By Virginia A. Unkefer
Positive is Negative
On March 23, we all learned that members of our KAUST community had tested positive for COVID-19. That day, we heard that two and then five and then finally seven people had the virus and had been transferred to Jeddah. What we had all been dreading had finally come to pass: the virus had made it inside the walls of the University.
That afternoon, as I was working from home, one of the family medicine physicians from KAUST Health called me and said that I had been in contact with one of the people who had tested positive. What I had been dreading had now come to pass: I might have the virus and I might have given it to my husband and to others.
The doctor said that I would be taken to the clinic for testing the next morning and that my husband and I would be in quarantine until we received the results from the test. That evening, I received a message from the Coronavirus Taskforce with a link to a quarantine agreement that I had to read and sign. Clearly, there would be no sneaking out the door to buy groceries for the next few days.
The next morning, a driver in a long golf cart came to pick me up to take me to the clinic. He passed me a mask while standing as far away from me as he could. As I put it on, I was directed to the very back row of the cart as he sat in the front to drive. He clearly didn’t want me near him; I didn’t blame him.
Because I had reported mild symptoms of a lingering sore throat, headache and cough, I went inside the clinic for my test. I could see that others would be tested outside in a temporary booth near the Emergency Room doors. When inside, I was put into a room by myself. The nurse came in to do the swab. She was in full personal protective equipment (PPE) and I noticed that she had ingeniously put on many pairs of gloves. Each time she might have contaminated the gloves by touching something that I had touched, she peeled a pair of gloves off. This way, her hands were never exposed.
During a swab test, a nurse inserts a long Q-tip up one of your nostrils until it reaches the back of your throat. She then rubs it around and then pulls it out and inserts it into the other nostril. The only word that comes close to describing the sensation is intense—worse than the worst time of getting water up your nose when plunging into a swimming pool. To add to the intensity, the nurse inserted a second swab, also into each nostril. The whole thing was over quickly, but it was unpleasant. By the end of it, my head was spinning and I had to grit my teeth to keep myself from crying. I also had a chest X-ray. This was an extra precaution because I had a cough. Most people called in for a swab do not get an X-ray.
Then, I was driven home again in the back of the long golf cart. When I walked through my front door, I knew that I would not walk out again for several days until I learned my test results. The news a few days later about my test was good: I was negative. In the world that had been rapidly turned upside down by Coronavirus, it seemed fitting to me that testing negative was positive and testing positive was negative.
Even with the negative test, however, we were required to spend two weeks in quarantine because I had mild cold symptoms and also had occasional abdominal pain. Most bothersome was pain and burning in my eyes, which continued to get worse. I thought that I must be allergic to something in the air or that I was spending way too much time on the computer, which I was. I had been glued to my screen since the virus first started making headlines. As my eyes grew worse, I tried to follow the advice about not touching my face, but that was almost impossible because of the burning.
Almost immediately after our quarantine started, the curfew on campus also began. It seemed to me then that everyone else was living with almost the same constraints that we were and that I shouldn’t feel sorry for myself. Almost the same constraints but not quite: bright yellow medical waste bags had been delivered to my door. Even my trash was now suspected of having COVID-19.
Two weeks later on April 5, I again climbed into the back seat of the long golf cart to go to the clinic for another swab test to be released from quarantine. This time, I took my test in the outdoor testing booth. This time, to my relief, it was just a single test on both sides of my nose, but what had been an intense sensation before turned into excruciating pain, particularly on my right side. I promised myself then that I would never take another swab test again.
The next morning, I read a story in the newspaper about a data scientist who was studying Coronavirus symptoms in Google search data. It sounded to me like another clever artificial intelligence project that could reveal something that we couldn’t see on our own. He had noticed that there were upticks in searches for eye pain in the virus hotspots around the world. He suggested that eye pain could be a telltale symptom, just like loss of smell and taste. As I read, I thought of the burning sensation that I had been experiencing in my eyes and I had a sinking feeling, and so, that evening when my phone rang, I wasn’t actually that surprised when the doctor told me that my most recent test was positive.
Positive meant negative: I was told to get ready to be moved to Jeddah. I had to leave that night even though it was already almost 10 p.m. I gathered things together and I talked with my husband who would stay behind. I called a friend on campus to let him know that I was leaving and to ask if he could help my husband who would be tested the next day and would remain in quarantine. I also wrote to my team to tell them the news. I felt responsible for keeping them informed because they were likely my contacts. I tried to keep them from worrying because it had been a full three weeks since I had seen them on the last day that we worked together at the office.
I rode in the ambulance to Dr. Soliman Fakeeh Hospital (DSFH) where I was immediately taken to a room, no waiting at admissions or in the Emergency Room. As I walked into the room, the door was immediately shut behind me. A nurse came in full PPE some time later and took my vitals. Later, a technician came to take another chest X-ray. It was after 2:00 in the morning when I finally settled to go to sleep. An hour or so later, a nurse came and poked me for blood, a rude awakening. Then, a couple hours later, she came back to take my vitals. At first light, I got out of bed and waited. At one point, a doctor came in and talked with me about my symptoms and what I could expect. He said that I would probably be moved to a hotel later that day where I would stay until I had two negative swab tests 72 hours apart. That didn’t sound too bad except for the part about the swab tests. I still had mild symptoms, which had lingered with me for weeks after I had been sick in early March, and my eyes were still terribly painful.
Later, the Hospital’s Chief Medical Officer called to say that I would be taken to King Abdullah Medical Complex (KAMC). I asked about the hotel but he told me that the Ministry of Health had determined that I had to go to KAMC instead. I guessed that this was because of my symptoms.
Eventually, I was told to gather my things and get ready to go. A nurse brought me PPE–a yellow gown, gloves, a new mask. I put them on and headed out the door, but I was instructed by a voice far away to wait inside the room until I was told to move. I could see from my open door that the hallway was being cleared of all people and that the elevator was being called before I would wait in the hall. Then, I was told to walk to the elevator with my ambulance driver. As I arrived at the elevator, an attendant walked out. He had a bottle of disinfectant in his hands and I could smell that he had sprayed the elevator before I got on.
The ambulance driver told me to stand at the back of the elevator with my face to the wall. Because it was a mirror, I could see that he was facing the front of the elevator. It was slowly dawning on me that all these infection-control measures were because of me. I was the source of concern; I was the source of fear. As the elevator opened on the ground floor, I was told to stay inside until the lobby of DSFH was cleared of people. Normally a very crowded place, it was already nearly empty because of Coronavirus, but as I was taken through, no one was allowed near me.
I was whisked into the ambulance and then whisked a long distance away, this time with the sirens blaring, to KAMC. When we finally arrived, we had to wait a long time because another ambulance ahead of mine was also dropping off a positive COVID-19 patient.
The infection-control measures at DSFH had impressed me. I could tell that they were taking Coronavirus seriously. The measures at KAMC were even more amazing. I was made to walk two meters behind one attendant while my ambulance driver walked two meters behind me. No one was in sight. Obviously, everyone had been told to stay clear of my path. It felt strange to walk though empty spaces that normally would be bustling with nurses, doctors, patients, and visitors.
I was taken directly into an isolation room. I passed through one heavy door. That door closed while I stood in a small vestibule. Then, I passed through another door into my small room, just big enough for a hospital bed, a table and a folding chair. There was also a small washroom. Once the door shut, I could not pass through it again. Each time someone entered my room, they changed their full PPE in the vestibule outside my door. Each time they left, they changed again. I could feel the air pushing in from the inner door, which had to be latched shut to stay closed. This was a negative-pressure room. All my germs would stay in the room with me. They would not escape to infect others in the hospital.
There, I remained for two very quiet days. Again, I had a chest X-ray; again, someone woke me at 3:00 in the morning to take my blood. The nurses would come in only when they absolutely had to. That meant that I would see them only when they brought my meals at odd times during the day. Only once did a doctor come in. After that, if doctors wanted to speak with me, they called on the telephone. They gave me an anti-viral medication that seemed to help. My lingering symptoms started to abate. I was incredibly tired, but I had nothing to do but stay in bed. One of the days, I had another swab test. So much for my promise to myself never to take another.
The Coronavirus Taskforce at KAUST assigned a contact person to me who checked in with me daily. When I told her that the Wi-Fi signal in the room was really bad and I needed to use my telephone to create a Wi-Fi hotspot, she worked with IT to expand my data plan so that I could have unlimited use. They acted swiftly and solved the problem within a few minutes. The cell signal was not that great either, but at least I could speak on the phone with my husband and family members. They were my links to the outside world.
After two days in the negative-pressure isolation room, I learned that I would be moved to a hotel in Jeddah. It took until late that night before it actually happened even though I had been told to pack my things and be ready hours and hours before. When it was finally time, I followed someone out, again through very empty halls. I was told to get on a bus where I waited with other COVID-19 patients with no regard for social distancing. There were seven or eight of us. We were driven a long distance across Jeddah. Even with the new 24-hour curfew, there were lots of cars on the highway, but there were also lots of checkpoints as we drove along. Somehow, no one wanted to stop a busload of C-19 positives. We drove straight through all the checkpoints and to the hotel.
When we arrived, we had to wait on the bus until we were each beckoned out of the bus individually. Everyone inside the hotel was in full PPE. The lobby had been transformed into a hospital waiting room. When it was my turn to enter the hotel, I was told to follow a red line on the floor. Then, I was told to go into an open elevator and to push the button for the sixth floor. Then, when I arrived on the sixth floor, I was told to go down the hallway and turn left. I asked what room number and a voice from far away said, “616.” The door to the room was open and I went in. There were written instructions on the desk. I felt like I was in one of those dreams in which I kept going further and further into a place I had never been before.
While in the hotel, I remain in strict isolation, but it is much more comfortable than the hospital. The Internet is powerful and fast and I have ample contact with the outside world through Skype, Zoom, SMS, email and phone. The bed is luxurious. The chair is comfortable. I can set up the room the way I want. I don’t need to worry. No one will come in. In fact, there is an alarm on my door. If I open it when I am not supposed to, there is a loud beep and the hall lights turn on. I found that out the hard way.
Each evening, I get a phone call and the hospital dietician asks me what I want to eat for lunch and dinner the next day. I order off the room-service menu. She allows me to order my breakfast directly from the kitchen each morning. Later, I get a call to put my mask and gloves on and to open my door. There, on the floor outside my door, I find my food in take-out containers on a Styrofoam tray. Inside my room, I collect all my trash—and there is a huge amount because once something comes in my room it will not be used again—in a yellow medical waste bag and when I am invited (by a voice on the phone), I place the full bag outside my door. Now and then, I hear a noise and then a few minutes later the strong smell of bleach wafts into the room. My door has been disinfected.
Each day in the hotel is punctuated by telephone calls from people on the other side of my door in the outside world. They call and say, “Put on a mask, sanitize your hands with hand sanitizer and stick only your right hand out the door.” Then, as I stand inside my room, I feel someone attach a device to my finger and then attach the device to a cord. I then hear, “98%” and I know that my oxygen saturation has been measured. The cord is released and I pull my hand back in with the device still attached. Now that it is contaminated by me, it will not be used again. Or they call and say, “Put on a mask and gloves and open your door for a temperature check.” Outside the door awaits a nurse in full PPE with a temperature sensor that she can hold close to my forehead for a reading without touching me. Once she has a reading, she nods and moves away. This is my only human contact all day.
After three days, when the phone rang, I was told to put my mask and gloves on. Then, I was told to go into the hallway and leave my door open. I was allowed to leave my room for the first time to go for another swab test. When I went into the hall, I could hear a voice from around the corner say, “Stand there until I tell you to come.” Then, I was told to walk directly into the elevator and go up to the eighth floor. There, I exited and was directed by someone pointing out to the roof terrace of the building. Outside, I was given the swab (brutal; it gets worse every time) and then I was shooed back to my room. I wanted to linger to feel the sun on my face, but there was no time. They were testing everyone in the hotel that day.
With thousands of confirmed cases in Saudi Arabia, there must be many such hotels filled with COVID-19 positives. What Saudi’s Ministry of Health is doing to contain the virus is incredible. To be in a place that has the resources and determination for this herculean effort is remarkable. The Saudi system is clearly working better than anywhere else right now. I am fortunate to be in isolation in a four-star hotel room and not in some hospital corridor or left at home to spread the virus.
We finally learned late on April 11 that my husband tested negative. He had been tested the on April 7. The wait for results has grown longer since I started on this odyssey three weeks ago. This was a particularly long and stressful wait. My husband has underlying health conditions and he would not have coped well with this endless isolation. Of course, he is in quarantine at KAUST, but my family, his family and I are checking up on him regularly and he can control his own schedule there, he can eat when he wants, and he can at least go into the back garden.
So much of this experience for me has been about accepting that I do not know what is going on, that nothing will happen quickly, that nothing is in my control. I know that there are life lessons in this about acceptance. When I have some distance from the experience and the hotel, I will try to reflect and learn something. For now, I am just trying to hang in there and to enjoy the silence. It is, after all, a rare gift.
Blame and shame
As I wait to return to KAUST, my thoughts turn to the University community. What will it be like for me to return there after having the virus? I know that my concerns are real because I learned from the person to whom I was contact traced that members of the KAUST community have actually accused him of bringing the virus to KAUST. They blame him for all the cases on campus, which cannot be possible. I have tried to convince him that he is not to blame; no one is to blame. I told him that I could easily have been the one to give the virus to him, and not the other way around. I was sick in early March and I could have had the virus then. We will never know. I do not blame him for giving me the virus and I hope that he does not blame me. I forgive him if he did give it to me and I hope that he forgives me. The community should forgive him and me too.
The night I rode in the ambulance toward Jeddah as a positive case, I was filled with dread about what would happen to me. Now, I fear returning home because I, too, have spread the virus. I had the crushing news yesterday that one of my contacts tested positive and he is now in Jeddah in another quarantine hotel. To have caused someone to be sick is far worse than being sick myself. I have been incredibly lucky to have mild symptoms. My painful eyes and my deep fatigue are my biggest complaints. Both are slowly resolving. My newest contact is also very tired, but he complains of nothing else. These are symptoms that are easy to overlook or to attribute to something else. I used a huge box of tissues in less than a week but I didn’t give it a second thought. All that time, I might have been spreading the virus. Likely the person who brought the virus to campus didn’t even know that they had it. Can we honestly blame them for that?
I wonder if I will also be met with such scorn when I return. I hope that I will be met with compassion. I believe that none of us who tested positive asked to have this virus and none of us planned to spread it. I know that all of us—the entire KAUST Community and the whole world—are facing the virus together. Some will get it now; some later; and some will be fortunate to be able to wait for the vaccine. We are too deep into this crisis to be assigning blame to individuals, particularly those in our own KAUST community.
To get through this crisis together, we need to be our very best, our most human. As a community, we need to be empathetic and to show compassion toward anyone who has tested positive for the virus. We are, after all, your neighbors and colleagues at KAUST. To speak this truth is why I agreed to tell my story and why I will not hide my status as a COVID-19 survivor.
Late on the ninth day of my excellent adventure, I was awakened by the ringing telephone. It was the same doctor’s voice that I had heard each night. He asked how I was and I groggily answered fine. He asked, just like every night for the last week, if I had any symptoms. I said no, I was feeling stronger now. He praised God and then said the words I had been waiting to hear: “You will go home tomorrow.” Still half asleep, I said, “Oh, that’s good. Thank you so much.” The call lasted less than 30 seconds. I turned over and quickly fell back to sleep.
The next morning, when I slowly came out of a deep sleep, I wondered if the news that I would be leaving that day was a dream. I wondered if it could really be true. When I called for my breakfast, the same friendly voice that had answered each morning was there again. He asked me how I was and I said, “Well, really well. I think that I will go home today.” I could actually hear joy in his voice when he replied, “That is great news. I am so happy for you.” Then, I said, “I think you know what I want for breakfast,” and he laughed and recited my daily order. I had made friends with someone I would never see.
A few hours later, the doctor who had called me each morning rang again. Just like every other morning, he asked how I was and if I had any symptoms. I said that I was well, that this was the third morning that I felt like I could get out of bed. My news seemed to bring him pleasure; he praised me for my recovery. And then I said tentatively, “The night doctor called last night after I had gone to sleep? I think he told me that I would go home today? I hope that wasn’t a dream?” My doctor then laughed out loud; he had found humor in his world surrounded by disease.
“Yes,” he said, “We think that you will go home today, but the doctor from the Ministry has to call and tell you. The doctor from the Ministry has to sign the document. We have to wait for that.” I told him that as long as I hadn’t dreamed it and as long as I might be able to go home, I could wait all day. He laughed again and replied, “Inshallah.”
Later, the doctor from KAUST called to say that he had been in touch with the doctors in the hotel and at the Ministry and that he was trying from his side to push the process along. He said that the ambulance at KAUST was being prepared and that it would arrive at my hotel around 4:30 p.m. He wanted me at home as much as I wanted to be there. He seemed more impatient than I was for it to happen quickly.
Exactly on time, I had a call from someone in the hotel to say that my ambulance was waiting. I said, “But do you have the paper? Did the doctor from the Ministry sign it?” He said yes, the paper was there. I should get ready to go. Then he said, “But stay in your room. We will call you.” Yet again, I had to wait for an instruction. This time I was willing to wait.
As I gathered my things, I took one last look at my room, my sanctuary of eight days. If I had to get COVID-19, this was the way to do it.
The phone rang and I was told to leave my room. There, near the elevators, was my nurse, the one who had come each day to take my temperature. I couldn’t see her smile because of her PPE, but I could tell that she was happy for me. She pointed to a particular elevator and said to take that one to the lobby. On its door was a sign that said, “CLEAN”. It was a different elevator from the one I had taken up to my room the week before and later had taken up to the eighth floor for my swab test. They thought of everything.
Now on the ground floor, I exited the lobby to see several people, all in PPE, waiting for me. The first said, “I am your dietician.” I greeted her and told her how she had made me happy each night with her call. Then I went to the desk, and there sat the woman doctor who was in charge. She praised me for my recovery. I signed a document and I was handed a Certificate of Quarantine from the Ministry of Health confirming that my result was negative. As I took it, everyone in the lobby, all standing two meters apart, started applauding. I laughed and then I cried. They were making me feel like I was a hero, but they are the heroes; they are the people risking their lives for us.
My trip in the ambulance was quick. Before I knew it, I was back at KAUST. When the ambulance did not turn toward my house but instead went to KAUST Health, I groaned to myself. Another delay. The ambulance stopped at the outdoor testing booth to let me out. I feared what was coming. There, I was greeted by the staff and then checked back into the University. They took my temperature but did not bring out the Q-tip. Alhamdulillah.
Then, I was driven home through the strangely empty streets. I had to remember about the curfew. Once inside my house, I hugged my husband long and hard. We closed the front door. We will keep it closed for another two weeks until we are tested once again before our release. Although the quarantine period on campus is now 21 days, they are counting from my last test and not from my arrival back to campus. Small victories.
I am actually happy to continue the quarantine. Not only do I want to make absolutely sure that I cannot pass the virus on to anyone else, I also feel a little fearful of facing the world. I know that my colleagues, family and friends would embrace me if they could. They have all been incredibly supportive throughout this ten-day journey. I have long text strings to prove it and I have long call logs on FaceTime and Skype.
One afternoon, I talked for five hours straight with my husband and then my three siblings. Many mornings, I engaged with my team via WhatsApp to stay connected and to tell them funny things about what was happening to me. When I apologized to them, in a group chat, for causing them to be swept into this mess, the very one who ended up positive and who followed me into a quarantine hotel somewhere in Jeddah wrote, “No need to apologize. I would rather get the virus from you than from anyone else.” Another colleague then responded, “That is so sweet! You have just won an employee of the year award.” I wonder if he thinks that now.
My friends, my family, the support system at KAUST, the doctors, nurses and hospital staff in two hospitals and a hotel got me through this. Now, it’s up to me to move forward. I can tell that I have a lot to process, a lot to think about. Last night, as I tried to read a book before going off to sleep, in my own bed, I realized that I have no concentration. In the next two weeks in my house that has never felt so big and in my lovely back garden, I will try to find back my authentic self, forever changed by COVID-19, I hope for the better.