Young, healthy and on a ventilator: coming back from COVID-19

TALI FEINBERG

Over the past month, the Sandlers stood by helplessly as their son and brother lay in a coma and on a ventilator in a Cape Town ICU, battling to survive. “We were told by a doctor that he had a 50/50 chance of surviving. The doctor said he had never seen such bad lung damage in a patient his age in his whole career,” says Justin.

He wants to share his family’s story to emphasise that the virus can viciously attack young, healthy people, and that they need to take as many precautions as those in high-risk categories. He also wants to be a source of support for others who may have family members fighting to survive.

It all started when the family’s domestic helper, Nomhle ‘Beauty’ Nxokomba, arrived on Glenn’s doorstep at the beginning of June. She had worked for the family for 37 years, and loved Glenn and Justin like her own children. In turn, they saw her as their “second mother”, and she continued to work in their homes when they grew up.

While the brothers told her to stay home and continued to pay her salary, she missed them terribly, and when lockdown restrictions were loosened at the beginning of June, she decided to visit Glenn. When she arrived, she wasn’t feeling well, and Glenn said she should stay at his home that night. He then sent her home in an Uber with a promise that she would see a doctor.

But she never did. “Two days later, her son Vuyo called me, and told me she had passed away. I was blindsided – it was so sudden. I loved her as much as my parents,” says Justin, who soon realised she had succumbed to COVID-19. “She had hypertension and diabetes. When we saw how the virus later attacked my brother, we realised she hadn’t stood a chance.”

As his family grieved the loss, Glenn began to feel ill. Within a day, he had crackling in his lungs, a clear sign of pneumonia. He developed a fever, and lost his sense of taste. But most of all, he was struggling to breathe.

Justin took his brother to the hospital in the middle of the night, but after hours of tests, they sent him home. Scans of his lungs were clear, and his oxygen levels weren’t low enough. His age and health meant he wasn’t considered at risk of declining.

His COVID-19 test came back positive. After another night of struggling to breathe, the brothers returned to hospital, but were again sent home. “Essentially, they can’t admit you unless you are on death’s door because there are so few beds,” says Justin.

By now, Glenn had acquired an oximeter, which showed that he was borderline hypoxic. For the third time, he went to hospital, and was finally admitted to a COVID-19 ward.

“It would ebb and flow. He would say he was feeling better, but then at night, he felt like he was drowning. He went from oxygen prongs, to an oxygen mask, to a ‘re-breather’ bag attached to the mask,” says Justin. When Glenn had to go to the bathroom, he had to remove the device and felt like he was holding his breath underwater. Essentially, he couldn’t breathe without assistance.

Then, within a 12-hour period, his oxygen levels declined further, and his body went into a “cytokine storm”, where it was essentially attacking itself. X-rays showed his lungs were in a “whiteout”, filled with fluid and breaking down. He now had acute respiratory distress syndrome (ARDS) and was rushed to the ICU. “The doctor told me he was now extremely worried, and hadn’t seen this level of COVID-19 trauma before,” says Justin.

Glenn had a test to evaluate the level of blood clots in his lungs. “A level of ‘1 000’ is bad, and his was 2 000,” says Justin. “He was put on a higher dose of anti-coagulation medication, and then, in a gasping voice, he told me that they were going to put him on a ventilator. We told him we loved him,” says Justin, his voice filled with emotion.

“The doctors said there was a high chance he might not survive. I had hope, but it was like a slow-motion car crash. He had been drowning slowly for a week. I wouldn’t wish it on my worst enemy,” he says. Glenn says he has no memory of this time.

Now on a ventilator and in a coma, Glenn continued to decline. There was discussion about putting him on ECMO (extracorporeal membrane oxygenation), which uses a machine to oxygenate blood outside of the body, taking the strain off the lungs. As a young and healthy individual, Glenn had the right criteria for ECMO. There was only one ECMO machine available in Cape Town, and it would be extremely dangerous to move him, but the family were willing to risk it to save his life.

Then, in a miraculous turn of events, hours before he would have been moved to go onto ECMO, Glenn began to stabilise. The doctors had started to treat him with an experimental steroid, anti-coagulant, and immunosuppressant drug. They also put Glenn in a “prone” position (on his stomach) for 22 hours a day, to allow the blood to move towards the less damaged front section of his lungs.

Together with the drug, it prevented further decline. But Glenn wasn’t out of the woods, possibly needing a tracheotomy to help him breathe. This was because extended use of a ventilator can permanently damage the trachea. Yet no doctor in Cape Town would perform a tracheotomy because it causes a “virus explosion” that makes it much more likely the doctor will contract COVID-19. “It was scary and sad that no doctor would risk this,” says Justin.

Just as quickly as he declined, Glenn began to improve. He was soon taken off the ventilator, and woken from the coma. He was given oxygen prongs, and moved to a general ward. Within days, he was feeding himself and talking. He says he has a long road to full recovery, which will include rehabilitation and physiotherapy. He still has a cough, his voice is hoarse, and he is very weak, but he has no long-term physical or neurological damage. He attributes his recovery to his family, his medical team, the nursing staff, and even his colleagues. “It really was a team effort.”

The brothers hope Glenn’s story will make other young, healthy people aware that COVID-19 can attack their bodies just as badly as older people or those with comorbidities. “Please take it seriously,” says Justin.

“You may not be as lucky as he was to actually get a bed. Glenn is you. This couldn’t be any closer. Every time you visit a friend or see your parents, you are playing the lottery with your life,” he says. “There isn’t much we can control, but do your part in what you can control. Yesterday [Thursday 9 July], he was allowed to go home. It’s so surreal. We will be forever grateful that he survived.”