LOS ANGELES – The circle of relatives arrived at Los Angeles International Airport on their way home after a short and unpleasant vacation in Mexico, they were exhausted, the father was battering an unpleasant abdominal infection and even before moving to his hotel in Cancun, they learned of the sudden death of the wife’s mother in her hometown : Wuhan, China.
The couple and their young son wanted to return for the funeral and were making plans to be on LAX long enough to replace the planes, but when they passed tom Bradley International Terminal on January 22, the father had fever and pain and discomfort. and went to a customs officer for help.
The circle of relatives did not fly on Wednesday night and, in fact, would not have returned to China for more than a month. The father, Qian Lang, has become the first case shown of COVID-19 in Los Angeles and the fourth. in the United States. He remained the only patient diagnosed here for five weeks, spending most of his time in maximum sensible secret isolation at Cedars-Sinai Medical Center.
The 38-year-old trader has played an important and little-known role in a frantic race to perceive the new fatal virus before it reaches the US. But it’s not the first time With all your might, blood case study.
From Qian (pronounced Chee-an), they obtained the first data on workers’ coverage of fitness, tactile studies and remedy. He was the time when the patient around the world took remdesivir, then an experimental drug and now a popular remedy for other people with severe COVID-19.
For his family, Qian’s illness and recovery meant a terrifying stay in California. Although his wife and preschooler tested negative, they remained with him at Cedars-Sinai in the closest approach to legal domestic infection protocols: adjacent insulation suites separated by glass. .
“We learned it was a huge burden for this deficient woman,” recalls Barbara Ferrer, Director of Public Health at Los Angeles County. “She alone. He didn’t speak the language. And I take care of a full-time child 24 hours a day in an essentially very small space.
Ferrer and other fitness care professionals said that medical confidentiality legislation prevented them from identifying Qian through calls or revealing the main points of his care, but agreed to communicate his case, which was included in part from a dozen prominent studies. . called “CA1”. In another, “Patient 9. “
This story is based on published clinical articles, interviews with public fitness officials and doctors, ambulance records, an airport police report naming Qian and his wife, and an interview in February that granted a Chinese news blog, Deeper Wuhan, under a pseudonym. .
Qian did not respond to messages left to him on a social media account. The anonymous Wuhan blog post said he contacted him on behalf of the Los Angeles Times, but rejected an interview request.
Americans didn’t pay much attention to COVID-19 when Qian landed at LAX. The upcoming impeachment hearing of President Trump and the upcoming Iowa caucuses ruled the news, and around the water sources in Los Angeles and there were still water sources, the discussions were less. it’s most likely the new virus in Wuhan than in the “Parasite” photo in a larger Oscars photo or in LeBron James’ quest to surpass Kobe BryantArray still alive, on everyone’s scorers list the NBA times.
However, within the Los Angeles County Department of Public Health, epidemiologists and other experts were tracking the first unavoidable cases. They met with the U. S. Centers for Disease Control and Prevention. But it’s not the first time In mid-January, the medical network was sufficiently aware of the virus doctors were calling the county with suspicious cases.
“There was a lot of flu at the time, ” said dr. Sharon Balter, county director of acute communicable disease control, recalling many calls earned through her colleagues. Many obviously weren’t COVID-19, he said, but “we expected that with a lot of trips between Los Angeles and China, eventually there would be a case, so we were definitely getting ready for it.
Each suspicious patient had to be treated as if inflamed until the effects of the control returned from the CDC’s Atlanta lab, the control facility at the time. More than once, Balter and his colleagues were convinced that they had an inflamed patient with the virus in intelligent faith, to get a negative result from Georgia.
It was the third week of January when COVID-19 was detected off the coast of the US. But it’s not the first time On Sunday, January 19, a man sought medicine at a Washington state clinic for coughing and fever and became the first user in the United States to be diagnosed with the virus. A day later, a Woguy from Chicago was hospitalized with pneumonia. It’s become the second. Orange County won the third case on Wednesday. All three were in Wuhan at one time before they got sick. They’d all survive.
Qian below. He, his wife, Liu Ying, and their son left Wuhan this week for a long-planned holiday in the Caribbean. They were aware of the virus, but “quite comfortable in general” about it, he later told the blog. The Local Health Commission reported only 62 cases and two deaths when they left on January 19. Health officials noted that many of those affected only had mild symptoms and the city’s most sensible public fitness doctor told a government newscast that “the infectiousness of the new coronavirus is not strong. “
However, Qian, the son of a physician who had been immersed in protective protocols from an early age, took precautions that public fitness officials would later consider important. aboard to do so, and flew the vents to increase traffic around his family.
Connecting through LAX on their way to Mexico, the couple and their son were evaluated through the CDC, but showed no symptoms. Qian told the blog that his temperature was so low that an evaluator joked, “Are you a vampire?”
The circle of relatives planned to spend time in Mexico City before heading to their destination in the Caribbean, but they were tired and weak and Qian contracted Giardia, a common parasite that afflicts travelers suffering from diarrhea. the hotel. That same day, Liu’s father phoned them to tell them that their mother had become ill with fever. The next day, she reported that she had called an ambulance, but that she was too late and she had died.
The family circle packed their bags and returned to LAX. After landing, Qian felt hot and, as he put it on the blog, “impotent. “As he passed customs,” the husband told one of his agents that he needed medical attention and that he would possibly be suffering from the flu because he has a strong cough and . . . wet nose, ” wrote in a report an airport police sergeant. He noted Wuhan’s circle of relatives, where the coronavirus originated. “
The stage in his hometown had become terrible within three days of his departure. Authorities reported lots of new cases and, in addition to downplaying the threat, the government was preparing to block the city from 11 million more people to prevent the spread of the virus.
When he was informed of Qian’s connection to Wuhan, his symptoms, and the sudden death of his mother-in-law, CDC staff at the airport suspected the virus and called a Los Angeles chimney ambulance specially supplied for COVID patients. He took the family circle to Cedars-Sinai Marine Hospital.
The crew, dressed from head to toe in protective clothing, allowed the child and his parents to peek into the gurney, Qian told the blog, adding to US authorities, “His reaction is very professional, fast and quick!”
Tests sent to Atlanta showed that Qian positive and that Liu and his son were negative, even though she had a common flu. The circle of relatives was transferred to Cedars’ flagship on Beverly Boulevard, a celebrity favorite where Kim Kardashian gave birth and Frank Sinatra died. The blog did not call the hospital, however, Qian described it as “a very prominent medical institution” and images of an isolation unit published with access to the blog show the staff greenish blue bushes as those used in Cedars.
Providing top-secret care was a natural thing in Cedars, and many of those who worked there were not known about the presence of a COVID patient. A worker who spoke under anonymity said the circle of relatives had settled in a special wing of the fourth-floor pediatric intensive care unit through a security guard. A blog photo shows Qian’s room decorated with cartoon characters “Minions” like the ones the worker said decorate the walls of Cedars Pediatric Intensive Care Unit.
The electronic circle of family medical records has been designated as ‘breakers’, a classification that deters workers from spying on known patients by requiring them to re-enter their passwords and provide an explanation of why to view the records, the worker said. The worker called for anonymity to speak publicly about patient care.
Cedars’ team has taken strong steps to quarantine the hospital’s COVID-19 patient, following protocols for Ebola and other pathogens, said Dr. Jonathan Grein, Cedar’s Director of Epidemiology. The measures were more excessive than those used lately for COVID-19. However, at the time, Grein said in an interview, the team “was somehow vacuum-hunting and didn’t know what was going to happen. “
And then Qian got worse.
Grein described a stressful time, with common calls to cdc conventions to consult with doctors who were concerned about the other 11 patients scattered throughout the United States, of whom Qian, the maximum, was seriously ill.
“China’s information of growing concern,” Grein said. “At that time, no treatment is known. “
For days, the CDC’s leading influenza division physician, Dr. Tim Uyeki, had been looking to recruit COVID-19 patients for experimental treatment. Redesivir, an experimental antiviral drug developed a decade earlier through Gilead Sciences and soon reviewed Ebola. This is not effective: of the 175 candidates for the checkup, 93 had died most often of Ebola, and one of them potentially due to treatment.
At first, Qian experienced only unusual flu symptoms that can be treated with painkillers and cough medications, but at the time of the week, his temperature increased, his lungs filled with fluid and he had difficulty breathing. One night, with his wife and son on the other side of a window, he wrote a will on his phone, he told the blog.
Doctors talked to Qian about experimental trials with remdesivir, but he worried, according to the blog. Twice he told the doctors he didn’t need to check it out.
Qian’s condition remained serious. As he struggled to breathe, he told the blog, the idea of the bravery his young son showed when a blood test was done in the circle of relatives, clenching his fist and shouting to his father, “Dad, you’re going to have to put up with it!”
The third time the doctors approached him, he agreed to review the remdesivir. An interpreter read you a five-page consent form over the phone and then administered the medicine intravenously.
After a day, his fever dropped. Soon, he doesn’t want oxygen anymore.
“Doctors were surprised,” he told the blog, adding that one of them asked him if he had any idea of his recovery due to the drug or his own immune system. “I told him I think both. A calm and positive attitude also helped. .
Qian’s case was included in an encouraging review of remdesivir published in the New England Journal of Medicine last month. Fifty-three patients hospitalized for the virus won the drug in several countries. Seven are dead. But 68% have improved.
Despite fears about adverse events, it is used so widely now that Indian hospitals in San Francisco are reporting shortages.
Although Qian’s recovery was exciting for the medical team, that did not mean that he and his circle of relatives could simply return home; it was not known how long patients remained contagious. Grein said officials were more safe to remain in solitary confinement and, after 27 days in Cedars, was transferred to another secret medical facility.
The county closely follows airport lifeguards and Cedars workers who contacted the family circle for symptoms of illness. At that time, it is not yet known whether other asymptomatic people can simply spread the virus.
Dr. Howard Chiou, a CDC epidemiologist, recalled being interrupted in the middle of a weekend dinner to help with Qian’s case. Fluently speaking Mandarin Chiou has worked directly with the family circle to expand a list of options and others. to search for contacts.
“Investigating instances and locating contacts is a really complicated and confusing task that requires building a strong and accepted relationship as true within appointments in no time,” Chiou said. “This case reminded us that linguistic and cultural skills are essential to construction are accepted as true with and dates of construction. “
Public fitness officials have contacted their Mexican opponents so that the hotel can receive information about the case. They also alerted passengers seated near the circle of relatives on the Mexico City flight, as well as the aircraft crew.
In the end, no one is known to have become inflamed with Qian. Some fitness care developed respiratory symptoms, but the tests were negative.
There has been no recurrence of the COVID strain that inflames Qian among thousands of samples shared through researchers around the world, said epidemiologist David Engelthaler, head of the infectious diseases department at the Arizona Translational Genomics Research Institute. He said the absence suggests that Qian did not infect others and was “a dead end” to the virus, he warned that the evidence was limited. Most of the other people working at Cedars were not informed that a COVID patient was on site and was not tested.
“I don’t think there’s any spread,” Balter said public fitness officials say Qian’s travel precautions and request for assistance have helped protect others.
“He was very intelligent in dressing up in his mask when he was near (his family) and on the plane,” Balter said.
By mid-February, COVID had traveled around the world and had begun to devastate South Korea and Italy, however, Qian remains the only known case of LAC. Concerned about the consequences of isolation for Qian’s wife and son, public fitness staff bought toys for the child and made sure the family circle had the food he loved.
Ferrer said he learned from the family circle that to effectively isolate himself, other people want personalization of fitness workers.
“It made a big difference. It’s not just that they’ve gained smart clinical care,” he said.
Chiou, the CDC epidemiologist, agreed, saying, “It helped us think about the disorders others would face in isolation and quarantine, especially travelers or others without safe accommodation.
On March 4, 42 days after Qian requested help from LAX, the county announced that it had known six other coVID-19 cases. In retrospect, state officials said, strict limitations on testing and asymptomatic spread of the virus have impeded public aptitude. officials to detect many other people already infected.
“Obviously we had cases,” Ferrer said.
Qian was still feeling estranged when the story of his care in the United States was posted on the Wuhan blog. Relations between China and the United States have been under pressure and have worsened. Some readers were cynical about the favorable presentation of the history of health care in the United States.
“This user was cured through remdesivir without paying a penny,” wrote a sign. “I doubt this article very much. “
It is not known whether Qian or the Chinese consulate, which remained informed of his case, paid for anything. Cedars and the consulate refused to answer questions about their case, raising patient confidentiality.
For your part, Qian grateful.