An Act of Love and Desperation
The prayer beads hanging from Chloe Le’s rearview mirror trembled as she exited the I-15 freeway in Lake Elsinore, California, heading toward a drive-through COVID-19 testing center in the parking lot of Diamond Stadium. In better times, the stadium was used for minor-league baseball games and the city’s annual Halloween “Field of Screams.” Health-care workers stood before rows of white tents, covered from head to toe in plastic, as cars lined up.
Chloe turned off her YouTube Music playlist of Vietnamese tunes. She pressed her driver’s license against the glass of her car window, so a worker could jot down her name. Chloe knew the drill. She had been through this process twice already at this very site. Both of those COVID-19 tests had come back positive.
It was April 16. Chloe needed this third test to be negative. She believed that her husband’s life could depend on it.
Forty-three miles away, 32-year-old Ted Le, also diagnosed with COVID-19, lay intubated on a ventilator. He had been unconscious in the intensive-care unit at Pomona Valley Hospital Medical Center, in Los Angeles County, since March 24. Prohibited from visiting his bedside, Chloe had not touched him in 24 days.
In early April, Chloe began reading news reports about doctors performing experimental treatments using plasma from recovered COVID-19 patients. The therapy hasn’t been proved to work, but survivors’ antibodies might help critically ill patients fight off the coronavirus. So across the country, hospitals and blood banks have been putting out calls for anyone who has recovered from COVID-19 to donate their plasma.
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Not enough plasma is yet available for all the patients who might need it. Positive COVID-19 test results can show up weeks after symptoms disappear, preventing donations. Survivors like Chloe who want to offer their plasma have had to wait or have been turned away because they did not meet eligibility requirements; others have been unable to donate because they have not yet built up enough antibodies. The controversial ban on gay men donating has prevented potential contributions as well.
The donor programs that Chloe had applied for required proof of a positive COVID-19 laboratory test and 28 days of being symptom-free. As of her third test, Chloe’s coronavirus symptoms, which included a mild fever, a runny nose, fatigue, and loss of taste, had ended 19 days prior—meaning she had nine more days until she could donate. A negative test would allow her to bypass that 28-day waiting period and donate sooner. If Chloe was coronavirus-free, she could offer her plasma to a blood bank as soon as possible, and request that it be routed directly to Ted.
Only a day before Chloe’s third test, Pomona Valley Hospital had received approval to administer the treatment. Now doctors could begin giving plasma to patients, but the hospital did not yet have any viable donors. Though many COVID-19 survivors had signed up wanting to give plasma, blood centers were still trying to sort out who qualified before setting up their donation appointments—and most still did not. Chloe had also posted pleas on social media, asking people anywhere (but preferably local) who had tested positive for the virus a month ago to come forward and help her husband.
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As Chloe pulled up to a health-care worker in the Diamond Stadium parking lot, I watched on FaceTime as she rolled down her window and tugged off her face mask.
“Okay, my dear, I’m going to have you put your head back,” the staffer told her, holding the swab with blue-gloved hands. “I’m going to put it in your nostril, twirl it about five times. It’s going to be a little uncomfortable.”
Chloe tilted back, her seat belt still stretched across her chest.
“Breathe through your mouth.”
Chloe’s jaw dropped. She winced.
“One, two, three, four. You got it,” the worker said.
Chloe’s eyes watered. She put her hands on the steering wheel, her mask dangling off her left ear.
“You’re going to get a phone call if it’s positive,” the health-care worker told her. “If it’s negative, you’ll get an email.”
It could take anywhere from three to 10 days to get results, the worker said. Chloe did not know if her husband would live that long.
Chloe always thought of Ted as invincible. He had no other health problems, had not smoked in many years, and did not use drugs. When Ted came home on March 17 from his job as a manicurist at a nail salon with a runny nose, Chloe did not immediately suspect COVID-19. But by the evening, Ted had a fever of 101. The next morning his temperature climbed to 103.
Ted, who also drove for Lyft and worked as a tattoo artist, did not want to go to the hospital, because his health insurance had lapsed. Four days passed. He lay in bed, moaning from body aches and a terrible migraine, his eyes bloodshot. Chloe begged her husband to visit a doctor. She told him he could get emergency Medi-Cal benefits through the hospital. By Monday, March 23, Ted could barely walk or eat. He had lost his sense of taste and was having difficulty breathing.
At Chloe’s insistence, Ted finally agreed to go. Chloe drove him to Pomona Valley Hospital, where she also works the graveyard shift as an admitting representative. She dropped him off in the front of the emergency room. Visitors are not allowed into areas with suspected or confirmed COVID-19 patients.
“Text me,” she told Ted. “Let me know when they discharge you.” She did not think he would be there very long.
“They took almost 20 vials of blood,” he wrote hours after being admitted, sending a photo of himself with a face mask connected to a blue tube.
“You have to get better,” she replied.
“I have no energy left.”
“Do you think you’re gonna make it?” Chloe wrote, growing more panicked.
Ted texted her on March 24: “They are going to transfer me to ICU.” It was the last time she heard from him before he was intubated.
That same day, Chloe drove to the coronavirus testing site in Lake Elsinore for the first time, along with her parents. Chloe and Ted’s 2-year-old son, Kendrick, came too. None of them showed any symptoms, but Chloe wanted them to get tested to be sure. The toddler sat calmly and didn’t even cry when the swab was inserted, just as it was for adults, sharply into his nose.
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Ted and Chloe lived in the same house as her parents. When the test results came back, Chloe and her 74-year-old father both were positive for the virus. But her 64-year-old mother tested negative, and so did Kendrick. Chloe’s mom and Kendrick moved out of the house, and into Ted’s mother’s home.
Chloe’s symptoms did not show up until five days later, and they turned out to be mild: barely a cough or sore throat. Meanwhile, her father remained asymptomatic. If it had not been for the severity of Ted’s illness, they probably would never have been tested or even realized they had contracted the coronavirus.
It made no sense to her, how Ted’s body could become so ravaged by the same illness that hardly bothered Chloe or her father. Or how the virus seemed to have avoided her mother and son completely, even though they had all five been living under the same roof.
Days passed in isolation at home, as Chloe checked social media and awaited FaceTime calls from doctors and nurses. Her boss dropped off grocery bags of honey, tea, oatmeal, oranges, and toilet paper in front of Chloe’s home. Chloe’s sister-in-law left home-cooked chicken soup, vermicelli, and pho on her porch for Chloe to pick up. Outside her window, she saw neighbors taking walks. She saw vendors selling tacos in her neighborhood without masks.
On Saturday, April 11, while many people were preparing to celebrate Easter the next day, Ted’s lungs collapsed. Doctors stabilized him.
Ted’s physician updated her daily through FaceTime, while standing next to his bed. “Doctors cannot give me false hope, and I understand that,” Chloe told me. She understood that Ted was a priority to receive the experimental plasma treatment if any donations came in. The doctor told her that “he will do everything in his power to make sure my husband gets the plasma,” Chloe said. “He promised me that, and I trust him.”
The treatment, Chloe knew, was no sure fix. Complicating matters, Ted had blood type B positive. Chloe had blood type A. Only when no perfect match is available can a plasma donation occur with mismatched blood types—a rare but not impossible feat that may not be as medically effective. Chloe brushed aside these technicalities. This was one of the few things over which she felt she had some semblance of control. An act of love, and desperation.
Nationwide, more than 1 million people in the United States have tested positive for the coronavirus, according to the COVID Tracking Project, launched by The Atlantic, which collects data on the outbreak in the United States. More than 180,000 individuals have recovered, according to the John Hopkins University tracker, and they could potentially become plasma donors for patients with the most dire cases. Yesterday in California, 4,616 COVID-19 patients were hospitalized, with 1,464 in intensive care.
Doctors across the country have already begun treating coronavirus patients with “convalescent plasma,” which contains the antibodies that the immune system develops while the body is under siege by the virus. More than 5,000 patients so far have been infused with plasma through a national program under the Mayo Clinic.
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On the Facebook group Survivor Corps, daily stories of recoveries, illnesses, deaths, people wanting to contribute plasma, places to donate, and people who have already donated fill the message wall, interspersed with heartbreaking pleas: “My family and I are desperately searching for an O+ plasma donor in Tulsa, Oklahoma! My husband is in critical condition in the ICU at St Johns hospital here in Tulsa and has been on a ventilator for 12 days. This is really our last hope.”
It is too early to see widespread results from the plasma treatments, though in a couple of studies, patients have shown improvement. But these aren’t enough to prove that the plasma works for sure. It is not uncommon for people to get better on their own—regardless of experimental treatments.
Data from clinical trials will begin to emerge in the coming weeks. Until then, family members with critically ill loved ones can only grasp at the fleeting possibility of a chance.
Chloe is 31, her birth name, Ngoc Lam Nguyen. She was born in Vietnam and moved to California in 2010, after an aunt in the U.S. sponsored her family. Three years later, she met Ted. His family had been refugees from the Vietnam War living in the Philippines, where he was born and given the name Truong. When he was just three months old, his family relocated to the U.S., where he became known as Ted.
They married in 2015, and after their wedding Chloe posted a Facebook photo of the two of them, her in a flowing white dress and long veil, holding his hand, both of their backs to the camera as they stood watching the sunset over the ocean. She called him “babe” instead of Ted or Truong. His term of affection for her was “doggy face,” she said with a laugh, “because their faces are cute and funny.”
In 2017, Chloe gave birth to Kendrick. “My son loves his dad; they are like shadows,” she told me. “Whenever my husband gets home from work, he’s like, ‘Daddy’s home!’ He runs to hug him and sticks with him the whole night.” Each week, Ted had one day off of work. Chloe also worked a second job at a vision-care clinic, doing medical billing. Time with their son was precious. Ted usually spent part of his day off with Kendrick at Chuck E. Cheese.
Twice, Kendrick had a chance to see his father, unconscious with tubes running through his nose and mouth, over FaceTime with Ted’s mom. “Daddy,” he said, looking frightened. “Hospital.”
As nurses held up an iPad during another conversation, Chloe told her husband: “You have to fight, because we are fighting for you; all the doctors and nurses are helping, trying everything they can. Your son misses you. You have to hang on and be strong.”
The week of Chloe’s third COVID-19 test, she was one of 500 people to complete the online survey to be a convalescent-plasma donor through the San Diego Blood Bank. Only 10 of them so far had met the basic criteria, which included being 28 days symptom-free and in good health, Mark Edmunds, its chief medical officer, told me.
Donation appointments were under way, but no plasma had yet been sent from San Diego Blood Bank to COVID-19 patients. By April 15, the American Red Cross, for which Chloe also filled out donation forms, had collected enough plasma to serve just 80 to 100 patients across the country, according to Pampee Young, the organization’s chief medical officer of biomedical services. Hospitals had requested plasma for about 400 critically ill patients through its program. And then, of course, many more requests had been received by other blood banks around the U.S. “We have not been able to meet the need,” Young told me. “I think this is true of virtually all blood centers across the country.”
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A donation from a single person could generate three to four doses—about 200 to 250 milliliters each—of amber-yellow plasma. When transfused into a patient, the plasma hangs from an IV bag alongside the hospital bed. It is infused through a peripheral vein in the arm, Edmunds explained. The process can take a matter of hours or less, depending on how the timer on the release pump is set.
Plasma programs and blood banks are still waiting for an influx of donors as antibody tests, which could work as quickly as a pregnancy test, are distributed widely to the public. But so far, many of these tests have not been screened or approved by the federal government. Medical professionals have until recently focused more on testing the sick than on those who are asymptomatic.
From her home, Chloe anxiously kept up with the news. She posted an article about antibody testing in L.A. County on her Facebook page. “It would help if we had the antibody test quickly,” she said, “to determine who else can be a potential donor.”
On the day of her third coronavirus test, Chloe found out she could go back to her job at the hospital, which had instituted a 14-day return-to-work policy for employees who had been ill but were now symptom-free. She hoped it would distract her from the distress. Returning to work, Chloe said, “is going to keep me sane.” She was put on the schedule for the next graveyard shift.
There was also another reason she urgently wanted to return. Although Chloe worked in an administrative area at the hospital, she knew exactly where the ICU was. “Maybe I can stand outside and look at him,” she said. “I know they won’t let me in the room.” She just wanted to be close to her husband, even if briefly. She wanted to look at him without the boundary of a touch-screen device.
“I won’t know until I get there,” Chloe said. “I will need to wander around, and maybe I can sneak in.”
Hours after receiving her third COVID-19 test, Chloe drove to the hospital to drop off the paperwork required for her to return to work. She pulled out her hospital badge. Once inside, she made a beeline for the ICU. The nurses seemed surprised to see her. But no one tried to kick her out. Chloe stared at her husband through the window. A nurse tried to bring her a chair, but Chloe only wanted to stand.
He looked comfortable, she thought, but completely unaware of anything going on around him. This was the first time she had been in her husband’s presence in nearly four weeks. Could he sense that she was close? She had no idea.
At some point during the 15 minutes she stood there, Ted’s doctor found her. “He’s headed in the wrong direction,” the doctor told Chloe. “His kidneys are failing.” Chloe had been clinging to the idea of a plasma treatment, to some kind of miracle. Now she had a sinking feeling. “It was hopeless,” Chloe said. There was no way to hug him, to comfort him or ease his pain. “In the moment there was nothing I could do.” She went home and tried to fall asleep.
At around 1 a.m. the next morning, a hospital employee called Chloe. Her husband’s oxygen-saturation levels had dropped perilously low. “He could code anytime now,” the health worker told her.
“Please save him if you can,” Chloe begged.
At 5:30 a.m., another call. Chloe told me the words she remembered hearing from the medical staff: “We couldn’t bring him back. His heart was already very weak. There was no oxygen in his blood. His skin was already blue.”
Two days had passed since the hospital had received approval to participate in the Mayo Clinic’s convalescent-plasma clinical trials. Still, it had not received any plasma. A day had passed since Chloe’s third COVID-19 test. Now Ted was gone. They had run out of time. Weeping and alone, Chloe clung to the phone as if it could give her a different answer. Outside, the sun began to rise.
Chloe knew there had never been any guarantee that the plasma would have worked, but she had held on to the prospect of the treatment with the wishful thinking that people pour into prayers. “They tried,” she said. “The system wasn’t fast enough to save him. He couldn’t wait.”
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Hours after she lost her husband, Chloe was still in shock when she received a message from the coronavirus testing program through the Lake Elsinore site. “I logged in to my account and saw my lab results,” Chloe said. They had come back in just one day, much faster than her previous two tests. “I am negative for COVID-19,” she said. “I’ve been cleared.”
On the day of Ted’s death, a dozen coronavirus patients remained at Pomona Valley Hospital. “We’ve certainly been frustrated that we haven’t been able to access plasma,” Daniel Gluckstein, the medical director of infectious disease for the hospital, told me. Several patients at the time had been candidates for the convalescent-plasma treatment, Gluckstein said, as well as for other clinical trials—particularly for the antiviral medicine remdesivir, which has been linked to recoveries in emerging studies. Gluckstein said the hospital has not been successful in getting approved for that trial, despite numerous attempts. But last week remdesivir received emergency approval from the Food and Drug Administration to treat severely ill patients. The drug is expected to begin arriving in hospitals this week.
As of Wednesday, the hospital was treating 14 COVID-19 patients, with three in intensive care. Six patients so far have received convalescent plasma. It cannot yet report if any of their conditions have improved, but a spokesperson confirmed that all of the patients who received the treatment are still alive.
Some of the hospital’s earlier critical patients had also received hydroxychloroquine as part of clinical trials (which the FDA recently warned can cause dangerous heart-rhythm abnormalities). Gluckstein could not say if hydroxychloroquine had helped those patients: “I haven’t been personally impressed.”
All of these treatments, like the virus itself, are in uncharted territory. Some patients may have improved with or without them. Some might have died with or without them. With convalescent plasma, there are also ethical concerns. With so little available, should it first go to the very sickest patients who are already in intensive care, or to those not yet at that stage who may have a better chance at recovery?
Chloe finally had proof of a negative coronavirus test and could safely see her son again. That weekend, she held Kendrick and did not yet tell him that his dad was gone.
By Sunday, April 19, Chloe had started planning Ted’s services, which would take place at a funeral home that permitted 10 people at a time for visiting hours, with an open casket. At home, Chloe looked around the bedroom she had shared with her husband. His clothes hung in the closet, their wedding picture on the wall. “I don’t want to stay in this room anymore,” she said. Not without him. “I will need to find another place.”
Chloe still planned to donate her plasma. She wanted to give hope to someone else. Recently, she drove an hour and 30 minutes from her home to a blood bank in Ventura County, California. After she arrived, a health-care worker checked her blood. Chloe has long been anemic, and her hemoglobins, the iron-rich proteins in red blood cells that carry oxygen around the body, were too low.
The health-care workers worried that she might not recover safely after donating, and told her to try to boost her hemoglobin levels with high-iron foods or supplements. This, Chloe understood, could take a couple more weeks. It is hard for Chloe to accept that potential donors are still getting turned away because they are not yet eligible.
She knows that for these families and for COVID-19 patients, every day is crucial. Chloe’s next plasma-donation appointment is scheduled for May 13.