Reflecting on Treating the First Person Diagnosed with COVID-19 in the United States

Dr. George Diaz, an infectious diseases specialist in Everett, Wash., expected that COVID-19 would hit the United States as soon as he heard about the initial cases in Wuhan, China. George’s experience in preparing to care for people with Ebola during the 2014 outbreak in Africa gave him firsthand insight into how quickly viruses can move around the world and the importance of advance planning.

So when news of the novel coronavirus was starting to make headlines in December 2019, he and his colleagues began readying Providence Regional Medical Center Everett (PRMCE) facilities for potential cases.

“We didn't know we’d be the first, but we certainly thought that novel coronavirus cases were going to be in the United States relatively soon,” George says. “With our health system being on or near the West Coast – in Alaska, Washington, Oregon, California, Montana, Texas and New Mexico – we see a lot of patients who travel between Asia and the United States.”

Preparation was no small effort, but the stockpiling of personal protective equipment (PPE), COVID-19 screening protocols and drills with hospital employees paid off.

Roughly one month after George heard about the cases in China, on Jan. 19, 2020, a man walked into one of Providence’s clinics. He’d just returned from Wuhan and was experiencing symptoms of COVID-19. The training kicked in immediately. The patient was isolated, staff put on PPE, and samples for COVID testing were sent to the Centers for Disease Control and Prevention (CDC).

When the CDC confirmed the person tested positive for COVID-19, he was admitted under George’s care, becoming the first known individual with the disease in the United States.

While preparation for incoming cases was one piece of the puzzle, treatment of people with COVID-19 was another. The genomic sequence for the disease was published only nine days before the man walked into the clinic.

The man’s health was quickly beginning to decline. He developed hypoxemia and required oxygen. “He felt really lousy and was having high fevers. I was pretty worried about him,” George says.

While continuing to care for the person, George explored treatment options with experts from the CDC.

“There was an investigational antiviral treatment that already had safety data from clinical trials for a different virus,” says George. After consultation with the CDC, he submitted a request for a single-patient emergency Investigational New Drug (eIND) to the U.S. Food and Drug Administration, seeking authorization for compassionate use of the treatment.

“My application was reviewed overnight,” he says. “By the next day, only 24 hours after becoming hypoxemic, the man was receiving the investigational treatment.”

The rush of admitting and treating the first person with the disease happened in a manner of weeks, but the massive surge of COVID-19 cases was still ahead. The experience offered George a valuable opportunity: to study and treat the disease by enrolling patients into clinical trials, and share that learning.

“After the first known person in the United States with COVID-19 eventually recovered and was sent home, we created an algorithm that could be replicated anywhere for triage of these patients to determine risk factors and the degree of illness,” says George. “Over the course of a year, we've enrolled thousands of people into COVID telehealth and are monitoring them at home. We’ve also been able to collaborate between health systems, and with the state and local county health departments.”

The pandemic has been an immersive lesson for George, and it has also granted him a deeper appreciation of the connection he creates with each person he helps treat.

“The people that come into our hospital all have stories and families. I've now seen hundreds of people with COVID-19. It's an awful disease," says George. "What motivates me is to try to get them back to their loved ones.”