: that person—the index case—is tested and treated. You then evaluate who they have been in close contact with and you isolate and test those people. If you have them isolated for 10 to 14 days, it keeps people who are about to become sick from mingling in the population.
Why is that important for COVID-19? The virus starts to approach peak transmission around 12 hours before someone develops symptoms. So, if we are letting people back to work and opening up restaurants, that person could go out to a meal and feel perfectly fine. Then, at 2:00 a.m., they feel sick. When they were out, they were shedding the virus like crazy, and most of the people were getting sick. He or she could have infected 30 other people.
PP: So, do you believe we should wait to re-open restaurants and other businesses?
I understand clearly the pain caused by the stay-at-home restrictions. There is an enormous amount of psychological and economic hardship that everyone is going through. People are tired of it. They want to get back to the way things used to be.
The stay-at-home approach has worked to a large degree. We had flattened the curve because of the patriotic engagement of the people of the United States, but relaxation of that without a public health infrastructure to support us as we release these stay-at-home orders will most surely put us back to where we were in March. Between 95 percent and 98 percent of the population has no immunity to this virus still. This virus is here. We have to be smart.
PP: What would you like physicians to know about COVID-19?
Start getting adjusted to this new way of life. We are in this for many, many more months. It’s not going to go away quickly and easily. The general public is having trouble embracing that. Providers and physicians need to begin preparing for it.
There is going to be a lot of hardship. I think we need to be looking at it through the lens of the Great Depression. We are okay with the short-term, but I don’t think anyone is prepared mentally or technically for this going on for months, so we need to adjust our thinking.