ID Specialist Diagnosed With COVID-19 in 'Ironic Twist'

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MARCH 19, 2020, BOSTON -- An infectious disease doctor who traveled to Boston to help coordinate the Conference on Retroviruses and Opportunistic Infections (CROI) 2020, which went virtual to help minimize the spread of COVID-19, is in home isolation after being diagnosed with the virus.

It's "an ironic twist," Michael Saag, MD, from the University of Alabama at Birmingham, tweeted on Tuesday night.

Before his diagnosis, he was already in self-quarantine, he told Medscape Medical News. He'd just returned from Boston, where he and a few dozen physicians, researchers, staff, and an army of IT people had converted CROI from an in-person to digital meeting in 36 hours.

Although the rest of the conference organizers who were in Boston are now in self-quarantine, none have exhibited symptoms of COVID-19 in the week since the conference ended, according to the CROI press office.

Saag said he thinks it's likely he acquired COVID-19 after leaving the conference.

Making the Decision to go Virtual

CROI, the country's largest HIV conference, was set to attract 4000 infectious disease clinicians, HIV researchers, and basic scientists from around the world to the Hynes Convention Center in Boston.

But 2 days before the conference, three people who attended a Biogen meeting in the city were diagnosed with COVID-19. That news tipped the scale for organizers, who had been on the fence about proceeding with an in-person conference, and the switch to digital was made, Sharon Hillier, PhD, chair of CROI 2020, reported during the conference.

About two dozen physicians and researchers — members of the CROI program committee — went to Boston anyway. This group included the heads of HIV research networks in the United States, such as the HIV Prevention Trials Network, the AIDS Clinical Trial Group, the Microbicide Trial Network, the HIV Vaccine Trials Network.

In addition, there were about 10 staff members from the International Antiviral Society-USA (IAS-USA), the organization behind CROI, and about 30 tech people "rattling around" the vast convention center where the science was supposed to be presented.

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As the virtual conference proceeded, it became clear that the switch to online was not overkill. The number of COVID-19 diagnoses from the Biogen meeting went from three to about 100 of 175 attendees, and the Boston health infrastructure was tested.

The last thing the nation's healthcare system needed was for all the country's top infectious disease doctors to be unavailable to treat patients because they were self-quarantining after travel or because they were themselves sick, Carlos del Rio, MD, from Emory University in Atlanta, told Medscape Medical News before the conference.

Everyone organizing the in-person part of the conference had been careful with hygiene, wiping down mics, practicing social distancing as best they could at the conference center, and "being incredibly conscientious" about hand washing and disinfection along the way, said Hillier.

By the time the conference ended, on March 11, organizers had uploaded presentations for 254 of the 255 conference sessions and posters. And a special session on COVID-19 was made available to the public. At the traditional wrap-up dinner that followed the conference, organizers sang a parody song about the wild and wooly switch to digital, to the tune of One Day More from Les Misérables. Saag wrote the song.

A Hotspot Road Trip

But then Saag took the train to New York City to see his son. By March 12, more than 200 people in New York state had been diagnosed with COVID-19, and his son wanted to get out of town, Saag told Medscape Medical News.

"He packed his dog up and we rented a car and drove back together," Saag said. But along the way, Saag's son began to feel unwell. By the time they arrived in Birmingham on Friday, Saag's son had a chill and his temperature was 102 °F.

"We threw him into quarantine," said Saag, adding that he had already planned to quarantine himself because he'd just been to two places where COVID-19 was spreading quickly.

"I started feeling bad on Saturday and we went to get tested on Monday," he explained before he received his diagnosis.

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"I had a little bit of a fever last night, but this morning I'm almost back to normal," he told Medscape Medical News on Thursday. "The infection waxes and wanes in its first week. My son hasn't had symptoms since Tuesday."

What's more challenging, though, are the mental health effects of living with the unknown, said Saag.

"If I experience a symptom, I'm imagining a battle between my immune system and the virus and what cytokines are being released," he said. "The part that's difficult for everyone, especially for folks who are a little older, is the concern about the unknown. What happens tomorrow or the next day? I think that's true for anyone with a potentially fatal illness."

"I manage it but it's still there," he added.

Diagnosis and Isolation

Saag hasn't exactly retreated in the face of COVID-19. He's using his diagnosis to share the latest information on COVID-19.

"I think it's important that I communicate about it," he said.

On a Twitter thread with 144 comments so far, Saag has answered questions on the sudden appearance of COVID-19 ("It's been around for a while but not dx'd.") and reinfection ("The assumption is that protective immunity develops and re-infection does not occur. Not 100% proven yet, but likely. That's the concept of how vaccines work."), among others. Plus, he gets a number of questions on whether people should go to this place or that.

"My answer is very simple," he said. "I think we all should stay home except to go out for essential activities, which I would define as something preserving life."

Many of the comments were well wishes for the doctor, who founded the 1917 Clinic, which is Alabama's largest HIV clinic. But Jeri Sumitani, PA-C, an Atlanta-based physician assistant, used the forum to share her own symptoms.

And over and over again, Saag has told people to follow the advice of public health officials who have experience with pandemics.

It's a directive Hillier echoed. Saag's diagnosis is more proof that physical distancing to control the spread of COVID-19 is not an overreaction, she explained.

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When her family members ask if "this whole thing's overblown," she said she tells them that the opposite is true.

"I think it's actually worse than most people understand. It's on both sides of the political aisle," she said. "People are still in a lot of denial."

When Hillier and the other CROI organizers returned home, they went into quarantine, too, out of an abundance of caution. And five IAS-USA employees who were in Boston are in self-quarantine as they wait to see if they develop symptoms.

"Other than wicked allergies that I have right now, everyone is fine," Donna Jacobsen, executive director of IAS-USA, told Medscape Medical News.

Hillier, meanwhile, is working from home and has shut down her studies because a COVID-19 quarantine is in place at the University of Pittsburgh. For now, she and everyone from Boston is doing fine, monitoring their temperatures and checking for symptoms. So far, nothing.

"The bottom line is, we were together last week; many of us were together with Mike," she said.

As for Saag, Hillier said she's optimistic because his symptoms so far seem to be mild.

"Mike is an indomitable spirit," she said of Saag, who is known for his penchant for Broadway songs. "He seems to be monitoring himself carefully. I think I told him, 'We'll be singing together again soon'."

Conference on Retroviruses and Opportunistic Infections (CROI) 2020.

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