When news of COVID-19 infections spreading across China began to fill my newsfeed, I was brought back to my hospitalization with a viral infection in Hong Kong in 2015. I had recently moved to the city for a full-time job and was on my third week when symptoms started to appear.
The first symptom was a sore throat. A dull, aching sensation that made it slightly uncomfortable to swallow, but was not suspect of anything more than an indication that I was developing a cold. Over the next few days, a few more symptoms started to pop up — my ears felt full and achy; my body seemed more fatigued than usual; my appetite was nonexistent and waves of nausea would suddenly waft over me.
“It’s probably just the flu. I will work from home for a few days, drink some fluids and I should feel better soon,” I thought to myself. My condition would continue to deteriorate from there.
One night, I found myself unable to move and sobbing in pain on the cold floor of my service apartment. Something was terribly wrong and was getting worse by the day. I crawled to my phone and called my company’s emergency health service. The earliest the doctor at the hospital could see me was the next afternoon. I spent the night alternating between vomiting and crying.
Stumbling into a taxi the next day, I made my way to the hospital for my appointment. I distinctly remember handing the receptionist my ID cards and immediately running to the bathroom to vomit. When it was time for my appointment, the nurse took my temperature. She gasped. 40°C. That is 104 degrees Fahrenheit. My temperature would stay above 104°F for the next three weeks.
The doctor did a nasal swab — the kind that makes it feel like an alien is prodding your brain. He sent me on my way and told me they would call once my test results came back. My cell phone rang 45 minutes later. Come back to the hospital now was the message. I was quickly admitted to the hospital, going through my medications and medical conditions.
I told the admitting nurse I had ulcerative colitis and was on mercaptopurine (6-MP), an immunosuppressant medication to manage my disease. She told me that I was only the third patient with IBD ever treated at this hospital.
That first night was a complete blur. Two other patients were sharing my room with me and with my high fever, it was difficult to get any rest. My doctor came back the next morning and informed me that I had glandular fever (aka mononucleosis) resulting from an infection by the Epstein-Barr virus (EBV). Since the incubation period of EBV is between four to six weeks, I had been walking around with the virus long before I was symptomatic. Many people mistakenly believe that EBV is only passed through kissing. However, it can also be spread via sneezing, coughing or sharing eating utensils and drinking containers.
“Don’t worry,” said my doctor, “You will be discharged from the hospital in a day or two.” That would have been true if I had been a “normal” and healthy 26-year-old. However, as an immunosuppressed 26-year-old with a chronic illness, a day turned into two days, and two days turned into four days.
My condition was not improving. In fact, it was getting significantly worse. Doctors typically expect to see the white blood cells of a normal and healthy adult effectively fending off a virus such as EBV. The immune system’s success in fighting the infection would appear as antibodies and a high amount of white blood cells in a normal blood panel. In my case and with my immunosuppression, my white blood count was suddenly tanking. For perspective, while a healthy person’s white blood count is typically above 4,000 cells per cubic millimeter, my count hovered between 800 to 1200 cells per cubic millimeter.
Epstein-Barr is a member of the herpesvirus family, same as chickenpox and shingles, and when you’re infected, it stays with you for your entire life. While it sounds scary, over 95% of the population is infected with the virus by the age of 40. It is one of the most common human viruses in the world. Symptoms disappear with mild treatment of fluids and rest. It is rarely fatal. For those of us who are immunosuppressed and who have autoimmune diseases, the virus can be extremely dangerous. Young patients with IBD are five times more likely than the general population to develop viral infections that lead hospitalization or permanent organ damage.
In my case, my immune system, already weakened by the medication I take to treat my IBD, could not keep up with the onslaught from the infection. The virus was attacking my white blood cells faster than my immune system could replenish them.
My fever spiked at 105°F and an infectious disease specialist was called to take on my case. He said it was the worst case of an EBV infection he had seen in over 500 cases. Having little to no immune system, I was moved to isolation and everyone had to be masked and gloved around me. My specialist took me off of my 6-MP and monitored my blood work daily. Two and a half weeks into my hospital stay, my condition was not improving. I remember crying to my parents that I did not want to die in another country.
The turning point came when my specialist started me on infusions of intravenous immunoglobulin (IVIG), a lifesaving treatment that pools the plasma and antibodies from healthy donors’ blood to help the immune system fight off infections. Since the majority of healthy people have already had an Epstein-Barr infection, most being asymptomatic, pooled plasma from healthy or recovered individuals already have circulating antibodies against the virus. IVIG is one of the treatments that scientists and doctors are looking to utilize to treat deteriorating patients with COVID-19. Their goal is to confer immunity (called passive immunity) to the hospitalized COVID-19 patients by taking the antibody containing plasma from recovered patients.
After four infusions of IVIG, my fever broke and my body started to produce my own antibodies to the virus. I was cleared for medical transport back to the U.S., where I spent a few more days in the hospital and three months recovering at home. Five years later, my body still has not fully recovered.
Whenever I hear someone brush off today’s global pandemic around COVID-19, I point them back to my own experience in Hong Kong many years ago. I remind them that Epstein-Barr, a commonly found virus that over 95% of the global population is eventually infected with, almost killed me. Imagine what a novel virus, one clinicians have never treated before, could do to me and others like me.
Yes, there is a lower likelihood that COVID-19 will be fatal to anyone who is young and healthy. However, it could be devastating to the elderly, to those with chronic heart or respiratory issues, to those who are diabetic and to those who are immunocompromised. Please help protect your communities, your neighbors. Please help protect me. I have a lot more life that I would like to go on living.
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