One survivor’s long road back
After near-death COVID-19 struggle, Ottawa trucker fights for mobility
Dean Taylor was staying at his brother’s cottage near Renfrew when he woke up in the middle of the night, gasping for air.
He’s not sure how he contracted COVID-19: Taylor thinks he might have picked up the virus while waiting in line at a bank machine. He remembers the woman in front of him had a cough.
For a week, Taylor tried to manage his respiratory illness in isolation. He went twice to Renfrew Victoria Hospital for help with his breathing problems before his brother, Jeff, called an ambulance. Taylor couldn’t fill his lungs no matter how hard he tried.
“I knew there was something seriously wrong because I couldn’t catch my breath,” remembers Taylor, 63, of Ottawa. “You know when you’re jogging and you do that final sprint and you’re gasping for air? It was like that.”
His memory goes dark soon after he was lifted into the ambulance on the night of March 29.
A diabetic, Taylor was unconscious when he was admitted to the intensive care unit of The Ottawa Hospital’s General campus. He was on a mechanical ventilator for 18 days and came perilously close to dying when severe pneumonia developed in both of his lungs: His body was being starved of oxygen. The ventilator was the only thing keeping him alive. Doctors told his brother they weren’t sure Taylor would make it.
For a month, his body fought to survive. Taylor, a truck driver and call centre worker, finally emerged from his dark world in early May. His first memory is of a nurse spoon-feeding him in his hospital bed.
Taylor’s life-and-death battle with COVID-19 exacted a heavy toll on his body. Inactive muscles atrophy quickly: Studies show someone in an ICU bed can lose 40 per cent of their strength in one week. After a month in intensive care, Taylor was unable to walk and had difficulty lifting his arms. His right side was particularly weak — the result of nerve damage. A mechanical lift was needed to get him out of bed. He also had some minor kidney problems and some short-term memory issues.
To make matters worse, Taylor continued to test positive for COVID -19 even though he no longer had any of the symptoms associated with the respiratory virus.
It meant that he couldn’t go to The Ottawa Hospital Rehabilitation Centre to begin the next phase of his recovery since the facility wasn’t set up to accept COVID-19 patients.
Taylor wasn’t alone. Doctors found that, for some reason, a small number of COVID-19 patients at The Ottawa Hospital persistently tested positive for the disease even after all of their symptoms had resolved. The phenomenon was consistent with the experience of COVID -19 patients in other jurisdictions, but no one knew what it meant: Were they still contagious? Or were they just harmlessly expressing bits of dead virus?
Without an answer to those questions, doctors didn’t know whether patients like Taylor could be safely discharged from the hospital’s COVID-19 unit.
“We had a conundrum,” says Dr. Shawn Marshall, division head of physical medicine and rehabilitation at The Ottawa Hospital. “Some of these patients were continuing to test positive: We didn’t know why and we didn’t know what it meant.”
Rather than have rehab-ready COVID-19 patients linger in hospital, Marshall and his colleagues resolved to design a specialized unit for them at the rehab centre. Staff cordoned off part of the second floor, and converted the patient lounge into a gym with portable stairs, treatment tables, wall bars, hand bikes and other exercise equipment.
Sandra MacLeod, interim professional practice manager of occupational and physical therapy, said safety protocols also had to be developed for the unit. “The challenge was helping staff feel 100 per cent confident that we have a safe process for them and their patients,” she says. “We had lots of volunteers in the end from the whole department.”
Opened three weeks ago, the unit is now treating six COVID-19 patients, including Taylor. (Four other recovered COVID-19 patients who have tested negative for the respiratory virus are being treated in regular wards at the rehab centre.)
The physiotherapists, occupational therapists, psychologists, social workers and nurses who work with COVID-positive patients wear full personal protective equipment: surgical masks, face shields, gloves and gowns. Two staff members and two patients are allowed in the gym at any one time. Staff members change gloves and wash their hands every time they move patients from a room into a hallway, then again when they enter the gym.
“We cannot allow this virus to escape the area that we’re treating them,” says Marshall.
The rehab centre has a vulnerable patient population that includes people recovering from major surgery, traumatic injuries and chronic lung disease.
Like other COVID-19 patients on the specialized unit, Taylor faces a host of physical deficits — but he’s steadily improving. He has graduated from a walker to a cane, and has regained almost full use of his left arm. He has also learned to do most things left-handed since his right side remains weak; he can only lift the arm up with the help of his physiotherapist.
“There seems to be a dead spot on my right side: The muscles just won’t do anything,” he says.
Still, the former rugby player — Taylor played with the Ottawa Irish for 15 years — is happy with his progress after two weeks: “I’ve got one good arm,” he says, “and I’m out of the woods.”
Dr. Guy Trudel specializes in the rehabilitation of people with severe injuries and complex medical problems, and is leading the treatment of the centre’s COVID-19 patients.
Dr. Trudel said the patients present with the same kind of deficits often seen in people recovering from severe bouts of flu or wide-ranging bacterial infections. “The deficits are not unlike what we see on a day-to-day basis,” he says.
Bed rest and prolonged intubation can diminish muscles, reduce the pliability of joints, and lead to pressure sores, nerve damage and respiratory problems.
MacLeod says the unit’s patients tend to be “severely de-conditioned” with weakness, tiredness and shortness of breath.
Occupational therapists work with them to ensure they can safely get out of bed, move to a chair, or into a bathtub, while physiotherapists help them to strengthen their arms, legs, hands and core muscles. They practice stairs, work on their balance, and use bikes to build endurance.
“Some of these patients are so fatigued and de-conditioned that they’re on supplemental oxygen even at rest,” MacLeod says. “Something like getting dressed may be difficult.”
The good news, Dr. Trudel says, is that COVID-19 patients have so far shown the ability to recover more quickly than those with similar deficits from other ailments. “If I say it will be three to five weeks, COVID patients usually beat those predictions, those estimates,” he says.
Still, most patients who have survived severe COVID-19 can expect to have some long-term effects, he says, particularly with respect to lung function.
Dr. Marshall says the goal of rehab is to allow patients to resume their lives and be able to feed, dress and bathe themselves. But some will have enduring respiratory disability, he says, which means that although they’ll be able to walk, they may have difficulty with stairs or distances. Returning to work or normal levels of exercise, he says, may be a challenge.
“There can definitely be longterm residual effects from this on people’s function,” Marshall says.
It’s also unclear what will happen if patients like Taylor continue to test positive for COVID-19. Marshall says some patients have
We had a conundrum. Some of these patients were continuing to test positive ... we didn’t know what it meant.
tested positive every week for the past two months — even as they exhibit no outward signs of the disease.
Will those patients be able to go home when they graduate from rehab?
“The answer is, ‘We don’t know at this point,’” says Dr. Marshall. “So we will make sure we don’t do harm: We’ll play it safe.”
In consultation with public health officials, rehab centre staff will consider each discharge on a case-by-case basis.
People who can effectively self-isolate will likely be allowed to go home, he says, but special precautions may have to be put in place if someone is living in a retirement home or long-term care facility.
For his part, Taylor says he’s thankful just to have the chance to work his way back home: “They saved my life and the rest is up to me.”