By Angie Leventis Lourgos Chicago Tribune
WWR Article Summary (tl;dr) As Angie Leventis Lourgos reports, these cases "provided early insight into everything from how the virus sheds to the length of time a patient is contagious to how COVID-19 is transmitted."
She was known as Patient 1.
The Chicago woman in her 60s had traveled on Christmas Day to Wuhan, China, where she cared for her elderly father who had fallen ill to a mysterious, undiagnosed respiratory sickness.
After returning to Chicago in mid-January, her own symptoms emerged: fever, cough and fatigue, followed by nausea and dizziness.
While hospitalized for pneumonia, she became the first patient in Illinois and the second in the nation to test positive for the novel coronavirus, a new and little-understood illness that would soon burgeon into an international pandemic, sickening millions and altering all aspects of daily life across the globe.
Her husband, who had not gone to China, also tested positive days later, marking the first documented case of person-to-person transmission in the United States.
What medical experts learned from that local couple, through lengthy interviews, rigorous coronavirus testing and analysis of so many of their specimens, helped shape much of the nation's earliest knowledge of the virus, which would later be called COVID-19.
The wife and husband remained anonymous to the public even after their recovery and discharge to home isolation in early February. Hospital officials said the wife in particular feared ostracism at a time when bigotry and xenophobia stemming from the virus hit a fever-pitch here and around the world.
"Please do not let fear or panic guide your actions," a leader with the U.S. Centers for Disease Control and Prevention implored the nation in late January. "For example, please do not assume that just because someone is of Asian descent that they have this new coronavirus."
Rhetoric on many social media platforms had blamed the first Illinois patient for bringing the virus to the Chicago area.
"Send her back," one local man had posted on Facebook when news broke of the first confirmed case.
"To (sic) many people coming here from other countries bringing in disease," a woman wrote on the site. "Keep out!"
Scientists now know the highly contagious virus, which has since infected nearly every country, leaving few parts of the world unscathed, was already spreading undetected across the U.S., possibly as early as December. The Chicago couple were simply among the first to be diagnosed.
Yet their bodies and oral testimony provided early insight into everything from how the virus sheds to the length of time a patient is contagious to how COVID-19 is transmitted. These first cases also helped health officials develop infection control protocols, testing guidelines and best use of personal protective gear for staff, as well as the earliest local coronavirus contact tracing operation.
The wife and husband were treated in isolation at Amita Health St. Alexius Medical Center Hoffman Estates, a midsize northwest suburban hospital that suddenly found itself in the epicenter of scientific inquiry and research into a world health epidemic.
Field teams from the CDC quickly converged with state, county and local health leaders, forming a makeshift command post of sorts in the basement of the hospital. To help draft a road map for care, hospital administrators contacted officials at the hospital in Washington state where the first U.S. coronavirus case had been confirmed days earlier.
New information was constant, and constantly changing, recalled Polly Davenport, president of St. Alexius.
"Guidelines, protocols, testing," she said. "Just a lot of information coming very rapidly. Our team did a great job. But I've been through hurricanes, I've been through power outages. This was a lot of unfamiliar information coming very quickly."
The CDC announced on Feb. 25 that the new coronavirus "will almost certainly spread in the United States," and urged schools, health facilities and businesses to prepare.
In retrospect, some local medical experts credit the state's early and aggressive COVID-19 precautions to these first two Illinois patients, who served as a harbinger of what was to come.
"It was almost a double-edged sword to have gotten the second case in the United States, because it was pretty taxing on our agencies," said Dr. Kiran Joshi, senior medical officer and co-lead of the Cook County Department of Public Health. "But at the same time, we were forewarned in a way of what could happen, and I think as a whole reacted much more quickly than perhaps other states."
Gov. J.B. Pritzker issued an executive statewide stay-at-home order that began March 21, one of the earlier and more stringent government-mandated policies of its kind at the time. These restrictions were eased starting at the end of May, later than many other parts of the country.
While these measures faced much criticism and multiple legal challenges, the governor pointed to declining COVID-19 positivity rates and deaths as metrics indicating early success. Even as the pandemic reached its peak here in May _ and with 30 counties currently at a "warning level" for resurgence _ Illinois has never lacked hospital beds or ventilators.
"While we definitely had a surge, there was never a point where our hospitals were overwhelmed," Joshi said. "We put into place the appropriate public health measures statewide to prevent that."
The first Illinois patient tested positive for the coronavirus on Jan. 23, back when the virus still felt thousands of miles away, mainly afflicting China.
This was before social distancing became standard practice in the U.S. Before in-person school felt like a weighty decision. Before masks were required and routinely worn in most public spaces. Before the World Health Organization on March 11 declared COVID-19 a worldwide pandemic.
"It feels like it was years and years ago, because the time between then and now has been so full with COVID and the pandemic in the United States," said Dr. Rachel Rubin, senior medical officer and co-lead of the Cook County Department of Public Health.
Joshi recalled meeting Patient 1 the day after she tested positive. Before entering her negative air pressure room at St. Alexius, he and a colleague from the CDC both donned full personal protective equipment, disposable gloves, gowns, eye protection and N95 masks.
It was a tense moment. So little was known about the new coronavirus, but both health officials had seen news coverage of so many deaths linked to the virus in China.
"We made eye contact in our PPE, and we just shrugged and walked in," Joshi said. "Like, here we go."
On Jan. 30, the first patient's husband tested positive as well. He already suffered from chronic obstructive pulmonary disease, causing a cough and labored breathing, so it wasn't clear at first that his symptoms stemmed from COVID-19, according to an article published in the medical journal The Lancet in April.
Joshi described both the wife and husband as very forthcoming, giving multiple interviews that lasted hours, rehashing details of what they experienced and any possible contact they might have had with others post-infection.
Health officials from the hospital and various levels of government worked together to quickly develop a contact tracing operation, creating a web of people, including many hospital employees, who might have been exposed to the patients.
"The learning curve was so steep," Rubin said. "Learning about the virus, but also learning how to do the surveillance and investigations ... and how to document this in the best way, knowing this is on a scale that none of us had ever seen before."
Both physicians recalled being surprised by how little the virus seemed to spread beyond the initial transmission from wife to husband, who had prolonged proximity from eating together, sleeping in the same bed and frequent face-to-face interaction.