The storm inside: How the coronavirus killed Keith Redding

She reached through the tangle of tubes that were taking the blood from his body and flushing it with oxygen and clutched his limp hand in one of her gloved ones. "I need your help."

It had been barely three weeks since Keith Redding, 59, started feeling weary and nauseated. Then came the diarrhea and the hoarse, hacking cough - early symptoms of covid-19, though neither Redding knew it then. By the time Dana, 48, drove Keith to the emergency room on March 11, a week after his symptoms first appeared, some 30 percent of his lungs had been damaged. On a rare three-dimensional CT scan of his chest, the profusion of viral particles and dead cells showed up like scattered bits of broken glass. His condition declined as the disease spread throughout his body, a storm of inflammatory proteins overwhelming his vital organs one by one.

Now machines and the medicine were all that kept him alive. And they couldn't function indefinitely.

"The doctor has told me I have to make a very hard decision," Dana told her unconscious husband. "I need you to let me know what to do. Because I don't know."

Keith was silent and still. Only his chest rose and fell as the ventilator pushed air into his struggling lungs.

More than a million people worldwide have been diagnosed with covid-19, the disease caused by the novel coronavirus. The majority are able to fend off the infection without hospitalization.

But for reasons doctors still don't understand, far too many others have been like Keith. After a week of mostly mild symptoms, their besieged immune systems seem to go into overdrive. Their bodies are bombarded by their own protective cells. Their lungs seize up, their hearts break down. The suddenness of the collapse leaves doctors and loved ones reeling.

"There is no parallel that I or other physicians I've been working closely with can compare this to," said Keith Mortman, 51, a thoracic surgeon at George Washington University Hospital, where Redding was treated.

And there is still no way of stopping it.

- - -

Dana was only looking for a new motorcycle when she walked into the Harley-Davidson dealership in Fort Washington, Maryland, in April 2008.

But behind the building she found a bear of a man in biker boots and jeans, sitting in front of a barbecue and smiling.

She sat down next to him.

"We definitely weren't looking to date," Dana recalled. Both were recently divorced. Dana, a Navy veteran who had just moved east from San Diego, was still adjusting to her new life.

But Keith, with his easy grin and good-natured sense of humor, was just so easy to talk to.

Dana joined his motorcycle ministry at the Fort Foote Baptist Church. They rode together at Rolling Thunder events. That autumn, when Dana's father fell seriously ill, Keith drove her to New York to see him. He stood at her side at the funeral, she said, and "he's been by my side ever since."

After the couple married in June 2010, they rarely went more than a few hours without talking. As soon as they arrived at their jobs each morning - Keith as program manager for an FBI contractor, Dana as senior technical assistant for the Internal Revenue Service - they would call to check in. Then again at lunch and once more before they headed home.

Dana was on a business trip the first week of March, and it was hard for them to connect the way they usually did. It wasn't until Keith picked her up from the airport that Friday that she realized something was wrong.

"This isn't like you," she told her husband. Keith waved her off, thinking his illness - loss of appetite, diarrhea, fatigue - was simply food poisoning. He insisted on getting dinner with his daughter and grandchildren, who were visiting from New York that weekend. He still went to work Monday morning.

That he might have the strange new virus sickening people in places like China and Italy never occurred to the Reddings. Keith hadn't traveled overseas. He hadn't been on a cruise ship. Though there were five confirmed cases in Maryland, state health officials were still telling people not to worry about community transmission.

Yet deep inside Keith's cells, the virus was multiplying. Researchers say the diarrhea that plagued Keith and other covid-19 patients may be an indicator that the germ invaded his gastrointestinal tract. Scientists have found coronaviruses can interfere with a person's blood pressure, damage the liver and irritate the digestive system.

Over the course of that week, Keith began to cough and couldn't stop. His temperature spiked, and his body was wracked with chills. Dana, too, was exhausted and aching.

She went to a Veterans Affairs clinic, where she was given a mask and advice to quarantine for 14 days. Alarmed, Dana grabbed her phone and dialed Keith's number: "You need to call your doctor," she said. "I'm not asking you. I'm telling you."

On March 11, they drove together to the emergency room.

- - -

Within hours of arriving at Fort Washington Medical Center, Keith was ushered into a CT scan machine, which X-rayed his lungs from multiple angles. Mortman would later assemble these images into a three-dimensional model of Keith's airway.

The doctor was stunned. Bacterial pneumonia is typically confined to one lobe of the lungs, and many cancers tend to look like solid masses. But in Keith's CT scan, the virus was everywhere - a haze of ravaged tissue engulfing every branch of his lungs.

Mortman said Keith had what doctors call "ground glass opacity," a condition named for the way it shows up on scans as a semitransparent scattering of damage. The thousands of tiny air sacs with which the lungs take in oxygen and release carbon dioxide had filled with viral particles, broken cells and other molecular detritus. White blood cells - the foot soldiers of the immune system - swamped the spaces between tissue, causing the entire organ to stiffen.

Keith's lungs, Mortman said, had come to resemble an oversaturated sponge - an oppressive, wet weight in his chest cavity.

The doctors at Fort Washington hooked the wheezing man up to an oxygen tank via a thin tube that ran through each of his nostrils. Keith's lungs were infected and inflamed, they said, evidence of pneumonia. He would have to be tested for the coronavirus.

It was long after midnight when Dana finally left the hospital. At home, she began to pay more attention to the local news. She examined a list of people at high risk from the virus: the elderly and immune compromised, people with asthma or serious heart disease. Keith didn't have any of those problems, except for high blood pressure. He was only 59.

"It'll just be a few days," she told herself.

When Dana returned to check on her husband the next day, his breathing was still labored, his temperature high. But Keith remained his charming, cheerful self. He'd already learned the name of everyone on staff and knew exactly how to tease them. "When he leaves here, we'd like to hire him," one delighted nurse told her.

Yet each day Keith's condition continued to deteriorate. The nasal cannula was replaced with an oxygen mask, which was swapped for a CPAP machine that could push air into his lungs.

Then came the worst news: Keith's coronavirus test had come back positive. Dana wouldn't be allowed to return to the hospital.

The last time she saw her husband, a tube was being inserted into his throat so he could be hooked up to a ventilator, which would provide him with high concentrations of oxygen. "Are you sure you want to watch this?" a nurse had asked Dana.

She was sure. If she couldn't be by his side, she would be as close as she could get.

- - -

Six days after he arrived at Fort Washington Medical Center, Keith was transferred to George Washington University Hospital and into the care of intensivist Katrina Hawkins. By then he was heavily sedated, his ventilator turned up to the highest setting. His blood oxygen levels remained perilously low, and he couldn't stop shivering.

Keith would have to be given extracorporeal membrane oxygenation (ECMO) - a treatment in which catheters take blood from a patient's body, run it through an artificial lung, then return it to the body full of oxygen.

And he would have to be paralyzed, to ease the burden on his overtaxed lungs and heart.

Rarely had Hawkins seen a disease progress as swiftly and inexorably as this one. Patients like Keith were showing up at the hospital with a cough and ending up on oxygen less than 24 hours later. Doctors had no drugs to fight the virus, no tools to curb the symptoms.

All she could do was try to keep Keith alive long enough for his immune system to control the disease on its own.

But inside Keith, another storm was brewing. Provoked by the intense damage to his lungs, his embattled immune system had unleashed an army of cytokines - proteins that send signals of an attack. The cytokines coursed through his body, triggering a systemic immune response that left his vital organs inflamed. Keith's heart was faltering. His kidneys failed. "Everything just shut down," Hawkins said.

This is the tragedy of the coronavirus. It hijacks the systems that are supposed to protect us. It tricks the body into betraying itself.

Thirteen days after Keith was admitted to the ER, George Washington University Hospital called Dana. Come quickly, they said.

Keith's doctors feared they were about to lose him. But Dana didn't realize that. "Or maybe I was in denial," she said.

She just suited up in protective gear - gloves, gown, mask - and stepped into his room.

Dana wanted to imagine that Keith's lungs could still save a life, even if they couldn't save his.

There was her exuberant husband, not seeing, not speaking, not able to move. Grabbing his hand, she repeated what would become her mantra: "I love you."

"Crystal loves you," she said, naming Keith's daughter. "Janelle and Elijah" - Keith's grandchildren - "love you." When she ran out of names she could remember, she started pulling people from the contacts list on his phone.

"Everybody loves you," she said. "Everybody."

Before she left that night, Keith's doctors assured her they would phone again if things became dire. It's a small mercy most families of covid-19 victims don't get. George Washington University Hospital no longer allows visitors, even for patients close to death.

The call came the next day. This time, Dana knew what it meant.

She printed out scriptures to hang on Keith's wall and brought an old clock radio set to a Christian music station. She got permission for Keith's daughter Crystal to join her, and the two of them sat vigil in Keith's room, holding his hands and praying.

Dana took in the beep and whir of machinery, the coils of IV tubes that were all that tethered him to life.

"You don't have to make the decision tonight," physicians had told Dana. Patients could live on ECMO for weeks.

Outside Keith's room, Dana turned to Crystal. "What do you ?"

"I'm so angry right now," she recalled the younger woman saying. "I feel so cheated."

They were still standing there when a nurse came through the doors to the waiting room.

"Mrs. Redding," she said. "Mr. Redding's heart is failing."

Later, Dana would beseech God for answers. Why had this happened to her? How could it all happen so fast? How was she supposed to mourn when only two people would be allowed at the funeral, when her family couldn't even comfort her because she had the virus, too?

But then Mortman would ask her to make public the images of Keith's lungs. CT scans of covid-19 patients are incredibly rare, he would say; most people are simply too ill for the procedure. The images might help people realize how devastating this disease is. They might help doctors looking for a cure.

Dana would agree. She would want to imagine that Keith's lungs could still save a life, even if they couldn't save his.

Wife and daughter slipped back into their layers of protective gear. They returned to Keith's room. Dana sat once more beside her husband and placed her hand on his chest, felt it move with each whoosh of the ventilator.

"I guess you made the decision for me," she told him. "I guess you want to go home and be with the Lord."

A nurse came in to shut down each element of Keith's life support. "I'm so sorry," she said as she unhooked his IV drip and switched off the ECMO instrument. "I'm so sorry," she said again as she stopped the dialysis machine.

Finally she came to the ventilator. "I'm so sorry for your loss," she said. She turned it off.

Underneath her hand, Dana felt Keith's lungs go still.