Thread by @Bob_Wachter

Until this week, I remained a NoVid, which I chalked up to being fairly cautious, fully vaxxed & a bit lucky.
This week my luck ran out. My case is a cautionary tale, particularly for the “just a cold” folks. Mine definitely was not...I literally have scars to show for it. (1/22)

I’ve got my 2nd bivalent in April, so my protection against a severe case was still strong, but the 2-3 month window of protection vs. getting Covid had passed. I've let down my guard a bit: still masking on planes & in crowded rooms, but I do now eat and drink indoors. (2/22)

This week, I was on clinical duty @UCSFHospitals. We are still required to mask in patient areas (good!). I felt fine until Sunday afternoon when, after leaving the hospital, I noticed a dry cough. By Sunday night, I felt flu-ish, with a sore throat, fever, and chills. (3/22)

Things got bad overnight. Monday, I woke up drenched in sweat, with a bad sore throat and a hacking cough. My Covid home test was neg. Given how “Covid-y” I felt, I planned to repeat it that night. I called in sick to work, didn’t eat or drink, and choked down 2 Tylenols. (4/22)

Then I made a mistake – I took a shower. While the instinct to take a shower when you’re sweaty and gross is understandable, stepping into hot water when you’re dehydrated and flu-ish can cause your blood vessels to dilate, leading to a dangerous drop in blood pressure. (5/22)

And that’s what happened: I work up in a bloody pool on my bathroom floor. There was a dent in the lid of a trashcan, likely where my head had hit. I remembered nothing. As I managed to get up, it was clear that my face was going to need stitches, and more than a couple. (6/22)

My wife is out of town, but luckily my future son-in-law Joe, who doubles as an intern in our residency program, was around and drove me to the UCSF Emergency Room. I won’t bore you with all the details, but over the next several hours the following facts emerged: (7/22)

1) I did, in fact, have Covid (I now tested positive on both a rapid test & a PCR)
2) I had smashed the hell out of both my right forehead & the back of my scalp
3) Given the extent of injuries on both front & back of head, the ED docs ordered a head and cervical spine CT (8/22)

4) The head CT showed a small subdural hematoma, a little rim of bleeding in the space around the brain. This bought me an overnight stay in the hospital for a repeat scan to ensure the bleeding wasn’t enlarging; it also led to a week of an anti-seizure medication. (9/22)

5) More fun: the spine CT showed a small non-displaced cervical fracture (C3 for aficionados), which bought me a cervical spine collar and a few neurological exams to be sure I had no symptoms of spinal cord damage. The docs also wanted MRIs to better assess the damage. (10/22)

6) I'll add 45 minutes of clanging, tomb-like MRIs while wearing a mask & having gauze over ones eyes to my list of life experiences I'd love to never repeat. Luckily the MRIs showed no additional damage. (11/22)

7) The neurosurgeons stitched the back of my scalp, while an ENT-plastics chief resident did the intricate stitching of my forehead. Luckily, at my age a few scars don't bother me much, and I believe my wife likes me for reasons other than my previously seamless brow. (12/22)

It’s nice to work at a place where you feel great about receiving care. As always, the nurses and docs @UCSF were fantastic, and not just because I’m a known quantity. And, as nasty as all of this was (and it was awfully unpleasant), overall I feel pretty darn lucky: (13/22)

With that kind of syncope and fall, I could easily have taken out an eye, been paralyzed from my spine injury, or died of a subdural bleed. I must have bruised my flank pretty good going down, since that’s what hurts more than anything – no fun while I was coughing. (14/22)

After 24 hours in the ED, they set me free. Now I’m home & in isolation; I’ll leave jail when my rapid test turns neg. I’m taking Paxlovid, convinced by the data that it shortens duration of illness, lowers the chance of a severe case, & lowers the odds of Long Covid. (15/22)

It’s now day 3 and I’m 90% better from the Covid – my cough is essentially gone and my sore throat is much better, as is the fatigue. The Paxlovid has been fine – I have barely noticed any altered taste (my wife called it “chewing on rebar”). (16/22)

Remember the controversy over whether hospitalizations were “for Covid” or “with Covid”? (I co-wrote about it: ) While my case probably would have been deemed “with Covid” (admitted for syncope & head trauma), of course it all stemmed from Covid. (17/22)washingtonpost.com/outlook/2022/0…

So, I've joined the 3/4 of Americans who aren't NoVids. I don’t think it'll change my behavior – as long as the case rates remain low (they are now, tho wastewater is showing a little uptick; Figure), I’ll continue being relatively careful, but no more than I've been. (18/22)

I will, however, be more careful about showering or taking a hot bath or hot tub when dehydrated. That's one important takeaway from this mess. (19/22)

By the way, I have no idea where I got Covid. Yes, I’ve been on clinical service but haven’t had any Covid patients. And I wear a KN95 in clinical areas. Outside of patient care, I have taken my mask off for meetings in non-crowded rooms… (20/22)

... and, as I said, I’ve been doing some indoor dining & socializing. But I haven't found any source, so it's likely to remain a mystery.
Nor do I know if I infected anyone – I certainly hope not. (Our infection control people do the checking at work.) (21/22)

So my first case of Covid was pretty dramatic – if I hadn’t passed out, it would have been 3-4 days of a pretty nasty upper respiratory illness. But I did, and so my (unusual) case goes on my list of reasons that Covid continues to be worth avoiding if you can. (22/end)