Nader Ammari, a 56-year-old Italian national living in Turlock, flew back from Venice at the end of February, when Italy was in the throes of the coronavirus pandemic.
About one week later, he and his wife received an email from the airline that a passenger in their cabin had COVID-19. Although they were well, they went for testing at Kaiser Permanente in Modesto.
Ammari doesn’t recall when he learned he was COVID positive, but a few days after the testing, he started developing symptoms of fever, fatigue and difficulty breathing, though no cough, so he returned to Kaiser on March 12.
Ammari, a visibly joyous person, told his story in a Zoom press conference on Thursday hosted by Kaiser Permanente.
“My oxygen was very low,” said Ammari. “Immediately, they admitted me to the ICU.”
His oxygen level was 40%, compared to normal levels of 93% to 100%. He required mechanical ventilation, a breathing machine, for his body to get enough oxygen.
“They used a unique treatment called front-to-end positioning .... with a special bed that rotates, and every few hours, it had me upside with my belly down,” said Ammari. “They used a side tube in my chest to help my lungs expand.”
Unique treatment uses gravity to help with oxygen
Dr. Ted Fong, chief of pulmonary and critical care at Kaiser Permanente, Central Valley, said with placing patients on their stomach, called prone positioning, gravity helps to get more oxygen into the lungs. The positioning has worked for other severe lung diseases.
Prone positioning requires extra maneuvering of the patient, as well as all of the monitoring wires and IV tubing.
Fong said Ammari had acute severe respiratory distress syndrome, ARDS, and one of Ammari’s lungs collapsed due to being so fragile, so a chest tube was needed to help the lung re-inflate with oxygen.
Ammari also received treatment with two medications that were being studied at the time of his infection. He received hydroxychloroquine, the anti-malarial medicine, which is hypothesized to block the coronavirus from entering cells.
He also received remdesivir, the anti-viral agent developed for treating Ebola, under a compassionate use protocol. With more recent, though limited data, remdesivir has emerged as the preferred treatment for COVID-19.
“This unique way of treatment saved me, “ said Ammari. “It helped my lungs regain strength.”
He was in a medically induced coma for 13 days and in the ICU for a total of three weeks, before being discharged on April 9.
What is known about COVID?
COVID-19 is the illness caused by the novel coronavirus, named SARS-CoV2. Initially in the outbreak, the typical symptoms included fever, cough (often dry) and shortness of breath. Loss of sense of smell or taste, nausea and vomiting were also seen.
Pneumonia and ARDS are common reasons that people with COVID-19 needed to be placed on ventilators. ARDS happens when the tiny air sacs in lungs become fluid-filled and oxygen can no longer get into the bloodstream, starving all of the organs of oxygen essential for functioning.
As the pandemic has continued, doctors have learned that the virus affects many organs of the body, not just the lungs, including the heart, kidneys and blood vessels, which may lead to strokes.
Adults age 65 and older and people with underlying health problems have increased risk of complications and death.
Ammari describes himself as healthy, but said he has mild hypertension and he thinks that contributed to him having such a severe case.
In a review of 5,700 COVID-positive patients hospitalized in New York City from March 1 through April 4, about 20%, 1,151 people, required mechanical ventilation, and among those ventilated patients, almost 25% died, about 3% were discharged alive and the rest were still hospitalized on April 4, according to a report in the medical journal JAMA.
Fong said Kaiser has had dozens of patients with severe COVID and describes Ammari as “sick as anyone.”
“He was really sick,” said Fong. “We were certainly concerned that he might not make it.”
For anyone who ends up on ventilators, including due to COVID-19, the road to recovery is long.
Ammari still requires dialysis while his kidneys are recovering and also has physical therapy to help regain his muscle strength after such a harrowing illness.
“I am feeling energetic. I’m ready to run a marathon,” said Ammari, smiling. “... It is a miracle that I am alive.”
Ammari had high praise for the skills and compassion of the medical team. He said he considers himself to be “very lucky.”
He said, “It is remarkable treatment that I got. It (was) so compassionate to human touch, what I felt from the doctors but especially from the nurses.”
During his ICU stay, he was not able to see his family or have any visitors.
Nurses praised for compassionate care
“The nurses, they don’t know me, but they held my hand and prayed for me,” said Ammari. “This touched me very much. This level of compassion, a thousand words of thank you is not enough.”
Before discharge, the doctors did two COVID-19 nasal tests and both were negative. He also reported that his wife and two sons have remained well.
“This level of care, even on the day of discharge, I was in tears,” said Ammari. “All the doctors and nurses were lined up clapping for me. Even management came.”
For his mental well-being during recovery, Ammari said, he is a very positive person and this infection will not get him down.
He said, “People should not give up hope, no matter their condition. Keeping a positive attitude helps.”
“It is clear that he is a vital, dynamic kind of guy, “ said Dr. Fong. “I would imagine that he’ll do well.”
Ammari’s recommendation to others, including people protesting the “stay-at-home” orders, “My advice - all respect for liberty of each individual, but (you) also need to protect yourself as well as others around you, your family, your co-workers,” said Ammari. “This is how the community all together will survive the pandemic.”
This story was produced with financial support from The Stanislaus County Office of Education and the Stanislaus Community Foundation, along with the GroundTruth Project’s Report for America initiative. The Modesto Bee maintains full editorial control of this work.
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