Sapna Kudchadkar, MD, PhD, a pediatric critical care physician and anesthesiologist at Johns Hopkins, initially thought the muscle aches might just have been the result of a long week on service.
Still, another physician on her team had recently tested positive for COVID-19, so when a low-grade fever set in, she asked for a test.
Within 24 hours, on Sunday, March 22, her results came back: she had coronavirus.
Over the next two weeks, Kudchadkar fought off a disease that she says was unlike any other she'd ever experienced.
"With the flu, you're down for the count but it's relatively short lived. You feel horrendous, but then you're fine in most cases. With COVID, the symptoms are extremely intermittent, and when they're present, they're debilitating," Kudchadkar told 鶹ý.
She's now done with her quarantine and recently re-joined her colleagues in their fight against COVID-19, and wanted to share her message with other coworkers: you can beat this, you can get back to work, and you'll contribute to important research efforts.
Crackling in the Lungs
"I fall in the spectrum of mild disease," Kudchadkar said. She experienced myalgia and low-grade fever starting on days 1 and 2, respectively.
By day 3, the cough started. First, it came every few hours, then it worsened. "By day 4, when I took a deep breath, it hurt, and could feel crackling in my lungs. If I'd had a chest x-ray, there would be findings. But when I was at rest, I was okay."
Her fever subsided by day 5, but that's when the anosmia set in. "I couldn't smell anything, and nothing tasted good, so I didn't have enough appetite."
The cough lasted for the next 5 days, and it was "significant, and deep breaths were hard. I would take deep breaths to keep my airways open."
During that time, Kudchadkar also had intermittent fatigue that sent her crashing. "You feel okay, then suddenly, you just want to sleep."
"I thought I was going to be so productive, that I would be able to sit and write papers, but I couldn't bring myself to do anything," she said.
That wasn't just a result of the fatigue: the isolation from loved ones also fed into her lack of inertia, she said.
"By day 10, I was in a pretty dark place," she said. "Having human touch and contact is so important to the psyche. I know this from my ICU research, but personal experience is so different."
"It was really hard on my kids," she said, noting that her 14-year-old-son is no longer much of a cuddler, but her 11-year-old daughter likes spending a lot of time with her mom. "Neither of us anticipated that emotional impact. It took her until day 12 to break down on Zoom, saying, 'Mommy, it's so hard not being with you.'"
She also worried about the rapid, severe worsening she'd read about in other patients, often happening around day 9 or 10.
Stopping the Spread
That was one of the reasons Kudchadkar decided to stay at home and isolate herself during her illness, rather than living somewhere else, away from her family.
"We thought through this deeply ... and decided that because of the potential for my own clinical condition to worsen that this wasn't the time for me to be by myself," she said. "I needed to have people around me who would be there to help."
She was able to isolate herself in her bedroom and have no contact with others. Her family would leave food at the door, but she'd only open it after they were long gone. She only saw her husband and kids on video chats, or watched them playing in the backyard from her window.
Kudchadkar believes their cautious, conservative approach is what prevented any of them from contracting the virus. She had been staying away from them as best she could even before she'd gotten sick. She would wear different clothes to work, change in the office, change before coming home, and shower as soon as she'd get home.
Even though she had seven family members living in her house while she worked that first week -- her brother, sister-in-law, and their 2-year-old child in addition to her own husband and kids -- no one else developed the disease.
On the day she started having symptoms, she began her 2-week isolation: "I came home and went straight to my bedroom, and didn't interact with family."
She added that she was lucky that Hopkins provided adequate access to personal protective equipment (PPE), and even despite that she believes she was infected by her co-workers because they often have to be close to each other to do procedures.
Out of the Woods
Ultimately, Kudchadkar escaped the symptomatic and psychological nadir of her illness, pulling through by day 12, when the fatigue had completely ebbed and she could even do yoga in the morning.
She didn't need much medication during her illness, she said, only Tylenol for the fever. At the time, there was some concern about ibuprofen, and while not proven, she opted for a conservative approach. She also took a multivitamin for its vitamin D content, as there'd been some evidence that deficiency was related to worse disease, in line with her lowest-risk approach.
She captured the moment on day 14 when she was finally able to emerge from her room and see her family in person again in a . She'd been posting updates under the hashtag #SapnasCOVIDDiary.
While she was mostly glad to be free, she also had some reservations. She wasn't able to test again to confirm a negative result, as tests were being reserved for identifying cases. "So I didn't know, am I okay to hug my kids now? For about 3 days after coming out of isolation, I still didn't hug or kiss them."
Now that she's potentially immune, she's also the designated grocery shopper, though she still wonders how concerned she should be about potentially exposing others.
"There are case reports that some people got infected a second time, and we still don't know enough about the immunity trajectory of this disease," she said.
That unknown is especially relevant now that she's re-joining the front lines, switching from pediatric to adult ICU.
Back to the Front Lines
"I have my own internal anxiety about taking care of a patient population that I haven't cared for in a while, but at the same time I'm so ready," she said. "I have a lot to offer because I'm potentially immune. I'll still use PPE, but I'll have a little less anxiety about my personal health."
She'll still leave her work clothes at work, and immediately shower when she returns home. She'll also wear a scrub cap and remove jewelry -- avoiding anything that the virus could potentially stick to.
Her pediatric ICU experience will be valuable for COVID patients, she says, because "we are used to managing low sats in the PICU," referring to the severe hypoxia that's a hallmark of the disease.
"In cyanotic heart disease, we see kids with pulse ox saturations in the 70s or 80s all the time, and we generally only intubate when we see increased work of breathing or poor perfusion," she said. "It can be alarming to see patients with sats in the 70s, just sitting there talking to you, looking fine, but we're used to that in PICU."
Prone positioning -- which is becoming important even for non-ventilated patients with COVID -- is also commonly deployed in the PICU.
Kudchadkar is also eager to get involved in research, though she usually plays the role of investigator, not study subject. She'll donate to a convalescent plasma multicenter trial for which Hopkins is one of the main sites, and will donate blood relatively soon for research on acute-phase antibodies.
Those contributions make her feel there was more of a purpose to her difficult weeks of isolation, when she felt she "wasn't contributing."
"But I realize how much I prevented," she said. "By doing my part to stay isolated at my home, and having my family stay at home, it encourages others to do the same. That's our job as medical professionals, to educate."
"Everyone across the world is struggling, hopefully with this once-in-a-lifetime event," she said. "It's a shared experience and we need to talk with each other to make sure we all understand the WHY -- that's it's for the greater good."