Dr. Philp McMillan,  John McMillan

Four months ago, Reuben Fisher was the picture of health. At fifty, the New Zealand father trained at the gym twice daily and competed in judo. He had no underlying conditions, no warning signs, nothing to suggest what was coming.

Mid-September, his wife Jen returned home to find him curled in a fetal position on their bed, incoherent, having vomited nearly a litre of blood.

What followed has left his medical team at Christchurch Hospital grasping for answers. Hundreds of blood clots scattered throughout his body. Failing kidneys. A dying heart. Multiple mini-strokes. And no diagnosis that ties it all together.

As reported by New Zealand outlet *Stuff* on January 9th, 2026, Reuben now needs a heart transplant, but doctors remain “in the dark” about what triggered his catastrophic decline. For his family, each day brings the same agonising uncertainty.

Dr. Philip McMillan, a researcher and clinician who has been tracking unusual post-viral presentations, believes cases like Reuben’s may represent a pattern that medicine is failing to recognise. He calls it the “COVID storm,” and he thinks we’re going to see a lot more of it.

The Iceberg Below the Surface

When Reuben arrived at hospital, the immediate crisis demanded attention: massive gastrointestinal bleeding, respiratory failure requiring ventilation. Twice he was intubated. Doctors suspected viral pneumonia.

But here’s where the story gets complicated. This wasn’t a sudden collapse from nowhere. In the weeks before that terrifying day, Reuben had been struggling to climb the stairs to his bedroom. His breathing had become laboured. He’d been coughing up blood.

These are textbook warning signs of pulmonary embolism (blood clots in the lungs). Yet they were initially attributed to something more mundane. Jen herself had recently been hospitalised with Influenza B, which had also caused her to cough blood. The logical assumption? The same virus was working through the household.

That assumption may have cost precious time.

By the time scans revealed clots “everywhere” (not ten, not twenty, but hundreds), the damage had cascaded through multiple organ systems. His lungs were failing. His kidneys were shutting down. His heart was giving out. And because he’d arrived actively bleeding, doctors couldn’t give him blood thinners to address the clots.

A filter was inserted in his vein to catch clots before they reached his heart and lungs. But the underlying cause? Still unknown.

A Vascular Disease Hiding in Plain Sight

Dr. McMillan argues that cases like Reuben’s make perfect sense, if you understand what COVID actually does to the body.

“COVID is primarily a vascular immune disease,” he explains. “It damages the lining of the blood vessels. It triggers clotting. It causes all kinds of inflammatory processes.”

The problem is that most people still think of COVID as a respiratory illness: severe pneumonia, rapid onset, microclots in the lungs. When patients present with multi-organ failure weeks after a mild or undetected infection, the connection simply isn’t made.

Here’s how Dr. McMillan believes the sequence unfolds. First, COVID enters the body, often causing symptoms so mild they’re dismissed as a headache or general fatigue. Tests may come back negative. But the virus quietly suppresses interferon responses, essentially switching off the immune system’s alarm bells.

With defences compromised, the patient becomes vulnerable to secondary infections like influenza or RSV. This is what gets diagnosed and treated. The COVID infection? Already cleared from the system.

Then, weeks later, the real damage begins. A delayed immune response to viral spike protein triggers autoantibodies that attack the body’s own tissues. The result is what Dr. McMillan calls a “Spike Triggered autOimmune Response Mechanism (STORM)” hitting multiple organs simultaneously: the heart (myocarditis leading to failure), the lungs (emboli and tissue death), the brain (inflammation causing confusion and mini-strokes), the kidneys (nephritis), and the vasculature itself (clots forming on both the venous and arterial sides).

Influenza can certainly cause serious illness. But hundreds of clots, global heart failure, kidney collapse, and neurological damage in a previously fit 50-year-old? That’s not a typical flu presentation.

The Testing Trap

Here’s the cruel irony at the heart of cases like Reuben’s. By the time the immune storm hits, typically four to six weeks after initial infection, a standard COVID swab will come back negative. The virus has cleared. What remains is the inflammatory wreckage it left behind.

Modern medicine often refuses to diagnose COVID without laboratory confirmation. So patients presenting with what looks like autoimmune vasculitis get treated for their individual symptoms (the bleeding, the heart failure, the kidney damage) rather than the single underlying process driving all of it.

Dr. McMillan believes this represents a dangerous blind spot. “I think this should be a clinical diagnosis,” he argues. “It should be COVID until you prove otherwise. If you have no other cause, assume it’s COVID.”

It’s a hypothesis, not a certainty. But when a patient is dying and conventional explanations don’t fit, shouldn’t every possibility be on the table?

What Families Can Ask

For those advocating on behalf of loved ones in similar situations, Dr. McMillan suggests several questions worth raising with medical teams:

Could this be driven by a cytokine storm? Are inflammatory markers persistently elevated? Has rheumatology been consulted? Should immunosuppression (high-dose steroids or similar therapies) be trialled alongside supportive care?

The logic is straightforward: if the driver is autoimmune inflammation, then treating the inflammation might halt the damage. Replacing a failing heart while the inflammatory process continues may simply give the disease a new target.

These aren’t demands. They’re questions designed to push clinical teams toward considering possibilities they might otherwise dismiss.

A Father’s Reckoning

Reuben Fisher has had four months to contemplate his mortality. He’s made a kind of peace with it. What haunts him is what he leaves behind.

“It’s everyone else, everyone around me,” he said in an interview. “I’ve already come to terms with… that aspect, but it’s what I leave behind, particularly a 12-year-old daughter. It’s a very important part of most young adults’ lives. And she’ll be going through a lot of emotions.”

His advice to others carries the weight of someone who can no longer take anything for granted: stop and breathe. Look around. Be thankful.

It sounds like a cliché, he admits. But clichés hit differently when you’re fighting for each breath.

The Pattern Ahead

As COVID continues to circulate globally, Dr. McMillan believes presentations like Reuben’s will become increasingly common, and increasingly missed. The absence of a positive test. The weeks-long gap between infection and crisis. The multi-system nature of the damage. All of it conspires to obscure the underlying cause.

Medical literacy has become a survival skill. Families may need to advocate for diagnostic approaches that clinicians haven’t yet embraced. The earlier inflammatory processes are identified and treated, the better the chance of preventing irreversible damage.

For Reuben Fisher, that window may have closed. Four months of cascading organ failure may have left damage beyond repair.

But for the patients who will follow, and there will be others, his case offers a painful lesson. Sometimes the diagnosis isn’t hiding. It’s simply wearing a mask we haven’t learned to recognise.