When Dr. Brian Boer got his first look at Nebraska's first COVID-19 patient, he knew he had a battle on his hands.
Emma Hutchinson, a 36-year-old Omaha woman with birth defects that hampered her breathing, was in rough shape.
Her lungs had filled with fluid. The oxygen mask on her face wasn't doing nearly enough. She was literally drowning on her hospital bed.
Boer, a pulmonologist who heads the intensive care unit set up to treat critically ill COVID-19 patients at the Nebraska Medical Center, said he'd seen such dire cases of lung failure, known as acute respiratory distress syndrome, before in patients with serious influenza.
But as he checked on Hutchinson on the morning of March 6, he knew this time it was different. This new coronavirus was more contagious and more dangerous than the flu. The hospital had already started ramping up for an expected onslaught of patients. The big concern — that this novel virus could swamp and overwhelm hospitals and staff.
"The big difference is that no human body has seen this before," Boer said. "If everyone gets it at the same time, if too many people get sick all at once, you can't care for all of them."
"Then you have to make the hard choices about who lives or dies," he said. "That's what happened in Italy."
But Emma Hutchinson didn't become a casualty of COVID-19.
After 30 days at the medical center, three weeks of isolation at her father's home in west Omaha, including more follow-up tests for the coronavirus, she was allowed to resume eating solid food and say goodbye to "Fred," her nickname for the feeding tube, attached to a steel pole on wheels, that she had been wheeling around.
Her first solid meal in almost two months? Her favorite sandwich at Jimmy John's, the No. 9, a sandwich called the Italian Night Club. A couple days later, she and a friend enjoyed an Irish meal donated by her favorite restaurant, the Brazen Head.
Now, she's back at her own apartment, and has resumed working at a structured workshop for the developmentally disabled in Omaha.
She's done a podcast for her church, Christ Community, located along Interstate 680 near the West Dodge interchange, in which she thanked her family and friends, the doctors and nurses at the Nebraska Medical Center, and even strangers who prayed and urged her to endure, even as she lay in an intensive care unit under heavy sedation.
"From the beginning of March to now, I felt like giving up on everything," Hutchinson said. "But I had a bunch of close friends and my family and the body of God who would surround me and encourage me to fight for my life.
"They told me not to give up," she said.
Hutchinson and her father, Ralph, a 73-year-old post office retiree who grew up in London, agreed for the first time to have their names used in a story.
He had initially reached out to The World-Herald shortly after posts on social media had accused his daughter of intentionally spreading the virus by participating in a Special Olympics basketball tournament on Feb. 29 at the Fremont YMCA just after she'd returned from a trip to England for her grandfather's 100th birthday.
The father, who didn't want his name used at that time to avoid even further digital abuse, made it clear that Emma had shown no symptoms until the day she was admitted to the hospital, and that lifelong breathing problems made it hard to discern whether she was even sick, much less infected with the coronavirus.
It wasn't until father and daughter returned to the hospital on March 5 — five days after the tournament — that a doctor noticed that her oxygen levels were dangerously low. He ordered X-rays, which strongly suggested that she had pneumonia. When he was told they'd just been to London, COVID-19 was suspected to have invaded her lungs. She was sent to Methodist's Dodge Street hospital.
After a trying night at the hospital, Hutchinson was transferred to the Nebraska Medical Center, the hospital that has worked in collaboration with the University of Nebraska Medical Center to establish one of the few centers specializing in the treatment of contagious diseases like Ebola, SARS, and now, COVID-19.
A photograph of her being wheeled into the medical center has become one of the iconic images of the coronavirus pandemic in Nebraska, a viral attack that has infected more than 9,000 in the state and killed more than 100.
In the photo by The World-Herald's Chris Machian, Hutchinson, who graduated from Omaha Northwest, is encased in a clear plastic inflated tube called an isolation pod. Emergency responders are wearing masks, helmets, head-to-toe protective suits, gloves and rubber boots. It looks like a scene from a sci-fi movie.
Dr. Boer said that when Hutchinson arrived at the hospital, personnel in the COVID-19 ward were wearing the maximum protective gear, which included helmets into which filtered air is pumped by a battery operated blower, like they had worn when treating Ebola patients flown to the Omaha hospital for specialized treatment in 2017. However, using those powered air-purifying respirators proved unsustainable for the several dozen nurses, techs and doctors working in the unit, who have since switched to the now-familiar personal protective equipment of face shields, N95-like masks, gowns and disposable rubber gloves.
But when the state's first patient arrived, the hospital was ramping up for a possible surge of coronavirus patients. The biocontainment unit had only four rooms and could hold a total of just eight patients. So a special COVID-19 intensive care unit was being established.
Things were moving fast. The unit was preparing for the worst. The stress level was high.
Working in such specialized isolation wards is labor-intensive and exhausting, Boer said. Protective gear must be put on when entering a room and removed when leaving. Gloves are disposable, but masks — three to each worker — must be sterilized each night.
Nurses, he said, have it the hardest, because they are frequently in and out of such rooms. Meanwhile, doctors, he said, can do a lot of his monitoring of patients outside the rooms.
"Our poor nurses. They're like heroes," Boer said. "They're the ones getting their butts kicked."
Soon after Hutchinson arrived, she was put on a ventilator — a mechanical lung that breathes for a patient — because her own fluid-filled lungs were too rigid to allow her to breathe on her own. She was heavily sedated and placed in a medically induced coma, in part to prevent her body from moving and consuming more precious oxygen.
"The body doesn't like something else breathing for you," Boer said, and will literally fight against the tube stuck in your airway.
Because she'd had surgery on her airway as an infant to improve breathing, installing the "vent" tube was tricky, he said. But it was successful.
Her oxygen levels, at times, dipped to as low as 50-60% — anything under 90% is low — and the ventilator was set at maximum.
The lack of oxygen, Boer said, was causing some kidney failure and some heart problems. If her kidneys got any worse, he feared she might have to be put on a dialysis machine, which lowers a person's chances of survival.
"We had to do a lot of tweaking," Boer said. "There was a solid week of not knowing if she was going to turn the corner."
But she did.
Hutchinson was transferred from the biocontainment unit to the special COVID-19 ICU, and on March 24 — 18 days after arriving at Nebraska Medical Center — the ventilator was removed, and she was placed in a more regular hospital room.
"The first thing she asked was if she did a good job," the doctor said.
"You did an awesome job, Emma."
She wasn't out of the woods yet. Removal of a breathing tube can sometimes cause damage, blocking the airway, and Boer said Hutchinson was at high risk for that because of her medical history. A team of physicians prepared for the worst — an immediate tracheotomy to allow her to breathe — but that wasn't necessary, he said.
As a precaution against the return of the virus and because doctors weren't sure she could swallow, Hutchinson had to continue to use a feeding tube after she was sent home April 4 to continue her recovery.
Her father became her nurse and attendant, crushing pills every day, twice a day, mixing them with fluid and and then injecting them with a syringe into the tube.
"She always said 'Dad, you're doing it too fast.' She could feel it into her throat," said Ralph Hutchinson, whose first wife, now deceased, had taken in Emma as a foster child at age 2, then adopted her three years later.
She was among the 1,063 critically ill COVID-19 patients across the globe who were enrolled in a blind trial of the drug remdesivir, a medication that had been used on Ebola patients. Because it was a blind study, neither the Hutchinsons nor Emma's doctor were told whether she received the drug or a placebo.
Boer said that personnel at the medical center had their suspicions about who got remdesivir and who didn't, based on patients who seemed to recover more quickly than others.
But the doctor said that the recovery of Emma Hutchinson, from near death bed, wasn't due to some "miracle" drug but rather to "evidence-based, supportive care" like that given to severe cases of influenza. That's sticking to the basics, he said, and not trying some untested medicine, like hydroxychloroquine, that more often than not makes things worse.
"These people need time, not a lot of tinkering," Boer said. "You just have ride it out, weather the storm and buy her time to fight the virus on her own.
"These are marathon cases, not sprints."
Emma Hutchinson, in her podcast, said that battling COVID-19 taught her to not take her family and friends for granted, and to recognize that possessions aren't that important.
Her father said he's grateful for neighbors and friends, for the doctors and nurses, and for the emails from well wishers he didn't know.
"I’d like to name them all, but it would get as tedious as an Academy Award acceptance speech," Ralph Hutchinson said.
"We were lucky," he added. "Many were not, and the toll will rise. Our hearts go out to everyone affected, directly and indirectly, by this awful virus."
What began as a headache and slight fever, John Aguiniga tested negative for influenza at the Kimball Health Services clinic on March 23, but was not tested for COVID-19 since his symptoms at the time didn’t fit into the rapidly changing national requirements for testing.
By March 28, he was experiencing increased shortness of breath, high fever, and an oxygen level of 85, far below the normal range of 95 to 100. Jennifer raced him to Regional West Medical Center in Scottsbluff, where he became the hospital’s first COVID-19 patient.