A double diagnosis of COVID-19 thrust Christy Yousefi into a weeks-long struggle to help save her parents.
Her account offers a glimpse into how some loved ones of those stricken by the disease find themselves helpless at times, yet push to learn more and advocate to influence the delivery of care.
Geoffrey and Steffi Cowan, of Ponca City, both came down with symptoms of COVID-19and went into self-quarantine at home in early March.
Steffi Cowan, 64, is a registered nurse who works at Stillwater Medical Center. Geoffrey Cowan, 69, is a child psychologist in private practice.
The couple tried to take care of each other as the disease progressed, said Yousefi, who lives in Alabama. Her twin sister lives in Ponca City but couldn’t visit them because of the threat of infection. A third daughter lives in Montana.
Reached by phone at home, Steffi Cowan said her husband was tested for COVID-19 by his doctor March 13 and it took several days to get the results. He was positive. She wasn’t tested but was presumed positive because of her symptoms and contact with her husband.
“I’m part of the numbers listed for Kay County,” she said.
The county of 45,000 residents has one of the highest per capita rates for counties in Oklahoma. As of Thursday, state health officials reported Kay County had 24 confirmed cases and one death. Cowan said a nurse at the county health department told the couple they were the county’s first two confirmed cases.
“It (the severity) went back and forth. One day Mom was sicker and the next day Dad was sicker,” Yousefi said. “She kept getting worse, so Dad took her to the ER (at the AllianceHealth Ponca City hospital) when he was terribly sick.”
They sent her back home that night because she didn’t meet the threshold for admitting someone with the coronavirus, Yousefi said.
According to guidelines from the Centers for Disease Control and Prevention, the decision to monitor a patient in the hospital or at home should be made on a case-by-case basis, depending on various factors.
“They really didn’t want it (in the hospital),” Cowan said. “They did a breathing treatment and said, ‘You have it.’ I think they only wanted to admit people at the respiratory failure stage. I don’t think they are being that restrictive now.”
The next day – after two weeks of self-quarantining – Geoffrey Cowan was so sick he was admitted to the same hospital and put on a ventilator.
Yousefi drove through the night from Alabama and arrived the next day. Dressed in protective garb, she got to see her dad. “They let me come in because they didn’t know if he would make it,” she said.
On March 19, Yousefi posted a photo of her father sedated and on a ventilator with the caption, “This is my DAD. This is COVID-19. This is real.” She wanted people to see how serious the virus is and how it can happen to any family.
Yousefi spent four days in Ponca City talking with health professionals in Oklahoma and beyond to learn everything she could about treatment options for her parents.
Unlike most conditions, there is no national protocol, or detailed treatment plan, for dealing with COVID-19, so hospitals must respond without one, said Yousefi, who like her mom is a registered nurse.
She said hospitals need more guidance that tells them: “This is what we’re going to do. This is how we’re going to handle it.” There are clinical guidelines from the CDC that advise use of infection prevention and control and management of complications.
But Dr. Larry Bookman, president of the Oklahoma State Medical Association, said there is no protocol because there is no specific treatment for COVID-19, which is incurable.
“At that point (when a patient is placed on a ventilator) it becomes somewhat experimental and what the doctors and hospitals have available,” Bookman said. “There’s no proven therapies.”
Yousefi said her dad was on standby for extracorporeal membrane oxygenation, or ECMO – a treatment that pumps blood out of the patient, adds oxygen and returns it. That would have required flying him to a hospital in Oklahoma City, but the idea was scrapped because of questions about its effectiveness for COVID-19 patients.
Through a family connection, a pediatrician from Virginia who is working on a COVID-19 research team reached out to offer help. The doctor, whose name the family is keeping confidential at her request, took Steffi Cowan on as a patient and consulted with the doctors treating her husband, Yousefi said.
Both patients were started on antiviral medications undergoing clinical trials for possible treatment of COVID-19. There are currently no antiviral drugs licensed by the U.S. Food and Drug Administration to treat patients with COVID-19.
“A doctor on the frontline of research on this saved both our lives,” said Steffi Cowan, who was admitted to the Ponca City hospital March 21, four days after her husband. “I went into respiratory failure too. I just didn’t have to go on a ventilator.”
Knowing both parents were in the hospital where they would be taken care of, Yousefi drove back to Alabama and tackled the next big challenge – to get a bed that would turn her father from his back to his belly.
“My dad needs help. We need a RotoBed. There’s red tape, there’s blocks, there’s contracts,” Yousefi said in a video posted March 24 to Facebook. “We firmly believe he’s at a hospital that’s taking great care of him … We cannot get a bed that he needs.”
To get any specialty bed, the hospital is required to go through the company it has a contract with and didn’t have access to one, Yousefi said. She tried calling companies herself without success. Her dad never got the bed.
Without it, the ICU team had to go in and turn him. “That’s harder on the patient and the team and more risky,” Yousefi said.
The breathing tube had to be removed and reinserted twice. “That’s where our setbacks came,” Yousefi said. “The first one was a big setback.”
After the second time, the doctors performed a tracheotomy to help his breathing and inserted a feeding tube. Yousefi said her dad also was started on another trial medication.
Geoffrey Cowan turned a corner March 26, his daughter said. “We don’t know if it was one or the other or a combination of both,” she said. The doctors could began gradually weaning him off sedation.
“We’re feeling a whole lot more positive now,” Yousefi said. “We can still have setbacks. It will be a very, very long process.”
Christy Yousefi posted this video on Facebook on March 22.
The next day, Steffi Cowan was taken home by ambulance after being treated for a week in the hospital. She began a 14-day quarantine. Cowan said she still is short of breath and weak, but is “getting a little stronger every day.”
On Monday, Yousefi posted to Facebook: “Dad woke up early this morning! He’s day 14 of being on the vent & sedation. He’s very weak & groggy. He will have a very long & intense recovery process.”
Yousefi said the plan is to move him soon to a long-term acute care facility in Oklahoma City or Tulsa to continue his recovery. She said the family must find a facility that will accept him. He will remain on a ventilator for an unknown amount of time.
Despite all the unknowns, there is one thing Yousefi is sure of.
“If your parents or friends or family get into this situation, be ready to fight, be ready to demand care and be their representative because we are in foreign territory,” she said in video posted March 22.