On the frontline of a pandemic

With just months left in his residency at Mount Sinai Hospital in New York City, Buckeye native Dr. Zachary Grimes found himself performing autopsies six days a week when the COVID-19 pandemic struck the city. Photo courtesy of Zachary Grimes

Suzanne Stewart
Staff Writer

The medical world was thrown for a loop last year when COVID-19 breeched the borders of the United States and cases of the severe respiratory illnesses were first reported in January 2020.

Along with medical professionals, medical students and residents were put to work to combat the virus and try to handle the insurmountable cases flooding into hospitals across the country.

One of those residents was Buckeye native Zachary Grimes. In his final months of his pathology residency at Mount Sinai in New York City, Grimes spent long days and nights helping to find answers to the hows and whys of this new virus.

“Pathology is the branch of medicine that deals with diagnosing disease, so part of our job is to do autopsies on patients who’ve passed away to help determine the cause of death or, in some cases, the manner in which the person died,” he said. “When COVID started happening, I kind of volunteered to do autopsies. There were a couple of us. I was the only resident, and there were three or four attendings who also volunteered.

“What we wanted to know was how COVID was affecting a person, because if you can understand the mechanism by which a disease presents and causes damage at the cellular level, then you can develop better treatment strategies,” he continued.

Grimes finished his residency while performing his COVID-related duties and was hired as a full-time faculty member at Mount Sinai in July. He was mentored under the guidance of Dr. Clare Bryce and the late Dr. Mary Fowkes.

“Medical education chan-ged once COVID happened, because it switched to dealing with the surge of COVID patients,” he explained. “Some residents in pathology and other departments were moved to take care of patients on the floor, because the hospitals were pushed to their maximum capacity.

“I was fortunate that I could work in the area that I was trained in and could provide that resource with the autopsies,” he continued. “I would say, from March to July, my main task was to do autopsies every day, six days a week. It was a full-time service.”

All medical professionals were going into the pandemic blind, as COVID-19 was a novel – or new– virus. There were no entries in textbooks or medical journals. In the same regard, Grimes was learning as he went.

“We didn’t know what we were looking for,” he said. “It’s a new disease. It’s not in any medical textbooks. We had some idea based upon the previous coronavirus outbreaks in 2002, mostly in China. There was some medical literature on what to look for in the lungs – but the other findings – we didn’t know how the virus was affecting the body, and we didn’t really know if we were at risk from doing autopsies on these patients. There was a lot of uncertainty surrounding it.”

This photo of Dr. Grimes and his mother, Velma, who is an RN, was shared on Facebook on his birthday this past December. The picture was taken the year he got his first microscope. “The world has never looked the same,” he wrote. That is so true.

For the safety of all involved, autopsies were performed in specially ventilated rooms, and there was a limit as to how many professionals were in the room during the procedure. The pathologists were unsure what kind of exposure risk there was, which added to the stress level.

“I think it was very scary, because you don’t know the enemy that you’re fighting,” he said. “Most of my medical training has been looking at a disease that I can at least reference in a book somewhere. I know how not to get it, like Hepatitis or HIV. I know that if I cut my finger while doing an autopsy on a patient that has Hepatitis C, I’m at an increased risk of contracting the disease.

“But I didn’t know any of that about COVID,” he continued. “I didn’t know how infectious a person was when they were deceased. I didn’t know if cutting a lung of someone who just died of the disease was going to be infectious. There were a lot of mornings I would wake up with fatigue and a sore throat, and I thought I had the disease because I was around it all the time.”

With each autopsy comes samples and paperwork, both of which Grimes said will help with current and future studies of the virus.

“We collected the tissue, and we froze it at minus eighty degrees, and the hope was that sometime in the future we can take that tissue whenever we want to and do studies on it to understand more about the disease and the virus,” he said. “That’s one of the things we did which was really groundbreaking in some ways, because we created a large bio repository of tissue that can be used for research purposes in the future.

“Now my job is to really review all of the slides that we take of all the organs and to look at it under a microscope to see if there are any changes that are happening microscopically.”

There were expected and unexpected discoveries made as Grimes and his colleagues studied the tissue samples.

“We found what was expected in the lungs,” he said. “We discovered that in the lung, the virus causes an extreme amount of damage – causing something called DAD or diffuse alveolar damage in patients who die from the disease, which obviously compromises their ability to breathe to get adequate oxygenation.

“But then one of the things that we did – we looked at the brain in these patients and we found the virus in the brain, which is really important to know where the virus is going,” he continued. 

The team of pathologists also made a discovery that had a significant impact on the way medical professionals treated patients with COVID-19.

“One of the early findings that was instrumental in the management of patients were pulmonary embolisms or blood clots,” Grimes said. “So there was something about the virus that was making some patients who contracted it more prone to developing blood clots, which could be fatal.

“With that information and also with collaborations from publications from clinicians, hospitals started giving patients anti-coagulants or blood thinners earlier on with the disease, which would lessen the mortality in those patients,” he continued. “That was one of the discoveries that we found early on. We’re still finding things as we process the cases.”

While there have been many discoveries made about COVID -19 through their work, Grimes said there are still many things unknown about the virus.

“We did autopsies on people who were in their thirties who died of the disease,” he said. “People who were younger than me. To say COVID is a disease of the elderly is a fallacy. You think you’re healthy and strong because you get up out of bed every morning and you go to work, but I can guarantee you – if it was possible to do an autopsy on you, I would find you’re not as healthy as you think you are.

“We saw that,” he continued. “We had ninety-year-old people on the autopsy table, and we had thirty-year-olds with bodies that look like Greek Gods they were in such good shape – but the one thing they shared is they were both lying on the autopsy table because of this virus. Knowing who is going to get the disease and their outcome is something that we don’t know. There are so many variables.”

The reason Grimes and his colleagues were able to make the discoveries they did was due, in large part, to the families who allowed them to perform autopsies on their loved ones.

“If it wasn’t for families consenting to that, we probably wouldn’t have the knowledge we have today,” Grimes said. “They’re the real heroes in all this, I think,” he reiterated. “We’re just the workers behind it.”

It was because of those sacrifices and the incredible amount of research that a vaccine for the COVID-19 is being rolled out.

While some may argue that the vaccine was rushed, Grimes believes it followed a natural timeline and is being released around the time it should have been expected.

“The technology that we utilize is built upon the success we’ve had in manufacturing vaccines from years ago,” he said. “I wouldn’t argue so much that it’s rushed as it is building upon the foundations of what we know in medicine and virology and immunology. We have such a good infrastructure today that it allowed us to really move quickly.”

Grimes’ interest in pathology reared its head when he was quite young. As a boy growing up in Buckeye, not only did he enjoy non-fiction books about pandemics, he also performed his first autopsy – or necropsy to be more specific.

“When I was a child, I was obsessed with a book called The Hot Zone which is about how these doctors went to Africa and discovered the Ebola virus,” he said. “I felt like I was reenacting scenes from that book in some ways [in my work].

“I did an autopsy on a calf, once,” he added. “I’ve come a long way from autopsying a calf to being in New York City doing autopsies on COVID patients.”

When he was in his early teens, Grimes’ friend, Jaynell Graham, asked him if he wanted to do an autopsy on a calf from her farm in Buckeye. The calf, a twin, was abandoned by its mother, which is usually a sign that something is wrong. The autopsy was performed at Grimes’ “lab,” and he discovered problems with the calf’s lungs and kidneys.

Years later, Grimes is spending months on end in the morgue with patients, which, he said, is both exciting and scary. Exciting because it was his medical dream turned into reality, and scary because of the gravity that came with his work.

“Obviously, it’s heartbreaking because you’re surrounded by so much mortality all the time,” he said. “When this was happening, New York was really shut down, so I would leave for work early in the morning and come home late at night, and there’d be no one out.”

Since the COVID-19 virus entered the United States in January 2020, there have been more than 400,000 deaths.

“I’m always amazed when people don’t see the seriousness of it,” Grimes said. “If you read the New York Times every morning or if you just glance over it, there are four-thousand people dying every day. That’s just such a huge number.

“We looked at 9/11 as the greatest insult to America since Pearl Harbor. Well, we’re living it every day, and we’ve become accustomed. That’s the scary part. We’ve become so accustomed to seeing these numbers that we’ve become immune to it.”

To put it in perspective, Pocahontas County has a population of approximately 8,000. That would mean half the county’s population is dying in a day.

Grimes doesn’t intend to be a doomsayer, but he said it is important for people to see what the pandemic has done to the country thus far and what will continue to happen if we don’t learn from the science and trust the medical professionals.

“The thing that people don’t realize is that something that is 150 nanometers can wreak havoc on a community and upon a family,” he said. “It can destroy you, and it can destroy everything that you hold dear.”

But there is a silver lining. With the vaccine, there is hope. It is just going to take patience.

“West Virginia is leading the nation in vaccinations which is really a great thing,” he continued. “That’s something that we should be very proud of in West Virginia. I think that Mountaineers are not going to be free so long as this virus is still present.

“That’s why it’s really important to try to get this under control with this vaccine.”

It has been a long and exhausting year for Grimes.

“I was sitting in my attending’s office when the first positive case came to New York City in March, and then about a week-and-a-half later, the first autopsy patient came, and then it was never ending after that,” he said. “I had to do autopsies on people that I knew. It takes about all the energy you have to get through it.

“It’s traumatizing, and it’s exhausting, and those are things I’ll never forget.”

But, it has not been for naught. Future generations will learn from what was done at Mount Sinai by Grimes and his colleagues.

“We’re fortunate because Mount Sinai has a lot of talented pathologists, and we’re able to keep up with the cases,” Grimes said. “We’ve published several papers on the pathophysiology of the disease. We’re writing the textbooks on this virus. This virus will probably be in every medical textbook going forward because of the research the people like at Mount Sinai are doing which is instrumental for when the next one comes.”

Next week, Grimes discusses the strain of the Covid-19 pandemic and what the post Covid-19 outlook is.

To read the publications Grimes was involved with, follow the links below:

“Fatal Pulmonary Thromboembolism in SARS-CoV-2-Infection”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214296/?fbclid=IwAR0labDWd3pOo_Tx4zkCyd_JVrnXFbaYtubzFgdTO2wrHhvnh-6_bpbMfuc

“A review of the main histopathological findings in coronavirus disease 2019”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395947/?fbclid=IwAR2XEx6HvRbTAOIAhdTdXcFDRbX1YzWQ20i23qXc4tSZQydyQSWYi4xWCGc

“Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)”

https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.25915?fbclid=IwAR2cZIHCDphpl6cl_ovJcYxybfD523Izv4sb1KO8qw1Ew_6t3Y_TqBnHEZE

“Pathophysiology of SAR-CoV-2: targeting of endothelial cells renders a complex disease which thrombotic microangiopathy and aberrant immune response. The Mount Sinai COVID-19 autopsy experience”

https://www.medrxiv.org/content/10.1101/2020.05.18.20099960v1?fbclid=IwAR112Op13nECOvchakDGwhskh7UmzbCeo4374rzq22t7Rn29IqxktD4-siQ

“Broad SARS-CoV-2 cell tropism and immunopathology in lung tissues from fatal COVID-19”

https://www.medrxiv.org/content/10.1101/2020.09.25.20195818v1?fbclid=IwAR112Op13nECOvchakDGwhskh7UmzbCeo4374rzq22t7Rn29IqxktD4-siQ

“Lessons from the Epicenter: What We Have Learned About COVID-19”

Lessons from the Epicenter: What We Have Learned About COVID-19

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