SINGAPORE - Madam Lee Sock Lee was fit enough to visit a Swab and Send Home clinic after getting a positive Covid-19 antigen rapid test result on Sept 13 morning, but things rapidly took a turn for the worse.
Within the next 24 hours, she was in critical care and fighting for her life.
The 43-year-old housewife, who was slipping in and out of consciousness as she was being rushed to the emergency room of Ng Teng Fong General Hospital (NTFGH) on Sept 13, was on the verge of cardiovascular collapse and would have died if not for the timely intervention of extracorporeal membrane oxygenation (Ecmo) treatment.
Ecmo is a life-saving machine which takes over the function of the heart and lungs.
Madam Lee, who is unvaccinated, was putting off vaccination due to previous episodes caused by food allergies but did not have any pre-existing co-morbidities. The family was waiting for the arrival of Novavax, a protein-based Covid-19 vaccine.
As a cautionary tale to those still holding off vaccination, she said on Thursday (Oct 28): "This is my second chance in life... If I had died, I will only have my husband to take care of our four children, who are still young. For those who are still hesitating on getting your vaccines, yes, there is a risk of side effects, but please do not delay any further."
Describing her experience as a traumatic one for her family, especially her husband, Madam Lee added: "Vaccination could potentially save your life. You won't have to go through what I went through and what I put my family through."
Her family of six was found to be Covid-19-positive. Thankfully, her children - ranging from three to 13 years old - and her husband had only mild symptoms such as fever and headaches.
Her husband is partially vaccinated and her eldest son is fully vaccinated. The rest are unvaccinated and those eligible will be getting their jabs in about three months - based on doctor's advice for recovered Covid-19 patients.
After admission into NTFGH, she was transferred to the National University Hospital (NUH) on Sept 14 and put on venoarterial Ecmo, a heart-lung machine used for catastrophic lung or heart failure.
The machine removes blood from the patient before removing carbon dioxide from the blood and adding oxygen to it. The machine then pumps the blood back into the patient.
Madam Lee is the first Covid-19 patient in Singapore to need Ecmo for heart support, with the vast majority, or 95 per cent, of patients needing Ecmo for lung support, Associate Professor Graeme MacLaren, a senior consultant at the department of cardiac thoracic and vascular surgery at the National University Heart Centre, Singapore (NUHCS), said on Thursday (Oct 28).
She was on Ecmo for four days and was also given a course of remdesivir and dexamethasone. She was discharged on Oct 6.
Madam Lee's heart managed to recover, but some lingering symptoms and scarring on her heart tissue have remained.
Her body was severely deconditioned, a result of being critically ill, and she had to relearn some basic functions.
"I had to undergo speech therapy, physiotherapy, occupational therapy, and initially, I had to relearn how to eat, shower myself, walk, balance and do things like folding clothes," she said.
She now gets more tired and breathless easily and is slowly regaining her strength.
"I had no idea how critically ill I was when I was hospitalised," said Madam Lee, who will return for a follow-up at NUH's cardiomyopathy clinic in November.
"The doctors and the team took great care of me... and I'll really encourage everybody to take the vaccine so they do not become seriously ill and become a burden to our doctors and nurses who have worked long hours just to take care of us."
Ecmo in Singapore
Only two centres in Singapore provide adult Ecmo support - NUHCS and the National Heart Centre.
Since the start of Covid-19, NUHCS has put six patients on Ecmo support, with five pulling through.
Ecmo is considered to be the last line of support for patients.
Given how resource-intensive Ecmo is, a whole team is needed to manage just one patient, Prof MacLaren said.
An Ecmo team would include specially trained intensive care unit (ICU) nurses, a perfusionist and specially trained intensive care physicians to manage day-to-day problems that might arise, said Prof MacLaren, adding: "It takes a village to look after one patient."
Based on international research, patients who go on Ecmo due to lung failure stay on it for about three weeks, while those who need it for heart failure have a much shorter stay.