An EvergreenHealth Medical Center physician who became infected with COVID-19 in early March, who spent more than two weeks on a ventilator and received last-resort treatments during what he described as a “brush with death,” is now at home recovering.
“You realize there are times in life that it’s completely out of control and you have to put your trust and faith in another person’s hands,” Dr. Ryan Padgett said in an interview Monday after receiving treatment at EvergreenHealth in Kirkland and Swedish Medical Center.
“It’s incredibly humbling in the midst of this pandemic, where we’re losing so many people every day, to know that your being alive is because this incredible team of 15 physicians over two hospitals refused to say, ‘We’re done,’ and saved my life.”
Padgett’s story of survival, extraordinary in its own right, could also help doctors nationwide better understand COVID-19 and some people’s dangerous immune response to the virus.
Padgett, 45, an emergency department physician, became ill in early March after becoming infected with the virus that causes COVID-19. EvergreenHealth was the first U.S. hospital to identify a local outbreak of the novel coronavirus.
Padgett was one of the first frontline health-care workers in Washington to test positive for COVID-19. He believes he likely became infected with the new coronavirus during what he described as an “onslaught” of cases flowing into the emergency department.
“I presume it was exposure to one of the LifeCare Center patients. I can’t confirm that part, of course,” he said, referring to the Kirkland nursing home that was the site of the state’s first outbreak of coronavirus. He said dealing with the outbreak in early March was new to hospital staffers and that they had to figure out how to don and doff personal protective equipment. “Presumably there was an exposure within that period.”
Padgett became ill March 7 with “minor things you can easily blow off” as an emergency department physician, like a mild headache and muscle soreness. Two days later, he had a fever, and a worsening cough followed.
“I presumed I likely had the illness,” Padgett said. Once a star college athlete as an offensive lineman for the Northwestern University football team that played in the 1996 Rose Bowl, Padgett said he thought that as a middle-aged and healthy person, he would be fine.
Feeling ill, Padgett called in sick for one of about five times in his career, he said.
Days later, as symptoms worsened, his oxygen levels dropped. Padgett arrived back back at EvergreenHealth, this time as a patient. He was intubated and put on a ventilator on March 13, within about eight hours of his admission.
“I’m told I had one quick phone call with my fiancee before I got intubated … I told her who to contact for life insurance,” he said. After that, “there were about 16 days that don’t exist in my memory.”
As his condition worsened, Padgett was taken to Swedish Medical Center and admitted on March 16 for experimental treatments.
The physicians who treated him at Swedish say the measures they took to help save Padgett’s life could provide anecdotal insight into how the disease works and why some people’s cases become so severe. They estimate Padgett came within 24 to 48 hours of death.
“He was not only in respiratory failure, but renal failure and cardiac failure,” said Dr. Sam Youssef, a cardiac surgeon and the director of Swedish’s advanced mechanical support program.
On the day he was admitted, the Swedish physicians began to use extracorporeal membrane oxygenation (ECMO) to provide life support to Padgett for about a week. The treatment draws blood out of the body, oxygenates it and delivers it back to the body through tubes inserted into a patient’s groin, Youssef said, adding that in the Seattle area, only Swedish Medical Center and UW Medicine have ECMO machines.
Just 202 COVID-19 patients in North America have received ECMO treatment, according to the Extracorporeal Life Support Organization (ELSO).
“It’s what we call salvage therapy. It’s not your first or second or third line. When you’ve done everything and you’re losing, is when you go to ECMO,” said Craig Coopersmith, interim director of Emory University’s Critical Care Center, who likened the data behind the treatment to a Rorschach test, where corners of the medical world look at the same information and come to divergent conclusions.
The goal of using ECMO, which requires two nurses for each patient, was to “buy time,” Youssef said. The doctors knew that there was another process “destroying his lungs, destroying his heart, destroying his kidneys.”
Early research from China, where the novel coronavirus first struck, gave them some ideas.
Researchers abroad believed that patients with COVID-19 who were very ill, like Padgett, might have features of a “cytokine storm,” in which the body ramps up production of inflammatory cytokine proteins.
These proteins can put the body’s immune system at war against patients’ own organs. Youseff said Padgett’s laboratory results were “classic” for such a response.
“Some patients get very, very sick. It’s perhaps their own immune system driving the degree of sickness, compared to the virus itself causing damage to the lungs,” said Krish Patel, director of the Lymphoma Program at the Swedish Cancer Institute, a physician who treated Padgett.
As Padgett put it: “Essentially my immune system was what was going to kill me. That’s what was pulling me down the drain.”
The physicians turned to an off-label use of an immunosuppressive drug, Tocilizumab, to suppress Padgett’s immune response.
“Over the course of the next four or five days, we were able to see those inflammatory markers come down significantly,” Youssef said. Better yet, Padgett’s body was still able to fight off the virus.
The drug is now being tested in clinical trials, of which Swedish Medical Center is now taking part.
As an otherwise healthy frontline caregiver infected early in the outbreak, Padgett’s case was the first to qualify for these extreme measures in the Seattle area, the doctors said. Since, Swedish doctors applied the same course of treatment to a 33-year-old woman.
“She also was able to wean off the ECMO circuit and just yesterday, the breathing tube was removed for her,” Youseff said on Monday.
The Swedish doctors caution that the patients’ experience might be promising, but more data is needed.
Emory’s Coopersmith, who was not part of Padgett’s treatment, agreed: “An anecdote of one or a few doesn’t tell you anything. We really need trials to see if this is beneficial or not.”
Padgett said he’s grateful to the Swedish doctors who went out on a limb and tried the extreme measures.
As his condition improved, Padgett said he became close to many of his doctors, particularly because family members were not able to visit him in the hospital due to COVID-19 restrictions.
“The isolation was crushing at times,” he said. “You’ve survived this brush with death and you can’t hug your fiancee, it was very difficult.”
Padgett left in a wheelchair on April 5. Family members awaited him, expecting to wheel him into a vehicle.
“I stood up and gave them all hugs,” he said. “I’ve cried more in the last weeks than in my whole life. Tears of joy, tears of the unknown moving forward.”
Padgett said he has several months of physical and occupational therapy ahead of him, though what the future holds remains unclear, particularly with the longer-term effects of COVID-19 unknown and not yet studied.
The original wedding celebration has been canceled because, well, “the world was closed,” as Padgett put it. But, he and his fiancee, Connie Kinsley, have filed for a marriage license and plan to tie the knot on a nice day on their boat, with friends.
They’re not sweating the details.
“The formalities of the real world fall away. That’s not the core of what you need.”