The 20-year-old man moved restlessly on a gurney in the emergency department at Greenwich Hospital in Greenwich, Conn., on March 14. It was hard for him to get comfortable. His head ached; his lips and mouth felt as if they were on fire. His hands were too swollen to close, and the skin and muscles all over his body felt tender and sore. Two days earlier, his mother picked him up from his university just outside Philadelphia, which had closed because of the Covid-19 pandemic. Several of his friends had been showing signs of a Covid-like sickness, and the young man and his mother were worried that he was, too.
As soon as she saw him, she could tell he was sick. His face was pale and sweaty. His skin was hot; his eyes were glassy with fever. She put on a mask, and then drove him home. Once he was safely in his bedroom, she called the Yale Covid-19 call center for guidance on what to do next. By then the first case of Covid-19 in Connecticut had been reported, a few days earlier on March 8. Given his likely exposure at school and his fever there and now at home, her son met the criteria of someone who should be tested, she was told. The soonest he could have the test at the local drive-through center was in three days, on March 15. In the meantime, she should assume that her son was infected with the virus and should be quarantined.
Before he could get to the drive-through, he began to get sicker. The day after he got home, March 13, he lost his appetite and developed a strange red rash around his nose, mouth and chin. The next morning, after he started vomiting, his mother took him to the hospital.
At the Hospital
In the emergency room, the young man had no fever. The rest of his exam was normal, except for the raw-looking rash on his face, hands and back. The blisters — and the round red lesions they turned into — were tender and made it hard for him to talk, eat or even use his hands. The masked nurse returned with news from the E.D. doctor: He was to be admitted. They would test him for Covid-19. The rash he had wasn’t typical of that infection, though they still had a lot to learn about it.
His rash looked more like a herpetic infection or hand, foot and mouth disease, an infection usually caused by the Coxsackie virus and most commonly found in young children and occasionally in adolescents. As the nurse explained this to mother and son, the mother erupted into a prolonged episode of coughing. “I’ve had this tickle in my throat for the past few days,” she explained to the nurse, apologizing for the interruption.
“I don’t like the sound of that cough,” the nurse replied. She should really talk to her doctor about being tested for Covid-19.
The mother couldn’t believe that she might have this viral infection. She had been very careful. She started wearing masks and gloves whenever she left the house at the end of February. People had looked at her as if she were crazy for wearing that kind of protection, but she didn’t care. She wiped everything down with disinfectant before she brought it into the house and left her coat and shoes in the foyer. She washed her hands dozens of times a day and scrubbed her counters and keyboards before and after every use. She was caring for her 91-year-old mother, who lived just a block away, and was terrified that the family matriarch would get sick. Her mother had isolated herself when the first cases hit New York City and depended on her daughter for anything she needed from the outside world.
The woman suspected that her husband wasn’t quite as careful as she was. He was commuting on the Metro North train to New York for work. He didn’t wear a face mask, but he said he washed his hands frequently and wore gloves when he was outside his home or office. But he had been coughing for the past week or so. He didn’t have a fever and didn’t feel short of breath. He just had this little cough that, he said, was nothing.
Trying to Be Tested
She had a cough, too, which started a few days before her visit with her son to the E.D. on March 14. A week earlier, she had a headache that felt like sinusitis. She went to a walk-in clinic on March 10, and the doctor there gave her azithromycin, an antibiotic. When that didn’t help, and with her son at home in bed, she went back to urgent care and was given a second antibiotic. That didn’t do much, either. Now the nurse who took care of her son in the E.D. suggested that she should be tested for Covid-19 — confirming her worst fears.
The next morning, March 15, the woman dialed the number for the Yale call center again. She explained about her headache, her cough and her sick son. A voice on the phone patiently explained that she didn’t meet their criteria for testing, even though her son might have Covid-19. She should just assume that she had it and isolate herself for 14 days.
The woman hung up, discouraged. She told me that it felt important to know for sure whether she had the illness. She called the number again, and a different voice answered. She again described her symptoms and her sick son. The voice asked if she’d had any fevers. The woman hesitated. She hadn’t had a fever but suspected that if she said that again, she wouldn’t get tested. Yes, she told the woman on the phone. She spoke to a doctor who told her she would need to be tested. She could go to the testing facility in Waterbury. But the results wouldn’t be available for another few days.
The Son, the Father
Her son stayed in the hospital for three days. His Covid-19 test still hadn’t come back by the time he was discharged on March 17, but the doctors suspected that he probably had hand, foot and mouth disease. It’s an infection consisting of a low-grade fever and a rash of small blisters that break open and then heal over the course of a few days. They are usually limited to the mouth but can spread to the hands and feet, and sometimes to the torso and buttocks. It’s quite contagious, but for reasons that are not well understood, adults rarely get it. A few days later, their hypothesis was confirmed: The patient’s Covid test was negative, and the test for the Coxsackie virus was positive.
Now that her son was home, the mother’s goal was to stay away from him until she knew for certain whether she had Covid-19. She’d also moved into a different bedroom to separate herself from her husband. But the day after she brought her son home from the hospital, her husband told her he was going to the emergency room. He felt terrible, he said, really short of breath. He’d packed a small suitcase, just in case he had to stay.
He did have to stay. His oxygen level was low, and a chest X-ray showed that he had pneumonia in both lungs. He probably had Covid-19, he was told. He was put in an isolation room. Occasionally one of his doctors came in, though mostly he spoke to them on the phone. The results of his Covid-19 test and his wife’s test came back the same day — on March 19. Both were positive. He stayed in the hospital for nearly a week. And when it was time for him to come home, his wife was so worried that he might infect their son that he moved instead into the small apartment they had in the city.
The wife’s headache slowly got better, as did her cough. She never had a fever. She is certain she got the virus from her husband. He wonders if he got it from her; he thinks his cough started well after hers. They will probably never know where it came from. As for their son, had he presented with the same rash and history at just about any other time, the diagnosis of hand, foot and mouth disease would have been obvious. But in this epidemic, with a bug we still know so little about and one that is moving so quickly, everything can look, at least at first, a lot like Covid-19.