Experiencing an unprecedented life-and-death battle, the hard journey has been one of the most miraculous feats in Vietnamese medicine, as leading doctors in the country spared no effort to save the life of Patient 91 and help him recover completely. The tough journey and the victory against the deadly new coronavirus will never be forgotten in the minds of the British pilot and the Vietnamese medical staff.

Putting all their minds, efforts and material resources into the over 100-day struggle to sustain the life of the patient has proved the ability and position of Vietnamese doctors in the fight against the COVID-19 pandemic. The medical team of leading Vietnamese specialists had to cope with the tough battle to protect the life of their special patient. They had to make life and death decisions to get the British pilot to escape death and miraculously recover.

Tough days

Arrived in Vietnam in late 2019 to work for the national flag carrier Vietnam Airlines, the British pilot’s life suffered a great blow as a sudden change, named COVID-19, forced him to be hospitalised on March 18, after making his first flight for the airline. He was confirmed positive for SARS-CoV-2 and was hospitalised for treatment at the Ho Chi Minh City Hospital for Tropical Diseases as the 91st COVID-19 patient detected in Vietnam. Thus, his tough days fighting against the coronavirus with Vietnamese doctors, sometimes confronting death, had begun.

After being hospitalised, his disease progressed very quickly. Five days later, his health began to worsen with respiratory failure. By March 25, Patient 91 was given oxygen through a mask, but the patient’s health had deteriorated extremely quickly, suffering from severe respiratory failure, poor blood oxygenation index, and sometimes the lungs solidified to just 10% of active function. To maintain his life, the hospital team had to use invasive mechanical ventilation. Afterwards, a team of doctors from Cho Ray Hospital was quickly sent to support him with extracorporeal membrane oxygenation (ECMO). During the 65 days spent at the Tropical Diseases Hospital, the Cho Ray team had to accompany him for 43 days of ECMO treatment.

  Patient 91 had to rely on ECMO. (Photo: Cho Ray Hospital)

According to doctor Nguyen Thanh Phong, Head of Department of Infectious D (HCM City Hospital for Tropical Diseases), during treatment, the patient's immune system overreacted when the virus attacked, producing cytokine against the body instead of protection, called a cytokine "storm". This is a major cause of acute respiratory syndrome and rapid multi-organ failure, which can cause COVID-19 patients to die in a very short time. In addition, the male pilot also had coagulopathy and heparin-induced thrombocytopenia (HIT) syndrome during ECMO treatment. When Patient 91 began to respond to heparin anticoagulants, doctors decided to use a drug that has never been used in Vietnam, a German-made intravenous anticoagulant.

Associate Professor, Dr. Pham Thi Ngoc Thao, Deputy Director of Cho Ray Hospital said that the Emergency Recovery Department had many serious patients, but no one was as critical as the British pilot, making doctors fell very pressured. They had tried their best to save their patient in any way they could. “This is the first case where, after two hours using ECMO, the membrane was frozen. We were required to change diaphragms so that the patient’s heart would not stop and he did not bleed. In 57 days, we replaced seven ECMO membranes. This is a very special case, there are not many cases in the world like this,” said Thao.

Seeking the light at the end of the tunnel

The British patient experienced two important stages of treatment, successful hospitalisation and treatment at the HCM City Hospital for Tropical Diseases and then being transferred to Cho Ray Hospital for recovery. Doctor Tran Thanh Linh, Deputy Head of the Department of Positive Recovery at Cho Ray Hospital, who directly treated the patient, said that the British male pilot was transferred to the department on the evening of May 22. A week later, providing him with medical treatment was the most difficult and stressful work for doctors and nurses there. At that time, the patient was still completely dependent on ECMO and ventilators.

In addition, he was injected with high-dose sedation, posing a risk to his brain. Therefore, the treatment team was determined to stop the sedative and muscle relaxants. However, the patient breathed too quickly after stopping such drugs, posing another risk of high oxygen deficiency. With his lung was still seriously injured, the more he breathed, the more likely the lung would rupture. The treatment team must replace the tracheostomy tube. Without experienced doctors during this period, the patient was at risk of cardiac arrest.

  Consultations were held regularly to seek effective treatment regimens for Patient 91.

Facing such risks, Cho Ray Hospital mobilised all doctors and resources to save the pilot. On May 26, the use of sedative drugs was stopped. By late May 26 and the morning of May 27, the male pilot had begun to show signs of consciousness. “We looked at each other and laughed happily. So, there was a light at the end of the tunnel. We can save the sick. Five days later, the patient complied with the orders from doctors. After that, we tried to quit ECMO by descending several parameters. We had to evaluate how to make it succeed, because if we failed, we had to put ECMO back and there might be no blood vessels to attach the plastic tubes. Every day, we had to adjust little by little; when it was safe, we gave up using ECMO on him on June 4,” doctor Thanh Linh recalled.

Symbol of Vietnam's pandemic success

From a critical ill patient who had just 10% of his lung capacity and was completely dependent on ECMO, as well as encountering a rare anticoagulant situation in the world medical records, with hundreds of risk factors for cardiac arrest and lung rupture, the patient gradually regained consciousness and was removed from ECMO, then stopped ventilated breathing and gradually recovered. On July 11, the patient was assessed as healthy and eligible for hospital discharge to fly back to his home country, without quarantine, on the same day. The success in treating his illness and the highly publicised efforts of Vietnamese doctors to save him has become a symbol for the country’s successful fight against the coronavirus.

Doctor Linh compared the 115-day process that the medical staff devoted themselves to save his life and help Patient 91 miraculously recover like a "a long flight". In such a "long flight", the patient was at times very near to death, but thanks to the determination of Vietnamese doctors, he recovered spectacularly to return to his homeland.

Speaking as he left Cho Ray Hospital on July 11, the British said: “I’ve said many things before. I’ve been overwhelmed by the generosity of the Vietnamese people and the dedication and professionalism of the doctors and nurses both here at Cho Ray and at the Tropical Disease Hospital.”

  The British pilot undergoing physical therapy with the support of medical workers at Cho Ray Hospital. (Photo provided by the hospital)

“The odds say that I shouldn’t be here, so I can only thank everybody here for doing what they have done. I go home with a happy heart because I’m going home, but with a sad one because I’m leaving so many people here that I’ve made friends with, so thank you again.”

Chairman of HCM City People's Committee Nguyen Thanh Phong said: “The recovery of Patient 91 is very miraculous. There were moments in which he almost died, but thanks to the relentless efforts of doctors from the HCM City Hospital for Tropical Diseases and Cho Ray Hospital, the patient recovered.” According to Phong, Vietnamese doctors have shown their role as excellent soldiers in the battle against COVID-19 while the country's medical conditions are still limited compared to other advanced nations.

Assoc. Prof., Dr. Luong Ngoc Khue, Director of the Medical Services Administration Department under the Ministry of Health cum Deputy Head of COVID-19 Treatment Subcommittee under the National COVID-19 Steering Committee, said that the miraculous recovery of Patient 91 was the result of the joint efforts and care for the British patient from the Treatment Subcommittee, the professional advising council and doctors and nurses over the past 110 days without worrying about their own hardships, regardless of the patient’s nationality, Vietnamese or foreigner.

  The British pilot says thanks to Vietnamese doctors. (Video by Cho Ray Hospital)

Dr. Nguyen Gia Binh, Head of the Consultative Group for Severe COVID-19 Patients under the Treatment Sub-Committee, said that treatment for foreigners or Vietnamese having COVID-19 is on par. “In treating the serious cases like Patient 91, we gain a greater understand of the dangerous SARS-CoV-2 virus. At the same time, we also update the diagnosis and treatment regimens for each situation and each patient so that when a bigger pandemic occurs, we can cope with it in a timely manner. In these difficult times, Vietnamese are more united. When hearing the British pilot had only 10% of his lung capacity and may need a lung transplant, dozens of Vietnamese people who are not familiar with the patient were willing to voluntarily donate a part of their lungs to him. That touched the hearts international friends, helping them to better understand the Vietnamese people who are still disadvantaged but rich in kindness, and that Vietnam is a safe and friendly destination.”

That Vietnam has focused strongly on comprehensively treating COVID-19 patients, both Vietnamese nationals and foreigners, not only demonstrates the spirit of “Vietnam leaving no one behind” in this tough war, but also shows the ethics of physicians as well as the beautiful traditions and values of the Vietnamese people, as outlined by Deputy Prime Minister Vu Duc Dam. “We are very fortunate that we are not in a position where we must choose who is to be given treatment priority because Vietnam has controlled the epidemic well. But assuming that as the case, Vietnam is definitely not only going to provide treatment only to Vietnamese people while not taking good care of foreigners. These values need to be fostered and promoted in order to earn a higher degree of confidence and fondness from our international friends,” Deputy PM Dam emphasised.

International community hails Vietnam’s pandemic success in treating Patient 91

The UK media has run articles highlighting the hospital discharge of the British pilot who spent more than two months on life support in Vietnam before returning home on July 12.

The Guardian cited the pilot as saying that he was overwhelmed by the generosity of the Vietnamese people, the dedication and professionalism of the doctors and nurses, and thanked them for what they’ve done. The article also quoted Tran Thanh Linh, the deputy head of ICU at Cho Ray hospital as saying that “huge effort and energy” had gone into saving the patient, who was given the country’s best equipment and whose case had captured the attention of everyone from doctors to government officials.

On July 12, the BBC also provided readers an insight into Patient 91’s hospitalisation days. "If I'd been almost anywhere else on the planet, I'd be dead,” BCC quoted the patient in his exclusive interview to the newspaper. “"I'm very humbled by how I've been taken into the hearts of the Vietnamese people. And most of all I'm grateful for the bloody-mindedness of the doctors in not wanting me to die on their watch."

  A BBC article on Vietnam's Patient 91

The Daily Mail said on July 11 that Vietnam keeps its perfect score when the British pilot finally left hospital.

The British pilot’s hospital discharge has also made headlines in several US newspapers such as Washington Post, USA Today and the Associated Press (AP), while the New York Times published an article titled “A Scottish pilot who became an emblem of Vietnam’s virus fight leaves hospital”, saying that the case of the pilot has come to exemplify Vietnam’s all-out effort to beat the coronavirus. Vietnam has been among the most successful countries in tackling the virus. It is the largest country not to have reported a single COVID-19 death, the article read.

A representative from the US Centres for Disease Control and Prevention (CDC) also sent an email of congratulations to Cho Ray Hospital on the successful treatment of the 43-year-old pilot. The US CDC’s representative noted that amid a lot of unhappy news about the pandemic situation, it was great to see Cho Ray Hospital receiving positive attention from international media.

Canada’s CBC.ca has also highlighted Vietnam’s success in fighting COVID-19 pandemic through the impressive case of the British pilot. The article entitled “Virus-free UK pilot, symbol of Vietnam's pandemic success, to return home” that was run by CBC.com on July 11 reported that the pilot is Vietnam's most seriously ill COVID-19 patient, who at one point seemed close to death, left hospital on July 11 on his way home after a dramatic recovery that attracted national attention. It said that the case, a pilot for national carrier Vietnam Airlines, became a sensation in Vietnam, where a combination of targeted testing and an aggressive quarantine programme has kept its coronavirus tally to an impressively low 370 cases, and zero deaths.

On July 12, Patient 91 returned to his homeland in the UK. On the special flight, he accompanied by Vietnamese medical staff. He brought home the sentiment of a nation which has helped him to make a miraculously recovery amid the global gloomy COVID-19 pandemic, as well as Vietnamese national pride on the mutual support for each other who in distress. More importantly, his special home journey was also full of peace and confidence in how Vietnam has successfully coped with the global pandemic.