A Previously Healthy Clinician, Now Critically Ill With COVID-19

A New Jersey physician assistant who was the state’s first COVID-19 patient is speaking out from his hospital bed, calling his illness “severe” and raising concerns about his treatment.

James Cai, a 32-year-old non-smoker with no other health conditions, has been at Hackensack University Medical Center for about a week and says his illness has worsened significantly over that time.

“In the beginning, they just treat me like normal flu. They say I’m young, I’m not going to die, but they don’t know the truth about corona[virus],” Cai said during an interview posted to Twitter over the weekend.

Cai didn’t respond to MedPage Today’s request for an interview, but he told CBS New York that his illness progressed rapidly. He’s now having trouble breathing and will likely need to be placed on a ventilator soon. He’s one of 15 cases in New Jersey as of press time. On Tuesday, the state reported its first death: a 69-year-old man with underlying conditions.

His story came to light over the weekend when Bill Pulte, a self-described Twitter philanthropist, posted a live interview with Cai that garnered social media attention. (Pulte is the grandson of William Pulte, founder of the large U.S. home construction company.)

Pulte said in a tweet that Cai’s family reached out to him for support, and he took up the cause because Cai “needs a patient advocate right now.” He said he wanted to help amplify Cai’s request to transfer to Mount Sinai Hospital in New York, where his brother works, and to get into a clinical trial of the antiviral remdesivir, first developed to treat Ebola but now repurposed as a potential coronavirus therapy.

Hackensack University Medical Center confirmed Cai is a patient there, but would not comment further. Gilead, which makes remdesivir, told MedPage Today it couldn’t comment on individual patient cases.

During the interview, Cai appeared at times to be struggling to breathe, and Pulte halted the interview at one point to give him time to catch his breath.

“For the last one week, it’s been hell,” Cai said during the broadcast. His symptoms have included dyspnea, chest pain, high fever, watery eyes, and diarrhea. A repeat CT scan performed over the weekend showed evidence of disease worsening, he said.

At one point, he said his oxygen saturation dipped below 80%.

“I don’t think they really understand what’s going on here,” he said. “My brother at Mount Sinai main campus, he understands. He can advocate for me.”

In addition to going to his brother’s hospital, he said he hopes he can start taking remdesivir soon.

“I need those two things,” he said. “I don’t know how many days I can last.”

Cai worries for his 90-year-old grandparents, his wife, and his 9-month-old daughter, and confirmed his family is currently in isolation.

He believes he contracted the virus during a medical conference he attended at a Times Square hotel in New York City the weekend prior to his hospitalization on Tuesday, March 3.

Cai urged on CBS New York that people should “take coronavirus seriously. It’s very serious.”

His pleas come as experts sound alarms that the U.S. health care system isn’t prepared for a substantial influx of COVID-19 patients and may quickly be overwhelmed.

Kristina Fiore is director of enterprise & investigative reporting, MedPage Today.

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