COVID-19: a first-hand account
Dr Ian Frayling, who recently retired from his role as a consultant in genetic pathology, describes his experience of COVID-19, and the lasting effects of his illness.
I told my wife: ‘I’m frightened. If it keeps coming at me, I’m done for.’
I initially thought my headache, mild fever and malaise that began on 3 March were due to a knee injury needing stitches and a tetanus boost – a view shared by my wife, Ann Ager, Professor of Cellular Immunology & Immunotherapy at Cardiff University. At that time there were only two cases of COVID-19 in Wales, each one at least 40km away. I did not have a sore throat, but things then started to taste strange with a burning sensation over my back and the onset of coughing at night.
Then on Friday 13 March the storm started, with severe bone- cracking fever and musculoskeletal pain and a cough like no other. I found myself on the floor after passing out with spasms of coughing. My blood pressure plummeted so I stopped taking my ACE inhibitor. My fever worsened while I listened to people on the radio saying, ‘don’t worry, this is mild’. I also thought ‘I can breathe easily, in and out, so I must be OK?’ That is until I noticed I had alternating hypo- and hyperventilation. Was this Cheyne-Stokes? Difficult to tell. I was confused, but as a medic it gave me angor animi. I’m SCUBA qualified in using enriched air: all I needed, I thought, was a tank of 36% oxygen with no need to bother anyone, but if this worsened I would have to be admitted. I told my wife: ‘I’m frightened. If it keeps coming at me, I’m done for.’
After the acute infection
Much is spoken about the physical effects of this disease, but there is an enduring mental effect too.
After tweeting that I had apparently survived the pandemic, but at some cost, a friend in the business sent me a side-flow antibody test kit on day 21. Despite only one drop of blood extracted with difficulty, the bands appeared, with IgG and IgM confirming that I had been infected with SARS-CoV-2. My wife tested negative and had not had any symptoms. She predicted that some individuals would have pre-existing cell-mediated immunity due to previous infections with other viruses and this has now been shown to be the case.
A local colleague, Dr Esther Youd, showed pictures on Twitter of microthrombi found in kidneys at post-mortem examination in COVID-19 patients. I wondered if the aspirin that I take had helped counter hypercoagulability in me. There are reports about the importance of vitamin D and last winter I took supplements after a friend who is the blood donor care doctor for Denmark noticed levels dropped in her donors each autumn. Maybe that helped too?
Much is spoken about the physical effects of this disease, but there is an enduring mental effect too. Severe COVID-19 is truly frightening, totally unlike flu. I still get very emotional seeing survivors on TV and documentaries and I can relate fully to their experience. Seeing people suffering alone is very hard. More than once I have cried at the misery caused by this disease. As a doctor I want to help.
My antibodies were high enough and my 560 mL of plasma could be used.
Fortunately, it turns out there are many ways I can help. Both my GP and sister-in-law, a nursing sister arranging COVID-19 triage, greatly appreciated me relating my first-hand experience of this new disease. My serum helped develop a better assay, since my day-34 serum titrated out to more than 1:5000. My wife also put me in touch with Professors Alan Parker and Paul Morgan, her colleagues in Cardiff University’s Systems Immunity Research Institute, and they have welcomed receiving my serum to help with their work on developing vaccines and an ELISA assay for specific neutralising antibodies (anti-RBD).
Through Professor Steven Jolles, Clinical Immunologist at University Hospital of Wales (and my wife’s PhD student in the 1990s), my antibody-producing B cells have been sequenced in Oxford in the Regeneron programme to produce therapeutic monoclonal antibodies that might be given, for example, to those who have to shield but cannot be immunised, or are on the clinical frontline. My serum has also enabled three-way comparisons between different antibody assays. My wife and I are already enrolled in UK Biobank and Sir Mark Caulfield acknowledged that we are a special matched-pair in the GenoMICC study given our peculiar circumstances: one affected badly, the other not at all despite exposure.
Hearing that Wales was to start a trial of convalescent plasma I unsuccessfully attempted to contact Public Health Wales and the Welsh Blood Service about donating plasma. I then heard Professor Dave Roberts talking about the trial on the RCPath COVID-19 webinar series and I contacted him about donating in Bristol. No problem! So, I had a great day out at the donor centre at Southmead, followed later by a letter saying my antibodies were high enough and my 560 mL of plasma could be used.
If I had been told last Christmas that all this would happen I wouldn’t have believed you.
I now find I am one of the 10% suffering long-term effects of COVID-19. After initially getting better I went back downhill, with profound shortness of breath on exertion, tachycardia, malaise, weakness, muscle aches, lethargy, nausea, sleep disturbance and a curious slowing of thinking with the ‘brain fog’. I have a cyclical relapsing version of chronic fatigue syndrome. I know others continue to have severe COVID-19-like symptoms, relatively unrelated to the severity of their original infection and this affects women more than men. I have been breathless just packing bags at the supermarket and people have generally been very kind. I have found fellow medics also suffering #LongCovid on Twitter and I was honoured to be included in a very positive teleconference with the World Health Organization (WHO) and a letter to the British Medical Journal.
It is ironic that I contribute to the WHO Classification of Tumours series. If I had been told last Christmas that all this would happen I wouldn’t have believed you. As my wife remarked: ‘You couldn’t make it up.’