Nebraska’s first coronavirus patient endured tough journey

OMAHA, Neb. (AP) - When Dr. Brian Boer got his first look at Nebraska’s first COVID-19 patient, he knew he had a battle on his hands.

Emma Hutchinson, a 36-year-old Omaha woman with birth defects that hampered her breathing, was in rough shape.

Her lungs had filled with fluid. The oxygen mask on her face wasn’t doing nearly enough. She was literally drowning on her hospital bed.

Boer, the medical director of the intensive care unit set up to treat critically ill COVID-19 patients at the Nebraska Medical Center, said he frequently treats such dire cases of lung failure, known as acute respiratory distress syndrome, in patients with other viral infections, like influenza.

But as he assumed the care of Hutchinson the day after she arrived on March 6, he saw that this was different. This new coronavirus was more contagious and more dangerous than the flu. The hospital had already started ramping up for an expected onslaught of patients. The big concern: that this novel virus could swamp and overwhelm hospitals and staff.

“The big difference is that no human body has seen this before,” Boer told the Omaha World-Herald. “If everyone gets it at the same time, if too many people get sick all at once, you don’t have the resources to care for all of them.

“Then you have to make the hard choices about who lives or dies. That’s what happened in Italy.”

But Emma Hutchinson didn’t become a casualty of COVID-19.

After 30 days at the medical center, three weeks of isolation at her father’s home in west Omaha, including more follow-up tests for the coronavirus, she was allowed to resume eating solid food and say goodbye to “Fred,” her nickname for the feeding tube, attached to a steel pole on wheels, that she had been wheeling around.

Her first solid meal in almost two months? Her favorite sandwich at Jimmy John’s, the No. 9, called the Italian Night Club. A couple days later, she and a friend enjoyed an Irish meal donated by her favorite restaurant, Brazen Head.

Now she’s back at her own apartment and has resumed working at a structured workshop for the developmentally disabled in Omaha.

She made a podcast for her church, Christ Community, in which she thanked her family and friends, the doctors and nurses at the med center, and even strangers who prayed and urged her to endure, even as she lay in an ICU under heavy sedation.

“From the beginning of March to now, I felt like giving up on everything,” Hutchinson said. “But I had a bunch of close friends and my family and the body of God who would surround me and encourage me to fight for my life.

“They told me not to give up.”

Hutchinson and her father, Ralph, a 73-year-old Postal Service retiree who grew up in London, agreed for the first time to have their names used in a story.

He had initially reached out to The World-Herald shortly after posts on social media accused his daughter of intentionally spreading the virus by participating in a Special Olympics basketball tournament on Feb. 29 at the Fremont YMCA just after returning from a trip to England for her grandfather’s 100th birthday.

The father, who didn’t want his name used at the time to avoid even further digital abuse, made it clear that Emma had shown no symptoms until the day she was admitted to the hospital and that lifelong breathing problems made it hard to discern whether she was even sick, much less infected with the coronavirus.

He and Emma made three trips to Methodist Women’s Hospital the same weekend as the basketball game, believing that she was suffering from migraines - a frequent problem for her - that might have been brought on when she was hit in the head by a basketball. On March 2, they visited their family doctor, who diagnosed a cold.

It wasn’t until they returned to the hospital on March 5 - five days after the tournament - that a doctor noticed that her oxygen levels were dangerously low. He ordered X-rays, which strongly suggested that she had pneumonia. When he was told that they had just been to London, COVID-19 was suspected to have invaded her lungs. She was sent to Methodist’s Dodge Street hospital.

After a trying night in the hospital, Hutchinson was transferred to the Nebraska Biocontainment Unit at the Nebraska Medical Center, the hospital that has worked in collaboration with the University of Nebraska Medical Center to establish one of the few centers in the nation specializing in the treatment of contagious diseases like Ebola, SARS and now, COVID-19.

Dr. Boer, a pulmonary and critical care specialist, said that when Hutchinson arrived at the hospital, personnel in the biocontainment unit were wearing the maximum protective gear. That included helmets into which filtered air is pumped by a battery-operated blower like they had worn when treating Ebola patients flown to the Omaha hospital for specialized treatment in 2014. But using those powered air-purifying respirators proved unsustainable for the several dozen nurses, techs and doctors working in the unit, who have since switched to the now-familiar personal protective equipment of face shields, N95 masks, reusable gowns and disposable gloves.

But when the state’s first patient arrived, the hospital was ramping up for a possible surge of coronavirus patients. The biocontainment unit had only four rooms and could hold a total of just eight patients. So a special COVID-19 ICU was being established.

Things were moving fast. The unit was preparing for the worst. The stress level was high.

Working in such specialized isolation wards is labor-intensive and exhausting, Boer said. Protective gear must be put on when entering a room and removed when leaving. Gloves are disposable, but masks - usually about three to each worker per day - must be sterilized for reuse each night.

Nurses, he said, have it the hardest, because they are frequently in and out of such rooms for extended periods of time. Doctors, he said, can do a lot of monitoring of patients outside the rooms.

“Our poor nurses. They’re like heroes,” Boer said. “They’re the ones getting their butts kicked.”

Soon after Hutchinson arrived, she was put on a ventilator - a mechanical lung that breathes for a patient - because her own fluid-filled lungs were too rigid to allow her to breathe on her own. She was heavily sedated and placed in a medically induced coma, in part to prevent her body from moving and consuming more precious oxygen.

“The body doesn’t like something else breathing for you,” Boer said, and will fight against the breathing tube placed in your airway.

Because Hutchinson had surgery on her airway as an infant to improve breathing, it was tricky for Boer’s partner, Dr. Craig Piquette, to place the “vent” tube. But it was successful.

Her oxygen level at times dipped as low as 50% to 60% - anything under 90% is low - and the ventilator was pumping at its maximum.

The severity of her illness, Boer said, was causing some kidney failure and some heart problems. If her kidneys got any worse, he feared that she might have to be put on a dialysis machine, which lowers a person’s chances of survival.

“We had to do a lot of tweaking,” he said. “There was a solid week of not knowing if she was going to turn the corner.”

But she did.

Her oxygen levels slowly improved. She started breathing some on her own. Her sedation was reduced, and the induced coma ended.

Hutchinson was transferred from the biocontainment unit to the new COVID-19 ICU, and on March 24 - 18 days after she arrived at the med Center - the ventilator was removed, and she was eventually placed in a more normal hospital room.

“The first thing she asked was if she did a good job,” the doctor said.

“You did an awesome job, Emma.”

She wasn’t out of the woods yet. Prolonged use of a breathing tube can sometimes cause damage, blocking the airway, and Boer said Hutchinson was at high risk for that because of her medical history. When the breathing tube was removed, a team of doctors prepared for the worst - an immediate tracheostomy to allow her to breathe. But it wasn’t necessary.

After Hutchinson was sent home to continue her recovery on April 4, she continued to use a feeding tube as an added precaution. “Fred” was mounted on a steel pole with wheels so she could move around.

Her father became her nurse and attendant, crushing pills twice a day every day, mixing them with fluid, then injecting them with a syringe into the tube.

“She always said, ‘Dad, you’re doing it too fast.’ She could feel it into her throat,” said Ralph Hutchinson, whose first wife, now deceased, had taken in Emma as a foster child at age 2, then adopted her three years later.

She was among the 1,063 critically ill COVID-19 patients across the globe who were enrolled in a randomized, controlled trial of the drug remdesivir, an antiviral medicine that had been used on Ebola patients. Because it was a blind study, neither the Hutchinsons nor Emma’s doctor were told whether she received the drug or a placebo.

Boer said personnel at the med center had their suspicions about who received remdesivir and who didn’t, based on patients who seemed to recover faster than others.

But he said the recovery of Emma Hutchinson, from near death, wasn’t due to some “miracle” drug but rather to “evidence-based, supportive care” like that given to people with severe cases of flu. That’s sticking to the basics, he said, and not trying unproven therapies outside of controlled trials, like hydroxychloroquine, that more often than not make things worse.

“These people need time, not a lot of tinkering,” he said. “You just have to ride it out, weather the storm and buy her time to fight the virus on her own.

“These are marathon cases, not sprints.”

Emma Hutchinson, in her podcast, said battling COVID-19 taught her to not take her family and friends for granted and to recognize that possessions aren’t that important.

Her father said he’s grateful for neighbors and friends, for the doctors and nurses, and for the emails from well-wishers he didn’t know.

“I’d like to name them all, but it would get as tedious as an Academy Award acceptance speech,” he said.

“We were lucky,” he added. “Many were not, and the toll will rise. Our hearts go out to everyone affected, directly and indirectly, by this awful virus.”