“I went upstairs to brush my teeth, and I’m like, well, I’ve got to lay down,” said Guiney. “It was like all the energy just drained out of me.”
Then came the clammy skin, the chills. Guiney had COVID.
A course of COVID
The week of Thanksgiving, Guiney, an emergency room doctor at Harris Regional Hospital, worked Monday, Tuesday and Wednesday — he has his guesses about how he may have contracted the disease, but really he could have gotten it anywhere. The doctor’s lounge, a COVID patient’s room or even from an asymptomatic person there for some unrelated reason.
To be honest, he was surprised he hadn’t contracted the disease earlier. Guiney encounters the virus on a fairly regular basis these days. Of course, when he’s working closely with somebody who is known to be contagious, he wears full PPE, but not everybody who has COVID knows they have COVID. It’s impossible to wear full protective gear all day long, so much of the time Guiney’s just wearing a surgical mask.
Luckily, Guiney had a moderate case of COVID. His vitals stayed strong, and he didn’t require hospitalization. Still, it was an ordeal.
“Every viral symptom you can think of, I get it, and it doesn’t come all at once,” he said while still in isolation Dec. 3. “It’s a progression.”
First there was the low-grade fever, the exhaustion, the tight chest. Then the congestion, a stuffy, runny nose. Interestingly, he never lost his sense of smell or taste. Not everybody does. By Saturday, he was feeling a lot better and figured he was about done with being sick.
“Then on Sunday things all of a sudden took a turn, and I was really short of breath and really coughing hard,” he said. “It was really weird. That was the only day I was actually worried.”
He was feeling some level of anxiety the whole time, however — wondering, will this remain a moderate case of COVID, or will things suddenly get worse? You never know with COVID. Guiney has seen patients come in who are holding their own, even getting better, and then suddenly wind up on a ventilator.
“You start worrying, what course am I going to have? Am I going to have a bad course or am I going to have the typical, predicted course for me?” said Guiney, who as a healthy 52-year-old non-smoker had a good chance of a positive outcome.
As Guiney started to feel better, though, the worst part of his diagnosis became apparent — the isolation. Guiney is an emergency room doctor, a Sylva town board member, a mountain biker, a husband, a father. In short, a busy guy who likes to stay in motion. Somehow, both his wife and daughter had escaped the virus, which meant that he had to spend 10 days in his bedroom, alone. His wife brought his meals to the door and he read his daughter bedtime stories on Facetime. He could hear his family downstairs, but he couldn’t see them. On Tuesday, Dec. 8, he was finally allowed out of isolation — it was a happy day.
At least, he said, he had a family to take care of him, and an employer who would work with him to make up for lost shifts. There are plenty of people for whom a 10-day isolation period would be emotionally and financially devastating.
“The loneliness thing, I think that’s the take home from the whole pandemic,” he said. “We think of all the folks in the nursing homes who have basically been locked down. They can’t see their families. It’s awful.”
Back in April, when the pandemic was just beginning, Guiney told The Smoky Mountain News that life at a hospital carried an ominous, “calm before the storm” kind of feeling. As headlines told of death and despair in places like New York City and Italy, case counts remained low in Western North Carolina. Not only was the emergency room devoid of COVID cases, it was devoid of most other kinds of cases too — people were staying home, getting into fewer accidents and passing fewer germs, and it’s likely that folks who really should have seen a doctor were putting off seeking help, scared of catching COVID.
Now, the situation is quite different. When Guiney spoke with SMN in April, only 15 cases had been confirmed in all of Jackson County. That number had increased by two orders of magnitude to 1,564 as of Dec. 7, with 155 people in isolation for active infections. It’s a similar story in neighboring counties. Haywood County has had 1,315 cases with 213 people in isolation, and Swain has 467 total cases with 40 in isolation. Macon County had 1,009 total positives with 54 active cases.
The increase in cases is translating to an increase in hospitalizations. As of 6:30 a.m. Thursday, Dec. 3, for instance, the Mission Hospital system was keeping 64 people with positive COVID-19 tests at Mission Hospital in Asheville, two at Angel Medical Center in Franklin, and one at Highlands-Cashiers Hospital in Highlands. An additional 17 were being treated at Mission hospitals further east. Wind back the clock seven months to 5 a.m. Thursday, May 7, and there were only four COVID-positive people hospitalized across the entire system, all in Asheville.
At Haywood Regional Medical Center, July was the first month when COVID-19 patients were consistently present at the hospital, with an average of three hospitalizations per week. In November that figure jumped to seven hospitalizations per week. The increase in cases prompted HRMC to suspend visitation for inpatient, outpatient and emergency room patients, effective Dec. 7.
“So far, our staff have responded very well to the changes we have experienced —working together as a team to keep our patients and themselves safe,” said HRMC CEO Greg Caples. “We have adequate levels of PPE and do not expect to experience any shortages. We are here for you when you need care.”
Across the 17 western counties, 113 people were hospitalized with COVID-19 as of Dec. 6 according to the N.C. Department of Health and Human Services, with that figure trending sharply upward since Nov. 27, when 68 people were hospitalized. Statewide, 2,240 people were hospitalized as of Dec. 6.
Cases are rising, and the hospitals are seeing more demand for COVID-related care. But, said Guiney, local hospitals have not to date gotten the crazy rush they were expecting when the news from New York started to come out. Of course, that could change, and perhaps already is.
“Now in the last couple of weeks we’ve really felt an uptick where it’s, ‘Here we go, is this it, is this where we’re going to get crazy?’” said Guiney. “We definitely started to see more COVID.”
Making it to May
While COVID cases are increasing, mortality from the disease appears to be going down. According to a research paper published in the Journal of Hospital Medicine in October, 25.6 percent of COVID patients at a three-hospital health system in New York died from COVID back in March, but by August that percentage had dropped to 7.6 percent.
“Data from one health system suggest that mortality from COVID-19 is decreasing even after accounting for patient characteristics,” the paper’s abstract said.
According to Guiney, that’s due both to doctors getting more comfortable with treating the disease and to various virus prevention methods succeeding in flattening the curve.
“We got better at taking care of those patients throughout the months since April,” he said. “We’re not as quick to intubate them. The high-flow oxygen stuff works much better. We know what to look for, so we’ve gotten more comfortable with it.”
That said, there is still no cure for the virus. And should the hospital get a massive influx of patients that strains its ability to care for each individual, outcomes might not be as good as they are now.
“There’s only so many of us, and when things start coming, we get overwhelmed. You just can’t keep up with everything. It’s just not possible,” he said.
Guiney said he worries about how a COVID surge might impact patients whose ailments have nothing to do with the virus.
“Aside from eliminating human suffering, the big thing really is to make sure that someone doesn’t needlessly die in the waiting room from a heart attack or a ruptured appendix because the place is full of COVID patients and there’s nowhere to put anybody,” he said.
The irony is not lost on Guiney that he got sick with the virus mere weeks before a vaccine likely would have granted him immunity. As a frontline healthcare worker, he would have received one of the first doses. But that just goes to show how important it is for people to continue taking the virus seriously until the vaccine is distributed. That’s why he decided to tell his story publicly, he said — not to garner sympathy but rather to urge the public to do their part to protect others.
“It’s always darkest before the dawn,” he said. “We know dawn is coming for pretty much everybody by around May, but until then, it’s who makes it to dawn. And that is completely dependent on us taking care of each other and taking responsibility that comes with the freedoms we have. That’s the real trick about the whole thing.”