By Melba Newsome
As the number of COVID-19 cases ticked up last fall, Douglas McClain’s wife and mother convinced him to take a flu shot for the first time ever, believing it might offer him an extra measure of protection against the coronavirus. A few days later, the 53-year-old Charlottean developed typical flu symptoms that got progressively worse and forced him to take a few days off from his finance job.
Out of an abundance of caution, McClain took a COVID-19 test. The results were positive.
Then he started to get really sick. He lost his appetite, suffered extreme fatigue and was gasping for breath. On Sept. 19, he finally decided to go to the emergency room near his home in South Charlotte, thinking the medical staff would recognize the severity of his condition and treat him accordingly.
He could not have been more wrong.
McClain’s wife drove him to the ER around 9:30 in the morning and waited in the parking lot while the medical staff checked him in and gave him a chest X-ray. Then, they put him on an ER cot, hooked him up to a pulse oximeter and left him unattended for several hours. At the time, McClain didn’t know that an oxygen saturation level below 95 was a reason for concern and below 90 required medical intervention. The alarm went off repeatedly as his oxygen levels dipped into the 70s and 80s.
It was early afternoon before McClain had a chance to speak with a health care worker.
“I asked her why nobody ever came to check on me when the alarm kept going off,” he recalls. “She said ‘I saw you go to the bathroom so I figured you were OK.’”
Hours later, another nurse nonchalantly told McClain his x-rays showed mild inflammation in one lung, handed him a prescription for steroids and sent him home.
The cost of being dismissed
Decades of research shows that Black patients receive inferior medical care to white patients. The pandemic has placed that phenomenon in stark relief. There are countless reports of Black and Brown people having their symptoms dismissed or being turned away from emergency rooms and hospitals despite exhibiting severe signs of COVID. These treatment disparities, in addition to lack of access to quality care, account for the higher infection rates, illness severity and deaths among people of color.
When McClain returned home, his condition continued to worsen. He labored to get up the stairs, walk down the hallway and even get into bed.
“At that point I couldn’t even put together a five-minute conversation without seeming like I’d just ran a marathon,” he said.
During a telehealth visit a few days later, his primary care doctor pleaded with him to return to the hospital. But, still seething over the callousness with which he had been treated, McClain refused.
“They left me there like I was something contagious,” he said. “Sure I had COVID, but that’s why I was in the hospital. I didn’t want to experience that again.”
Receiving appropriate care
McClain knew he ultimately had no choice. He wouldn’t survive without medical attention, so he checked into a different hospital where he had a markedly different experience.
In the span of four days, McClain’s condition had gone from inflammation in one lung to pneumonia in both, along with blood clots in his lungs, a potentially fatal condition. Doctors supplemented high doses of steroids and antibiotics with high flow oxygen with dexamethasone and anticoagulants for the embolisms in his lungs.
“When I went into the hospital, I didn’t know if I was gonna come out,” he recalls. “I didn’t say everything I wanted to say to my family and they couldn’t come to visit. I couldn’t sleep and my mind was constantly racing because of the medications. I would just sit there looking up at the ceiling all night long, trying to keep positive about everything. After a while, you run out of positive thoughts.”
After five or six days, the blood clots in his lungs dissolved and his oxygen levels improved. Most importantly, said McClain, his appetite returned.
“That was the best food I ever had in my life!” he said. “I hadn’t really eaten in a few weeks so even hospital food was delicious to me.”
McClain was discharged on Oct. 2. For the next month, nurses and therapists made daily visits to his home to monitor his oxygen levels, check his vital signs and draw blood.
A long, slow recovery
Before he got sick, McClain was a fitness beast. He did hard cardiovascular workouts and lifted heavy weights. Within weeks of contracting COVID, he was down more than 30 pounds and needed help getting around his own house. He worked to regain his fitness bit by bit.
“I was trying to do squats but could only do one or two before my breathing would jump to the moon and my heart rate would jump into the 150s.”
He continues to make slow, steady progress in his overall health and his physical conditioning, only through sheer will. He takes a brisk walk around his housing development every day. Ten minutes in, he’s breathing heavily but pushes through for another 30 minutes until he’s dead tired.
His pulmonologist suggested sprints but he said he’s not ready for that yet.
“I tried a couple of times and I can’t get through more than two or three,” he said. “This has been a very humbling experience.”
Long COVID’s disproportionate impact
A report issued in March from the Greenlining Institute concluded that COVID-19 health care costs have already resulted in severe debt and unemployment for some people and threatens to worsen health disparities, as higher numbers of people of color are left uninsured and unemployed.
Coronavirus’ high toll on the Black community is well-documented. Now, researchers and clinicians are increasingly concerned that systemic health care bias, lack of insurance and unemployment will also create similar disparities for long COVID, too.
“While we do not yet have clear data on the impact of post-Covid conditions on racial and ethnic minority populations and other disadvantaged communities, we do believe that they are likely to be disproportionately impacted by these conditions as they are more likely to acquire SARS-CoV-2 and less likely to be able to access health care services,” John Brooks, chief medical officer on the COVID-19 response at the CDC, said at an April 28 congressional hearing.
McClain first heard about long haul COVID in the early months of the pandemic. By Christmas, he realized he fell into that category. Even now, he experiences stabbing chest pain whenever he coughs or sneezes. He calls that a strong reminder. His pulmonary doctor warned that the lung damage might take a year or more to heal. He’s sanguine about it, nonetheless.
“I feel like I’ve overcome the worst stuff already,” he said. “I stopped watching the news because seeing all the death totals was bringing me down. Every now and then I hear something disturbing like people with COVID may have long term mental issues. Whenever I can’t recall something or feel that intense pain in my chest, I wonder if this is ever going to go away.”
Overcome the worst?
An informal Facebook survey conducted by Survivor Corps, a grassroots group of COVID-19 survivors, found that roughly 40 percent of participants reported mild to full resolution of their long haul symptoms after they were vaccinated. Some said that their symptoms got worse temporarily. John M. Baratta, co-director of the UNC COVID Recovery Clinic in Chapel Hill, says that’s an expected reaction if the body reacts to the molecules in the vaccine it perceives as an infection.
Getting worse, even for a short time, is something McClain isn’t willing to risk. He has resisted pressure from his doctors to get vaccinated.
“I’ve heard that the vaccine makes you feel like you have COVID all over again,” he said. “I don’t want to go through what I went through before, the struggle to breathe and the searing pain in my chest. I’m really, really nervous about that.”