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Jul 25, 20205 min read

The Strange Variations of COVID-19 Recovery

This is a feature story I wrote for my NYU Journalism class. All sources are included at the end.

Some of the tools of at-home COVID-19 recovery. (Photo: Jane Cook)

02 JULY 2020


On March 27, Jason Klotz knew he couldn’t wait any longer to go to the emergency room. The shortness of breath he had developed four days earlier had worsened to the point that he needed to catch his breath every couple of minutes. He worried about having to go on a ventilator. But much to his surprise, the ER doctor sent Klotz home and told him to return only if his shortness of breath became so extreme that he was unable to talk.

“What do I take?” said Klotz, echoing his thoughts from when he was sent home. “There’s nothing to take, there’s nothing to do.” His only option was to wait and hope his body could fight off the infection from COVID-19.

In spite of the WHO reporting average recovery times of two weeks for mild to moderate cases, Klotz is entering his second month of recovery. He takes medication to regulate his respiratory symptoms, and still describes how he feels day to day as a “roller coaster.”

Klotz’s frustrations are becoming increasingly common. In the U.S., only 0.1% of COVID-19 patients need to be hospitalized according to the CDC, leaving the overwhelming majority of the U.S.’s 2.6 million coronavirus patients recovering at home with limited knowledge of what that recovery may look like.

Mark Roberts, M.D., Ph.D, an epidemiologist and physician, says that part of the problem is that there simply is not a lot of recovery data available yet. But what we do know is that 95% of patients will survive a COVID-19 infection, according to Johns Hopkins University. Those patients need to know what to expect as they recover from the viral infection sweeping the globe.


Not the Flu

Early information about the coronavirus seemed to follow a consistent narrative. Fever, cough and shortness of breath were touted as the defining symptoms, with mild cases being flu-like and severe cases primarily striking the elderly and immunocompromised. As case numbers climbed, however, it became clear that the effects of COVID-19 were novel and unpredictable.

For Philip Wentworth, the defining differences between COVID and any previous illness were a prolonged fever and a seven-week-long recovery. “It’s like nothing else I’ve ever had,” he says.

Wentworth describes a daily pattern of a few hours’ improvement followed by an hour or two of feeling “horrible” again, a pattern that lasted six weeks. His description echoes that of Klotz and many other COVID-19 patients, including Cindy Mahler, who fell ill in early April.

Mahler describes a similar non-linear progression to overcoming her main symptom of extreme fatigue and frustration at the day to day inconsistency. As her recovery stretched into May and early June, she recalls thinking, “Am I crazy? Am I imagining this?”

While patients like Mahler who have moderate cases of COVID-19 experience some commonality in their recovery processes, those at either extreme have a very different story to tell. Some are luckier, like Arno Goetz, whose college roommate tested positive for the virus before Goetz and his remaining roommate began experiencing symptoms. Goetz felt entirely recovered within five days after only mild symptoms.

On the other end are patients like 54-year-old Michael Hoffman, who spent 30 days on a ventilator and 73 days total in the hospital according to Texas Health Presbyterian Hospital Dallas. A hospital news release reports that Hoffman had to relearn basic tasks like walking and swallowing after coming off the ventilator, a very different and more difficult recovery journey than most will face.


The Long Term

Now over six months into the COVID-19 pandemic, studies about the long-term effects of the disease are emerging. What they’ve found so far is a far cry from a straightforward respiratory virus.

“It’s a very unusual virus in the sense that it affects a lot of different organ systems,” says Sean Black, M.D., an ER doctor in Texas. Studies have found convincing links to heart, kidney and liver damage in addition to lung damage. Blood clots are emerging as dangerous complications of COVID-19, prompting many doctors to put their patients on blood thinners. Even stranger to Black are the “perplexing” neurologic symptoms like strokes appearing in otherwise healthy patients. “Normal rules don’t really apply right now,” says Black.

Understanding some of the long-term effects of COVID-19 may have come too late for a 44-year-old woman in Houston who passed away in late March from a pulmonary embolism, a blockage of a coronary artery in the lungs. She was a friend of Mahler, who said that her late friend suffered from a week of severe shortness of breath before her death but was unable to gain admittance to a hospital. COVID-19 patients are exhibiting an increased prevalence of pulmonary embolism according to an April research paper in the journal Circulation.

The challenge for doctors and researchers now is to disentangle damage caused by the virus from damage caused by treatment. Roberts says that time on ventilators increases risk for future pulmonary complications. A recent FDA report found that the experimental drugs used to treat COVID-19, hydroxychloroquine and chloroquine, may be responsible for some of the heart rhythm, kidney and liver problems surfacing now.

The exact causes, effects and prevalence of the near dozen COVID-19 symptoms listed on the CDC website and the cascade effects on other body systems remain to be determined, but researchers are working around the clock to get information out of the lab as fast as possible. “Following the science of SARS CoV-2 and COVID-19 is kind of like drinking from the scientific firehose,” says Roberts. Some of that research will answer our current questions, but until then, people will be recovering from the virus with whatever immune defenses they can muster.


Self-Care

“The question is, do you have COVID at home or COVID in the hospital?” says Black. With case numbers hitting record highs every day, the answer will likely be “home.” But like any virus, there are some basic guidelines to look after yourself. Rest, fluids and good hygiene are the recommendations from the CDC.

Klotz said Tylenol and copious amounts of water are what helped him feel better. For Wentworth, healthy eating and frozen strawberries were his recovery go-tos. But both men emphasize the importance of looking after your mental health as well as your physical health. “Physically, it was not that daunting. Mentally, I would put it at a 9 (out of 10),” said Wentworth. Klotz said having a friend to check in with about each other’s mental health helped him through his recovery process.

Protecting others from the coronavirus is also essential if you are sick. Roberts emphasizes the importance of continued frequent hand washing and wearing a mask in public, even as you recover.

With a vaccine likely still months away, taking appropriate health and safety precautions is as crucial as ever, perhaps even more crucial with many states and countries attempting to reopen in any way they can. “It’s going to be out there,” says Black. “A lot of people are going to get sick, and we can’t have them all come to the hospital cause we’ll drown.”

“This may be an endemic thing we’re not going to get rid of,” he says.


Sources:

Johns Hopkins COVID map: https://coronavirus.jhu.edu/map.html

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