Celebrating Covid-19 positivity

In the Covidomania atmosphere that has been prevailing for over five months, anything from a headache, singular sneeze or cough reflex is construed as a ‘Covid-19 related’ symptom. Added to this is the worst-ever stigma and discrimination against those infected, in life, and even after death. Living in a family of four doctors out of six has advantages but can also be challenging. Apart from me, there are my daughters - one an infectious diseases specialist and frontline Covid-warrior, the other a microbiologist and my elder son-in-law, a radiologist. Who else would you need to rapidly suspect Covid-19 and suggest a plethora of remedial steps, when dad gets symptoms? In addition to the Covid 19 scare, we had a number of events: my younger daughter delivered on April 18, and her elder sister who was carrying full-term delivered on August 15. My younger son-in-law, a banker, has been working from home. We are all locked-down since March 20.

Naturally, I preferred to self-diagnose and self-medicate when I didn’t feel well!

Last month (months after my now irrelevant travel history in February-March to Australia and Indonesia), I got fever with shaking chills one night. Having noticed a number of mosquitoes around, I suspected malaria and started popping anti-malaria pills, without telling my wife. Last year, I had suffered from Chikungunya and overcome its debilitating consequences with great determination, physiotherapy and family support, but also taking lots of homeopathy and HCQ (Hydroxychloroquine) for a considerably long period of time. I did presume some  immunity to the Coronavirus was natural, as suggested by the wide-ranging discussion on HCQ effects on Covid-19 prevention and inclusion in our national guidelines.

The next day, I self-tested for malaria, dengue and chikungunya with complete blood counts. All the test results were negative. Being familiar with tests and lab reports as part of her patient-counseling and supervisory stint at the clinic, my wife added the Erythrocyte Sedimentation Rate (ESR) to the testing profile. We were astonished when it was 120 mm at one hour (the normal range <15 for an adult male).

My low-grade fever continued, rising in the evenings. Headaches and night sweats started. Then a mild dry cough got added to the list. Now I self-diagnosed myself for another condition: Tropical Eosinophilia. And started Diethylcarbamazine to cure it. I did take my younger daughter into confidence.

Another round of blood-letting followed along with an IgE test to look for any allergies. By then, I reached the last, frightening test milestone! Under pressure from my caring, but increasingly scared family, we ran an array of tests that brought in Covid-19 and included a thyroid test. Nothing conclusive. And the thyroid reports were awaited.

Loss of appetite, 4-kg weight loss and pain in the neck, literally. The fever continued leading now to a suspicion of tuberculosis. Radiology and blood tests followed. With my age at 62+, malignancy was also considered. By now all three ‘family’ doctors were fully involved, and had started discussions in their respective specialty circles. Ace radiologist Dr.Bhavin Jankharia suggested a full-body PET/CT scan with a Thyroid radio-uptake study the next morning, followed by a Covid-19 RTPCR test.

In a new development, I noticed a painful swelling in the Thyroid region and as test results for the Thyroid Stimulating Hormone (TSH) were very low, it was suggestive of acute thyroid inflammation. That was a saving grace! A Eureka moment! In the new light of discovery, endocrinologists were consulted, thankfully postponing the PET/CT scan. Throughout the medical callisthenics, I was reluctant to do the RTPCR and kept postponing it, on account of the associated stigma. However, the Covid-19 rapid antibody test was done. Again, fortunately negative for both IgM and IgG antibodies, suggesting neither current or past Covid-19 infection.

A steroid course started for Thyroiditis and gave me some relief as the fever started subsiding. Experience suggested all these can also happen in Covid-19 commonly.

But the debate on suspected Covid-19 never stopped. Both scenarios were discussed. If I turned positive, in the most ideal scenario, then all of us having been exposed, presumed positive and remained asymptomatic, the infection had come and gone in everyone! So, the other seven would have escaped, considering the long duration of my symptoms! If negative, that was also fine, but the sword of Damocles still hung over us with the possibility of Covid-19 in the future. Also, the situation didn’t help much: the escalating Covid-19 cases in Mumbai, my clinic and residence both being in Red-Zones, my continuing medical practice, though using standard precautions.

While returning, we stopped by a bakery and bought cake for the celebration, come-what-may! Covid-19 positive or negative!

I was left with no option but to succumb to pressure and submit myself for the swab test. A ’home visit’ was preferred. Discussions continued on the subsequent course if the test results were positive.

The home-visit technician had used hand-gloves, mask, disposable paper apron (worth ~Rs.20), from her backpack – supposedly reused several times and head-shield in hand! This was all in the name of a PPE kit for which labs charge Rs.600/- extra!

The swab was put in my nose and I felt such terrible pain. The kind of pain that I do not remember, definitely not in recent times! Physical pain settled but the psychological pain started! What if the test results are positive?

Though I have no-co-morbidity, my age is itself considered ‘high-risk’. The children started discussing all the possible courses of action – and that included preferences of hospitals and physicians, ambulance, Oxygen-support, ICU, ventilator!

The negative report was a major solace for me as I had already lived and died!

That night of waiting was terrible: my wife started listing assets, liabilities, credit-card numbers, passwords and telling me to show everything to the children all in the run-up to the ‘winding-up’ mechanism:  just in case I don’t return from the hospital! At the back of my mind, I was assured a decent cremation with my close family in attendance, unlike the kinds of cases we had been seeing. Of course, not expecting other family and friends!

The next morning, my wife drove me to the clinic. I don’t drive, she has been driving me during the lockdown as the driver, being from a containment zone, Every hour inquiring whether the report has come? While returning, we stopped by a bakery and bought cake for the celebration, come-what-may! Covid-19 positive or negative! Awaiting the report, the table was laid, cake-decoration done with confused faces around.

The ‘Report’ came to my younger daughter, the microbiologist. It was negative. Though we didn’t get to the scenario of celebrating Covid-19 positivity, it was still a cause for celebration. The negative report was a major solace for me as I had already lived and died!  I even dreamt that I had an array of medicines following different protocols –Ivermectin, Azithromycin Tablets, Remdesivir and steroid injections included. And that I had reached the so-called Cytokine storm and got a Tocilizumab shot. Both were made available to me despite scarcity -  but finally reached a ventilator! I was just short of writing my own obituary, when I woke up!

I am much better now and on steroids and under the care of endocrinologist Dr.Shashank Joshi with the final diagnosis of Acute Painful Thyroiditis. Born again! And doing my bit to better the course of the Covid-19 pandemic, especially in the area of preventing stigma and discrimination.

(The writer, a Consultant in HIV and infectious diseases, is President, AIDS Society of India and Governing Council Member, International AIDS Society)

This diary was published in the online editions of The Hindu newspaper. Read Celebrating COVID-19 positivity​