Lessons from a Main Line doctor who is surviving the coronavirus

Belinda Birnbaum started coughing in the middle of February. It didn’t strike her as particularly worrisome at first; as someone who has asthma and allergies, she’s used to being dogged by a chronic hack.

The United States had only a handful of known coronavirus cases at the time, but Birnbaum, a rheumatologist, decided to start wearing a mask at the Bryn Mawr office where she practices. “Coughing scares people,” she said, “and I didn’t want to scare my patients.”

Soon, it was Birnbaum’s turn to be scared.

On March 15 — four days after the World Health Organization declared COVID-19 a pandemic — her cough worsened, and a low-grade temperature blossomed into a 101-degree fever. She was tested for the virus. The results came back positive.

In the days and weeks that followed, the virus sank its hooks in her, dragging her down, down, down, sending her to the hospital twice, while it spread like a fog through her house, infecting her husband and one of their two children.

Somewhere during that first week after her diagnosis — as she shed pounds from the fever, and the cough became unrelenting — she and her husband, Dan Vogl, had a frank conversation in the middle of the night, the kind that most parents wouldn’t want their kids to overhear:

If both she and her husband became gravely ill, who would sign off on life-and-death decisions? Who would take care of the kids? Was their will up to date?

Birnbaum, 46, knows there are some who still doubt the threat the coronavirus poses, who shrug off social distancing and scoff at the idea of donning a mask outside. She offered to revisit the details of her fight against the virus — one that isn’t remotely finished, even now, a month later — with the hope that it might encourage people to take it seriously, and plan ahead for the worst.

“It was terrifying,” she said, “because you don’t know which way it’s going to go.”

So how did you get it?

Birnbaum hears variations of that question whenever she tells someone she had the virus. Maybe they’re looking for an explanation — like she caught it from a sick patient — that would imply they’re less at risk than a doctor. (Thus far, 1,250 health-care workers have tested positive for COVID-19 in Pennsylvania, according to the state Department of Health.)

“The honest answer is, I don’t know,” she said. “I was at the supermarket, too, you know?”

What is clear is that the virus wore down her immune system quickly, its symptoms piling up like a stack of bricks. By March 18, Birnbaum had lost her appetite and developed abdominal pain. She started having trouble taking deep breaths, and found her oxygen levels were plunging.

Then her 45-year-old husband, who had started to feel unwell about the same time she did, also tested positive. “He never had a fever,” Birnbaum said. “But he had a really bad headache, a terrible cough, and horrible body aches. We both lost our senses of smell.”

Two people with an unpredictable virus under the same roof seemed bad enough. But then Birnbaum and Vogl heard an unsettling sound echoing from their 12-year-old son’s bedroom.

“It was that same deep cough that we both had,” Birnbaum said.

Their son developed a fever, too, but his symptoms passed within a few days. Their 10-year-old daughter, meanwhile, didn’t show any signs of being ill.

On March 25, Birnbaum made her first trip to the Hospital of the University of Pennsylvania. She was thoroughly dehydrated. “I had lost nine pounds and couldn’t keep anything down. I kept vomiting,” she said.

Birnbaum worked at HUP for a decade, and her husband is an oncologist there.

“It’s familiar territory for me. But walking in as a patient was bizarre,” she said. “We pulled into the ambulance bay, and it was completely empty. I had on a mask and a hat, and the security guard came out. He also had on a mask. I yelled at him: ‘Stop! Don’t come closer! I’m COVID-19 positive!’ ”

The waiting room was a ghost town. Birnbaum was led into a negative pressure room meant for patients with contagious diseases. She was struck by an overwhelming sense of gratitude for the nurses who ventured into her room to check on her, and provided her with fluids for dehydration.

Doctors discovered a secondary bacterial infection. Birnbaum was given an antibiotic, and sent home the following morning.

By the end of March, her condition started to show signs of improvement. “I had no fever. I was able to start to eat again, drink again, and start to feel a little better,” she said. “I was still feeling very weak. I was napping during the day, which is something I don’t generally do. Still coughing, still not smelling anything.”

She felt well enough to take a brief walk around the Main Line neighborhood where she lives — baby steps, but still encouraging.

And then came her next big scare.

On April 4, Birnbaum tried to walk up a flight of stairs inside her house. An unsettling sensation stopped her in her tracks.

“I had chest pains,” she said. “My oxygen level had dropped to a level that I thought was problematic.”

By that point, there were more than 10,000 reported coronavirus cases in Pennsylvania, and more than 3,000 in Philadelphia. She returned to HUP, where she noticed the atmosphere had changed. The emergency room was busier. Patients were being triaged under tents outside the building. Registration was being done by phone, as were some conversations with doctors.

A scan showed that Birnbaum’s lungs were still plagued by residual pneumonia. She was released — a pulmonologist recommended additional medication — and relieved she didn’t have to experience life as a coronavirus patient restricted to a hospital bed, barred from having visitors.

“It must be a lonely, desperate feeling,” she said.

She is still coughing, still not remotely 100%. Neither she nor her husband has returned to their offices, but both are conducting telemedicine from home, and encouraging patients with ongoing medical issues to continue to communicate with their doctors.

The experience has left Birnbaum with an urge to try to enlighten people. “This was the sickest I’ve ever been,” she said, “but on the spectrum, not as sick as I could have been.”

She’s come to view her family as a case study in the importance of social distancing. Imagine, she said, how easy it would have been for her daughter, who could be asymptomatic, to spread the virus to a teacher or a friend at school — were schools still in session — and for that person to take it home to their family, and on and on down the line.

There are other lessons. That unnerving middle-of-the-night conversation that she and her husband had about their will, and the possibility of having to make serious medical decisions? Don’t wait to have one like that with your family, until you’re on the verge of hospitalization.

People with chronic illnesses should compile lists of their medications, histories, and primary doctors that could be shared with hospital personnel, a move that would save time for everyone. And families ought to have a clear understanding of one another’s wishes — wills, and potential life-sustaining treatments.

“Nobody wants to talk about death. Ever," Birnbaum said. "But I think there’s really no better time than when you’re at home right now, with your loved ones, to say, ‘What do we do?’ ”

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