A man suffering from COVID-19 was fighting for his life in intensive care as his health rapidly deteriorated, but a treatment using steroids saved him and could offer a path to recovery for others suffering from the disease.
When 44-year-old banker Alex Fernandes arrived in Brazil on March 11, he got off the plane feeling ill.
"I didn't have a fever or anything, I just felt slightly off," he tells Newsmax.
But as the day wore on, he began to feel worse and developed a high fever. Because Fernandes travels frequently from his home in Dallas to Brazil, he contacted his doctor, Dr. Roberto Zeballos in Sao Paulo who said he might be suffering from the flu, but to exercise caution in case it was the coronavirus, which was just taking hold in that country.
"He told me to buy a mask and self-isolate," Fernandes recalls, adding he had to buy a pack of 50 masks, as that was the way they were sold. The next day he was feeling so weak he was out of breath just going to the bathroom.
"I've never had any breathing problem like asthma or bronchitis in my life, so this was very upsetting," he says.
Fernandes called his doctor again and they met at the hospital where his oxygen levels were tested and a CT scan performed on his lungs. He was also tested for COVID-19.
The results showed Fernandes had the disease and his lungs were severely inflamed with viral pneumonia. He was given antibiotics to prevent a secondary infection and oxygen to boost the saturation level of his lungs. But as the days went by, his numbers deteriorated, including his c-reactive protein or CRP levels which mark the level of inflammation in the bloodstream.
A week after his first symptoms, Fernandes was so weak he could barely move.
"I couldn't lift my blanket," he says. "It took two nurses to get me into a wheelchair to go to the bathroom."
By now, he was put into ICU where doctors discussed what options they had to save his life. Zeballos consulted with Dr. Marcelo Amato, a pulmonary expert, and they decided to try steroids to stop the cytokine storm caused by inflammation that was threatening to shut down Fernandes' lungs.
A cytokine storm occurs when the immune system overreacts and attacks parts of the body it should be protecting, including the lungs.
According to NPR, a strange and tragic pattern happens in some cases of COVID-19: The patient struggles through the first week of illness and then suddenly crashes.
"They initially were just requiring a little bit of oxygen. In 24 hours, they're on a ventilator," says Dr. Pavan Bhatraju, an assistant professor at the University of Washington who works at the intensive care unit at Harborview Medical Center in Seattle. The crash typically happens seven days into the disease and can occur in young, otherwise healthy victims of COVID-19.
Researchers speculate the cause is a cytokine storm – the body's own immune system overreacting to the virus, releasing a storm of small molecules called cytokines that help coordinate the battle against infection. When the release goes into overdrive, according to NPR, they cause more damage to the body's own cells than to the invader. Some doctors here in the United States have used powerful anti-inflammatory drugs to try and slow or stop the process.
"The impact was dramatic," says Dr. Daniel Griffin, chief of infectious disease for ProHEALTH Care Associates, a group of physicians that serves the New York City area. The first six patients to be treated appear to be improving, he says.
Fernandes' physicians decided to use corticosteroids, following a protocol developed by Chinese researchers for patients suffering from acute respiratory distress syndrome or ARDS due to the coronavirus.
The doctors told Fernandes about an article published in the Journal of the American Medical Association (JAMA) that treatment with methylprednisolone, a powerful steroid and anti-inflammatory drug, seemed to be beneficial for patients in his condition. In the meantime, the ICU doctors had planned to put him on a ventilator the next day.
"I was very concerned that putting me on a ventilator would increase my risk of infection and even death," Fernandes said.
He and the doctors discussed the experimental protocol with Fernandes' wife, Dr. Becca Marcus Fernandes, who is a dermatologist in Dallas: "She said, 'go for it.'"
The next day, after being given methylprednisolone, his numbers improved. They postponed putting him on a ventilator until that evening, and his condition became more stable from the steroid treatment; he improved so much, he was able to talk and move.
Within a week, Fernandes was almost back to normal and he tested negative for the virus. He stayed in the hospital until his round of antibiotics was over and then tests were re-run.
"My lungs were crystal clear," he said.
Fernandes said he was the first patient in Brazil to be treated with steroids, but since his success there have been dozens more.
The treatment that saved him could help others too.
Dr. Donald Marks, an infectious disease expert from Wharton, N.J., tells Newsmax: "In cases where there is potentially deadly inflammation of the lungs due to a viral infection, steroids such as methylprednisolone can be lifesaving."
As for Fernandez, he returned home the day before Easter and spent the holiday with his wife and four children.
"It was the most meaningful Easter ever," he said. "I feel like I have been reborn myself."
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