MONTREAL -- For the last ten months, Dr. Earl Rubin has focused intently on developing infection control strategies and protocols for the Montreal Children’s Hospital to keep COVID-19 at bay.
The infectious diseases specialist knows how to protect himself and others - or so he thought until he caught the virus himself.
“I was shocked that I got infected. It was really a low-risk exposure and it really underlines to me that we know so little about this virus," said Rubin.
And while he would never have chosen to get this type of on-the-job-training, Rubin said his experience as a patient in a COVID unit gave him “a tremendous amount of insight.”
He recalls hearing the cries of others suffering in adjacent rooms and witnessed his colleagues in action, working non-stop to try and do whatever they could to help them.
TRANSMISSION
To the best of his knowledge, the pediatrician says he could only have caught the virus from one particular colleague when they met during the holidays to do a “sign-over for clinical responsibilities.”
“My colleague was perfectly well when we did that, “ said Rubin, underscoring that “we don’t always know if someone’s infected, because they can be asymptomatic and still transmit.”
When he later retraced his steps using a measuring tape, he determined they had been sitting 1.7 metres apart in an office, just shy of the two metres recommended.
They both wore medical grade surgical masks and the meeting lasted about 30 minutes.
“We generally say something is a low-risk contact if we have masks if you’re greater than two metres apart and less than 15 minutes. So we didn’t fulfill all criteria but it was still considered a low-risk exposure,” the pediatric specialist said.
That night his colleague got sick. Her COVID-19 test came back positive, showing a high viral load which refers to the number of virus particles present once a person is infected.
People who have a high viral load may also shed more virus particles, making them more contagious.
But again, since it was still considered a low-risk exposure, Rubin followed hospital protocols that allowed him to continue to work, wearing protective equipment when required.
On day five post-contact he was tested - the result was negative. On day seven, he developed a fever. A second test also came back negative. But Dr. Rubin was isolating because he knew with a fever, and no other viruses circulating in the community, he checked every box for COVID-19.
On day nine, the results of a third test finally came back positive and confirmed his self-diagnosis.
WORSENING SYMPTOMS
By then Rubin’s fever was higher and he was starting to feel very ill. He had gastrointestinal symptoms, a slight cough and difficulty breathing, and developed some chest pain. He had no energy and slept all the time.
The doctor also obtained a pulse-oximeter and watched his blood oxygen levels hover around and below normal measurements.
“A friend called it the covid-coaster for a reason. You don’t know what tomorrow will bring and that is the most difficult part,” said Rubin.
A friend who is also an infectious diseases colleague kept checking in, finally arranging a Zoom call with two other doctors so they could try and evaluate their friend’s condition online.
“I was reluctant to go to the hospital but the next day she said enough is enough,” so heeding the expert advice, Dr. Rubin the patient went to the MUHC emergency room and was admitted to the hospital.
“As physicians, many of us are very good for our patients,” the specialist said, “ but we often don’t do for ourselves what we would do for others.”
Knowing that people with COVID-19 often get sicker around day 10, said Rubin, he acknowledges it was the right thing to do.
There were some amusing moments in the hospital. Rubin recounts how he had to try not to butt-in and administer his own care. Only once was he told by an emergency room doctor to “please sit down and not treat yourself,” after standing up to plug in his iPhone and setting off a series of beeps - that Rubin protested weren’t anything to worry about.
Treatment for the infectious diseases specialist, as for many other COVID-19 patients included steroids and the antiviral medication remdesivir. Rubin said he can’t say for certain either helped or if the illness simply ran its course.
The doctor, so accustomed to working in a hospital environment day-after-day for decades, was struck by the isolation COVID-19 patients have to endure when he heard an elderly woman who seemed to have dementia, crying out from an adjacent room.
“It’s heartbreaking for an elderly person who doesn’t really understand what’s going on,” said Rubin, especially in the crisis context when patients aren’t permitted to have any visitors.
In sharp contrast, Rubin was at least able to wave at his medical colleagues as they spoke to him by phone from the other side of the window as they passed through the COVID unit.
He says he received exceptional care and though he thinks he’s always been sensitive to patients’ needs, “certainly after being a patient it does heighten that sensitivity and give you a different perspective.”
MORE LESSONS LEARNED
After spending five days in the hospital, Earl Rubin went back home to rest for a few days but is now back at work.
“I’m very grateful overall, and optimistic because I feel so much better,” he said, but he finds he is unusually tired at the end of a day and his capacity for any exercise is limited.
He hopes his remaining symptoms don't linger or worsen as they do in some post-COVID
As he and others in his field try and keep up with all there is to discover about SARS-CoV-2, Dr. Rubin says he thinks the most important takeaway for him has been that “even when you think you are perfectly safe and even if you try to adhere to every guideline - unless you stay alone in a room, we’re still learning with time about transmissibility.”
