Surviving COVID-19 can be just the start
WHITE PLAINS, N.Y. — Hugo Sosa arrived here a hero, triumphant over the worst that COVID-19 can inflict on the human body.
Nearly 100 of his fellow first responders whooped and cheered as Sosa was wheeled out of a hospital last month. They chanted his name. He flashed them a thumbsup from his gurney.
Twelve days later, frail and drawn in his room at Burke Rehabilitation Hospital, Sosa puzzled over a pile of coins his speech pathologist had set before him.
“Forty-five cents from a dollar, what do you get back?” Kristen Lucke asked.
“Fifty-five cents,” Sosa responded quickly.
“Good, show me 55 cents.” That was more difficult. Sosa would have to hold the number in his head while he searched for the right coins. Today that was too much to ask. Perhaps tomorrow.
For the fortunate COVID-19 patients like Sosa who survive intensive care and long stretches on ventilators, the journey home can be an arduous and lonely one that runs through places like Burke.
Their survival is testament to the lifesaving value of some of the world’s most sophisticated medical interventions, but their deficits reveal the toll of the disease and of hospitalization itself. Their futures can depend on what happens here.
“A lot of the time, it’s a win to get discharged from the hospital,” Lucke said. “Everyone forgets there are so many things that go on before you actually make it home, if you can make it home.”
The sheer size of the coronavirus pandemic means that thousands of people may need this kind of therapy. Their numbers already are forcing change on a U.S. medical system that didn’t see COVID-19 coming.
Two weeks ago at Burke, 39 of its 156 beds were occupied by COVID-19 patients. Another 146 people, former COVID-19 patients and others, were waiting to get in.
At the peak of the surge in April, Burke housed 90 people infected by the virus, including acute care patients who had nowhere else to go.
Now the hospital is back to focusing on survivors, accepting them even if they still are positive for the novel coronavirus.
Another New York hospital system, Northwell Health, has opened two small units where patients will be weaned off ventilators outside the ICU and begin physical therapy before they’re ready to move to traditional rehabilitation centers.
Sosa, 53, a captain of the dispatch team that sends first responders to emergencies in the Bronx and Manhattan, lost his sense of smell March 26, a telltale sign of COVID-19. By April 1, he was hospitalized.
He spent 44 days in the intensive care unit at White Plains Hospital, 19 of them on a ventilator.
The virus invaded his lungs, injured his kidneys, inflamed his liver and left him with deep skin wounds on his face and buttocks.
His wound nurse isn’t sure those are bedsores; it’s possible they are caused by COVID-19’s attack on blood vessels.
He also developed methicillinresistant Staphylococcus aureus (MRSA), a common, severe hospital-acquired infection.
Once a lineman for the Fire Department football team, Sosa lost 32 pounds as his body worked overtime to clear the virus. The nutrition funneled through his feeding tube could not keep up.
When his lungs healed, his sedation ended and his ventilator tube was removed, doctors couldn’t wake him for days.
A CT scan showed the disease had allowed large blood clots to travel to both sides of his brain, a “bilateral stroke” in medical terminology. Much of his working memory, which allowed him to organize coins, was badly damaged. His dominant right hand was more severely affected, but his left was weakened as well. He couldn’t walk, stand or get out of bed on his own.
“All the terrible things that could go wrong with COVID, he had them all,” said his wife, Blanca Delgado-Sosa, an EMT in New York.
While Sosa was hospitalized, his entire family developed the disease. His twin 13-year-old children had mild cases. His wife contracted a more severe version, with painful symptoms, but wasn’t hospitalized. His 85-yearold mother-in-law, who lived with the family, quickly died in the same hospital where Sosa was being treated.
The family, worried about the impact on Sosa’s rehabilitation, didn’t tell him about her death until June 1. The two were very close. Sosa blames himself for his mother-in-law’s death, his wife said.
Since entering the Burke rehab facility May 15, Sosa has come so far, so fast that doctors are unwilling to predict the limits of his progress.
Therapists have retaught him how to swallow, use a knife and fork, and comb his hair. His physical endurance, near zero when he arrived, has improved dramatically. He can walk 30 feet with a walker and on June 1 took his first steps without any assistance at all. With each passing day, he requires less oxygen through the cannula in his nose.
“Before I came to Burke, I was bed-bound,” Sosa recalled. “Now I can stand up. Now I can brush my teeth. Now I can take a shower. … It sounds like baby steps. but it was a tremendous step. What we take for granted is bathing ourselves, brushing our teeth, shaving.”
Less clear is how his brain will rebound from the twin attacks of stroke and oxygen deprivation.
“My husband is used to doing drug calculations (for emergency patients) in his brain,” said Delgado-Sosa. “He was like a whiz with doing that. That was something he would brag about.”
As a captain and supervisor, Sosa had to track where paramedics, EMTs and firetrucks were located and where they needed to go.
“I don’t know what capacity he’s coming home in,” DelgadoSosa said. No date has been set for her husband’s release.
There’s no good data on how many people have been placed on ventilators during the pandemic. Studies on the number who survive vary widely. Early reports out of China and elsewhere suggested a mortality rate of about 90 percent, and some U.S. studies put it at about 80 percent.
But more recently, doctors who work extensively with COVID-19 patients on ventilators have said 50 percent to 80 percent recover.
Jacqueline Stewart, a 56-yearold psychiatric nurse, spent four weeks on a ventilator before she was discharged to Burke for rehab.
She arrived “deconditioned,” essentially unable to move on her own, with nerve damage in her right arm, probably from her position in the ICU bed. She has a raspy voice from a paralyzed vocal cord and what she calls her “battle scars” — marks on her neck from an intravenous line and a tracheotomy. She vowed never to cover them with makeup.
After weeks of physical therapy, Stewart went home May 29. There are 20 steps up to her front door in Yonkers. Burke would not allow her to leave until she proved she could climb 20 steps in the hospital.
“I’m alive, so everything else is gravy,” Stewart said. “Everything else is a bonus. I’m alive. I can’t believe it.”
Some patients never will recover their full strength, so Burke teaches them ways to manage their exertion. They can dress and shower sitting down, arrange their kitchen to minimize standing and group their tasks to reduce the number of times they go up and down stairs, said Matthew Bartels, chairman of Burke’s department of rehabilitation medicine.
Quality of life can be largely maintained, he said
“I tell (them), ‘You’ve seen the Energizer Bunny? You’re the other guy,” he said.
Almost no one arrives at Burke with a single problem. Like Sosa, most patients have underlying medical conditions, such as diabetes and heart disease, that leave them more vulnerable to the coronavirus and complicate their rehabilitation.
“They bring all these co-morbidities with them,” said Mooyeon Oh-Park, Burke’s chief medical officer. “They bring that complexity here.”
Sosa’s parents immigrated to New York from Ecuador. He was born and raised in Manhattan. He and Delgado-Sosa started at the academy on the same day in 1991, then worked their way up the ranks of New York’s EMS. When the World Trade Center was attacked on 9/11, Sosa triaged casualties a block from the North Tower, then ran for his life when it fell.
“Hugo is a survivor,” his wife said.
A physical therapy session two weeks ago was conducted in Sosa’s cramped room at Burke.
Sosa stood with the aid of a walker, as physical therapist Domenic Facciola closely monitored his heart rate and blood pressure. Sosa has been taught to take deep breaths to steady both after the exertion of rising to his feet.
Eight days earlier, “he was only able to stand for 10 seconds,” Facciola said. “Now he’s up to two minutes. This is phenomenal in the PT world after COVID.”
Slowly, Sosa traversed 6 feet of floor space four times, relearning the basics of mobility, one step at a time.
“Domenic is teaching me to walk again,” Sosa said. “It’s a reset. It’s a true reset of learning, of getting your strength back. The hospital kept me alive. Burke is putting me back together.”
Only through thousands of repetitions will Sosa’s physical and mental skills return, Oh-Park said. But his caregivers are pleased with the pace of his improvement.
Sosa is “really making major gains here in rehab,” said Andrew Abdou, his physician. “We’re really excited about how far he’s going to go.”
Sosa wants to go back to his family, to play golf again and to get back to the dispatch center.
“I love to work. I’m a workaholic,” he said. “I want to get back into it. If I get a full recovery, that’s the first thing I want to do is go through those doors and say, ‘Here, guys, I’m back.’”
Delgado-Sosa wants her husband to retire, to take his pension and enjoy life outside the EMS.
“He survived 9/11. He survived this,” she said. “We don’t know how much more time we have.”