michael barbaro

From The New York Times, I’m Michael Barbaro. This is “The Daily.” Today: As the pandemic quickly spreads across the U.S., hundreds of hospitals are now confronting their first serious cases of the coronavirus. Susan Dominus on the lessons from the first confirmed case in New Jersey. It’s Monday, March 30. Sue, tell me how you first heard about James Cai.

susan dominus

Well, a few weeks ago I heard about this young guy, a 32-year-old physician assistant, who was the very first patient in all of New Jersey to test positive for Covid-19. And so I reached out to him while he was still at the hospital. And I was sort of wondering, would it possibly be OK, could you maybe find some time to talk? And he said, sure, call me now. I’m in isolation, in other words, and I have time.

james cai Hello? [COUGHING] susan dominus Are you there? james cai Yes. [COUGHING] susan dominus OK.

michael barbaro

And what was the story that he told you?

susan dominus

So James lives and works in New York City.

james cai So my name is James Cai, and I’m a physician assistant.

susan dominus

And his mother and grandfather live in New Jersey, and so he spends quite a bit of time there as well.

james cai And I work as a primary care, urgent care and nursing home P.A.

susan dominus

He came to this country when he was about 16 from Shanghai. And he’s married and has a 20-month-old daughter, whom he adores.

susan dominus Why did you go into medicine in the first place? Why were you drawn to medicine? james cai Oh, because of my grandparents. They are doctors. My grandfather is an anesthesiologist in Shanghai. And when I was young, I always sick, so I always went to his hospital. So I had a good impression.

michael barbaro

And as someone working in the medical field, was James expecting to interact with this epidemic, the coronavirus? Was he maybe even thinking he would end up treating coronavirus patients?

susan dominus

Well, he doesn’t work in a hospital. And because he works in private practice, I think he probably imagined he might be working remotely — with telemedicine.

james cai I actually heard about coronavirus many months ago when China had outbreak. But I always followed the disease.

susan dominus

But because of the family background and because he does work in medicine, when news of the coronavirus did start coming out of Wuhan, he definitely understood how quickly the virus could spread. And he definitely understood that the only way to guarantee that you could survive this was by not getting it in the first place.

james cai Around end of February, I started to pile up all the food, like canned foods, frozen vegetables, dumplings.

susan dominus

So soon after the coronavirus landed on the west coast, he and his family went to Costco and stocked up —

james cai Our family plan is to stay home for two months.

susan dominus

— for like, two months’ worth of supplies.

michael barbaro

Right. So they were going to avoid any meaningful exposure to the virus?

susan dominus

Yeah, if there was communal spread and it had become widespread, their plan was to shelter in place.

michael barbaro

And well ahead of the rest of us.

susan dominus

Yeah, I think that’s right.

susan dominus So you weren’t sure at what point you would start doing that, but you felt you’d know when it was time? james cai Yes.

susan dominus

But, you know, he’s stocking up at the end of February. You know, people in the U.S. were still flying all over the country. Kids were going to school. Bloomberg was in the race for president. People were planning vacations and weddings and all sorts of conferences and events. And the same was true of James. So like everybody else, he’s going about his life. And around this time, without really too much concern about his health, he went to a medical conference in Times Square.

james cai So I changed diaper for my daughter and gave her morning milk. And I kissed my wife and to go to conference.

susan dominus

On the fourth day of the conference, Monday, March 2, he comes down with a cough. And he starts to realize he’s actually getting sick.

james cai I start to cough and a fever and tired.

susan dominus

So he leaves and texts his wife that he’s going to go to New Jersey, where his mom has a house. His mom’s away. And he doesn’t want to come home and get his wife and the baby sick.

james cai Because of my daughter, when I went home, she always hugged me and kissed me. And she will catch it.

michael barbaro

And what’s running through his head at this moment? Is he thinking, I have a bad cough? I might have the flu? Is coronavirus even on his mind?

susan dominus

Not really. I mean, there had not been a single case in all of New Jersey. He thought he probably had the flu. By then, he was mostly feeling this bad cough. He had an elevated heart rate. His eyes were really runny. He had diarrhea. He was not feeling well at all. But he also was not alarmed. You know, he decided to go to one of those drop-in centers to get a flu test, because he wanted to be told he didn’t have the flu so he could go home. So the doctor gives him a strep test and a flu test. They discuss whether he should get a coronavirus test, in fact, but the doctor didn’t have one. So they moved on. And the results came back that although the strep and the flu tests were negative, his symptoms were consistent with something called a pulmonary embolism, which is a clot in your lung that can be fatal.

michael barbaro

So this could potentially be even more serious than just a seasonal flu or —

susan dominus

Yes. Certainly more serious than the flu.

james cai So after, I went direct to the Hackensack emergency room.

susan dominus

So the doctor sends him to the E.R. at the Hackensack University Medical Center, which is not far from that doctor’s office.

james cai And in the emergency room, they asked me questions. Asked me if I cough. I said, I do, I do have cough. I do have shortness of breath.

susan dominus

So as called for, the doctors do a CT scan. And after they do, they realize that, no, he does not have a pulmonary embolism. But that in fact, because of the symptoms he’s having and the way his lungs look in the scan —

james cai They see a ground glass nodules. So this can be coronavirus.

susan dominus

— he might actually have coronavirus.

michael barbaro

And how do the doctors at this hospital react to that?

susan dominus

Well, at this point, they haven’t seen any coronavirus patients. So they don’t seem to him terribly alarmed. That said, they do put him in a tiny isolation room, a windowless room on the floor of the emergency room. That’s where he spends the night, texting his friends and his wife and getting increasingly unnerved and feeling quite ill.

james cai I was nervous. And at the same time, since I’m in the hospital, I’m going to check everything. Make sure I’m OK and then I go home.

susan dominus

So then on Tuesday, March 3, which is the second day in the hospital —

james cai They decide to do a test on me. So the test takes about 24 hours or 48 hours.

susan dominus

— they do a Covid-19 test. And they tell him he’s going to have to wait a few days for the result, but he shouldn’t worry, he’s young and healthy. At the same time, he’s wildly Googling symptoms for Covid-19 and realizing that he has almost every one of them.

james cai I had maybe lied to myself, was like, trying to calm myself down. I don’t have the Covid-19, I shouldn’t have it.

susan dominus

And so, it’s day three for James in the hospital. It’s Wednesday, March 4. He’s still waiting for the results in his tiny little room with a TV. And —

archived recording [SOUND OF LOCAL NEWS THEME]

susan dominus

— a local news report comes on.

archived recording (newscaster 1) We we begin tonight with breaking news regarding the coronavirus. archived recording (newscaster 2) Yeah, that virus arriving in the Garden State tonight. Governor Phil Murphy announcing the first presumptive positive case of the virus right here in New Jersey.

susan dominus

And the news report says —

archived recording (newscaster 2) A man in his thirties is hospitalized in Bergen County.

susan dominus

There’s a guy in his thirties in Bergen County, which is where he is, who’s tested positive for coronavirus. It’s the first case in New Jersey.

archived recording (newscaster 2) Governor Murphy saying —

susan dominus

There’s even a tweet from the governor of New Jersey confirming it.

archived recording (newscaster 2) — “We take this situation very seriously and have been preparing for this for weeks. I urge residents to remain calm” —

susan dominus

And it occurs to James, they really might be talking about him.

james cai And then I asked the doctor, saying, is this me? And the doctor’s saying, no, your test is not back yet.

michael barbaro

And of course, he hasn’t heard anything about the results of his test yet?

susan dominus

No, he has not heard anything.

susan dominus Wow. So you found out from the news from the governor of New Jersey? james cai Yes. On TV. And I asked the doctor. The doctor say, the result is not back yet.

susan dominus

And then the next day, his doctors come to him and say, yes, you have tested positive. And he is the first person in New Jersey to have tested positive for Covid-19.

michael barbaro

Right. And perhaps the first person in the history of the universe to find out he has a disease, not from his doctor, but from TV news.

susan dominus

Let’s hope so.

michael barbaro

And how does the hospital react in this moment?

susan dominus

So he’s really scared. But the hospital is telling him that he really has nothing to worry about. He’s a 32-year-old guy. He’s got no preexisting conditions.

james cai Even Dr. [INAUDIBLE] was telling me, oh you’re so young. It’s like a flu.

susan dominus

In fact, one doctor even told him —

james cai If it’s not because everybody is talking about corona, you can go home already.

susan dominus

You know, if it weren’t for all this attention about the coronavirus, you’d be home right now, just getting better in the comfort of your own bedroom.

michael barbaro

In other words, it would probably just self-resolve in somebody of his health?

susan dominus

That was definitely the expectation.

james cai I mean, that day, I was so depressed.

susan dominus

I think he felt that as a medical professional, he actually — he knew that he was quite vulnerable, that nobody was invulnerable. And there was this disconnect between his own concerns and their own insistence that he was overly anxious.

james cai America is not ready.

susan dominus

It also dawns on him that he is the first person in this hospital to be treated for coronavirus.

james cai I feel like, I’m in real trouble. Why I come to this hospital? Because I feel they don’t know how to treat this disease, and they don’t have deep understanding about this disease.

susan dominus

Nobody there has any experience. Nobody there can make good predictions. Nobody there has institutional knowledge about what happens when this goes wrong or something unexpected happens. He’s the first person, and that’s a very frightening position to be in.

michael barbaro

We’ll be right back. So Sue, James is newly diagnosed. He’s in isolation at this hospital in Hackensack, New Jersey. He’s been there for about four days. Physically, how is he doing at this point?

susan dominus When you first got the results of the positive test, on a scale of 1 to 10, how bad did you feel physically? 10 being the worst? james cai I would say 10. susan dominus Wow.

susan dominus

He is feeling worse by the day.

james cai Getting worse. So my heart is compensating, beating very fast.

susan dominus

He definitely has that cough. And he also is having real trouble breathing.

james cai It’s like I’m in the water. susan dominus Tell me more about that. james cai It’s like, normally, we can just take very deep breaths in and out.

susan dominus

He describes it as that feeling when you’re underwater and you have to come up to gasp for breath, but you can’t quite get that oxygen that you want. And it’s very panicking feeling. It’s a very scary feeling.

james cai So my lung is not allowing me to take deep breaths.

michael barbaro

And how is the hospital treating him now that he’s officially tested positive?

susan dominus

They move him to a room with certain protections in place. And they’re keeping an eye on his numbers. And they’re giving him oxygen when he needs it. And he’s also keeping an eye on his numbers. And he’s worried, because he is not breathing well. And on Friday, March 6, his fifth day in the hospital, he worries that he is desaturating to a dangerous level.

james cai And I desats.

susan dominus

He desats.

susan dominus You desaturated.

michael barbaro

And what does that mean, to desaturate?

susan dominus

It means that when you desaturate below a certain level, your blood is not getting enough oxygen from your lungs for you to function in a normal, healthy way. And this is really concerning to him.

james cai You have pneumonia, it’s normal. Just use oxygen.

susan dominus

But he still has the sense that the hospital is telling him he’s overreacting, that he’s being too anxious. He’s going to recover just fine.

james cai I was confused. And also, I was worried, because I think I’m not getting enough care. And my oxygen level dropped, and they — they cannot even see it.

michael barbaro

And why do you think people in hospital are saying that? And maybe more importantly, why are they thinking that? Why are they insisting on being so calm about what it would mean to have an infection like this?

susan dominus

I would have to guess that it’s because the widespread impression that people had was that young people were not going to be terribly affected by this virus, and that it was going to feel like a very, very bad flu. And that he was going to recover just fine, just like the statistics supposedly said he was going to.

susan dominus And did you actually feel yourself having difficulty breathing at that point? james cai I just feel tightness. susan dominus Tightness in your chest? james cai I feel like, a very scary — very scared. And I don’t know what to do next.

susan dominus

And James is all too aware that no one in that hospital has ever treated anyone with coronavirus. And he’s really worried about his symptoms, because he knows he’s feeling worse and worse every day.

james cai So I told my cousin, I told everybody, and they just start searching. .

susan dominus

So he starts reaching out to friends of his who are plugged into the Chinese medical community, including his best friend, who’s a physician — and whom he calls his cousin — and his boss. And they start making phone calls and trying to get information from experienced people who can maybe share what they’ve learned.

michael barbaro

Which is what?

susan dominus

You know, there’s advice that he should get high doses of vitamin C, there’s some discussion of whether he should get a steroid treatment if things get worse.

james cai He translate the seventh edition.

susan dominus

They say that maybe he wants to look into antiviral medication. They tell him he shouldn’t wait too long before getting a second CT scan. But his doctors were really reluctant to do that.

michael barbaro

Why was that?

susan dominus

They felt like they were giving him good care and that probably the results of the CT scan would not change that.

michael barbaro

So James is more or less beginning to advise his own doctors on how to treat him, based on his research, based on his relationship with other medical professionals, which is pretty unusual.

susan dominus

Yes. Very unusual. And then the evening of the 7th, he starts desaturating to a level that really scares him. He’s concerned that if he desaturates to a certain degree, there could be no turning back. He’d have to be intubated, which definitely increases, you know, all of the risks of the illness. It would mean that a machine was going be doing all the breathing for him. It could lead to organ failure and in some cases, of course, death.

james cai And I mean, if I intubated at night, I probably would just die by myself alone, without seeing the loved ones.

susan dominus

And his friends — also, some of them see this real urgency to save his life. And you know, one of his friends said to me that he personally felt responsible for making sure that the doctors took James’s case as seriously as possible. Here he is. He’s the first health care worker in New Jersey also to come down with Covid-19. If he didn’t make it, it was going to feel like the battle was over before it had even begun.

james cai You always live in fear that you’re never going to wake up. And also, in isolation. And nobody can see you. So it’s very miserable. If people die, think about it, people die and they cannot see their loved ones. What — I mean, like, I feel like it’s very tough, right? For somebody to die alone. susan dominus You were scared. I mean, you were probably too weak to really speak forcefully, but you were letting them know that you felt that your life was on the line at this point. james cai Yeah.

susan dominus

And we don’t exactly know why, but on the 8th, he did get that second CT scan.

james cai And it come back very bad.

susan dominus

It’s bad. He has pneumonia in both lungs. 30 to 40 percent of his lungs seem to be affected. That’s astonishing, that it would go from a small spot just a few days earlier to where it is now. And if he had gotten that bad in three days or four days since the last CT scan, how much worse was he going to be in another four days? And now, James starts to worry that he really might not survive this.

james cai I was praying to everybody, to God, to Buddha, to everybody, saying, don’t let me die. When I know my oxygen levels keep desaturating, one of my requests is can I see my mother and my wife or my daughter for the last time? It was that time, when my chest X-rays show so bad, and my oxygen level every day is dropping, and I would tell them that I have to be strong, but I don’t know how many days I can live. And the good thing is, after the CT, they listened. When she saw second CT, she was like, OK, we have to treat you.

susan dominus

I spoke to a doctor at the hospital who was part of the team overseeing his care. And he said they’d been looking at the whole clinical picture, had recognized that he was declining even before the CT scan. But from James’s point of view, everything changed after the scan. He feels like, now they’re taking this very seriously and they’re listening to him. They’re coming around to seeing just how serious it is. And also recognizing that, yes, even a young person can get very, very sick with coronavirus. And they’re willing to try something.

michael barbaro

And at this stage, what is he asking them to do?

james cai So then a doctor in China recommend a high-flow machine.

susan dominus

James wants a few different types of treatment. He’s been advised that the doctors should try providing him a more intensive form of oxygen therapy. And he wants to go on three experimental antiviral medications — Kaletra, chloroquine and remdesivir. And at this point, he and the doctors at Hackensack and all the other doctors he’s working with are pretty much all on the same page. He finally gets the main things he’s been asking for.

james cai And I think the next day, Dr. [INAUDIBLE] came in. He said, the medication’s here. We’re going to give it to you.

susan dominus

And finally, after more than a week in the hospital, James starts to turn around. He does start to feel better.

james cai So after the first day, my fever finally dropped. And my oxygen stopped dropping. I’m getting better and better every day. So that’s the whole thing.

michael barbaro

And does he have a sense, do you have a sense, do his doctors have a sense of which of these treatments was responsible for that?

susan dominus

Not really. I mean, it might have been any one of the drugs, or all of the drugs, or the oxygen, or some combination of that. Or he might have just gotten better on his own. We really don’t know.

susan dominus And so I asked you how you felt on a scale of 1 to 10, 10 being the worst, when you first got the results of the test, and you said that you were a 10. On a scale of 1 to 10, how do you feel now? james cai I would say now, maybe 3. susan dominus That’s pretty good. james cai Yeah, because I feel like all the symptoms have gone. I mean, I will be maybe no worry if tests come back negative. Then I know the virus is dead. Now, I don’t know if it is dead or not. susan dominus It’s now 10:37, and I need you to get a good night’s sleep. So I’m going to call you in the morning and see how your oxygen level were. Is that OK? james cai Yes. OK. Thank you. susan dominus All right. Thanks, James. Bye. Bye. james cai Good night. Bye-bye.

michael barbaro

Sue, it feels — correct me if I’m wrong — like a big reason why James survived was because he was such an aggressive advocate for himself. And he had this network of expertise that he could tap into. He himself was a medical professional. And that that put him in a very strong position. But I wonder why the people around him in this hospital were not better prepared, given the stage of this pandemic when he arrived in Hackensack.

susan dominus

We don’t really know what saved his life, because these drugs are still in clinical trials. What we do know is that the entire story of coronavirus in this country is a story of lack of preparation. People did not believe that it simply was never going to be as bad here as it was in Wuhan or Milan. That is a universal story. It was hardly just these doctors at this hospital. I mean, part of it is that they are busy people. They are moving things really quickly. They are saving lives every day. In fact, we all know that they’re saving lives and putting their own lives on the line right now. But also, it is just hard to put yourself back in that moment — March 1, March 2 or the end of February — and remember how unlikely we all still hoped and believed, against all evidence, that this wasn’t going to be devastating here the way it was elsewhere.

michael barbaro

Right.

susan dominus

That said, to their credit, the doctors at this hospital were open-minded and they were flexible and they were nimble. And they were willing to try whatever they could that was safe when they realized that whatever they had been doing definitely was not working. And I know James feels really appreciative, ultimately. He sent out a tweet that expressed his gratitude for the hospital saving, as he sees it, his life.

michael barbaro

Sue, what do you think the lesson of this story is, of James, his very unique situation in these early days of the pandemic in the United States, and of what happened to him at this hospital?

susan dominus

One of the things that I’m hearing from doctors is that until you are in this moment and experiencing the onslaught of patients, it is very hard to imagine it. You can’t really know until you’re actually living it. And you know, every hospital in this country is likely to have its James. It’s going to have that first patient who comes in, who is really ill. They’re not exactly sure how to treat it. We still really don’t know how best to treat this virus. That is the hard, cold truth of it. There are some protocols that we hope will help, that are thought might help. But it’s unclear. It’s so new. And it’s going to be really hard for all those hospitals. And they’re going to have to make difficult choices. They’re going to have to make complicated ethical choices. They’re going to have to make decisions on the fly and build up their clinical experience. And it’s not going to be easy for any of them.

michael barbaro

Sue, how is James doing at this point? I don’t know when the last time it was that you spoke with him, but what did he tell you?

susan dominus

He’s home. He is still in quarantine. So he still has not been able to see his wife or daughter. And his lungs are still recovering. It’s unclear just how fully they will recover. You know, it’s definitely a long road ahead of him. And at the same time, you know, he’s reading the news and he is feeling so lucky.

michael barbaro

Lucky to be alive?

susan dominus

To be alive.

michael barbaro

Thank you, Sue.

susan dominus

Thank you, Michael.

james cai Hello? susan dominus Hi, James, it’s Sue. How are you doing? james cai I’m good. susan dominus Are you actually in your own home? james cai Yes. susan dominus How does it feel? james cai It feels great. I’m going to sleep on my own bed. susan dominus Fantastic. james cai Once I’m out of the hospital, I feel like I’m alive. I feel like everything is so new to me. The grass, trees, cars, new people face, the sky. And then when I drive on the road, I appreciate every building, every people I see. I feel like it’s a second chance to live again, to be alive. susan dominus What is the first thing you’re going to say to your daughter and wife when you finally get to see them in person? I know you’re quarantining for almost two more weeks now. james cai Yes. So when I see my daughter and my wife, I definitely will give them big hugs. Try to don’t let them go. I maybe will, like, have my daughter in my arms all the time. I will come home and spend every minute with my family. Appreciate every day, living. susan dominus All right. Good night. Have a great night’s sleep. Thanks, James. james cai Thank you. Thank you for checking in on me. susan dominus My pleasure. Bye. Goodbye. james cai Bye-bye.

[music]

michael barbaro

We’ll be right back. Here’s what else you need to know today. In interviews on Sunday, members of the president’s coronavirus task force delivered dire warnings about the pandemic’s projected path in the United States.

archived recording (dr. deborah birx) No state, no metro area will be spared. And the sooner we react, and the sooner the states and the metro areas react and ensure that they put in full mitigation, at the same time understanding exactly what their hospitals need, then we’ll be able to move forward together and protect the most Americans.

michael barbaro

Speaking to NBC News, Dr. Deborah Birx said that the White House was asking every state to prepare for the kind of outbreak now occurring in New York, where there are about 60,000 infections.

archived recording (jake tapper) Well, Dr. Birx said yesterday, as you know, that she doesn’t think any city will be spared from this virus. How many cases do you think the U.S. will reach? archived recording (dr. anthony fauci) I mean, looking at what we’re seeing now, you know, I would say between 100 and 200,000 cases — excuse me, deaths. But I just don’t think that we really need to make a projection when it’s such a moving target.

michael barbaro

On CNN, Dr. Anthony Fauci said that millions of Americans could eventually be infected, and that between 100,000 and 200,000 could die.

archived recording (dr. anthony fauci) What we do know, Jake, is that we’ve got a serious problem in New York. We have a serious problem in New Orleans. And we’re going to be developing serious problems in other areas.

michael barbaro