First confirmed case recalled
Editor’s note: The Pine Bluff Commercial is beginning a series of stories today on how the covid pandemic has affected the Pine Bluff area. Today’s offering details what happened a year ago when the coronavirus was first detected.
Erin Bolton had sent the patient’s sample to the state Health Department to be tested for covid and was then standing in the hospital’s 9 a.m. meeting.
It was Wednesday, March 11, 2020.
Getting the Health Department to test the sample for the coronavirus, which was spreading around the country but to that point had not been diagnosed in Arkansas, had been a struggle for Bolton, a registered nurse at Jefferson Regional Medical Center and the director of quality and regulatory.
The sticking point for the Health Department was that the person at the hospital, as far as medical staff members had determined, had not traveled, and certainly had not traveled outside the country. Travel, the Health Department said, was a clear risk factor for someone becoming infected with covid.
And yet, there were troubling signs with the patient’s health condition, and the problems were identified by a doctor who had never even met the patient.
Dr. Steven Wright is a Jefferson Regional doctor who specializes in nephrology — the care of the kidney. He also oversees the residents
who are finishing up their medical training by working at UAMS South Central in Pine Bluff. Both endeavors — his medical specialty and overseeing young doctors — would work to his advantage in figuring out what was wrong with the patient, who was admitted to the hospital on Friday, March 6, placed in a regular room and then later moved to the intensive care unit.
As the residents would make their rounds and report their findings about their patients, Wright kept thinking that there was something about one person’s condition that just didn’t make sense. Wright said he is always looking for opportunities to advance the residents’ knowledge, particularly in the areas of quality medical care and instruction.
“For this person, I had particular insight into his condition,” Wright said. “I’ve been in nephrology for 22 years.”
Wright said he would go home at night, turn on the TV and soak in the “24/7 drama” of the covid pandemic, and then he would read every article he could find in various medical publications and think to himself: “Here’s a guy who meets all of the criteria for covid, based on everything I’ve seen and read. Why aren’t we testing him for covid? He seems to have everything that everyone is talking about. Why is nobody testing this guy?”
That’s when he told Bolton that he wanted to have the person tested for covid.
“Are you sure?” Bolton remembers asking Wright.
“I’ve tested him for everything else,” Bolton said Wright told her. “I don’t know what else it might be.”
On Monday, March 9, Bolton contacted the Health Department and asked for the test. But the medical staff there again said no, although it did agree to do a “respiratory panel” to check for the regular flu, pneumonia and a variety of other lung problems.
The next day, March 10, the Health Department staff called to say that all of those tests had come back negative.
Again, Bolton asked for the covid test but was told no, with the reason again being that the patient had not traveled and didn’t fit the risk pattern being seen across the country.
Finally, Wright picked up the phone and called the Health Department himself, thinking at the time that “Arkansas is not excluded” from the rest of the nation when it came to covid, but he got the same answer and explanation — a lack of travel.
“They told me no,” Wright said. “But I ordered the test anyway. Clinically, he had all of the symptoms except travel. Finally, the Health Department said, ‘OK, we’ll do him if he has such a high index of suspicion.’”
Once the swab from the patient was sent to Little Rock, Bolton said, the staff went about its business and certainly was not anxiously awaiting an answer.
“They’ll call us,” she said, describing the mood. “It’ll probably be nothing. We didn’t forget about it, but we put it out of our minds.” Then her phone rang. It was 9:01 a.m. on March 11, and the morning status meeting was just getting started. During such meetings, officials from all the various hospital departments come together to talk about the day and what obstacles they faced. One obstacle they had not expected was about to change their world.
Bolton looked at her phone when it buzzed and might have ignored it for the time being had she not realized that it was from a Little Rock area code and was coming in on her personal cellphone. Both were unusual.
She eased across the back of the room, opened the door and stepped outside into the hallway.
Standing alone, she got a better look at her phone and saw the name of the caller, Catherine Waters, the outbreak response nurse manager and section chief with the Health Department.
And when Bolton answered and Waters announced her name, Bolton knew what was coming next.
“My heart went into my stomach,” Bolton said, explaining that Waters wouldn’t be calling her on her personal phone if the news had been anything but bad. “Her first words to me were, ‘Erin, I need you to find a place to sit down.’ Well, I looked around and there weren’t any chairs in the hallway, and I said, ‘No, ma’am, I know what you’re fixin’ to tell me.’”
And then Waters told Bolton what she feared hearing.
“You have got the first covid-19 patient in the state of Arkansas,” Bolton remembers Waters saying.
Bolton happened to have a piece of paper in her hand, and she started writing as Waters was “rattling off a list of things we needed to do.”
“I was shaking so bad I could barely write,” Bolton said.
At that point, the others in the room were wondering where Bolton had gone. One of them, Mary Daggett, a quality officer, stepped outside, frowned a bit and mouthed the words, “Are you OK?”
Bolton, still listening to Waters, wrote at the top of her piece of paper “COVID PATIENT” and then turned the paper toward Daggett, who was equally stunned.
Daggett then hustled into the meeting room and came back out with Peter Austin, the hospital’s chief operating officer. From there, the top medical and administrative players “huddled up in a classroom,” Bolton said, and began mapping out the strategy — a strategy that the hospital had prepared for but was not necessarily expecting to have to implement so suddenly and as the ground zero institution in the state.
Bolton has been present in the “covid command center” ever since, although now that the infections are dropping, the command center is finally being dismantled.
When Wright heard the results of the test, he said, he was “a little bit relieved.”
“I had only seen this guy through the window,” Wright said, “but I had such a strong suspicion. Sometimes you just have a gut feeling and think, ‘God, this has to be that.’ It’s almost like a test of your own logic. He didn’t fall into any other categories. And once we knew, I said: ‘Let’s go! Let’s rock and roll and take care of him.’”
Taking care of Patient Zero fell to a team of doctors, nurses, specialists and technicians in the ICU, which is overseen by Dr. Ali Alnashif, a pulmonary and critical care physician who is the medical director of the ICU department. The patient, however, was having a rough go of it.
“He started deteriorating,” said Alnashif, who has been in his position for 18 years. “But we worked really hard on this gentleman and gave him the best supportive care we had to keep him going. It was a collaborative effort with doctors and nurses and respiratory therapists. Everybody pulled together and worked on his case, and we had an excellent outcome.”
Alnashif said he was “shocked” when he learned that the patient had tested positive for covid.
“I knew it was in Washington state and in bigger cities,” he said, “and I knew Arkansas would eventually see it, but I never imagined the first case would be in Pine Bluff and I would be the physician taking care of that patient.”
Some of the medical workers became sick with covid from dealing with the patient because they did not realize at first that he had been infected. Alnashif, however, because of his training, always wore a mask when he was around the patient, thinking the person might have a transmissible disease. Alnashif said he had to quarantine for 10 days because of the exposure to the patient, but tests on Alnashif always came back negative.
“Wearing a mask protects,” he said, “whether people believe it or not. I can say that from personal experience.”
The experience with that one patient, however, would soon be followed by many others.
“That was just the beginning,” he said. “At times, the hospital floor and ICU were flooded. A quarter to a third of the 18 ICU beds were covid patients. It was just devastating.”
The problem, of course, is that there is no curative treatment for a covid infection. Because of that, members of the medical team have to rely on “supportive care,” which means they treat the symptoms as best they can and hope for the best. But in a country where more than a half-million people have died from covid, even the sophisticated care one gets in an ICU can fall short. In Jefferson County, 161 people have died from covid, according to the Health Department.
“A lot of people have passed away,” Alnashif said. “Every one of them hurts to lose. It’s very emotional. People you know, previously healthy people, we do all in our power and it doesn’t work out. It takes its toll on you. It’s been a long, difficult year.”
But the past couple of months have given Alnashif hope that something akin to the end is nearing.
“I’m glad to see a light at the end of the tunnel and we have a vaccine on board,” he said. “If we do the right things, we can get close to normal. This has been unprecedented in our lifetimes. Hopefully, we will not see this again in our lifetimes.”
★★★
Almost 50 days after the person who became Patient Zero entered Jefferson Regional, a weak but victorious James Black left the hospital on a gurney and then was taken on to other care facilities where he eventually was able to regain his strength. According to his social media accounts and media reports from 2020, he and his wife, Shaunika, both got covid after they went to Mardi Gras on vacation — a trip that doctors were unclear about initially. But while she recovered, his compromised health conditions created complications from the covid infection that were almost fatal.
The Blacks are scheduled to be at Jefferson Regional hospital today as part of a one-year remembrance to celebrate the work of the hospital’s staff and the resilience of the patients who survived, as well as to mourn the patients who were not as fortunate as James Black.