They talked as if they'd never see each other again.

Darryl Jackson spoke through tears during that video call last month, saying he wished he and his wife could trade places, just before COVID-19 forced her onto a hospital ventilator.

It was a dreaded step for Amanda Jackson, who at 38 was pregnant with the couple's fourth child. As her condition worsened over the days that followed, her husband was stricken with fear.

"I was just waiting for that phone call saying that she had passed," he said.

But a risky treatment of last resort not often used on pregnant women during the pandemic not only helped return Amanda to good health, but kept her on track to deliver her baby in July. Last week, Amanda was back at Hennepin Healthcare in Minneapolis for a checkup that found no lingering problems with her pregnancy.

Doctors say her story shows that they're still learning how best to treat COVID-19 patients. It also is evidence that risks from the pandemic endure even as cases decline and vaccine protection spreads.

"She's a walking miracle," said Dr. Tracy Prosen, a maternal-fetal medicine specialist at Hennepin Healthcare, which runs HCMC hospital in Minneapolis. "We weren't sure if mom was going to make it. We weren't sure if baby was going to make it."

In cases like Jackson's, doctors use technology called extracorporeal membrane oxygenation as a lung bypass machine, redirecting blood outside the body so the lungs have time to heal. But pregnant patients need blood thinners to manage the threat of clotting associated with the technology, called ECMO for short. Those medications can become a risk if doctors need to perform an emergency C-section to rescue the baby.

Some doctors opt for a delivery before using ECMO, but Jackson's baby was just 28 weeks' gestation, meaning she would face significant risks due to prematurity.

"I really applaud the HCMC team," said Dr. Sarah Cross, a maternal-fetal medicine specialist at the University of Minnesota Medical School.

"It's true, if they had to deliver her while she was on ECMO, it would have been dicey. But the whole thing was dicey. The whole thing was a terrible situation and they had an excellent outcome from it."

Younger patients getting sicker

The Minnesota Department of Health reported 599 new cases of COVID-19 and nine new deaths linked to the pandemic on Saturday. More than 2.83 million Minnesotans have received at least one vaccine dose.

Hospital indicators are improving, but Amanda Jackson's story shows how COVID-19 continues to drive serious illnesses, even in younger adults.

"The whole theme of the last few months, for us anyway, has been younger patients and healthier patients getting very, very sick with COVID," said Dr. Matthew Prekker, a critical care specialist at Hennepin Healthcare.

Even before she learned of the pregnancy in late October, Jackson was vigilant about keeping guard against COVID-19. Yet somehow this spring, the virus came to the family's home in Minneapolis.

She suffered painful headaches and a bad cough and lost her appetite. Going to the emergency room, she felt she wouldn't make it home again. Once admitted, she told her husband: "Don't put me on a ventilator.''

But four days later, doctors said a ventilator was her best hope for recovery.

The last chance was ECMO, which doctors estimate has been used with fewer than 25 pregnant patients sickened by COVID-19. Within a few days, Jackson started showing signs of improvement. After three weeks on the ventilator, she was discharged this month.

Jackson has few clear memories of the hospital stay, but her husband vividly recalls the details.

Their 13-year-old daughter, Persephone, celebrated a birthday in April, and the family had to abandon a beloved tradition — "if we don't all sing 'Happy Birthday' on your birthday, then you're not that age yet," Darryl Jackson explained. As Amanda's condition deteriorated, her husband made certain that their 20-year-old son, Joseph, who attends college in South Dakota, made it home in time to see his mother. An athlete, he tacked a tag from his running bag to the bulletin board in his mom's hospital room.

Earlier in her pregnancy, Jackson opted against immunization for COVID-19 because the vaccines were so new. While she now favors getting a shot, she was troubled by what she felt were inconsistent messages about vaccine safety and effectiveness in pregnant women.

"If I had to tell people, as far as what I think, I would say get vaccinated. Because this stuff is real and it's deadly," she said.

Vaccines and pregnancy

Pregnant women face a dilemma with COVID-19 vaccination, Prosen said, because they weren't included in clinical trials of the vaccines. So there's limited data that's specific to them, although no evidence has emerged of a safety problem.

Not many pregnant women with COVID-19 get as sick as Jackson did, but studies suggest they run a greater risk of serious illness. "COVID is really unpredictable with anybody, but it's even more unpredictable in pregnant people. So, we encourage all of our pregnant patients to consider vaccinations," Prosen said. "I recommend it."

After 31 days in the hospital, Jackson is regaining strength. She's thankful for the support of caregivers, families and friends. And considering how COVID-19 has taken so many, including a friend who died just this month, Jackson feels lucky.

"It's heartbreaking. ... What made me survive, versus her?"

Christopher Snowbeck • 612-673-4744