On 16 June, 2020 the RECOVERY Trial discovered that the inexpensive steroid dexamethasone reduces deaths by up to a third for patients hospitalised with severe COVID-19. In the nine months following the announcement, this result saved an estimated one million lives worldwide, including 22,000 in the UK.
John Hanna (65) from Inverclyde, Scotland, received dexamethasone as a trial participant after becoming so critically ill with COVID-19 during April 2020 that his wife Esther was convinced he would never return from hospital. This is their story.
‘The first indications that something wasn’t right was that I was very lethargic, had difficulty concentrating and felt like I had a heavy cold’ says John, a planning engineer for Balfour Beatty. This soon progressed to breathing difficulties, forcing John to sign off sick from work. ‘I was spending more and more time asleep. When I was actually conscious, I felt really cold all the time.’ Esther recalls how he struggled to eat anything, even half a cup of soup. With no sign of improvement after a few days, she rang the NHS Out of Hours number and was advised to take John to an assessment centre at Maryhill, Glasgow.
By this point, John was so clearly unwell that he was given a wheelchair and oxygen support as soon as he arrived. ‘The doctor didn’t even bother taking my details, but called an ambulance straight away,’ John says. Social distancing precautions meant Esther had to stay behind, and she was asked to hand him his mobile phone as he left the building. He was taken straight to Glasgow Royal Infirmary hospital and admitted into a COVID-19 ward. ‘A few hours later, I had a text from him saying that he was about to be put on a ventilator and the sedation process had already started,’ she said. ‘When he left in the ambulance,
When he left in the ambulance I really didn't think I would ever see him again.
John was placed in a medically-induced coma and was unconscious for most of the time, suffering from vivid, disturbing dreams. ‘They were horrendous – in every single one, I was dying’ he says. Meanwhile, it was a lonely, frightening time for Esther, waiting for news alone at their home since the COVID-19 lockdown prevented their children from being with her.
That night at 11:30 pm, Sunday 12 April, Dr Chris McGovern rang to tell her that John was now so seriously ill with viral pneumonia that he had been moved into an intensive care unit (ICU). Although this was the news Esther had been dreading, the doctor then offered a glimmer of hope by telling her about the RECOVERY trial.
‘He explained that they were involved in a study testing six possible treatments for COVID-19, and that this could give John the best chance of surviving’ she said. ‘They couldn’t guarantee what he would get – it would be like a roll of the dice, done by a computer.’
John was heavily sedated at this point and unable to breathe, let alone speak for himself. But Esther knew that he had participated in clinical research several years ago, during treatment for bowel cancer, so she gave consent on his behalf to participate in the RECOVERY trial.
‘If it didn’t help John, I thought it might help someone else,’ Esther says.
John was randomly allocated to receive dexamethasone, and was given his first dose the next day, Monday 13 April. Although he began showing signs of kidney failure the following day, John soon began to stabilise and by Wednesday, for the first time, he started trying to breathe by himself. Finally, on Saturday, John came off the ventilator for good. It was just in time for the couple’s 40th wedding anniversary, and John arranged for flowers to be sent to Esther.
None of my doctors expected me to survive - I really have been one of the lucky ones. I firmly believe the dexamethasone made all the difference.
Nevertheless, John was still far too unwell to be discharged. A week in intensive care had left him two stone lighter and with severe muscle wastage. On a COVID-recovery ward, he learned to stand and walk again, and slowly regained his appetite. Throughout this time, Esther remained unable to visit him, and only saw him once during a Zoom call arranged by the hospital. Finally, on 28 April, John was discharged and the couple were reunited.
‘It’s been a right rollercoaster ride’ said Esther. ‘But all the medical team at the hospital were fantastic, and they contacted me every day with an update on John. There are too many to mention, however I’d like to especially thank Dr Chris McGovern; Angela Harkins, the nurse who was allocated to look after John; and Dr Patrick McGorey, the consultant who oversaw John since his admission to ICU.’
The couple are also grateful to Susanne, the nurse who managed John’s participation in the RECOVERY Trial. John recalls how strange it felt to meet her during a follow-up appointment after his discharge: ‘She said she was so delighted to see me because she didn’t think she would ever have a conversation with me’ says John. ‘I had to say that I was very sorry, I didn’t know who she was because I hadn’t been conscious at the time!’
Since then, John has continued his recovery at home. Despite having permanent lung damage, he set himself walking targets and other milestones. Thanks to this progress, he was able to start working again in September 2020, and enjoy a short summer break with Esther on the Cowal Peninsula. The couple are now looking forward to celebrating the birth of their sixth grandchild this summer.