September 22, 2020

One man's unlikely recovery from Covid-19 offers hope—but 'no simple conclusion'

Daily Briefing

    One patient's unexpected recovery from a harrowing case of Covid-19 shows that "[t]here is no simple conclusion or silver lining" to the epidemic—even for patients who survive the disease, writes Daniela Lamas, a critical care doctor at Brigham and Women's Hospital, in the New York Times' "Well."

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    A recovered Covid-19 patient is still haunted by the disease

    Lamas describes a patient in Brigham's critical illness recovery clinic who, when she first encountered him four months earlier, was not expected to survive his bout with Covid-19, the disease caused by the novel coronavirus.

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    According to Lamas, when she first cared for the patient in May, she was shocked by his chest X-ray—"the kind of X-ray," she writes, "that should not have been compatible with life." At one point, nurses called Lamas and her team to the patient's room in the ICU, where she saw "bright red blood in the vent tubing and suction canister, oxygen saturation wavering."

    The hospital allowed the patient's family into the room for the first time in a month, "as the rules at the time said that family members could only enter if a loved one might be dying," Lamas writes. She had to explain the condition of the patient to his family, how "the ulcers" on his face "were from lying on his chest, the tubes in his neck and groin were to remove his blood and run it through a lung bypass machine."

    But in a survival story that Lamas "did not expect and still cannot fully explain," the patient recovered and returned home after "more than three months" in the hospital.

    It is, in some sense, a success story, Lamas acknowledges. But while the patient recalls nothing from his time in the ICU, he "struggles to sleep at night, awakened by vivid nightmares of his childhood," Lamas writes, and according to his son, the patient is more forgetful than he was before.

    The patient also has lost sensation in a patch of skin on his left thigh, has an ache in his shoulders and chest, and has lost blood flow to the tip of one of his fingers—which, according to his rehab doctors, was at one point at risk of being amputated.

    Ultimately, Lamas writes, his recover is "bittersweet." Although he is reunited with his family, "his eyes are haunted, … he can't sleep, and I have no idea how or when he can return to … work."

    She adds, "As much as I want to reassure [him and his family] that things will be OK, I can't make that kind of promise."

    There's more to Covid-19 than mortality, Lamas writes

    "At the start of the [epidemic], it was easy to see mortality as the only outcome that mattered," Lamas writes. And still, almost six months later, coronavirus-related mortality is used as "an indicator that things in this country are finally getting better. But it is increasingly clear that mortality is not the full story—not for any of us."

    There is so much we still don't know about "the long-term impacts of this virus," she writes, such as "the strength and duration of immunity, or even which therapies actually work to improve outcomes."

    Nor do we know "how many of those who survive severe Covid-19 return to work, to what extent lungs heal, how often patients are readmitted, the burden of psychiatric disease and the long-term consequence of isolation," Lamas continues. "We don't know why my patient was the only one in his family to grow so sick and why he got better."

    What we do know, however, is that the "medical manifestations and trauma of this virus persist and impact the quality of the lives that are saved," Lamas writes.

    Which means that, despite our desire for the epidemic to be over, "it continues—even as the caseload falls. And our responsibility to our patients does not end when they leave our hospital doors" (Lamas, "Well," New York Times, 9/17).

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