The final day and night Kelsey Ellis spent with her twin sister Audrey was their 29th birthday. Audrey had flown from Denver to Portland, Ore., to spend a few days together, but by their March 17, 2020, birthday, Kelsey noticed her sister's lips had turned purple. They went to urgent care, she was diagnosed with pneumonia, and Audrey canceled her return flight. By March 22, Audrey would be dead, her heart ravaged by a disease she had contracted in early December—COVID-19. As Dustin Jones reports in a lengthy piece for NPR, there was no COVID test at the time, nor was it on US doctors' radars. Audrey described it as the worst flu she'd ever had, one that left her with a lingering cough and chest pains. But as Jones writes, she was otherwise the picture of health: a transplant nurse who had recently run a marathon.
The sisters woke up on March 18, and the pneumonia diagnosis didn't seem to sync with Audrey's worsening symptoms, so Kelsey took her to the ER—where doctors discovered her heart was failing. What Dr. Lori McMullan, the cardiovascular disease specialist who was called in to treat Audrey, believes went on inside Audrey's body: unbeknownst to her, fluid started accumulating around her heart and lungs in December, and she likely developed the very rare pulmonary veno-occlusive disease. As a result, scar tissue developed in her lungs that impeded blood flow there, putting stress on her heart, sending it into overdrive for three months. Jones details the ends the hospital went to to try to save her, but ultimately, "Her heart had stretched out to an extent that was not compatible with life," says a doctor involved in her care. Their determination months later: Audrey "had heart failure as a sequela of COVID-19 infection." (Read more Longform stories.)