Virus Story: Rare things happen.

Americans have been drafted into the war on COVID-19

No pay. No barracks. No mess hall. No GI Bill. No health care. And some people get very, very sick.

Click: new and confusing

Some people in the prime years of their work life are draftees into the COVID-19 war. They lose their jobs, income, and health insurance, if they had a job with health benefits. They are sacrificing for the benefit of all of us, especially older, more vulnerable people. 

Boomer readers who notice mask-less young people, and protesters restless to go back to work can remember how they felt about the draft back in the Sixties. Possibly they, too, were draft resisters back in their youth. As back in the Sixties, some people think the war effort is overdone and immoral. Some places, like Jackson County, Oregon where I live, a county of 200,000 people, had two new COVID-19 cases in April, and no deaths. Few people wore masks in the grocery store I visited this morning and no customer other than me wore one in the farm supply store where I bought irrigation equipment. Many people here act as if this is a theoretical risk, not a real one, with the battleground far away, in New York, New Jersey, or in jam packed factories elsewhere.

Meat processing plants are considered essential. That means packing plants stayed open until the companies themselves closed them amid skyrocketing numbers of new cases. Tyson has plants in Iowa with up to half the employees testing positive. The Commerce Secretary told Tyson they feed America and directed them to re-open. Employees are directed to come to work and if they do not, they lose their unemployment benefits. It isn't considered an occupational injury if they get sick, just bad luck. Republicans in the US Senate are adamant that any new relief legislation will include blanket liability immunity for employers if their employees get the virus.

The casualties in this war are on their own.

This blog's comments on health care motivated one reader, Robert Mann, to report on his own experience with the American healthcare industry, his case of shingles. Like with COVID, much of the time the illness is temporary and survivable. I had many clients over the years who got shingles, were very uncomfortable for a while, and then got better. Sometimes things go bad.

As readers mentally calculate their chance of getting the COVID-19 virus and their likelihood of dying, Mann's story reminds us that one does not get 3% sick. Instead 3% of us get all the way sick, and die. Mann survived, and can write about it.

Mann grew up in Medford, studied Russian at the U. of Oregon, U. of Kansas, and at Cal Berkeley, and has taught Russian language and literature.

Robert Mann:  Story of my illness

I only had a vague notion of the shingles virus. I knew it was a painful skin rash that afflicts old folks and sometimes returns for an encore. Near the end of August, 2019, I started to experience pain and itching in the right side of my neck and around my ear. By Labor Day it had grown worse, so I went to the ER at Shands Hospital, the teaching hospital of the University of Florida. They performed a CT scan and did some blood tests but found no evidence of inflammation. I left with a report that ended: "No Diagnosis." 

As the ER doctor suggested, I went to primary care physician. He wanted to prescribe me an antibiotic. I protested that with no evidence of inflammation that could be a very bad idea. He responded with an arrogant "Well, do you want to get this taken care of or not?" Against my better judgment I acquiesced. He injected me with an antibiotic and a steroid and prescribed two weeks of an oral antibiotic. My condition deteriorated fast. Within a few days I was losing my ability to swallow and talk. The pain was creeping down to my collarbone and over my right shoulder. I returned to my doctor in a weakened, exhausted state. My weight had fallen from a lean 180 to 145. But my doctor offered nothing. 

Soon I returned to the ER, hoping at least for IV hydration. On the verge of delirium, I was admitted to Shands Hospital. After four days doctors had no idea what the malady was. They performed an endoscopy against my protests that my digestive tract was fine. They ran several Xrays. Still no diagnosis. 

My family pulled me out of Shands and took me to the hospital in Jupiter, Florida. The team of doctors assigned to me lacked an infectious disease doctor, and there was a delay of around a week before an I.D. physician joined the team. By now it had been over a month since the onset of the disease. All the doctors, like those at Shands, were stymied and kept running various tests despite my protests. But by mid-October the blood tests had detected Varicella Zoster virus, the shingles virus that lurks dormant in your nerves until your immune system is compromised by old age. 

Doctors were still confused by the symptoms. They had never encountered vocal cord paralysis caused by VZV, and I exhibited no nasty rash, which they believed to be a telltale symptom of shingles. Even before the diagnosis, they poked a hole in my belly and stuck a feeding tube inside to ensure that no liquids might go down my trachea, causing pneumonia. (Epiglottis and vocal cords are the last barriers to protect the lungs.) 

In mid-October they began to administer the standard antiviral acyclovir. My condition improved somewhat, and I was transferred to an old folks home that they called a "rehab center." In the hospitals, I had been subjected to umpteen tests - spinal tap, MRIs, CT scans, X-rays, endoscopy, swallow test, blood tests.

After about ten days at the "rehab center" the acyclovir ended and my condition worsened. When I checked out after three weeks, my weight had fallen another ten pounds: 135.

After going home, I searched for "Zoster + vocal cord" on the internet and found four reports of my "presentation" of the shingles virus, voiceless and no rash. It is extremely rare. Patients who were immediately treated with acyclovir recovered within a year, but it must be administered within about three weeks. I was given the antiviral six weeks after the onset. Doctors give me no prognosis for recovery.

But I survived and now weigh 152.  The pain in my head, ear, neck and shoulder has never abated and seems to be worse than before. I am extremely weak. I tire after minor exertions. 

Everyone who had chicken pox should seriously consider signing up for the shingles vaccination. It's not a magic bullet, reducing one's chances of contracting shingles by about fifty percent. And it can actually boomerang, bringing on the shingles syndrome. But bear in mind that VZV can be a paralyzing, debilitating disease. 

The team approach used in hospitals is potentially a flawed system although it has been adopted in hospitals around the world. Its effectiveness depends on how conscientiously it is implemented. In my case, I feel that this standard approach to patient care contributed to failure. None of the doctors on the team assumed the responsibility to do his homework, to research the rare and perplexing condition.

If you develop symptoms of shingles, don't postpone going to the doctor--ad our profit- based system leads many of us to do. Anti viral drugs must be administered immediately to be effective.