Perspective of a Physician Who Tested Persistently Positive for Coronavirus Disease 2019

To the Editor—Life is destined to be dramatic.

As human beings, we tend to think that bad things—such as earthquakes, fires, car accidents, and severe illness—will never happen to us, even though we have witnessed or heard about such tragedies that others have experienced.

When a major medical event hits, the general public is prone to judge it based on their own experience without sufficient medical knowledge. Healthcare professionals are sometimes no exception, particularly when a new or unknown disease emerges. The coronavirus disease 2019 (COVID-19), as with other new infectious diseases, has presented us with unprecedented challenges and presented a huge dilemma.

As a physician on the clinical front line, B. Q. had been treating patients actively and wishing them an early recovery, but never expecting that B. Q. would be infected. However, B. Q. suddenly turned into a patient, an ill person in need of intensive care.

Because in the early stage of the epidemic we knew little about COVID-19 and the possibility that someone with COVID-19 can transmit the virus even if they are not showing symptoms, many healthcare professionals were infected. The situation worsened later due to the shortage of medical supplies, inadequate protective equipment, and accumulated fatigue of medical staff as a result of high-intensity work. According to a press conference of the World Health Organization–China Joint Mission on COVID-19 on 24 February 2020, 3387 medical staff have been reported to be infected, among which > 90% were from Hubei province [1].

Similar to other COVID-19 patients, B. Q. had dry cough, fever, body aches, and fatigue during the first week. My chest computed tomography (CT) examination showed features of ground-glass opacities, and my reverse-transcription polymerase chain reaction (RT-PCR) test was positive. It has been reported that clinical deterioration or improvement occurs during the second week of illness [2]. On the 10th day after onset, B. Q. developed chest tightness and palpitations, which became worse after activities. The CT reexamination showed increased and enlarged lesions in both lungs. With the additional administration of small doses of glucocorticoids, the clinical symptoms completely disappeared in the third week.

Unexpectedly, the CT scan in the fourth week revealed new lesions in the right lung, including lesions completely absorbed the week before. Moreover, my RT-PCR retests (8 times) were all positive after hospital admission. All of these results indicated that the disease remained uncontrolled. As a potential “persistently positive” patient, B. Q. was not alone. The Corriere della Sera, a daily newspaper in Milan, Italy, reported that a 23-year-old woman had tested positive for novel coronavirus 6 times during the 57 days after her diagnosis [3]. This new group of patients has brought new challenges to COVID-19 treatment. However, the cause of persistent positive results remains unknown, and no treatment has so far been proven to efficiently help a patient turn from positive to negative.

As time went by, my condition neither worsened nor improved. The courage to win the battle was gone. A mood swing started, accompanied by endless imagination of gain and loss. Was it because COVID-19 is more severe than other infectious diseases such as seasonal flu? Or was it due to a lack of proper immune response? Is it possible that B. Q. would become a long-term carrier of this new coronavirus? Would B. Q. be discriminated against? There is no existing or specific medication for the disease. My heart rate was high (the highest was 130 beats per minute). Given a high angiotensin-converting enzyme 2 (ACE2) level in the heart, would the virus attack the heart and cause viral myocarditis? Would it lead to cardiopulmonary sequelae? China’s Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia has been renewed 6 times [4], but various treatment options still exist and agreement has yet to be reached.

Singing is my favorite way to relieve stress. Through online video, when B. Q. sang my favorite folk chengdu in the hospital room, my daughter played piano accompaniment for me at home whose piano sounds made us immerse into the memory of that we casually went from street to street in search of local various foods with my daughter holding my right cuff while B. Q. putting my left hand in my trouser pocket.

“Daddy, when are you going home?” my daughter repeated in every video call. “A few more days.” “A few more days? How many more days exactly?!” She pouted, and B. Q. knew she was upset.

My friends sent me photos of food, boasting as if they were chefs and gourmets. B. Q. knew they just tempted me with food to encourage me to carry on.

Relatives, colleagues, and friends sent me wishes to keep me warm. Doctors and nurses encouraged me to stay strong. It seemed that my life was back to normal and full of trivial things: chatting with family and neighbors, and strolling down the street or on the campus. My distorted thinking subsided, and B. Q. gradually calmed down.

Finally, after 53 days of hospitalization with treatment of integrated Chinese and Western medicine, B. Q. was declared cured and discharged! B. Q. want to thank every person who offered me support and help—you are the torch carriers, lighting my way home.

The epidemic in China is at present under control and treatment is being improved, but COVID-19 has become a pandemic and has spread rapidly across the whole world. Although the disease was first reported in China, the source of the virus has not been confirmed. Many issues regarding prevention, control, and treatment of the disease need to be addressed by medical scientists and sociologists worldwide.

As a doctor infected with this highly infectious disease, B. Q. sincerely exhort that all of us stay in awe of the virus but do not despair or panic. We should not only maintain proactive health and hygiene regiments, but also cooperate and study actively to fully understand and defeat COVID-19.

Notes

Acknowledgments. The authors thank Dr Ruoqing Chen for her help with language editing.

Financial support. National Key Research and Development Program of China (No. 2018YFC1002804, 2016YFC1000600), and the National Natural Science Foundation of China (No. 81771662, 81771618, 81971356).

Potential conflicts of interest. The authors: No reported conflicts of interest. Both authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

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