A young woman whose lungs were destroyed by the coronavirus received a double lung transplant last week at Northwestern Memorial Hospital in Chicago, the hospital reported on Thursday, the first known lung transplant in the United States for Covid-19.
The 10-hour surgery was more difficult and took several hours longer than most lung transplants because inflammation from the disease had left the woman’s lungs “completely plastered to tissue around them, the heart, the chest wall and diaphragm,” said Dr. Ankit Bharat, the chief of thoracic surgery and surgical director of the lung transplant program at Northwestern Medicine, which includes Northwestern Memorial Hospital, in an interview.
He said the patient, a woman in her 20s who had no serious underlying medical conditions, was recovering well: “She’s awake, she’s smiling, she FaceTimed with her family.”
But she has a long way to go. She is still on a ventilator because even though the transplanted lungs are healthy, her long illness has left her chest muscles too weak for breathing, and it will take time for her strength to return.
The transplant was her only chance for survival, Dr. Bharat said. His team wanted other transplant centers to know that the operation could save some desperately ill Covid-19 patients.
He said that other medical centers had been calling to find out about the operation and that some wanted to send Covid-19 patients to Northwestern for lung transplants.
“I want to emphasize that this is not for every Covid patient,” Dr. Bharat said. “We are talking about patients who are relatively young, very functional, with minimal to no comorbid conditions, with permanent lung damage who can’t get off the ventilator.”
For such patients, he said, the news of a successful transplant “absolutely could start something.”
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An X-ray of the patient’s lungs before the transplant, showing severe damage.Credit…Northwestern Medicine
He also said that doctors were closely monitoring Covid-19 survivors who had been on ventilators with severe lung damage, to see whether they recover fully or have scarring in the lungs that might eventually lead them also to need transplants.
The patient’s name is being withheld to protect her privacy, and her family has declined to be interviewed, said a Northwestern spokeswoman, Jenny Nowatzke. She said the woman wasin her late 20s,lives and works in Chicago, and had recently moved there from North Carolina. She also said the woman is Hispanic, an ethnic group that has been hard-hit by the virus in the U.S.
She was healthy before she contracted the coronavirus, Dr. Bharat said. She had had a minor illness that required her to take a medication that suppressed her immune system somewhat, but it was not clear whether the drug made her especially vulnerable to the virus.
She was ill for about two weeks before being admitted to the hospital on April 26. She soon needed a ventilator. Her condition kept worsening, and doctors connected her to a machine that pumps oxygen directly into the bloodstream.
Weeks passed with no improvement, and the lung damage began to put a strain on her heart and liver. It became clear that her lungs would never recover, Dr. Bharat said.
“You have someone in their 20s, who’s otherwise healthy, this poor girl,” Dr. Bharat said. “The whole team felt it’s hard to let someone go like that. We wanted to give her every option. Everybody was just rooting for her.”
One of the lungs removed from the patient. The surgeon said the damage was among the worst he’d seen.Credit…Northwestern Medicine
Previously, he said, he and his colleagues had debated what they would do if they had a young patient with irreversible lung damage. They had heard of such cases at other centers where care was withdrawn, and patients died.
It seemed reasonable to try a lung transplant. Northwestern Medicine performs 40 to 50 a year; Dr. Bharat said he does most of them.
The patient was put on the waiting list for a transplant only after she tested negative for the coronavirus.
Frequently Asked Questions and Advice
Updated June 5, 2020
Does asymptomatic transmission of Covid-19 happen?
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
How does blood type influence coronavirus?
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
How many people have lost their jobs due to coronavirus in the U.S.?
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Will protests set off a second viral wave of coronavirus?
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
How do we start exercising again without hurting ourselves after months of lockdown?
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
My state is reopening. Is it safe to go out?
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
What’s the risk of catching coronavirus from a surface?
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
What are the symptoms of coronavirus?
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
How can I protect myself while flying?
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Should I wear a mask?
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
A matching donor was quickly identified, and a few days later the young woman underwent the operation.
She was the sickest patient to whom he had ever given a transplant, he said, and her lung damage was among the worst he had ever seen. A pathologist who examined the lungs confirmed that the damage was irreversible.
Researchers are studying them in hopes of learning more about the disease, to help answer one of many unanswered questions, Dr. Bharat said: “What is the failure of repair mechanisms in the human that make someone get to this point?”
The patient must take immune-suppressing drugs to prevent her body from rejecting the transplant. They can increase the risk of infection, Dr. Bharat said.
The patient has already been tested several times to see if the drugs could somehow have reactivated the coronavirus, but so far, those tests have been negative.
