Stuck on hospitalization carousel
‘Long-haul’ virus patients’ repeat visits strain system
The routine things in Chris Long’s life used to include biking 30 miles three times a week and taking courses toward a Ph.D. in eight-week sessions.
But since getting sick with the coronavirus in March, Long, 54, has fallen into a distressing new cycle — one that so far has landed him in the hospital seven times.
Periodically since his initial five-day hospitalization, his lungs begin filling again; he starts coughing uncontrollably and runs a low fever. Roughly 18 days later, he spews up greenish-yellow fluid, signaling yet another bout of pneumonia.
Soon, his oxygen levels drop and his heart rate accelerates to compensate, sending him to a hospital near his home in Clarkston, Michigan, for several days, sometimes in intensive care.
“This will never go away,” he said, describing his worst fear. “This will be my going-forward for the foreseeable future.”
Nearly a year into the pandemic, it’s clear that recovering from COVID-19’s initial onslaught can be an arduous, uneven journey. Now, studies reveal that a significant subset of patients are having to return to hospitals, sometimes repeatedly, with complications triggered by the disease or by the body’s
efforts to defeat the virus.
Even as vaccines give hope for stopping the spread of the virus, the surge of new cases portends repeated hospitalizations for more patients, taxing medical resources and turning some people’s path to recovery into a Sisyphean odyssey.
“It’s an urgent medical and public health question,” said Dr.
Girish Nadkarni, an assistant professor of medicine at Mount Sinai Hospital in NewYork, who, with another assistant professor, Dr. Anuradha Lala, is studying readmissions of COVID-19 patients.
The data are incomplete, but early studies suggest that in the United States alone, tens of thousands or even hundreds of thou
sands could ultimately return to the hospital.
A study by the Centers for Disease Control and Prevention of 106,543 coronavirus patients initially hospitalized between March and July found that 1 in 11 was readmitted within two months of being discharged, with 1.6% of patients readmitted more than once.
Recurring admissions don’t just involve patients who were severely ill the first time.
“Even if they had a very mild course, at least one-third have significant symptomology two to three months out,” said Dr. Eleftherios Mylonakis, chief of infectious diseases at Brown University’s Warren Alpert Medical School and Lifespan hospitals, who co-wrote another report. “There is a wave of readmissions that is building, because at some point these people will say ‘I’m not well.’ ”
Many were vulnerable to serious symptoms because they were over 65 or had chronic conditions. But some younger and previously healthy people have returned to hospitals, too.
When Becca Meyer, 31, of Paw Paw, Michigan, contracted the coronavirus in early March, she initially stayed home, nursing symptoms such as difficulty breathing, chest pain, fever, extreme fatigue and hallucinations.
Meyer, a mother of four, eventually was hospitalized for a week in March and again in April. She was readmitted for an infection in August and for severe nausea in September, according to medical records, which labeled her condition “long haul COVID-19.”
Because she couldn’t hold down food, doctors discharged her with a nasal feeding tube connected to protein-and-electrolyte formula on a pole, which, she said, “I’m supposed to be attached to 20 hours a day.”
Feeding tube issues required hospitalization for nearly three weeks in October and a week in December. She has been unable to resume her job in customer service, spent the summer using a walker, and has had a home health nurse for weeks.
“It’s been a roller coaster since March and I’m now in the downswing of it, where I’m back to being in bed all the time and not being able to eat much, coughing a lot more, having more chest pain,” she said.
Readmissions strain hospital resources, and returning patients may be exposed to new infections or develop muscle atrophy from being bedridden. Long and Meyer said they contracted the bacterial infection C. difficile during rehospitalizations.
“Readmissions have been associated, even before COVID, with worse patient outcomes,” Mylonakis said.
Some research suggests implications for hospitals currently overwhelmed with cases. A Mount Sinai Hospital study of New York’s first wave found that patients with shorter initial stays and those not sick enough for intensive care were more likely to return within two weeks.
Lala, who co-wrote the study, said the thinking at overstretched hospitals was “we have a lack of resources, so if the patients are stable get them home.” But, she added, “the fact that length of stay was indeed shorter for those patients who return is begging the question of: Were we kicking these people out the door too soon?”