Patty Secrest woke from a three-week, medically induced coma in April, with her lungs taking back the role of breathing that had been left to a mechanical ventilator during her severe bout with COVID-19.
It meant survival, but it was only the beginning of the Stillwater woman’s recovery story.
Her first try at sitting up after regaining consciousness at Bethesda Hospital in St. Paul lasted 10 seconds, she said. “There were armrests, but I was so weak I couldn’t do it.”
After admitting and treating more than 4,300 patients with COVID-19, Minnesota hospitals are reporting better-than-expected survival rates but worse-than-expected complications even after patients have technically recovered from the infectious disease.
Major hospital systems in the Twin Cities have launched special rehabilitation programs in response to help patients regain memory, strength and energy. Secrest, 65, was one of the first patients discharged from Fairview’s post-acute COVID-19 rehab program, which offers four step-down therapy and exercise services to help people get back what they lost.
Continued breathing problems were expected, but the muscle loss and cognitive problems in patients coming off ventilators surprised caregivers at M Health Fairview, which includes the Bethesda Hospital that treats only COVID-19 patients.
“The patients that are coming to us have a lot of challenges and a long road in front of them,” said Liz Larsen, director of M Health Fairview’s acute rehab unit at the U medical center and the transitional care unit at Ebenezer Care Center in Minneapolis. “The fatigue and the lack of energy in doing what you want to do lasts longer than we would have guessed.”
Research is uncovering the long-term consequences of a viral infection that didn’t exist in humans until late 2019.
Doctors in hard-hit Italy reported in the Journal of the American Medical Association Thursday that they found problems in 87% of patients who were screened for post-acute care 60 days after their initial COVID-19 symptoms. More than half reported fatigue. Joint and chest pains also were common, along with labored breathing.
The virus attacks multiple organs and can have long-term consequences, but patients also can be affected by the paralyzing drugs that are often used during ventilation, said Dr. Farha Ikramuddin, chief of rehabilitation services at M Health Fairview. And then there is the overaggressive immune system response that is a key feature of severe COVID-19 cases.
“This immune response itself can impact a variety of organs, including the muscles and the nerves and our brains,” she said.
Good news at the moment is that hospitalizations for COVID-19 have declined in Minnesota from a single-day high of 606 patients on May 28 to 227 patients on Friday — including 124 patients needing intensive care.
State officials worry that an uptick in COVID-19 infections among young adults could lead to more cases among older adults at greater risk. The Minnesota Department of Health on Friday reported 609 new cases and five COVID-19 deaths, bringing the totals in the pandemic to 40,767 known infections and 1,495 deaths.
More than 19,000 test results were reported, exceeding levels seen before the July 4th holiday.
The percentage of tests that are coming back positive is rising — one sign that case counts are not increasing solely because of more testing. Over the past seven days, an average of 4.5% of tests found COVID-19 compared with 3.8% one week ago.
Everything was fuzzy when Secrest emerged from her coma, weeks after she was admitted for hospital care on March 28. The confusion of being surrounded by doctors and nurses in gowns and face shields didn’t help, and she experienced hallucinations — including that an air circulator near the window was a person.
When she was first moved from Bethesda to Fairviews’s inpatient rehab unit, she couldn’t remember her password to open her phone. The sign language that was fundamental to her work as an interpreter at Century College was a blur.
Secrest entered rehab 30 pounds lighter due to the loss of muscle and said her first steps in therapy exercises felt like a “dinosaur walk.”
“Every step was just clomp, clomp, clomp,” she recalled. “There was nothing normal about it at all.”
Grief hindered her recovery. Shortly after emerging from her coma, Secrest learned that her partner of 18 years, Donald Lydick, had died of COVID-19 on April 10 at age 60.
“That made it harder to deal with everything,” she said. “The hardest thing was knowing that I wasn’t there for him.”
Initial odds of surviving COVID-19 after placement on a ventilator appeared grim at the start of the pandemic, though perhaps overstated. High death rates reported in China and Italy were partly related to their hospitals being overwhelmed with patients and unable to provide usual levels of care and monitoring.
Northwell Health in New York raised fears in April with a report that 88% of COVID-19 patients on ventilators died. A week later, the health care network updated that report to stress that this included only discharged patients. When including all patients, including those still being treated in hospitals at the time, the death rate was 24%.
Even so, Minnesota hospital officials said they have improved outcomes. The Health Department reported a death rate in May of 42.8% of patients who had completed hospital care for COVID-19 and had been placed on a ventilator or a heart-lung bypass machine. In June, the death rate among such patients dropped to 30.6%.
Lessons learned since the early days of COVID-19 include earlier use of alternative and less-invasive forms of oxygen support such as nasal cannulas, said Dr. Alex Teeters, a critical care and pulmonary specialist at Allina Health’s United Hospital in St. Paul.
Doctors were initially encouraged to move patients quickly to ventilators and to avoid the use of cannulas that could blow the virus into the air and spread the infection, he said. That concern subsided, though, and early oxygen support with these alternatives proved helpful in treating patients and even helping them avoid ventilators, he said.
Doctors also have learned when to adjust ventilator pressure settings and how often to place patients in prone positions that support their lungs. Better data on drug therapies is helping — with early data from a British study last month showing that a steroid, dexamethasone, could improve survival for COVID-19 patients in intensive care.
Teeters said the social distancing and state-mandated stay-at-home order helped, because the hospitals never were overwhelmed to the point of having to ration care or draft doctors and nurses into the ICU who weren’t specialists in critical care.
“That is a big one — that we have the same standard of care now as we always have had,” he said.
Ikramuddin said she suspects that the length of time spent on ventilators correlates to the level of lingering health problems and need for rehab services.
“I’m so astonished to see these patients with severe muscle atrophy,” she said. “There is so much muscle dysfunction.”
Secrest found some rehab therapies to be silly — practicing putting dishes in a cupboard and operating a microwave — but realized they were helping in her slow recovery.
“I was thinking, ‘I know how to do this stuff,’ but when it came to actually doing it, it wasn’t really smooth,” she said.
Some of the guilt holding her back was lifted when a caregiver in the rehab unit showed her a TV news feature about the nurse who took care of her partner and kept him company in his hospital isolation when he died.
“At least I knew there was someone with him,” she said.
Secrest still couldn’t walk very far when she returned home — a hardship for someone who achieved 10,000 steps every day before her infection.
Relatives and friends have helped with meals and exercise outings to help her build strength. Rehab and a special diet helped her regain 10 of the 30 pounds she lost during her hospitalization.
Watching the interpreters during COVID-19 state news conferences has helped, but Secrest acknowledged she still isn’t as adept at sign language and can forget things. She hasn’t returned to work.
It’s been nearly four months since she was infected with the coronavirus, probably at a store. “I still to this day get tired very easily,” she said, “but it’s much, much better. When I first got home, I had to make it up two to three stairs and I’d just be breathing heavily.”
Staff writer Glenn Howatt contributed to this report.