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Video: School of Pharmacy Town Hall · Marilyn Stebbins's COVID-19 patient story

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Part 1—General updates and Q&A

School of Pharmacy Dean B. Joseph Guglielmo, PharmD, shares the latest UCSF and School-specific updates on COVID-19 and answers questions from the School community.

Video transcript

[Joe Guglielmo]
Good afternoon, everybody, and welcome to the weekly School of Pharmacy COVID-19 update. This week's webinar is hosted by Alexa Tam. And it's gonna be a little different town hall compared to the last several that we've had, in that we will do a shorter update for me, along with a fairly limited Q&A which will be moderated by Eric Davila. And then what will follow will be an interview of Marilyn Stebbins, which will be conducted by Grant Burningham which will follow a Q&A which will really take the majority of the town hall.

I'll remind you, in addition to the format that you're well aware of, that there are a few things that you need to be aware of as it relates to these town hall webinars and that would include the following. Your audio and video will be automatically muted, only panelists can unmute themselves. The chat function at the bottom of your stage at the bottom of the screen is not functional. You'll have to use the Q&A if you have questions that you want to ask. And you can put those in anytime you'd like. Any questions we're not able to answer as always, we will answer you directly in email if you let us know who you are, or if anonymously, we'll try to do it at the next town hall.

I want to thank you all once again, we're in our fifth full week of shelter at home. I also want to remind you as I do every week, please use the emotional health and well being page of the UCSF COVID-19 website. So I'm going to start as I always do, give you a very quick update on the numbers in terms of how things are going and a little bit of what is new, at least from the chancellor. So the state and Bay Area situation as of a week ago is can be summarized the following. So I'll start at world and come down to the Bay Area. Last week, there were 1.5 million cases in the world and about 94,000 deaths. Today, there are 2 million cases and 128,000 deaths. A week ago in the United States, there were 457,000 cases with associated 16,250 deaths. Today, there are 616,000 cases and 26,000 deaths. And then lastly, California a week ago, I informed you that there were 19,127 cases with 501 deaths. Today, there are 25,700 cases and 789 deaths. Recall that we have relied on the University of Washington and their predictions in terms of when our peak would be in the number of deaths. You may recall that the projection last week they said the peak would be April the 15th. And they assumed, on that date, which is today, there'd be 67 deaths. And they thought there would be a total number of 1600 deaths by August the 4th. Now that has changed yet again in a favorable way. They now believe the projected peak will be in four days on April 19. And they expect 52 deaths down from the 67. Previous who expected with the April 15th peak. And then down from the 1600 total deaths by August 4th, they expect there will be a total of about 1480 by that date.

And the UCSF situation, last week, I informed you there were 20 patients hospitalized at UCSF, about 50% of them were acute care, 50% were in critical care, and that those are the numbers today as well. We're sitting at about 20 exactly. So it has not increased in a week's time.

The update from the Chancellor is the following. The main thing in discussion with Chancellor Hawgood today was the following, that is, when are we getting back to work, essentially back to normalcy, what we knew before. And I'll just quote him in terms of what he said. And that would be the following. He says that in two weeks, you can expect there will be a loosening up of criteria on a shelter at home. He has been in direct contact with London Breed the mayor of the City of San Francisco, who has that plan in two weeks of loosening things up. However, it's not going to be like they're going to open up the faucets and allow things to happen exactly as we were before. What you can expect will happen and the Chancellor said quote, unquote, over weeks if not months, is what it would be to get us back to what we were at before. Now, he cautioned, we will never get back to what we were before, because in all likelihood, the virus will still be with us. And we will have some very new ways of doing things with smaller groups as we try to do the work, the great work that the School does. And so that would be what you expect. They think the way it will happen is, at that two week period, you can expect that one or two, what they would call essential personnel, we can try to bring them back. And the way that that's going to work initially, is that would be my decision as dean for anybody associated with the School of Pharmacy. If in fact, the numbers are larger than one or two, like 10, it's a Chancellor's decision at this point. So that's really the most I can tell you. They're already thinking ahead that as people coming back how we accommodate them getting to work when Muni is not full service and neither is Bart. And they're already prepared to offer Lyft to those individuals that end up, start coming back. And I think with that, I'm going to stop, those are the updates. I will also maybe point out one thing that's perhaps of interest to this particular group. And that is, I would point out a very interesting editorial that appeared in the New England Journal of Medicine yesterday, and it came out from Jerry Avorn and others. And the entire thing is on things that we've talked about, and that is the current state of affairs of use of drugs for the treatment of COVID infection. It gets into a very interesting discussion of when should you do things, compassionate use, and when is it better to participate in randomized control studies, and he highlights hydroxychloroquine, chloroquine, azithromycin, and remdesivir in that article. It's a very short read. I'd recommend that you take a look at that. I think it reinforces the practice we've had at UCSF, and that is, if at all possible, put people in controlled trials. And after that, if that is no longer possible, than case by case, consider one of these other drugs. So at this point, I'm going to stop. And I'm going to turn this back to Eric Davila, who is going to if there are any questions I can answer. I'm going to try to answer those for the next five minutes or so. And then we will move toward the majority of the time with Dr. Stebbins being interviewed by Grant Birmingham. So what questions do we have, Eric?

[Eric Davila]
All right, first up from Pam England. She'd like to know if the climate controls will be turned back on in the buildings in which they're now being turned off.

[Joe Guglielmo]
I do not have that answer, but I will get that. I will talk to the individuals that are responsible for that and I'll get back directly to Pam with that answer but I do not have that answer today.

[Eric Davila]
All right, next up will the first year pharmacy students be finding out if they're returning for IPPEs next week?

[Joe Guglielmo]
I think Sharon Yeomans must have set her up, set this person up for the discussion. There is a memo going out from Sharon and from Val Clinard in the next hour to answer that question, so I will not steal their thunder, it will be coming to the first year class by the time before evening falls.

[Eric Davila]
We do have a few more minutes dedicated for Q&A for the dean and school leaders. So if anyone else has questions, now's the time to get it in.

[Joe Guglielmo]
I have I have a response from last week that we were not able to answer and maybe this would be a good time to do this. A question from a student. And it was, it went directly to Dr. Fran Aweeka. And the question was whether there are any opportunities for students to participate in the COVID-19 research. Her answer was, many students are already actively participating in these projects. Since some of the faculty pursuing COVID-19 research are also precepting students on their projects, Fran encourages students to contact their preceptors to see if there are some part of the project that may evolve to address COVID-19 questions and COVID-19 science. I think that was the one that was hanging out from last week. Other questions of me from the group?

[Eric Davila]
Yes. I think that people could interpret this in different ways. But the question is, do we have plans for phase two of this outbreak?

[Joe Guglielmo]
So I don't know if there's a phase two, three, four, five, six, and seen. And it depends what you're referring to. There is little doubt once again in two weeks, that little by little depending on the science, depending on the educational needs, depending on the administrative needs, that I will have the authority to allow a few individuals to get back to on site at work. And but as I said, they were very clear just one or two. And if it's anything more than that, it will be a Chancellor's decision.

[Eric Davila]
Well, there's no more questions pending now. So I think that should be bringing us to the end of this portion of the program.

[Joe Guglielmo]
Thank you Eric.

Part 2—From the ski slopes of Idaho to the ICU, a COVID-19 patient story

Guglielmo invites faculty member Marilyn Stebbins, PharmD, to share her personal story as a COVID-19 patient. Facilitated by Grant Burningham, School editorial director.

Video transcript

[Grant Burningham]
Okay, we're very fortunate to have Marilyn Stebbins joining us here today to tell pretty personal story. Marilyn was patient number one in Yolo County. And thankfully, she's feeling better Marilyn. We're all glad that you're feeling better. And we're also really glad that you're here to tell your story. So let's just take it off the top. When did you first start feeling sick?

[Marilyn Stebbins]
Oh, can everybody hear me?

[Grant Burningham]
Yeah.

[Marilyn Stebbins]
Okay. Well, I ... it ... this is all a retrospective look, obviously, but I was getting ready for a vacation and I was leaving on a Sunday morning to go skiing. And on that Saturday, I noticed that I had I was starting to get what sort of the prodrome of a cold and I had just a really sporadic mild cough and a runny nose and I just know that because I went to the store and bought zinc and elderberry syrup and started zincing every two hours because I didn't want to be sick on my ski trip. I also noticed that out of my suitcase, I had two bags of cough drops that I never opened, but I had bought them thinking that I might need them so possibly, and depending on whether the sort of cold and cough syndrome was a precursor, but it certainly didn't bother me. But I would say the symptoms that I can look back at and tag was on February 26. On we were we had skied for three days up in northern Idaho and we had great powder skiing or skiing far more hours than I'm used to skiing. Because it was great conditions. And at the end of the third day, in the afternoon after lunch, I said to my husband and my brother in law who were skiing with us, does anybody else's lungs burn? So when I take a breath in, it burns and they both said no, and they I just sort of chalked it up to altitude and cold air and exertion. So didn't really think much more of it. And then the next day, we were driving back to the airport in Spokane, and I got hit with a very urgent bout of diarrhea and nausea, and said it's time to pull the car over immediately. And I thought I had food poisoning, because I just didn't feel good. And so I think on it really it was the 26th and 27th of February, that some of the, what I call COVID-like symptoms probably presented themselves, although I wasn't thinking in that way.

[Grant Burningham]
So you're talking February 26, February 27. At that point in the country, there's well under 100 cases of the coronavirus. So you would have been one of the very first people to be exposed to this, especially if you factor in the five to 14 days that it typically takes to show symptoms after you've been exposed.

[Marilyn Stebbins]
Yeah, I was counted is somewhere between number 69 and number 102 in the United States or COVID for testing positive, so I definitely was a really early case. And clearly I wasn't thinking in the realm of COVID at that point at all. The next day, the 28th, I think, was the 28th, I woke up and everything sort of hit me. I felt absolutely horrible. I had myalgias every muscle in my body hurt. I was really achy. And I had developed the cough and it really started to burn when I was breathing, and I continued to have the GI symptoms. And I called my doctor because I actually thought I had the flu. I'd had a flu shot, but I knew people that were getting mild cases of the flu even after having a flu shot this year. So I called my doctor who couldn't see me that day on a visit but she said, you know, with you describing that your lungs are burning, I really want you to go to the emergency room and get a chest X-Ray. And she's a friend of mine and I balked and said, "I don't really want to go to the ER, I don't like going to the ER, it's a long, you know, wait," and "can't I just go to an urgent care?" And she called me back and said, "Nope, I need you to go to the emergency room, you can go to the local emergency room here in Davis, and their wait should be less than UC Davis." So I did, after sort of putting it off for a couple hours. I went to the emergency room and of course got asked all the COVID questions at that point, which were "Did you travel from China?" "Have you been in contact with anyone who could have been exposed to the coronavirus?" And so, of course, at that point, my answer was no. And they did a chest X-Ray and discovered that I had multifocal pneumonia. And they gave me normal community acquired pneumonia treatment augmentin for 10 days and azithromycin for five days, and gave me a mask and sent me on my way and said that my chest X-Ray really didn't look like it matched me because it was really extensive. And I actually looked pretty good at that point. My vitals were normal. My oxygenation was good. And they said it is really the chest X-Ray troubled them. So they wanted me to get in and see my doctor within the week because it looked like there could be something underlying the chest X-Ray, and they even mentioned the word malignancy, which, you know, sort of freaked me out a bit. So I instantly sent a message to my doctor and said, "can I get in and get a repeat chest X-Ray? They told me I have community acquired pneumonia." And she scheduled me for that Monday.

[Grant Burningham]
So one thing some people might know this about you but probably not everybody. You're an extraordinary athlete. You're super fit.

[Marilyn Stebbins]
I don't know that I'd call myself an extraordinary but I really try. I you know, I've thanks to Val Clinard, I've gotten into distance trail running so had done a 30k trail run in the Marin Headlands the week before all of this and was getting ready to run a 50k with Val the week after I came back from vacation. So yeah, I mean, I'm I look at myself and say I'm in pretty good aerobic shape and do a lot of running and Pilates and circuit training. So yeah, I consider myself to be a pretty fit 58-year-old.

[Grant Burningham]
So at this point your symptoms don't ... I mean, obviously the pneumonia sounds very COVID, but it doesn't sound like you are having dry cough or fever. You're just having body aches and GI issues.

[Marilyn Stebbins]
No, I actually I had a cough so I went in there because the cough started. So no, I definitely had a cough. But the thing that was that continued to throw everybody at that point is I never had a fever. Interestingly, I had pretty horrible chills. But every time I took my temperature, I had a low temperature not I didn't have a (unintelligible), I didn't have a fever and I wasn't warm. So I didn't fit the bill at that point because I didn't have a fever.

[Grant Burningham]
So you take these results to your doctor and then what happens?

[Marilyn Stebbins]
Well, I continued to get worse over the weekend. I just got so weak and wiped out and basically had a hard time making it up my stairs. And every time I would cough, it would throw me into a bit of nausea, and a headache, and shortness of breath. And I literally just felt horrible. I went to bed and try not to get up because it was so ... I was just really miserable. And talked to a few people that said, by Sunday, hey, look, you've now had two full days of antibiotics in you, you should be feeling better. You know, you should be thinking hard about maybe going back to the emergency room and I said, you know, I'm going to be seeing my doctor tomorrow. I think I can, you know, tough it out. I am not sure what an emergency rooms gonna do for me right now. So I really wasn't thinking at all along the lines of COVID. And by the way, I did ask them to flu test me because I felt very viral. Like I had something viral going on. So I asked to be flew tested at the first ER visit, and my sleep test came back negative.

[Grant Burningham]
And really quickly, what does viral feel like versus bacterial when you have pneumonia?

[Marilyn Stebbins]
Well, I've never had pneumonia before. So I can't tell you but I had all of the flu-like symptoms. So when you think of flu, you think of body aches and fever. I didn't have fever, but I had chills. You know, I have the upper respiratory or at that point, lower respiratory symptoms. So more like a viral flu.

[Grant Burningham]
So if this had happened, two weeks, three weeks later, I assume you would have been treating yourself like you were radioactive. But this was so early in the outbreak that I'm guessing you are still interacting with people and just thinking oh, I have a flu. I haven't been to China.

[Marilyn Stebbins]
Yeah, I mean, it's when I as soon as I got sick. I didn't see anybody except my husband, you know, I think when I, after I went to the emergency room and had the respiratory symptoms, I was, although I did, you know, have burning lungs on a ski lift. So, you know, I once I was home, I didn't go anywhere because I just felt horrible. So the only person I was around was my husband. Once I got home, I was around my brother-in-law when I was in Idaho. But really, other than going to my to the, to the emergency room and then to my physician's office. I was in no way you know, no way feeling like I was going to be interacting with anybody. I was pretty much in bed.

[Grant Burningham]
So at what point does it end up that you end up in the hospital?

[Marilyn Stebbins]
So I went to my doctor's appointment on that Monday afternoon and again just felt pretty miserable and when she did a repeat chest X-Ray showed the same thing as my original X-Ray, a multifocal pneumonia, and she thought about adding another antibiotic. And then you know, they did a pulse ox (pulse oximeter) and I was now down to 93% on room air and she said, "You know, this, your visit is the emergency room that I saw showed you were, you know, oxygenating at 99%. So this is a drop. If you feel any more short of breath, I want you to go to the emergency room." So I went home that afternoon, it was late in the afternoon. And by about seven o'clock I told my husband I need to go to the emergency room. I just I just feel horrible. I'm really short of breath. I'm every time I get up to move, I'm so nauseated and dizzy and get more short of breath and cough. And you know, I I was just miserable. So we went to UC Davis and I got seen very quickly got asked all the same questions. And went through sort of the whole "is this bacterial is it not" work up so I add blood cultures and procalcitonin and lactic acid and did the whole viral panel and just the whole workup.

And ultimately, at about midnight, they moved me into an isolation room in another part of the hospital, in this old dingy, old emergency department that just had their one reverse airflow room, and they moved me in there until all my test results came back. But at that point, my nurses and everybody, they then did an Infectious Disease consult, and my nurses and everything else that point were masked but weren't in what I would call the PPE protocol at that point. The next morning Infectious Disease came to see me and told me that all of my tests were coming back. My viral panels were all negative. And that Infectious Disease was now considering testing me for COVID because I met CDC guidelines because I was hospitalized, even though I didn't have a fever. And so it was at that point, when they did when they put me in the emergency room, they put me on oxygen. And then when I was in the, in that isolated room, I was like, continued to get oxygen and then Infectious Disease, I got a COVID test at about six o'clock that next evening, so the day after the night after I presented to the ED and then the second I was COVID tested, everything changed. The protocol when in place and all of my nurses I had one nurse, but anyone coming in my room had to have full PPE, which at that point didn't just include like the beekeeper hats and accounting in the gloving, but it was the actual respirator because they hadn't determined that COVID was a droplet. They were still looking at it as aerosolized. So the they all had to be in respirators. And that was very crazy because there was like this wizard behind the curtain. There was a person that was in charge of donning off and donning and doffing, they called it the, the PPE gear and had to watch and teach everyone how to use it. And I believe they were probably from the company but they were out there and the nurses have to go through protocols it literally you know, I couldn't need anything quickly because it took them 20 minutes to get this gear on. It felt like it was really quite a protocol.

[Grant Burningham]
Did you have the loss of smell symptom that people have talked about?

[Marilyn Stebbins]
I don't really remember other than to tell you that the last night we were in Idaho, we went to dinner, and I just completely lost my appetite, which of course after a long day of skiing isn't like me, or it's not usually like me ever. But I just I barely ate any dinner. I just I wasn't hungry. So I don't know if that was it. I do know that my sense of taste. I don't really know about my sense of smell, but my sense of taste was gone for a while from the perspective of nothing really tasted good to me and it didn't taste normal. But nobody was talking about taste them. I just chalked it up to crummy hospital food.

[Grant Burningham]
I assume you've been sick lots of times. How does this compare to like when you've had the flu in the past or any other illness that you've had?

[Marilyn Stebbins]
You know, I think I can remember having the flu maybe once or twice where I just remember being on the couch and being really achy and miserable. But this was just a myriad of symptoms that just cycled that was really intolerable to me. I mean, it was just, it was such a, it just took everything out of me. And again, I've never had pneumonia, so I don't know what bacterial pneumonia feels like either, but I just, it felt like a cough would trigger trigger nausea. Nausea would trigger a headache. I was incredibly short of breath which would trigger a cough talking triggered cough. And so it just cycled and cycled and I was, I just a you're just not yourself, I mean, you're just sort of a different person. It's a completely different feeling from anything I'd had before. I have never ever been that sick.

[Grant Burningham]
So your husband after the fact tells you that he was very concerned about you, especially by the time you go to the hospital.

[Marilyn Stebbins]
Yeah, that was a that's a tough one.

[Grant Burningham]
Yeah, yeah.

So tell me I mean, I guess we're all hoping to hear that people spring into action and start tracing where you've been and everything that where you've been in the last week or two. What happens in terms of people coming in to talk to you about your contacts?

[Marilyn Stebbins]
Yeah, the contract tracing was the responsibility of County Public Health. So it wasn't the responsibility of my doctors. But at that point, even though my test came back within 24 hours, and I was told by the infectious disease team in the medicine team that I was COVID positive and I was moved to the medical Intensive Care Unit. And I didn't they didn't talk to me at all about contact tracing. And it wasn't until, so that was Wednesday evening, the 4th that I heard that I was COVID-positive, and move to the ICU, and then it was Friday the 6th that I heard from Public Health, they called me and told me and that I was the first case and I, I assume it's because results had to go to the CDC for confirmation at that point, so that may be when they were alerted. Because when I look at their website, they look they use March 6 is my date, as being the first case. So they called me on that day and told me that they were going to be releasing a press release as I was the first case. So they asked me a few questions. And they told me that someone would be calling me back to talk to me about my contacts. And a couple hours later, they called me back and they asked me, you know, my contacts in the last several days. I let them know that the day I came home from the from the trip when I thought I had food poisoning. You know, the vanity in me got to me and I had broken a fingernail on the ski trip, so I ran to my manicurist and had her fix my nail that afternoon. So I clearly was there. The good news was she was masked, because she always wears a mask. But you know, I had contact with her I had contacts with my brother-in-law I had contact with my husband. I had contact on the airplane. I had contact in the airport. I had contact with the emergency department of the first emergency room I went to, I had contact with my doctor's office, I had contact with the staff at the doctor's office, I had a chest X-Ray done. And so, you know, they, I gave them all of that. And the one thing that I have to say, kind of shocked me the most is the only person they contacted was my husband. And he had already been quarantine since I was tested positive and the last I was able to see him was the night in the emergency room. He wasn't able to come back. So his current 14 day quarantine started on that day.

But they didn't contact my manicurist. They actually asked me if I would like to contact her because I knew her. And I was like, oh my god no why would have to tell this small business person that she can't you know that I've just potentially infected her and she can't work and ... No, I don't want to tell her. So I said I would really prefer that you did that. I gave them my brother-in-law's phone number and the county that he lived in because he didn't live in Yolo County. So, but he was never contacted by anyone. His physician put him on a 14 day quarantine as well. And I know I don't know about the emergency department that I went to first because it's not my home, hospital or healthcare system. But I do know my physician told me that Public Health never called her but UC Davis because obviously she's a physician physician for UC Davis. They put her on a quarantine as well. So contract contact tracing didn't go quite the way I would have anticipated it would go and I think it's probably gotten much better since. I know being there first case that it was likely if it's brand new territory, so I don't want to, you know, really say much about Public Health because I think they were struggling, they're under-funded and understaffed and this was the first time for them to. But I can say that I don't think contract contact tracing happen the way we would all like it to. I do know, thankfully that my work friends and my work bosses were silently doing contact-tracing from my time before I left on my vacation for who I might have been in contact with.

[Grant Burningham]
So you go into the hospital and how many days? Are you in the ICU until you start to improve?

[Marilyn Stebbins]
You know, it was a couple of days that I, you know, was on oxygen. I think I was on oxygen until that Friday and I went into the ICU. I started on oxygen in the ER. And it really I I always, you know, I kind of laughed because I was in this glass bubble with curtains and people would look would peek in and, and I know they were looking for me to be intubated or whatever. And I never really felt at risk for that. But I have to say, in retrospect, in reading accounts that these New York doc's are talking about talking about having their patient being on a cell phone talking to a family member, and they're O2 stats dropped to 60 and need to be intubated and they may need to tell them to get off their cell phone so they can intubate them, is really shocking. And, so I never really felt like I was a threat to being... needing intubation and I kind of felt funny being in the ICU because everybody else in there, there was only one other patient in there that was COVID-positive. Well someone had been moved out that ended up being negative, but everybody else was a traditional ICU patient that was intubated. So I felt kind of like an imposter in the ICU. But I was later told that, that because people could change on a dime, their, you know, their status that they needed me to be in a place that they could quickly take action needed to. But I actually, you know, my lungs, even though I couldn't take a deep breath in my biggest problems were my GI problems. They were my headache, my nausea and, and my cough would trigger that my shortness of breath on oxygen seem to be pretty well controlled by But it was these other symptoms that were really making me still feel sick.

[Grant Burningham]
So being the first patient in Yolo County, I understand they sent out a press release and how do they describe you again?

[Marilyn Stebbins]
Yes, I was an "older woman with underlying health conditions." So, my friends to later I told her that I was case number one and YOLO said, we thought this was like a, an 80-year-old woman in a nursing home. You know, and I was a little frustrated. So between the time they said they were going to do the press, press release, when I was talking to the person who said, you know, clearly, you know, you're not, you don't, you're not classified as older and you are, you don't, you're a normal, healthy person. And between that time and the time the press release was released, I found out that the press release was released before she even got off the phone with me. So she had no say. And when I talked to the person who did the contract tracing, she said, we'll make sure when they actually do the press conference that they don't describe you as that, well, they never changed it. So it became sort of the joke in the ICU that I was that older woman with an underlying health condition.

[Grant Burningham]
I do feel like that could have changed people's perception, just because it's, it's been so many weeks of us realizing that this is a threat to all kinds of ages. Right. So that, you know, unfortunately, sounds like they missed an opportunity to educate the public. So you're, you finally turn the corner, and then they're, they're ready to release you what happens at that point?

[Marilyn Stebbins]
Nobody knew how to release a COVID patient you know, easily. And also I was going to a different county where a different County Public Health was going to be taking care of me because UC Davis is in Sacramento County. So it took a couple of days to actually get me released. Nobody could figure out quite how I was going to be tested. At that point they had hoped that they could test me twice, and I would be negative. So they tested me on Monday. I think that was the night they tested me. And their plan was to test me again on the 10th before they released me hoping I would have two negatives. Well, in that time, any positives were still being sent to the CDC. So my results didn't come back till I was home for three days. And I literally I think they were really worried that they were going to get this potential onslaught of need for ICU beds and I clearly didn't need an ICU bed, but they also didn't really want to have another ward in the hospitals that required PPE. And they, as long as I was sort of, they didn't know if I was positive or not. So they figured home was the safest places as any place. But then it was how do I get home? And the first was okay, we could have an Uber driver and we were like, No, that doesn't work, that's the public. I'm positive, you know, or we have to assume I'm still positive because I'm symptomatic still. And, okay, and your husband can come pick you up. And I said, but my husband hasn't been tested yet. No one will test him to see if he's maybe an asymptomatic positive, or if he's negative. I said, He's under quarantine. And when I go home, he has to be in isolation from me. So he's supposed to get in a car with me, you know, three feet from me. So they said, no, that's a bad idea. And then they said basically, we're gonna have to figure this out. And so the idea was okay, maybe I could find somebody who could drive my car to back parking lot at UC Davis that didn't have a lot of people or there were some buildings that weren't being used. They could leave my car in that back parking lot. The nurse could take me through the back of the hospital where there weren't any, you know, they'd have a security guard, clear the hallways so that I could go out, be taken out, and then I could drive myself home. So I went from an ICU bed to driving myself home, which seemed really surreal, and I hadn't been out of bed in, you know, nine days in the hospital and about 12 days total. And it just seemed really odd. I mean, you It was strange. I had a mask on and I had people with PPE putting me in my car. And then it was now what, how do we isolate? We had talked about, they said, can your husband, can you afford to have your husband go to a hotel for two weeks? And I said, and, you know, you have hotel staff that's going to be coming in and cleaning a room? And no, that's that's not a good idea. That's again, putting the public at risk. And they said, so we're going to have to isolate you in your home. And so do you have a separate bedroom and bathroom, you can stay in? And I said, yes. It's upstairs, so I'm not comfortable being home alone until I know that I can navigate the stairs. We have two dogs that need to be let out. You know, can I do that? So I really wanted him to be home. But then it was okay. How do I avoid infecting my husband when I come home and how do we stay isolated. So that was our next big problem was how do we do this?

So again it was they sent me home with six masks No gloves. I had a box of gloves at home for cleaning. So I had gloves at home and my husband would use our big dish soap or dish gloves that look like these industrial strength, you know, quadruple ply gloves that he would do and he would put food out in on my door, outside the door of the bedroom and I would get it and then he would know he would glove and I would I was masked and gloved and then he would take it and put it into the dishwasher and immediately and do that. So that got old fast. I mean that was, that was not an easy situation and being sort of locked in a bedroom when I was starting to feel better when it was sunny outside. Really was, you know, I wanted, I knew if I was ever going to get better, I had to sort of get up and around. So it was, how did we figure out how to isolate from each other? And how could I at least be able to get out, get downstairs get outside to be able to enjoy some sunshine in my backyard at least. So that became problematic. We're still quarantining and we still, weren't not doing that same process, but I'm still in a separate bedroom and bathroom. We separate from each other in the house, but I'm not masked in the house. I figured he's got he's either had it and he's asymptomatic as a positive, or he's one of the most resilient people. And he's not, you know, he's not going to get it from me. But I'm still not willing. You know, we're still saying, you know, we're separated in our bathroom in our bedroom. So it's been a real challenge.

[Grant Burningham]
Of the people that you know you're in contact with. Has anybody gotten sick?

[Marilyn Stebbins]
Nope. Oh, my brother-in-law's and fine. Again, I don't believe that any of the nurses that cared for me because for I was watching that because I they were reporting out and how many health care workers at UC Davis were testing positive and for the two weeks after me none worse so I was hopeful.

[Grant Burningham]
And tell me where you're at now in terms of recovery and test results and everything else.

[Marilyn Stebbins]
So the test result they did the day before I went home, which was the 9th of March was positive. And then it was, the guidance was changing, you know, "do we even test people," and "what do we do" and then it became symptoms and for me, my respiratory symptoms lasted you know, probably after I went home about 10 days, but they the real thing for me was stamina. I was just so weak. And then literally like that overnight, my stamina started to come back about, I would say, eight to 10 days ago. But my problem remained my GI issues. I could not, I couldn't beat the diarrhea, the nausea was getting better, better. But everything I ate just went through me and it was really problematic. So I wasn't asymptomatic. I was asymptomatic and I never in this entire time ever had a fever. Never, never in the hospital never since, so I wasn't typical in that way. But my GI symptoms just didn't stop. And so I wasn't ever really asymptomatic, so I didn't know what that meant. And so when my doctor was trying to sign me back into work at the beginning in the beginning of April I didn't fit criteria because I wasn't asymptomatic. But I was working virtually, and I felt fine. So I said, just put me back to work. I'm not going anywhere. And she did. And then she wanted to get me tested. And so I actually went 72 hours without any GI issues. And Public Dealth at that point was calling me every day. And they said, okay, you're off isolation. And I said, "Okay, that's fine, but I'm still not going anywhere. Everybody is sheltered in place, and I'm not comfortable, you know, going to a grocery store, still not knowing what's going on."

So I got tested, the day after Public Health took me off of isolation, and that was on April 2, and I was still testing positive. So that was 31 days from my first test. And for my first symptom, it was about 36 days, if you just count my symptom of my lungs burning, so I was testing positive longer and who knows what that means. And then my diarrhea came back. So that's been something that I'm just dealing with it without every third day, I'm back to the old drawing board and then I'm doing okay, so I actually have been now working with Occupational Health at UCSF, as well as my primary care doctor and I'm actually going to be tested. I found out right before I got on this call, I'm going to be tested tomorrow. They're going to try to do get to negative tests for me because CDC guidance changed again two days ago for healthcare workers and the gold standard and it's going back to being two negative test, if you can get them. So again, that's the big "if you can get them." So we're going for that and If I test positive again, I think I'm gonna be the longest standing person that's known out there that's tested positive, but I feel good. So I feel like my respiratory symptoms have resolved. I'm back, running very slowly. In a deserted field, I'm still not comfortable going out. I just feel like I don't ever want to be responsible. So I, and I don't even know what testing positive means. At this point, it probably doesn't mean I'm infectious. But what does it mean? I don't think any of us know. So I feel like that's where I am now. I'm in that world of when you're an early patient. What's next, right?

[Grant Burningham]
I mean, you're almost you're almost a model of what recovery looks like at this point because

[Marilyn Stebbins]
...I feel great. I feel great...

[Grant Burningham]
Seen it here. And you were such an early case. What are what are you doing after the fact? What are people testing you for now to try and learn about the disease?

[Marilyn Stebbins]
Yeah, so I'm participating in the COVID-19 citizen study that's being done through UCSF. I encourage all of you to do that. It's an app-based—the app is called Eureka. And it's an app-based surveillance program. It's very simple. It asks you three questions a day, and then once a week, it asks you a few more questions. I also was able to work with some of our UCSF lab researchers who needed antibodies so that they can help test some of the antibody tests. And so I donated blood on I don't remember, I think it was Monday at the blood bank ad down in San Francisco for my blood To be tested, and then I also am waiting to donate convalescent plasma for treatment. And so they're the rules on that are changing. So it's either I think, 28 days symptom-free or two negative tests that allow you to do that. So I am waiting to do that I really feel very strongly about making a positive out of this. There's got to be research that can be done with my crazy virus. And I'd love to be able to help someone else with my antibodies.

[Grant Burningham]
So we've got about seven minutes left and I'm just going to go through a bunch of the questions that are stacking up in the question and answer. A lot of people are wondering how you think you got infected?

[Marilyn Stebbins]
I initially thought that I got infected through air travel, going through Washington, that was when Washington just started to hit. But I went through Spokane, but who knows where people on my plane were coming from, but I also sat in the airport in Spokane for an hour and a half waiting for my brother-in-law to fly in. So I thought initially that was probably where I had my exposure and that was on a Sunday and my first symptoms, my burning lungs, started that Wednesday afternoon, and that was about 4 days, but then I look back and say even on that Saturday before I left I had some minor cold symptoms and if that's case, that week before might have been where I contracted it, and guess where I was? I was at work. So who knows, but nobody else that I know has been symptomatic, and, at work. So that's a tough thing to know.

[Grant Burningham]
Ricky wants to know if there was a turnaround moment in your recovery.

[Marilyn Stebbins]
I think after I came home, as I said, it was like 8-10 days ago where, for a while I thought "am I ever going to feel normal again?" Because I was taking 1 or 2 naps a day, I couldn't do anything for more than half an hour and I was in bed half the time and that's not like me. And literally, about, I don’t remember what day it was, I literally woke up one morning and felt better. It just happened. I have no idea why but 8-10 days ago. Which means I’m in week 6 of this, so it took a good 4-4 and a half weeks.

[Grant Burningham]
Tom Ferrin wants to know, “has anyone told you which of the 7 strains of the virus you were infected with?”

[Marilyn Stebbins]
No, no not yet. You know, I’d love to be anyone’s guinnea pig on that. I feel really strongly about getting anything out of this we can get out of this.

[Grant Burningham]
Candy Tsourounis is asking “do you think your husband got infected and had a very mild form? I find it hard to imagine that your closest personal contact wasn’t affected.”

[Marilyn Stebbins]
We always say he’s an asymptotic positive just because we can’t imagine it either. But, you know, he’s had seasonal allergy symptoms, so, a runny nose, with a sort of intermittent cough that goes with that but certainly nothing like the cough that I had, or that people i have know have had. And he’s attributed to how he feels with seasonal allergies. So, I’d love to have him… nobody would test him. I would love for him to have the antibody test, obviously, when that’s ready to go to see how he would test, and the same with my brother-in-law. We were all in the same house, eating the same food, sitting on chairlifts together. You know, so, it’d be interesting to know that.

[Grant Burningham]
Tia is asking if you’ve been tested for C-Diff because of the antibiotics you took.

[Marilyn Stebbins]
Yes, I was tested for everything before I left the hospital. I was tested for every sort of parasitic thing as well. So I was negative on everything.

[Grant Burningham]
uhh… have …

[Marilyn Stebbins]
It’s actually not clear, it’s actually not clear. None of us are sure if I was swabbed for COVID in my stool. At one point I thought they told me I was positive but I can’t find test results. But we think they may be at the CDC level. We’re not really sure.

[Grant Burningham]
Amanda is asking if you had a follow up chest X-Ray that looked normal now.

[Marilyn Stebbins]
No. Nobody wants me in their office, until I test negative. But actually, if you can see, I can take deep breaths. I can run slowly. I feel like my lungs have recovered very well.

[Grant Burningham]
I was going to ask you if you had a 30k in you right now.

[Marilyn Stebbins]
No. I … I have about a 5k in me right now.

[Grant Burningham]
Conan MacDougal is asking, “Hi Marilyn, glad to hear you’re doing better now. If you want to share, did you get any anti-virals?”

[Marilyn Stebbins]
No we talked about Remdesivir, right when they tested me, they said “look.” I think they didn’t want to scare me. They wanted me to know there was a possibility of treatment. And i have to say behind the scenes the pharmacy department at UC Davis was really amazing. They had it ready to go for me, because at that point it was compassionate use and investigational. So they were ready to go if I needed it. And they knew my case, even though I didn’t know they knew my case at that point. The infectious disease people, and the investigational drug pharmacist. We talked about it, and discussed it because the first case that came through UC Davis they used it, and she had a positive result. She was actually intubated. But when we talked about it,, we said can we just see how I do? Because at that point I wasn’t sure I wanted an investigational drug. I really, I wasn’t feeling like my pharmacist self, like I knew what that drug was all about. When I heard it was used to treat Ebola, those types of things, I was a little bit nervous. I said can we see if my O2 stats, to see if they’re holding their own before we do it and then we decided against it.

[Grant Burningham]
This question is from Julie, and I guess we’re almost out of time, so maybe this one and maybe one more. “Hi Marilyn, is there anything you would do differently now you that you know what you know. And what advice do you have for others to help us self-diagnose and what first steps should we take?”

[Marilyn Stebbins]
You know, I think we know so much more now. You know, I don’t know that I would do anything differently that I did because I think I followed all the steps any patient would follow. I talked to my doctor, I didn’t just go to an emergency room, I think, you know, I asked to see, I asked for advice, and I really, I even as frustrated as I’ve been about getting retested, I understand that I’m not the priority. So I know that people are really scared and want to get tested, but unless you’re really sick they’re not going to do much for you anyway other than isolate you. I think it’s just to tell people to watch their symptoms, call your doctor, and just keep a close tab on it and follow the advice of your providers.

[Grant Burningham]
Ok, I see that Joe just popped back on there. Joe do you have any final words?

[Joesph Guglielmo]
I guess we are going to close it here. It’s 4:30. I guess I have to thank Marilyn for an incredibly personal and transparent and wonderful journey that she was willing to share with all of you. And I thank Grant for doing such a great job asking the questions. I hope that all of you that listened in and watched Marilyn appreciate her courage and her willingness to tell, I think a story, that all of use could learn a little something. So thank you Marilyn from me.

[Marilyn Stebbins]
Joe, I just wanted to say one thing, we had questions that weren’t answered. I’m also more than happy if you want to email me to answer your questions.

[Joesph Guglielmo]
Great, thank you for that.

[Marilyn Stebbins]
I feel that knowledge is power, the more we know the better off we are.

[Joesph Guglielmo]
Great thank you for that as well Marilyn. In the meantime I will remind you that we will have another town hall it is scheduled for Thursday, April 23. It will be 30 minutes, from 3 to 3:30 and an Outlook invitation has already been sent. Stay safe, be well. Especially you Marilyn. And we’ll see you all

[Marilyn Stebbins]
Get tested.

[Joesph Guglielmo]
Alright