'It's like slowly being strangled': Worn out, hooked to a ventilator, coronavirus patient still beats odds

Lona Towsley had beaten cervical cancer at the age of 19, then uterine cancer at 28. She never doubted she would survive. For 23 years, she's been cancer-free.

But on April 19, the day the doctor said she would need to be placed on a ventilator, the 53-year-old mother of two felt worn out from fighting COVID-19. She didn't think she could fight anymore.

The survival figures for COVID-19 patients on ventilators inspire little hope. A study in China found that 86% of those who required mechanical ventilation died. A larger British study of 165 patients reported a death rate of 66% for those needing advanced respiratory support.   

As she lay there at UW Health University Hospital in Madison, Lona could feel her lungs filling with fluid.

"It's like slowly being strangled," she said.

Nurse Britney Kershner suggested that before they hooked her to the ventilator, she might want to have a FaceTime talk with her husband, Lee. 

The talk was brief. Lee, a man who seldom weeps, broke down. They both did.

Gathering his composure, Lee told his wife of 23 years that he loved her and was praying for her. He urged her again and again to stay strong.

"I'll try," she said. 

Lona told her husband she loved him, too. Then a spasm of coughing jolted her body, bringing the talk to an end.

Twice as contagious as the Spanish flu

The face of the COVID-19 pandemic in the U.S. has been largely urban.

Think of the images. Overwhelmed hospitals in New York, Newark, Boston. Exhausted doctors and nurses risking their lives to help patients gasping for breath. The frightened sick, sequestered in rooms only entered by staff in full-body protective gear; visitors barred.

And outside the hospitals, empty cities, walled-off in response to one of the most infectious viruses in modern medicine. A single COVID-19 patient spreads the disease to a median of 5.7 people, making it twice as contagious as the 1918 Spanish flu, according to a report in the journal Emerging Infectious Diseases.

But the pandemic is sweeping through rural America, too, small towns where the sickest patients must be transferred from local hospitals to distant, larger ones. While many hospitals have not experienced frantic scenes like those in New York, COVID-19 has challenged them like nothing before it.     

Lona Towsley and her husband live in Avoca, a village of 640 an hour's drive west of Madison. Her two children by a previous marriage are both grown and live in Illinois.

Lona works 25 minutes away in Richland Center at a place called VARC Inc., which hires people of varying abilities to fill assembly and packaging contracts.

In early April, one of VARC's clients, a man in his mid-40s, tested positive for COVID-19 and subsequently died.

"We found out about him," Lona said, "and the next day I started coming down with symptoms."

It was April 7.

Weeks passed with no surge

Although the staff at the Madison hospital had time to prepare, no one knew quite what they were preparing for. 

Founded six years after the 1918 Spanish flu, UW Health University Hospital reported its first positive case of the new coronavirus pandemic on Feb. 5. The patient was well enough to be sent home to stay in isolation. 

Weeks passed without the expected surge of new patients. UW Health established two special units for people hospitalized with COVID-19, but no patients arrived. Staff waited.  

"None of us have done this before," said Ann Sheehy, a doctor there for 15 of her 46 years. "We had to create new processes."

Sheehy helped build a large backup team of doctors and other clinic staff who don't normally practice in the hospital but are certified to do so. They were offered special training and the chance to shadow hospital staff in preparation for COVID-19 duty.

The UW Health nurses, who see patients more often than anyone else, readied themselves for what was to come.

"You are the one, minute to minute, seeing the changes no one else sees," said Sara Schoen, a 34-year-old nurse manager who has worked at the hospital for 12 years.

Nurses also provide care that goes beyond medicine, something essential when patients and families cannot visit.

"The patient care, that human connection — you get to have that with someone when they are at their most vulnerable," Schoen said.

COVID-19 would also test environmental services workers, among the most invisible of the invisible in a large hospital. Their work — disinfecting the building — would be more important than ever.

The SARS-CoV-2 virus — which causes coronavirus — can survive for up to 72 hours on plastic, though the amount of virus will decline sharply during that period. The comparable figure for stainless steel is 48 hours, for cardboard 24 hours, and for air, three hours. 

The staff, known as EVS techs, disinfect everything in the building: patient rooms, operating areas, the ER, hallways, elevators. At the Madison hospital, that's a total of 1.7 million square feet.

"I knew what I was signing up for. I knew the kinds of things I would be around," said Jeffrey Kaethner, a 31-year-old EVS tech. 

Stephanie Childs, a 34-year-old day shift supervisor, repeated a saying she often tells the techs whom she oversees: "The doctors make sure they get rid of the infection. We make sure it's not going to come back."

After that first positive test for COVID-19 in early February, six weeks passed.

Not until March 23 would staff be called upon to treat an infected patient sick enough to be hospitalized.

Within eight days, the total hospitalized with the disease went from 1 to 21. 

'Each day I was getting worse'

The first day, Lona thought her symptoms were just allergies acting up in the spring weather. Two days later, when she returned from work, she had a fever and no appetite.

That night she suffered chills. Her husband piled on the blankets.

"I still couldn't stop shaking," she said. "It was like if you go out in the winter without a coat and you shake. It was like that, but I couldn't stop I was so cold."

She didn't wake up until noon the next day, April 9. After calling the hospital in Richland Center, she was told to come for a drive-through COVID-19 test. She gave a nasal swab and had her pulse and blood pressure taken around 3:30 that afternoon.

Two hours later, her family doctor called. She had COVID-19. Given her medical history — the cancer treatments, a thyroid condition and her years as a smoker — Lona was told to return to the hospital the next day. She drove herself.

She was not struggling to breathe at this point, but doctors determined the oxygen levels in her blood were low. She had never been a worrier. She thought she'd be in the hospital a couple of days, then leave and go into isolation at home.

Her stay at Richland Hospital lasted from April 10 to 16. 

"Each day I was getting worse," she said. "I was starting to feel short of breath. My chest was tight. My ribs were hurting from the strain of breathing."

The hospital staff kept turning up her oxygen level. One of her doctors called a colleague at UW Health and learned that Lona might be a good candidate for a study examining the use of plasma from recovered COVID-19 patients.

On April 16, an ambulance carried her on the bumpy ride from Richland Center to the UW hospital more than an hour away.

In their eyes, one emotion: Fear

On the day Lona arrived at UW Health, the cumulative number of hospitalized COVID-19 patients had grown to 45. 

The university was helping the hospital staff to deal with equipment shortages. The School of Engineering was making face shields on 3-D printers. The UW School of Pharmacy was making hand-sanitizer.

COVID-19 was already testing the nurses. Patient doors in the coronavirus units had to remain closed most of the time. Nurses couldn't poke their heads in to say "Hi." 

Christina Brahos, a 24-year-old nurse, who began working at the hospital at the end of October, felt the isolation of the patients and found herself tempted to enter rooms more often.

But even when she was able to enter rooms, it felt harder to connect with patients while wearing the mask and other protective equipment.

Under it all, she said, "the patients are basically seeing a set of eyes."

In their faces, Christina saw mostly fear. As much as possible she tried to keep conversations with the COVID-19 patients "normal". There were times, though, when she felt helpless.

"I've come into a patient's room and they're having a coughing fit," she said, "and there isn't anything I can do." 

The barriers were similar for the EVS workers, who pride themselves on being the people who enter patients' rooms, but never poke or prod them.

Jeffrey Kaethner made it a point to talk with his patients even when he was in full protective gear, even when the patients could not talk to him.

One day, he was cleaning the room of one male patient who was fitted with a breathing tube and could not speak. He watched the patient write on his board, then hold it up so that Jeffrey could read the words.

"Thank you for doing this."

'I should have a will'

The doctors were also at a disadvantage against the virus.

"Usually when we are taking care of patients we have several treatment options," Ann Sheehy explained. "With COVID-19, the standard of care is supportive care, giving the patient oxygen and allowing the body time to heal. I think we're all just hungry for things that we know will work."

By mid-April, the hospital had joined the nationwide effort to use plasma from recovered COVID-19 patients to help those still sick with the disease. Evidence supporting the use of plasma was promising but largely anecdotal.

Two very small studies in China showed good results, but UW and dozens of other universities and hospitals were now using the treatment under the U.S. government's expanded use policy. They were also launching clinical trials.

On April 16, Lona agreed to allow her doctors to treat her with survivor plasma. For the first few days she could see the nurses at the UW hospital peeking in at her through the window on the closed door. At times, doctors and nurses entered.

"I kind of know what a cat or dog feels like in a pet store," she said. "Everybody is smiling and nice, but you can't touch them or talk to them."

Still, she could hear, and she remembered what Kershner, her nurse, kept telling her: "You're doing it. Come on. You're going to kick this."

She remembers nothing of the 50 hours she was hooked up to the ventilator; it is lost time. Right before the procedure she remembers thinking, "I should have a will."

The same day Lona went on the ventilator she received the infusion of plasma.

Relief, joy, and then a mint malt

Her eyes opened on April 21 and the first thing she saw was Kershner smiling down at her as she took her vital signs.

Lona was no longer on the ventilator. Her throat felt sore, but it was much easier to breathe. Her body did not ache as much as it had.

"I've made it," she remembers thinking.

At home, her husband, Lee, had spent the last two weeks thinking about his wife, running through the "What ifs?" and praying — something that was not his custom.

"She had to get through it," he said. "I didn't want to be without her."

The nurses hadn't told him that Lona would be coming off the ventilator. They wanted it to be a surprise. And it was.

When he saw her during their next FaceTime chat he felt enormous relief and joy.

Lona remained in the intensive care unit for a few more days, then moved to a regular room. On April 28, doctors allowed her to go home. They gave her an oxygen tank to help until her lungs regained their strength.

Lee picked her up in the couple's 2014 Ford Escape. On the way home, she felt a sudden craving and Lee made a detour. They went to the drive-thru window at Culver's and she ordered a mint malt.

Lee feared that he might get the virus at his maintenance job and pass it back to his wife, so for several days they both wore masks and she stayed in their master bedroom.

"Last night was the first night we slept together in that bed in a month," Lee said on May 8.

Lona has signed up to donate her plasma and urged other COVID-19 survivors to do the same.

"That's what saved my life," she said.