Some days, the fatigue and depression can be overwhelming for 59-year-old Frances Byrd.
Although she returned to work in July, Byrd, a Covid-19 survivor, is still struggling with symptoms.
“I’m back to work now,” says Byrd. “But if I don’t pace myself, I get really tired.”
The Rosenhayn resident was hospitalized at Inspira Medical Center in Vineland in April after testing positive for Covid-19. She was intubated, transferred to Cooper Medical Center in Camden, put into an induced coma and placed on extracorporeal membrane oxygenation (ECMO), a form of life support that pumps and oxygenates blood outside the body, allowing the heart and lungs to rest.
Byrd was weaned off a ventilator in early June at Acuity Specialty Hospital in Willingboro. She then spent seven days of rehabilitation at Virtua Our Lady of Lourdes Hospital, where she relearned how to walk. She had been bedridden for so long that her legs had atrophied.
Byrd’s experience is not unique. Hundreds of New Jerseyans who have recovered from Covid-19 are feeling the persistent effects of the virus that has, as of Dec. 14, affected more than 405,440 New Jersey residents and taken the lives of 15,900, according to the state’s Department of Health.
Although the vast majority of Covid-19 patients appear to recover fully, some patients who no longer test positive are facing ancillary health issues that continue to baffle doctors.
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Covid-19 is associated with a wide range of short- and long-term health effects, according to the Centers for Disease Control and Prevention. While symptoms vary from patient to patient, doctors see common threads, including fatigue; joint pain; headache; respiratory, cardiac, neurological and gastrointestinal issues; blood clots; hair loss; depression; post-traumatic stress disorder (PTSD); and anxiety.
“We are starting to now see a lot of these patients in what we are calling post-Covid syndrome,” says Dr. Christina Migliore, director of the Medical Intensive Care Unit at Newark Beth Israel Medical Center. Lingering effects, she says, are even seen in those who did not have to be hospitalized when they had the virus.
Janice and Michael George, of Woolwich Township, were diagnosed with Covid-19 in April. Janice, 57, had a milder case and was not hospitalized, but Michael, 52, spent a total of 40 days on a ventilator. He still feels weak and has a problem lifting things. “I have nerve damage, numbness on the outside of my fingers and in both hands and in my feet,” says Michael.
Being kept immobile for such a long time caused Michael’s muscles to atrophy. He has had to rebuild muscle; like Byrd, he had to learn how to walk again.
Janice complains of lingering fatigue. “No matter how much rest I get, I feel tired,” she says. She also suffers from massive hair loss, PTSD, vertigo and emotional issues. The “emotional stuff,” she says, “is very real.”
In April, Dr. Karan Omidvari, a pulmonologist at Hackensack University Medical Center (HUMC), was treating early Covid-19 patients. When he started developing symptoms of the virus, he quarantined at home for a week. When his oxygen levels went below normal, he was admitted to the facility where he works and, two days later, was placed on a ventilator for eight days.
Omidvari was the 1,000th Covid-19 patient to be discharged from HUMC. Eight months later, he remains extremely weak; his capacity for exercise has decreased dramatically. “I feel like I aged 10 years,” he says. “I have muscle pain and hair loss.”
In early March, Dr. Christopher Pomrink, medical director of Medical Specialties at Virtua Medical Group in Marlton, experienced extreme exhaustion, fever, chills and shortness of breath. He was admitted to the hospital for several days.
Pomrink, 48, says that after his fever resolved, it took three to four weeks before he felt somewhat back to normal. “The shortness of breath lingered for months, and so did the exhaustion.”
The surge of Covid-19 in the spring presented unique challenges for health professionals. They learned from the experience, and, as New Jersey’s winter closes in, the lessons continue. The short-term acute challenge has, for some patients, become a matter of managing chronic conditions.
“What we are finding now from patients that have recovered from mild illness is that there are multiple system manifestations that are individualized from patient to patient,” says Dr. Steve Sheris, president of Atlantic Medical Group, an Atlantic Health System practice.
In other words, not everyone experiences the same combination of long-term effects. “That’s why,” says Sheris, “care has to be individualized.”
To that end, Atlantic Health launched its Covid Recovery Center in October. Sheris describes it as “an infrastructure” to provide individualized care to Covid-19 patients in multiple settings, including at an Atlantic Health facility or at home, if necessary.
“We are learning more every day,” says Sheris. “We are building what needs to be built and addressing what is going to be a long-term challenge for many patients.”
Other area medical centers have also established dedicated resource centers to better treat and understand the health care issues of post-Covid-19 patients.
In August, Saint Peter’s University Hospital in New Brunswick announced its specialized Covid-19 Recovery Program to provide comprehensive, multi-specialty treatment for individuals who have previously tested positive for Covid-19. The program offers care to individuals who were treated for Covid-19 at Saint Peter’s or another medical facility, or who recovered at home.
“We remain vigilant in evaluating the long-term impact of Covid-19, a syndrome that still has many unknowns,” says Dr. Amar Bukhari, chief of Pulmonary, Critical Care and Sleep Medicine at Saint Peter’s. “While some patients feel better sooner, there are others that are experiencing lasting symptoms. To complicate matters, these symptoms can vary in intensity and duration from patient to patient; what we’ve noticed is that no two cases present the same.”
Hackensack Meridian Health established its Covid Recovery Clinic in early July under the direction of Dr. Laurie Jacobs, chairperson of the Department of Internal Medicine at Hackensack Meridian School of Medicine and HUMC. The program offers access to primary-care physicians and specialists via telemedicine or office visits. Patients can also opt to donate blood or tissue specimens for research.
“I hold a once-a-week phone call with all the docs so that we can talk about what we are seeing, how we are treating it, and what kind of referrals were made,” says Jacobs. “My goal for this program is to serve the people of New Jersey. They can be either patients who were treated here or anywhere.”
The center includes a rehabilitation program that treats post-Covid-19 patients for three to six months—and sometimes longer.
Health experts say treatment options for post-Covid-19 patients are evolving. They include a variety of medical treatments as well as respiratory, physical and occupational therapy. Specific treatment is based on the patient’s symptoms and experience with the disease.
To facilitate such personal care, Atlantic Health’s Covid-19 recovery initiative, for example, has packaged its information and care-coordination systems under one program that can be accessed in an Atlantic facility or a patient’s remote location.
Major insurance carriers and Medicare generally cover the costs of recovery programs for post-Covid-19 patients. Patients should check with their insurance carrier for specific benefits under their plan.
Omidvari, who is back at work and treating patients at HUMC, says his experience as a Covid-19 survivor gives him a new perspective when interacting with patients.
“I tell them that if I made it, you can make it,” he says.
Among the challenges doctors are facing, says Omidvari, is giving post-Covid-19 patients a timeline for when their symptoms might go away. “We can’t reassure them because we just don’t know,” he says.
Sheris says it is imperative to let patients know that other Covid-19 survivors with ongoing symptoms are getting better.
“That often gives them strength,” he says, “and sustains them through the uncertainty.”