Corona Daily 428: Patient 91 in Vietnam

The Vietnam government publishes information about each Coronavirus case. For privacy reasons, patients can’t be named, only numbered. In March, for example, newspapers mentioned that patients 88, 89 and 90 were Vietnamese girls studying in Europe or the US, who had flown to Ho Chi Minh City.

Patient 91 was a 43 year old British male, living in district 2 of Ho Chi Minh City. A pilot with a Vietnamese Airline, Ho Chi Minh was his base. Between 13 and 18 March, he ate and drank at different bars and restaurants. The well known Buddha bar and grill is close to his house. On 14 March, he attended a party there. On 16 March, he piloted VN 272 to Hanoi and VN 607 back on the same day.

On 17 March, he felt feverish, tired, and started coughing. On 18 March, he was admitted to the hospital of Tropical Diseases. His X-ray showed damage to the right lung tissue. As per procedure two swab samples were taken. Results of all tests were positive. Immediately local authorities locked down Ascent apartment, where he lived with 764 residents, including 158 foreigners.

On 8 April, the British pilot began to deteriorate. Vietnam’s Ministry of Health appointed its best experts to look after the case. The government sought a rare coagulation (blood clotting) drug from abroad. By mid-April, patient 91 went into coma. He was put under ECMO (extracorporeal membrane oxygenation) intervention, actively resuscitated with mechanical ventilation, put on antibody-filtered dialysis and given antibiotics and anti-fungal drugs.  

On 15 May, Nguyen Van Vinh Chau, the hospital director said the pilot’s lungs were seriously damaged and a transplant was essential. Vietnam mounted an all-out effort. More than 50 people offered to be lung donors. Patient 91’s parents are not alive. The Vietnamese hunted down his closest relatives in the UK to get permission for a lung transplant.

Then doctors discovered patient 91 suffered from cytokine storm syndrome, where the immune system overreacts to the virus and releases too many cytokines (proteins released by white blood cells), damaging the organs. The doctors kept treating each condition. In total, Vietnam spent $215,000 treating patient 91.

On 27 May, he awoke from coma. He had been on life support for two months. When checked, his lungs were working 20-30% as compared to the earlier 10%. Drinking sugar water, his limb strength began improving. His latest Corona tests were negative. Soon he was off dialysis.

On 3 June, he was disconnected from the ECMO machine, after 57 days. He cried when he saw the nurses and doctors around him. On 5 June, the doctors declared he was safe and on his way to recovery.

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This saga may remind you of Spielberg’s film Saving Private Ryan. Did Vietnam take this effort because the patient was British? A foreigner? Luong Ngoc Khue, the medical director was surprised at the question.

It had nothing to do with his nationality. Vietnam borders China. Since the pandemic began, it has aggressively pursued testing, tracing, isolation. It is the only large population country (97 million) with zero Corona deaths.

 ‘A corona death will be a stigma on our overall effort,’ said Luong Khue. ‘We must do absolutely everything to avoid the first death in Vietnam, and that’s all we did.’

Ravi