While much of the coverage of the coronavirus pandemic has rightly focused on its rising death toll, the overwhelming majority of those who contract the disease ultimately recover from it. Although their experiences of the disease can vary widely—from no symptoms at all to ICU visits—these people are asking themselves similar questions after the virus runs its course: What comes next? Am I now immune—and for how long? Why did I survive while others did not?
On this episode of Social Distance, Katherine Wells calls two of her friends who have recovered from COVID-19—Karan Mahajan, a writer and professor at Brown University, and F. T. Kola, a writer and Stegner fellow at Stanford University. They share their experiences with the disease and ask James Hamblin a few questions about their future.
Listen to their full conversation here:
What follows is an edited and condensed transcript of their conversation.
Katherine Wells: Tell me when all of this began.
F. T. Kola: We got together for a friend’s wedding in Miami during the last weekend of February.
Karan Mahajan: It was before America really became cognizant of the scale of the COVID-19 crisis.
Kola: I had been following the virus really closely, but it felt like a thing that was coming rather than a thing that was here.
James Hamblin: How long after the wedding did you start to think something might be wrong?
Kola: I flew back to San Francisco on March 3, and I was fine until March 6. That night I started to feel a little bit off. I had a mild fever, but at that point, the possibility that it might have been COVID seemed extremely unlikely to me.
Mahajan: I returned to Providence on March 3, and I returned to teaching on the fourth. At the end of those few days, I started to think I’d come down with a flu of some kind. I had body aches and fatigue.
Hamblin: At what point did it get bad enough for you to seek testing and care?
Kola: Over the weekend, it gradually got a little bit worse. That Monday, I tried to pack my dishwasher and tidy up my kitchen a little bit, and it felt like I’d done a workout. So that day, I had a videochat with a doctor who said that she thought that she could hear pneumonia when I was speaking to her.
She said that the next day at lunchtime, when there would be the fewest people at Stanford Express Care, I should put on a mask, come down to Stanford, and wait in my car. I had not had contact with a confirmed COVID case, but I think they decided to test me because I have type 2 diabetes, which is a comorbidity for COVID-19.
I remember waiting in my car, and the doctors in their really intense PPE coming towards me. It felt like a scene out of Contagion. After my test, I went to sleep, and I had the most intense chills of my life. My teeth were chattering so hard that I was afraid they would break.
And then I started to hallucinate. I thought that my sister, who lives in Brooklyn, was coming into my apartment to take care of me, and I had this repeated conversation with her over and over again.
I woke up to a phone call telling me that I had COVID. I was really shocked. And the clinician from the San Francisco Department of Public Health said, “I think you should be in the hospital.” And they told me to sit tight and wait for an ambulance, which would come to pick me up.
Wells: Karan, what was going on with you?
Mahajan: I started to self-isolate that Friday. I canceled my classes for the week. I was tired, and I started to lose my sense of taste and smell in a way that I’d never experienced before. Eating pizza was like eating cardboard. But the university, at that stage, had not taken any steps. And it wasn’t until March 13 that the university decided to send students home.
I called up the Brown University nurse hotline. I was then told to call the Department of Health in Rhode Island, but I only got the voicemail a few times. Eventually I got a call from the Department of Health. My symptoms were never that serious—I never had a high fever, for example—so the people at the Department of Health seemed a little casual until they heard about F.T.’s case. Then they said that my wife, Francesca, and I would be tested the next day.
Francesca and I drove out, and there was a hazmat tent and three health-care workers in hazmat suits and masks. They came up to the car and took swabs from our mouths and noses as we proffered our heads out of the car. About 20 hours later, on Friday evening, I got a call from the Department of Health saying that I had tested positive and my wife, miraculously, had not tested positive.
The next day, I had a very long conversation with the Department of Health and a CDC doctor, in which they reconstructed everything I had done over the past 10 days since I’d come back from Miami and become symptomatic. Which was like being subpoenaed or something, where all your movements are suddenly imbued with this negative meaning.
My case ended up feeling like a mild flu that lasted for two weeks. And then it faded after that.
Hamblin: F.T., talk about how your experience contrasted with that.
Kola: They took me into the ambulance. The EMT had lab goggles on, and they were filled with sweat. And he kept apologizing that they were filled with sweat. And I kept apologizing to him that he was coming into contact with me. It was this apology extravaganza as we traveled through the streets of San Francisco to UCSF. That’s where my subsequent two-week stay in the hospital began.
I remember saying to the nurse, “I’m so sorry that I’m here. I’m so sorry.” And she said to me, “You don’t have to apologize. You’re very sick.” And I remember thinking, Oh, am I?
The virus was like a werewolf or a vampire. During the day I felt mostly fine. But like clockwork at five o’clock, the fever and the chills would hit and the nurses would just pile blankets on me, put heat packs all around me, and I would feel like my body was made of ice.
This was between the 11th and 16th of March. March 16 was my day 10 of the virus. That night I was particularly hit hard by it. And the next day they took me to the ICU and put me on six liters of oxygen.
Hamblin: That’s a lot. It’s about as much as you can give someone before you need to use some other form of oxygen delivery or intubate someone.
Kola: I realized in retrospect that at that point I’d already had moderate hypoxia, and I’d already had sepsis. But I didn’t know that I had had those things. And I was ultimately lucky. I stayed in the ICU for three days on that six liters of oxygen and didn’t deteriorate further.
Then on March 19, they moved me to a newly created COVID-only ward. I was slowly weaned off the oxygen until I could breathe on my own. Then they discharged me and took me home in an ambulance.
Wells: What did it feel like to have no human contact beyond a person in a hazmat suit for those weeks?
Kola: The aesthetic experience of it was really terrifying. I was also acutely aware that every time the hospital staff came into contact with me, they were putting themselves at risk. That was quite traumatizing.
But everyone I came into contact with went to incredible lengths to humanize the experience. When I was in the ICU and very weak, I had nurses who were wiping my body free of sweat, who were standing over me and counting my breaths. X-ray technicians who were managing somehow to take an X-ray without moving me. Even the men and women who cleaned my room would ask if I was okay, if I needed anything, even though they didn’t have to.
The kind of care that was given to me by the doctors and nurses and hospital staff really humbled me. I kept thinking of it as a kind of radical love, to care for someone you don’t know, who’s not related to you, in these incredibly intimate ways. To care for them at great risk to yourself. It felt like the closest thing to grace that I’ve experienced.
I was lucky to have the space and resources and equipment at a hospital that was prepared to deal with this.
Wells: What does it feel like to be on the other side of this?
Kola: The uncertainty has caused me a significant amount of anxiety. No one has been able to tell me, with any certainty, that there is immunity. Or how long the immunity might last, or what form it would take. Then there’s the question of viral shedding: Am I still shedding this virus in some way?
The thing that has been most anxiety producing is not knowing if there is any long-term damage from this. And there is the inherent trauma of being ill, of coming close to dying. That is exacerbated by the way in which everyone in the world, even the people who are not infected, are experiencing the trauma of the virus. So it doesn’t feel like a clean recovery in any way.
Mahajan: I’ve been proceeding on the assumption that I’m not immune.
Wells: Jim, what do we know about immunity?
Hamblin: Most viruses do cause at least a short-term adaptive immune response. That’s different from your innate immune response, which is where the civilians of your immune system gather their pots and pans and hammers and torches and take to the streets to try to fight off this thing. The adaptive immune response refers to the antibodies that take weeks and months to populate your body. It’s an open question how long those antibodies last and whether you develop enough to be fully immune.
There was a study this week that came out of China, not peer-reviewed, that suggested that many people might not have enough antibodies [to combat reinfection]. So it’s not a binary question of whether or not you get them.
I think it’s safe to continue living as though you are not immune. But if I had to bet, I’d put money that you are, at least for a while.
Wells: What is a while? Weeks, months?
Hamblin: It’s impossible to say. It could be years.
Kola: What about viral shedding? How long are people shedding the virus after they recover?
Hamblin: After you’re no longer feeling bad, you’re very likely not infectious. Just wait a few more days after that before getting back in the same spaces as the rest of your family.
Wells: Is reinfection possible?
Hamblin: It seems extremely unlikely. It seems that, when it has appeared to have happened before, there was really just a false negative in between two true positive tests.
Wells: When will we have an antibody test?
Hamblin: Really soon. The FDA just approved one a week ago. It’s approved and recommended by the World Health Organization in a research capacity so that we can understand how many people might be immune.
Wells: There is this idea that once we have the antibody test, we’ll be able to know who’s safe, and those people can restart life. That we’re just waiting for the antibody test to be able to return to some semblance of normal life. Is it more complicated than that?
Hamblin: Everything’s more complicated than that. You’ll want to make sure that that test is really specific, so that if you test positive, you’re 100 percent certain you have the antibodies. And you need to know that the antibodies last for a meaningful period of time.
You also have to have sufficient numbers of those antibodies to be meaningful. The tests you’ve seen going around look almost like pregnancy tests; they give a simple yes or no. Ideally, that’s all we’ll need. But we might need to know that you have a certain number of antibodies in order to be safe. All we can say from the current antibody test is that you have been exposed to this virus.