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British pilot with coronavirus in Vietnam wakes from coma

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Patient may need double lung transplant and could be repatriated, say officials

A British pilot who was critically ill with Covid-19 in Vietnam has awoken from a coma and is showing signs of improvement, yet his long-term outlook remains ominous, doctors have said.

The man, 43, who works for Vietnam Airlines, had awoken from a coma and was capable of basic communication after doctors reduced his levels of sedative medication, Vietnamese state media announced on Wednesday.

The patient, referred to in Vietnam as Patient 91, developed a fever and cough on 17 March and was later admitted to Ho Chi Minh City Hospital for Tropical Diseases. Since then, he has spent more than two months on life support.

Tran Thanh Linh, the deputy head of Ho Chi Minh City-based Cho Ray hospital’s intensive care unit, told local media the man was able to perform simple gestures such as moving fingers and toes, yet breathing issues, organ damage and limb weaknesses remain.

The pilot is on an extracorporeal membrane oxygenation machine (ECMO), a form of life support used when a person’s heart or lungs are unable to fully function, and is being treated with antibiotics, according to a report posted on the government’s official news portal early in May.

Linh added that, by the end of this week, an official decision would be announced on whether or not doctors would gradually wean him off ECMO, or even stop the treatment altogether. His lungs are currently functioning at about 20-30%, an increase from 10% a few weeks ago.

The man is no longer receiving kidney dialysis treatment and has repeatedly tested negative for Covid-19. Yet after experiencing cytokine storms, an overreaction of the immune system, his organs have been so severely damaged he remains in a poor condition.

Todd Pollack, a Hanoi-based infectious diseases specialist at Harvard medical school, said the situation was worrying. “A quick review of the medical literature shows that use of ECMO in Covid-19 patients is associated with very high mortality rates of 50-82%, based on early reports from China, so his general prognosis is not good based on the long-term requirement for ECMO.”

Vietnam, a country that has as yet reported no deaths from Covid-19, has focused all available resources and spent more than $200,000 on saving the patient’s life.

Earlier in May, reports suggested the man could receive a double lung transplant if a suitable donor was found. Last week, Vietnam’s health ministry said it was considering repatriating the man to the UK for further treatment if his condition allowed.

“A lung transplant would obviously only be considered if there were no other options,” Pollack said. “There are case reports from China of successful lung transplants being performed for patients with respiratory failures.”

The British embassy in Hanoi said it was unable to comment on the case, citing patient confidentiality, although the British consul general, Ian Gibbons, sent a letter to medical staff in Ho Chi Minh City on 21 May thanking them for their support.

Vietnam, a country of 96 million people that shares a border with China, has so far recorded just 327 cases of Covid-19, owing in part to its aggressive contact tracing campaigns, creative public health messaging and decisive, early action.

Nguyen Quoc Thai, an intensive care doctor at the infectious disease department of Hanoi’s Bach Mai hospital, said: “In China, they did the operation with teams who have experienced hundreds of cases each year. Our Vietnam team has worked on just a few cases, so it’s … very courageous when we mention such a double lung transplant. I hope everything will go smoothly, but still, I worry so much.

“At this time, with advances in medical transportation, I believe the patient could be transported safely back to his home country … but I am afraid the decision would push him to be in peace, instead of fighting in his homeland.

“Now, we all know the patient cannot live without the continuation of ECMO support. His lungs and other organs are in bad condition. But he is still alive.

“Many people want to save money for other very poor patients, and they are thinking about ending the treatment. However, I don’t think we should. For me, as a physician, I value any tiny opportunity to save lives. We cannot bargain over lives.”

By Chris Humphrey – The Guardian – May 28, 2020

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