Outrunning the risk: Conrad freshman with cystic fibrosis tries to stay ahead of COVID-19

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Shortness of breath and chest congestion are common conditions for Mallory Holloway.

The Conrad Schools of Science freshman has cystic fibrosis, a genetic disease in which the lungs chronically clog with mucus.

In addition to daily medication and therapy, Holloway fights back at cystic fibrosis by building her breathing power and cardio-vascular strength as a distance runner.

“It definitely makes them feel healthier and it makes them feel stronger,” Holloway said of how running boosts her lungs.

Holloway was second-team All-State in cross country last fall after finishing fourth in the Diamond State Conference Championships and sixth in the Division II state meet.

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When she can’t run, such as during periodic hospital visits for special treatments, Holloway said her breathing actually gets worse.

The chance to slip back into her sneakers and jog on cross-country trails or zip around a track, as she did last week at McKean High near her home with teammate Michaela Gates, isn’t a grind.

It’s a gift for Holloway. 

 “I feel like I have better lungs than other people sometimes,” she said.

But in the coronavirus pandemic, Holloway, her lungs already compromised, would be a  particularly unwilling target.

COVID-19 causes respiratory tract illnesses such as pneumonia. Symptoms include fever, cough and difficulty breathing, according to the Centers for Disease Control and Prevention.

The very nature of Holloway’s illness undermines her breathing, making COVID-19 additionally perilous.

“It definitely kind of scares me a little bit just because I know that, like, it’s a possibility,” Holloway said during a recent interview in which proper social-distance standards were employed.

“I feel like I’ve taken all the precaution that I can really take so what happens happens and I’ll just fight through it if it comes up I guess.”

All the safeguards that have come to be routine for most must be done unfailingly by Holloway.

“I really haven’t hung out with anyone,” she said. “No one new has been in my house really.”

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Mallory’s mother, Katrina, is boys cross country and boys and girls track and field coach at Conrad, where she teaches English. She is now teaching those classes remotely.

Because of her illness, Mallory was going to stop attending school before stay-at-home orders were issued and schools closed statewide.

“We definitely have been concerned,” said Katrina Holloway, adding COVID-19 would “potentially be devastating” for Mallory’s well-being.

“Cystic fibrosis is a significant respiratory disease and so since school ended we have been on a virtual lockdown.”

Mallory's cystic fibrosis care is managed by Dr. Aaron Chidekel, a pediatric pulmonologist who is director of the CF Care Center at A.I. du Pont Children's Hospital.

"Anyone with underlying lung disease is going to be more vulnerable to any respiratory tract infection," Chidekel said, mentioning influenza as a typical example. 

Children have proven to be at a significantly lesser risk of getting severely ill from COVID-19, the CDC has reported, though it can still become serious and fatal.

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"I would put children with underlying lung conditions into that vulnerable population, but it doesn't mean that they're as vulnerable as the elderly and the elderly infirm." Chidekel said. 

"So there's a balance there that is a little bit hard because we don't have the full picture. But on the other hand the answer is the same. Everybody needs to stay away from each other. Everybody needs to social distance. And everybody needs to do everything to protect themselves, wash your hands, wear a mask in public, all of those things that are being recommended now."

Born to run

Mallory is an only child. Her father, Matt, owns and operates Henry’s Bicycle Shop, which has been able to remain open, in Pike Creek. Henry's annually hosts the "Movin' for Mallory Spinathon" to raise funds for cystic fibrosis research.

Mallory didn’t test positive for cystic fibrosis during infant screening. At 16 months old, she underwent various tests because of a persistent cough and congestion. In particular, a sweat test revealed an excessive amount of sodium, a marker for cystic fibrosis.

“This sounds kind of weird but it was actually a relief because she was so sick and we didn’t know what was wrong with her,” Katrina said. “She wasn’t gaining weight. She was always wheezing and so once she was diagnosed we were able to get her on meds and get control of what was happening and make her feel better.”

Rigorous treatment began immediately. It included chest physical therapy applied by her parents and up to 30 minutes per day of “piles of medication,” Katrina said, every time Mallory ate.

 Of course, the medicine was tailored for someone her age and soon this routine “became the new normal,” Katrina said. If Mallory was spending the weekend with grandparents Bob and Marilyn Smith, they’d get a spreadsheet for what to take and when. 

Mallory remembers no other way of life except waking up and immediately having to clear her lungs through various techniques and ingesting medication. In addition to the lungs, cystic fibrosis also affects the pancreas and its enzyme production and the digestive system. Mallory has also coped with reflux and allergies.

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Her daily regimen now begins by spending 15 to 30 minutes wearing an airway-clearance vest that vibrates to loosen her chest congestion and pumps high-frequency air into her lungs. She may don the vest again later if her lungs feel obstructed. A nebulizer that propels a mist of medication into her lungs is also a daily tool.

Throughout the day, she’ll take nearly 20 different pills of about a half-dozen different medications, including anti-biotics and vitamin supplements, usually with meals.

The most important three pills Mallory takes every day, Katrina said, are Trikafta. Just approved last year by the U.S. Food and Drug administration, Trikafta targets protein in the defective CFTR gene that is the culprit in the majority of CF patients.

“It treats the root cause,” Katrina Holloway said. “It’s super cool. Within a month after she started taking it she gained five pounds. In May of 2019 she was at 50 percent lung function. In November after taking this she was at 75 percent. It was amazing.” 

Some with cystic fibrosis eventually must undergo lung transplants.

“It definitely makes me feel fortunate,” Mallory said of the new drug.

From a physical activity standpoint, Mallory first got involved in ballet with the Delaware Dance Company when she was in kindergarten, appearing in its annual production of The Nutcracker.

“I kinda thought that would be her thing,” Katrina said, “and then when she got to sixth grade [at Conrad] she said ‘I think I want to run cross country.’ ”

Mallory joined the middle school team at Conrad. That made sense, because Katrina was coaching the high school team and Mallory was well aware of her mother’s own successes in the sport.

Katrina née Smith was two-time Blue Hen Conference cross country champion at McKean, winning as a sophomore in 1991 and as a senior in 1993 in races at Lums Pond State Park. Katrina was a four-time All-State selection and sparked the Highlanders to their lone state cross country title in 1991 in Division II.

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Mallory’s uncles Eric and Rob Smith were McKean soccer stalwarts who went onto greater things also. Eric was an Elizabethtown College All-American who played for the Delaware Wizards pro team. Rob starred at South Carolina, captained the 1996 U.S. Olympic team and became Delaware’s first Major League Soccer player with the Columbus Crew, playing five seasons. He was a 2015 Delaware Sports Hall of Fame inductee.

Dad Matt had been a distance runner himself at Humboldt State University in California and a competitive cyclist. Katrina, also a South Carolina grad, and Matt met after she took a job at a Palo Alto, California, YMCA where he also worked.

“It seemed like I could probably be good at it, just cause of like the genes and stuff,” Mallory said of distance running.

Mallory, not surprisingly, was a natural, quickly becoming a medalist in middle-school meets and winning a big mile race. 

Able to compete for the varsity as a Conrad eighth-grader in cross country, Mallory was 12th in the Diamond State Conference and 26th in the Division II state meets.

Last spring, Mallory placed 14th in the 3,200 meters in both the New Castle County and Division II state track meets. But the latter, a 13:12.42 time on a warm, sunny afternoon at Dover High, was an example of some of the rare difficulty she does encounter with her illness.

“When it’s really hot,” she said, “it affects me more. I just get overwhelmed.’’

That’s when the inhaler she always carries comes in handy.

Chidekel confirmed that being a runner has been very beneficial for Mallory.

"Exercise is great for everybody," Chidekel said, "and exercise has been proven to be very, very important and protective for people, specifically, with cystic fibrosis. It really does improve long-term outcome and quality of life."

Using the lungs helps them "grow and develop," Chidekel added, while also "clearing secretions" from airways and boosting aerobic fitness that "is correlated with quality of life and health outcomes for somebody with CF." 

Mallory has always been active and never, both she and her mother said, wasted time feeling sorry for herself.

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Tough times have included a hospital visit when medical personnel had a difficult time placing the Peripherally Inserted Central Catheter line in Mallory’s arm. It’s an IV-type devise that delivers treatment directly to a major vein near the heart. Periodic hospital stays are necessary for treatments that fight bacterial infections and provide chest and respiratory therapy. 

Katrina Holloway’s major concern with the coronavirus is how it may lurk undetected, giving some a false sense of security when the situation appears to have improved.

“It’s a big unknown about what this is gonna look like when things start to lift,” Katrina Holloway said. “She may not go back to school at the same time as her friends. We might have to be a little bit more gradual with her exposure.”

After such a successful freshman cross country season and finishing 11th in the 1,600 and 10th in the 3,200 at February’s state indoor track meet, Mallory relished the 2020 outdoor season.

It is now on hold and may never be.  

“It’s definitely disappointing,” she said. “We have a girl on the team [Destiny Samuels] who’s a senior and I just feel really bad about the track season and the final [year of] school. It’s probably just annoying for her because she probably could have qualified for states. I know I have a lot more chances because I’m a freshman but for all the seniors I just feel really bad.”

In the meantime, she'll just enjoy the chance to get out on the track herself and revel in the delightful sensation of her lungs filling with air.

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