James “Cort” Taylor spent the week after Christmas 2020 feeling increasingly ill but determined to tough it out at home. Finally, after he grew so weak that he was unable to stand, his daughter insisted that he go to the emergency department at Lancaster General Hospital (LGH).
The hospital staff sent Taylor directly to the intensive care unit (ICU), where one doctor gave him a 20 percent chance of survival. Even as his condition further deteriorated, his family refused to give up hope, repeatedly declining gentle suggestions that it might be time to prepare for the worst.
Taylor, 74, managed to defy those dismal odds, leaving LGH after three weeks on a ventilator. But even today, seven months after his ordeal began, the school bus driver, father of four, and grandfather of eight continues to struggle with lingering symptoms of COVID-19.
“It’s been a long haul,” Taylor said of his ongoing recovery. “I just barely, by the skin of my teeth, survived. It’s remarkable that I recovered at all.”
While many, even most, patients recover from COVID-19 without lasting effects, for others, the recovery process can be more prolonged and complex. These patients continue to experience physical, emotional, or cognitive symptoms, which can significantly impact their overall quality of life.
Tony T. Ton-That, MD, medical director of Penn Medicine Lancaster General Health’s Post-COVID-19 Recovery and Rehabilitation Therapy Program, said more than 10 percent of patients suffer from continuing symptoms six months or more after a COVID-19 infection. Those symptoms can range from weakness, pain and fatigue to “brain fog,” anxiety, and depression.
“Given the novelty of COVID-19, we are still learning about the possible long-term effects,” he said. “Our COVID-19 recovery program offers multidisciplinary rehabilitation care to address these symptoms, so patients can once again function as active members of their communities.”
LG Health’s multidisciplinary COVID-19 recovery and rehab team includes physical, occupational, and speech therapists, as well as neuropsychologists, behavioral health counselors, and nutritionists. Patients are referred by their primary-care provider, a specialist, or themselves.
The LG Health program is part of an ongoing effort across Penn Medicine to help patients who face lingering challenges after COVID-19. Penn Medicine’s Post-COVID Assessment and Recovery Clinic offers a similar multidisciplinary approach to care through virtual visits, as well as in-person visits in Philadelphia, Radnor, and Cherry Hill.
The Penn Neuro COVID Clinic — the first such clinic in the region — treats patients who continue to experience symptoms related to cognition, headache, vertigo, and brain fog. In addition, Penn’s Princeton Health offers virtual support and education on issues such as rebuilding endurance and energy, emotional after-effects, and vocal recovery.
For patients like Taylor, that continued care and support can prove essential to finally returning to a more normal life.
Helping Patients Make a Full Recovery
A case manager coordinates each patient’s care at the LG Health Post-COVID-19 program, ensuring timely access to the appropriate providers across various specialties. Patients receive an evaluation and personalized care plan, which takes into account medical history and any pre-existing conditions that may be exacerbated by COVID-19.
Case manager Jill Fehrman said the program sees patients of all ages and genders, who experienced varying severity of illness with COVID-19. While the length of rehabilitation therapy varies based on the patient and their progress, about six to eight weeks is typical.
Continued lack of energy and stamina is the most common issue patients in the LG Health program say they face, Fehrman said. Physical therapy can help to rebuild strength and endurance through monitored exercise on a treadmill or stationary bicycle, use of resistance bands, balance training, or other approaches.
“We are seeing people who had COVID-19 back in December and are still easily fatigued and have poor endurance,” she said. “In some cases, that can lead to additional concerns, including weight loss.”
Cognitive impairment — or “brain fog” — can lead patients to struggle with activities of daily living long after their initial recovery from COVID-19. Occupational or speech therapy can be helpful for those patients.
“Many of our patients sometimes have a hard time figuring out the right word for what they want to say,” Ton-That said. “Others have trouble gathering ingredients to cook a meal. It takes them a longer time to accomplish routine tasks.”
When it comes to emotional health, patients who have recovered from COVID-19 might experience anxiety, depression, and even post-traumatic stress disorder. A neuropsychologist or counselor can help to address these symptoms, which may be especially prevalent in patients who had lengthy hospital stays and severe illness.
While most patients improve with rehabilitation therapy, Ton-That said some might require additional care from a pain specialist, cardiologist, or pulmonologist.
‘I’m feeling very blessed’
Taylor, a veteran of the U.S. Navy and the Peace Corps, was active and in good health before his COVID-19 diagnosis. After a long career in financial services, he found new purpose in caring for adults with special needs and now working as a school bus driver.
Following his stay at LGH and a month of inpatient rehab, Taylor came home in late February. He found that he had missed a lot, including a major home renovation and the news that his wife, Marilyn, was hospitalized with COVID-19 for two weeks while he was unconscious in the ICU. (She made a full recovery.)
In early March, Taylor began speech, physical, and occupational therapy through the LG Health program. For two hours, three days a week, he worked painstakingly, and sometimes painfully, to regain his stamina, balance, and memory, motivated by a strong desire to get back to driving a bus by April 1.
“My care team was very compassionate, but they made me work really hard,” he said. “They told me it was going to take time, and it would feel like a struggle. But there was also a lot of hope, and they were there to support me through it.”
Today, Taylor considers himself about 85 percent recovered from his bout with COVID-19. While he has returned to driving his bus, as well as playing golf and gardening, he still struggles with some lingering symptoms. His voice remains hoarse and raspy from his intubation, although he has noticed some improvement. His equilibrium is sometimes slightly off.
He continues to experience memory issues and brain fog, which he describes as feeling like he’s a step behind everyone else, or as if he hasn’t slept in a couple of days. He sometimes struggles to find the right word in a conversation.
But more than anything, he’s very grateful that he survived COVID-19, which he credits to God, his faith, and the tremendous care and support he received from his medical team, family, and friends.
“I had about as bad of a case as anyone’s ever had, and I survived,” he said. “Anybody who knows about the disease and the condition I was in has literally marveled at my recovery. I’m feeling very blessed.”