June 20, 2021

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Keep Fit & Healthy

David Lat, a 44-year-old marathon runner and founder of Above the Law, was on life support for COVID-19. After a miraculous recovery, his family shares his cautionary tale.

12 min read

David Lat, a 44-year-old legal recruiter, spent six days on a ventilator after COVID-19 nearly killed him.
David Lat, a 44-year-old legal recruiter, spent six days on a ventilator after COVID-19 nearly killed him.

Facebook/David Lat

  • David Lat, a healthy 44-year-old New Yorker who founded the legal blog Above the Law, nearly died of the novel coronavirus last month as it ripped through his respiratory system.

  • Lat was hospitalized at NYU Langone for 17 days — six of them under sedation hooked up to a ventilator.

  • He told Business Insider he had struggled in the early days of his symptoms to get tested for COVID-19, and by the time one was available he could barely breathe.

  • Lat and his husband, Zachary Shemtob, walked Business Insider through each step of the harrowing experience.

  • Visit Business Insider’s homepage for more stories.

The 44-year-old lawyer had just arrived in the emergency room for the second time in two days. He couldn’t walk. He could barely even stand. He clutched the reception desk for balance and gasped for air.

“I can’t breathe,” he said.

David Lat, a well-known legal recruiter and founder of the Above the Law blog, which covers courts and law firms, had pleaded for days with his primary-care doctor and emergency-room staff to be tested for the novel coronavirus. As his flu-like symptoms worsened, all of New York City had ground to a halt. In the third week of March, city officials closed school and shuttered nonessential businesses, effectively confining millions to their homes and upending any semblance of normal life.

But this time, on March 16, the COVID-19 test was the furthest thing from Lat’s mind. He could focus only on the tightness in his chest — a sensation of being suffocated. It felt like trying to catch your breath after running a race, but relief never seemed to come, he told me when we spoke earlier this week.

Immediately, staff at Manhattan’s NYU Langone Medical Center rushed him out of the waiting room. They moved him into an isolation room and placed him on oxygen.

NYU Langone Hospital, March 16, 2020.
NYU Langone Hospital, March 16, 2020.

Associated Press/John Minchillo

The 17 days Lat spent in the hospital would ultimately leave him on the brink of death, sedated, and hooked up to a ventilator for nearly a week. Major newspapers started preparing his obituary and death rumors circulated online. Lat’s social-media posts about the virus, which meticulously chronicled his symptoms and efforts to get tested for the virus, had garnered worldwide attention and jolted his followers. It had finally begun to dawn on many of them that people of all ages could become severely ill or even die.

“Here was someone who already had a voice, but he was also young, with a young family, and a 2-year-old,” Shemtob told me. “That narrative, given the fact that he already had a presence on social media combined to get a lot of people to pay attention to our story.”

Lat’s illness, which had crept up on him for about a week, ripped through his respiratory system in mid-March, at roughly the same time New York City’s outbreak exploded into a public-health crisis.

At NYU Langone, doctors initially placed Lat on their specially designated “COVID-only” floor, in an effort to separate contagious patients from others. By the end of his stay, the outbreak had swallowed up seven of the hospital’s floors, all packed with those sick from coronavirus.

There were only 11 confirmed coronavirus cases in New York City when Lat began noticing symptoms

Lat still has no idea how he caught the coronavirus. He and Shemtob didn’t know anyone who had recently traveled to so-called hot spots, like Iran, China, or Italy. In the early days of March, they went about their daily lives as usual.

The virus “had a somewhat abstract quality, and there were hardly any confirmed cases,” Lat said. “Even though we followed the news, I wouldn’t say it was something of great concern to us.”

That was still days before the state shut down all but the most essential services, and weeks before face masks and gloves became crucial protective attire in public spaces. “Social distancing” had only just become part of the vernacular, and New Yorkers continued commuting to work en masse each day and visiting shops, gyms, and restaurants.

On the day Lat began noticing his very first symptoms, the city had confirmed only 11 coronavirus cases. Despite the low figure, state officials were already on high alert, bracing for a crush. Health officials raced to quarantine thousands of New Yorkers who might have caught the virus from those initial cases. Andrew Cuomo became one of the first governors in the country to declare a state of emergency.

Sixth Avenue during the coronavirus outbreak, April 3, 2020.
Sixth Avenue during the coronavirus outbreak, April 3, 2020.

Associated Press/Frank Franklin II

Neither Lat nor Shemtob worried for their health, or that of their young son, Harlan. Like many Americans, they assumed their youth and immune systems would protect them.

Though Lat sometimes uses an inhaler for exercise-induced asthma, he was otherwise healthy and active. He has run marathons in the past and regularly attended HIIT exercise classes — intense cardio workouts broken up by rest periods.

On March 7, Lat and Shemtob went out to dinner with friends. Part way through the meal, a sudden wave of exhaustion passed through Lat’s body. He felt an overwhelming urge to lie down.

He also noticed an unsettling sensation at dinner the next day at one of his favorite restaurants: None of the dishes had any flavor. He didn’t know it at the time, but he was likely experiencing one of COVID-19’s most peculiar early symptoms, a loss of taste and smell.

The illness only picked up speed from there. Fatigue, chills, body aches, and a burning fever that veered back and forth from 101 to 104 degrees followed. A persistent cough and chest congestion prompted him to call his doctor’s office on March 13, when the nurse prescribed a Z-Pak, an antibiotic frequently used to treat bronchitis and other bacterial infections.

“You should get better in a day,” Lat recalled the nurse telling him over the phone. But 24 hours later, Lat had begun struggling to breathe. He and Shemtob started to suspect he had COVID-19.

Lat’s first trip to the ER at NYU Langone didn’t go well. The hospital refused to test him for the coronavirus, even after he received negative tests for cold and flu. The staff told him to return the next day for a COVID-19 test, frustrating him.

“It meant that if I actually had COVID-19, which I did, I had to go back onto the streets, back into a cab and potentially infecting a cabbie, back to my apartment, potentially infecting Zach,” he said.

But by the time Lat returned to the ER 24 hours later — after saying goodbye to his husband, whom he wouldn’t see in person again for two and a half weeks — he no longer cared about the test. He just wanted to breathe.

Lat’s doctor said it was ‘scary’ to treat coronavirus patients. They seem fine at first, but their health deteriorates fast.

Dr. Luke O’Donnell’s very first day treating those sick from the coronavirus coincided with Lat’s hospitalization. The NYU Langone internist had been preparing to care for elderly patients with multiple underlying medical conditions. Instead, he wound up treating Lat.

“A lot of us had never treated this before,” O’Donnell told me. “We were all expecting him to do quite well, because he’s young and otherwise healthy. We were very surprised that he ended up not doing so well, and that he needed to be intubated.”

The rapid progression of COVID-19 in some patients has baffled doctors. Lat, for instance, spent days receiving a continuous small dose of oxygen, before doctors noticed his health quickly deteriorated and realized he’d need more drastic intervention, O’Donnell said.

“People can work quite well for a long time needing very small amounts of supplemental oxygen, and then very rapidly and very suddenly, without warning, get very sick,” he said. “It’s very scary to treat because you can look at them and they look great now, and a lot of what we’re doing is observational, seeing how people progress. And then the next moment a patient could be much worse.”

Medical workers with patients at a special coronavirus intake area at Maimonides Medical Center, on April 6, in New York.
Medical workers with patients at a special coronavirus intake area at Maimonides Medical Center, on April 6, in New York.

Spencer Platt/Getty Images

Lat’s parents, both doctors in New Jersey, seemed to anticipate the pattern and eagerly offered advice and potential treatments.

Lat would phone his mother and place her on speakerphone each time his doctors came to his bed. She would press them on his medications, urging treatments like hydroxychloroquine, the antimalarial drug doctors have been using to treat COVID-19.

But there was one treatment Lat had grown wary of, after his father tossed out a casual warning in one conversation.

“David, you don’t want to go on a ventilator. You won’t make it back from that.”

The 6 days Lat spent on a ventilator are ‘blank space’ in his memory

Late at night on March 20, four days into Lat’s hospital stay, his oxygen levels plummeted.

“Over the course of a few hours, he went from someone that we were fine monitoring before to someone who needed to be intubated,” meaning doctors would have to put a tube down his windpipe so that a ventilator could pump oxygen into his lungs, O’Donnell said.

Someone (Lat can’t recall who) entered his room and told him he would have to be intubated immediately.

“I was terrified,” Lat said, recalling his father’s warning just days earlier. “I just started praying.”

What seemed like a million masked faces peered down at Lat as an anesthesiologist administered a sedative, then a paralytic. Lat recalled no pain, only anxiety, as he lost consciousness. Next, a doctor began the intubation, wrenching open his airway with a tool called a speculum, and slotting in a tube to connect the ventilator with his lungs.

Lat can’t recall a thing from the six days he spent on the ventilator. “It’s kind of blank space,” he said.

But Shemtob remembers every agonizing hour of that week. Inundated with COVID-19 cases, NYU Langone proved difficult for Shemtob to contact on his own. Sometimes as many as 48 hours would pass between calls from the hospital updating him on his husband’s condition.

Also alarming, early research has shown that many COVID-19 sufferers who go on ventilators don’t come off them. Doctors have even begun debating whether less invasive oxygen treatments might be more effective.

“The sense I got was it was a coin flip whether he would live or die,” Shemtob said. “After David got off the ventilator, I read [the studies] and realized that a coin flip may have been generous.”

Doctors use the machines to buy time for patients’ bodies to fight off the virus. But since there’s not enough evidence to show which medications are effective, Lat’s doctors had to resort to experimental drugs.

Shemtob likened the process to “throwing everything against the wall” and hoping something stuck.

O’Donnell confirmed that he and his team treated him with four main drugs: the antiretroviral agent Kaletra, hydroxychloroquine combined with the antibiotic azithromycin, and another experimental therapy called clazakizumab.

Because Lat was sedated, he couldn’t sign the official consent form to approve the treatments, leaving the task to Shemtob. “You are eligible to participate in a trial for patients who are experiencing a potentially fatal pulmonary failure,” the form read.

“I was incredibly concerned, very scared,” Shemtob said. “If we were at the point where they were using these experimental drugs, then, you know, it was not a good place to be.”

Lat doesn’t know which of the medications ultimately led to his recovery. He and Shemtob have watched the roaring debate over the efficacy of hydroxychloroquine with bemusement as President Trump has touted the drug as a “game-changer” and even suggested he might take it himself.

O’Donnell said he and his colleagues would continue monitoring the active research into the drug. But so far, reports have been “all over the place,” he said.

Both Lat and Shemtob agreed it’s unwise to have a strong opinion on whether the drug did or didn’t work, until clinical testing reveals an answer.

Hydroxychloroquine.
Hydroxychloroquine.

Associated Press/John Locher

As for Lat, his recollections of the medications and their side effects are hazy. He said it’s impossible to tell what helped or harmed him.

“I had all these various conditions and I don’t know what was caused by what,” he said. “I felt really tired — what was that from? Was that from the disease? Was that from the respirator? Was that an aftereffect of the ventilator? I had diarrhea. Is that from medications? Was that from illness?”

But one thing Lat knows for sure is the ventilator saved his life.

But taking him off the machine keeping him alive was a fraught decision. Shemtob said a nurse practitioner told him Lat’s oxygen levels were high enough to see if his lungs could cope, unaided.

If that failed, Shemtob said, doctors would perform a tracheostomy, slicing into Lat’s throat to re-intubate him and put him back on the ventilator.

That frightened Shemtob, who had been reading reports of nationwide ventilator shortages.

“I was seriously concerned that David would lose his ventilator,” Shemtob said. “This goes to the larger point of the lack of ventilators and how morally disgraceful it is.”

The shortage has prompted states across the US to stockpile the machines and engage in eBay-style bidding wars against one another. Even Trump has intervened, invoking the Defense Production Act to force General Motors to ramp up production.

On March 26, doctors finally took Lat off the ventilator and told Shemtob his conditions were looking good. Lat had previously needed six liters of oxygen, but now he was down to three and a half.

Shemtob slowly began to realize that his husband would likely survive.

Lat’s recovery will be slow and long, and he doesn’t know whether his lungs will ever fully recover

Less than two weeks after his discharge from Langone, Lat remains in rough shape. He is easily winded just by crossing a room or walking up a flight of stairs, and his voice is still hoarse from the intubation.

He said he lost 15 pounds in the hospital. And while he has already regained 5 pounds, he likely faces a long road to recovery.

The couple wants to know how much Lat’s treatment ultimately cost them. Even insured people have reported paying thousands of dollars for their hospital stays. Lat expects to see a total well into the six figures when he receives his explanation of benefits document. He assumes his health insurance will cover most of it, but he won’t know until he receives the paperwork.

Lat took this selfie from his hospital bed not long after he was taken off the ventilator.
Lat took this selfie from his hospital bed not long after he was taken off the ventilator.

Facebook/David Lat

Lat and O’Donnell said it’s still unclear whether he’ll ever regain the full use of his lungs. Early research suggests a 20% to 30% reduction in lung function in some who have recovered from COVID-19.

Amid the misery of a weekslong hospital stay, Lat was happy to discover he could play a small part in helping others by donating blood. Recovered coronavirus patients’ blood plasma contains antibodies that some experts believe could be used to treat others who have had the virus.

Though the US Food and Drug Administration has prohibited gay men from donating blood until they’ve waited at least three months since their last sexual activity, Lat said hospital staff did not ask him about his sexual history when he donated the blood.

Back at his parents’ home, in New Jersey, Lat and Shemtob are spending time with their son and enjoying being a family once again. Fellow COVID-19 patients around the world have inundated Lat with questions. They want to compare notes about symptoms and medications.

Above all else, he wants people to understand the necessity of small but important things that can help slow the virus’s spread: washing hands, wearing masks, and practicing social distancing. And young, healthy people have to remember COVID-19 doesn’t just hit older people.

“I want people to understand how serious this is,” he said.

Read the original article on Business Insider

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