Recovering from the coronovirus? Here's what to expect

“Covid brain” or a decline in cognitive function is one symptoms health care workers are noticing in those recovering from the coronavirus.

And it eventually goes away, according to Dr. John Walsh, a pulmonologist with Midwest Respiratory and medical director of AMITA Health Saint Joseph Medical Center

Moreover, if a person recovers from COVID-19, the person’s organs tend to recover, too, Walsh said.

In fact, 80 percent of the people who recover from ARDS (acute respiratory distress syndrome) have full lung function after a year, Walsh said. The severe form of the SARS-CoV-2 virus often causes an atypical ARDS, he said.

Overall, COVID-19 recovery follows the same pattern as the virus that causes it: it's unpredictable.

Dr. Kristopher M. McDonough, a pulmonologist with Midwest Respiratory, said no one can predict exact recovery times because the virus is still so new. A comprehensive understanding may take several years, he added.

“The surprise we run into are these people who look terrible on ventilators and are getting as much supportive therapy as we can give recover dramatically over the course of a few days,” McDonough said. “In many cases, they go home without requiring oxygen.”

He said one patient on ventilator for nine days and  went home without any supplemental oxygen, “which is nuts,” he said.

“But then we have other people who don’t ever progress to needing a breathing machine, but they need oxygen for weeks after they leave the hospital,” McDonough said.

McDonough said a man he discharged last month who never needed more than six liters of oxygen when he was in the intensive care unit went home on five liters of oxygen.

Generally, patients who had the most severe forms of COVID-19 – patients who wound up with acute respiratory distress syndrome (ARDS) – will experience lingering respiratory difficulties, such as persistent cough and shortness of breath, McDonough said.

In fact, those symptoms, as well as abnormal chest X-rays, may continues for up to 6 months to a year, McDonough added

Mechanical ventilators are lifesaving and not without risk

Although it unquestionable saves lives, mechanical ventilation comes with risks of its own, McDonough said.

Some of those risk include pneumothorax (collapsed lung), worsening injury to the lungs and blood clots, he added.

“That said, when people need a ventilator, they absolutely need a ventilator in order to give them time to get better,” McDonough said.

When possible, health care workers opt for a less invasive means of providing oxygen and breathing support. They can deliver a very high level of oxygen through a nose cannula.

Or they can use a BiPAP, which pushes high amounts of oxygen in and out the respiratory system with high pressures after doctors seal the patient’s mouth and nose with a mask.

Proning – placing patients on their stomachs for part of the day to take pressure off the lungs for up to 16 hours a way – helps breathing, too.

Treatments

In the meantime, McDonough  wants people to know that, nationally and internationally, health care workers “are making headway with this disease.”

“We’re not fixing everybody; we’re not curing everybody,” McDonough said. “But we are doing a great job of taking care of people. We’ve shown we can lessen the severity of this disease and modify its course.”

Typically, the more severe the disease and the longer a person was sick, the longer the recovery time, McDonough said.

In general, if a person was hospitalized four days, plan for a month to recover. A 25-day hospital stay requires a six-month recovery.

“If you’ve had problems with blood clotting and tissue damage due to a hyperinflammatory state, those things are going to take a while to heal,” McDonough said.

Although the  U.S. Food & Drug Administration revoked its emergency use authorization for both hydroxychloroquine and chloroquine, another antimalarial drug on June 15, a common steroid may reduce deaths in patients with COVID-19.

The study showed that patients on ventilators who received dexamethasone had a 33% reduction in mortality and those on oxygen has a 20 percent reduction in mortality. Patients on oxygen had no reduction.

In addition to supportive care, McDonough said patients who received the intravenous antiviral remdesivir had “dramatic improvement in their status,” which has been “very, very rewarding to see,” he said.

In addition, patients at AMITA Health Saint Joseph Medical Center in Joliet and Silver Cross Hospital in New Lenox have received convalescent plasma treatments.

Patients with cytokine storm (a major overreaction of the immune system) may also receive an immunosuppressant called Actemra, McDonough said.

Some patients also receive blood thinners since some people develop “very tine blood clots throughout the body,” which is a very uncommon complication of infectious disease, McDonough said.

This can disrupt oxygen getting into body tissues because “their blood vessels are closed in small ways everywhere,” McDonough added.

"Patients are presenting with strokes after getting blood clots in the vessels that supply blood to the brain," McDonough said. "Or heart attacks due to clots in the vessels that supplies blood to the heart muscles."

McDonough said this progress isn’t as good as it will be six months or even a year from now. But many “smart people” all over the world are working hard to understand and find treatments for the virus and it’s paying off.

“It’s really reassuring,” McDonough said. “It’s one of the things that keeps us going.”