One of Dr. Nyan Pyae's first lucid thoughts in intensive care, after a long battle with COVID-19, was that he had to finish a lecture for an upcoming hospital grand rounds.
Only the event had already taken place — weeks earlier.
Pyae would later learn that he had endured one of the longest recoveries from COVID-19 in Minnesota — spending 106 days in HCMC — before his send-off last week.
"It was a very tough thing to take in," said Pyae, 45. "I missed Father's Day. I missed my daughters' birthday."
Pyae's survival — with his cognitive abilities and friendly demeanor intact — was a lift for a medical staff at HCMC that has been grinding for months in response to the pandemic, which as of Monday had caused 1,922 deaths and 84,949 lab-confirmed infections in Minnesota.
His recovery story also serves as a reminder that COVID-19's toll goes beyond basic numbers of infections and hospitalizations.
The Minnesota Department of Health is doing a case control study to find out how many patients have nagging or even chronic health problems after COVID-19, which is caused through infection with a novel coronavirus.
The risk of long-term health problems already has influenced decisions by Gov. Tim Walz and state health leaders to continue social distancing requirements in public places and capacity limits on restaurants and businesses, and to limit reopenings of schools to prevent children from getting infected and spreading the virus to older adults at greater risk of severe COVID-19.
"It really emphasizes why ... we take COVID so seriously, because it's not just the symptoms you have initially. It's how the virus affects your health for the long term," said Kris Ehresmann, state infectious disease director.
Over more than three months at HCMC, Pyae was placed on a ventilator and a heart-lung bypass machine; he received dialysis from his own nephrology colleagues for his failing kidneys; he was treated for alternating blood bleeds and blood clots; and he underwent multiple surgeries, including a tracheostomy as a final step to get him breathing independently again.
Pyae received an emotional farewell from the hospital last Thursday, with colleagues lining the hallway as he moved with the help of a walker out of his room.
"That was a highlight of my year for sure," said Dr. Matt Prekker, a critical care specialist who treated Pyae — a hospitalist who has been completing a nephrology fellowship at HCMC over the past year.
Hard road ahead
Pyae's COVID-19 journey is ongoing. Therapy exercises are intended to restore lost mobility in his right leg. He and his wife and twin 7-year-old girls have temporarily moved in with his parents in Roseville because there are too many stairs back at home in St. Paul.
"My hope is that I can recover, if not completely, then with very minimal residuals," he said. "I want to finish my fellowship. One year more to go."
Pyae was hospitalized on May 27 at the peak of the pandemic in Minnesota. The state the next day reported a one-day record of 606 Minnesotans hospitalized with COVID-19, compared with 233 now. The current tally includes 135 people who needed intensive care due to breathing problems or other complications.
The median length of hospital stays for COVID-19 has declined to five days, according to the latest state Health Department hospitalization data. Research proved the effectiveness of drugs such as the antiviral remdesivir and the steroid dexamethasone. Studies of donor plasma infusions are ongoing as well.
Pyae received all of the above — as well as an experimental dose of cancer-fighting tocilizumab to try to manage a harmful overreaction by his immune system. White blood cells called eosinophils kept surging without medication to harmful levels.
"The body can clear the virus, our medicine can tamp down the inflammation, but boy when people are sometimes young and healthy, the immune system just gets too revved up. It's all about the collateral damage," Prekker said.
Why Pyae suffered a severe case is unclear. The doctor isn't even sure how he got infected, though he had been taking precautions in public and figures it must have been when he was called in to consult on kidney care of COVID-19 patients.
The latest state data indicate that more than 7,300 health care workers suffered COVID-19 through exposure to the virus at work and that more than 400 required hospital care.
Pyae felt the usual COVID-19 symptoms of fatigue and lost appetite last May but got worried and went to the hospital when he took his own blood oxygen level and found that it was surprisingly low.
Little memory of illness
He went with his wife — Dr. Sunn Sunn Thaw, a cancer specialist — to the hospital assuming he would receive take-home oxygen and return. Instead his breathing and condition declined to the point that he agreed to being placed on a ventilator.
"I felt that it was necessary, instead of wearing myself down," he recalled. "I do not really recall any of the events happening after that until I started waking up like 80 days later or so."
He was placed at one point on a heart-lung bypass machine — a last-ditch option with a 53% survival rate, according to the latest international data — and then appeared to recover. But he spent only one day in June trying to breathe on his own before being intubated again.
While Pyae doesn't remember, Thaw said she is trying to forget the hardships. She first talked via videochat and played music for her husband when she couldn't be in his room. She was able to visit starting in July but said it was hard because Pyae would talk but not make sense, or ask randomly about things like household chores that he would just forget.
"So many times, I lost hope," she said, but then he would get stronger and recover from each downturn.
By mid-August he was healthy enough to leave intensive care and work on strengthening himself for the return home. His complications had been so diverse and involved so many organs that Prekker said almost every doctor in the building had consulted on his care.
Pyae said he is appreciating life and will never forget what the HCMC caregivers did: "Without them, I would have been gone. I'm very grateful."
Jeremy Olson • 612-673-7744