FORT LAUDERDALE, Fla. — When Dimeji Lawal rolled out of the Intensive Care Unit at Cleveland Clinic in Weston, Florida — hospital staff cheering him in his wheelchair — he began to comprehend that he had survived COVID-19. More than two months on a ventilator, he had beat the disease and was headed to rehabilitation.
Nine months later, Lawal, 57, often has to remind himself he is fortunate.
"Some people didn't make it, but I am here," Lawal said, words still difficult to get out even after intense speech therapy. "It's been a journey, I pray and pray and do therapy, and I am trying to get my life going again."
As fall arrives and the delta wave recedes in Florida, an unprecedented number of COVID ICU survivors must now tackle the recovery phase: an intense journey to overcome effects on the mind and body. Many of them are people who wound up hospitalized because they never got vaccinated.
Nationwide and in Florida, little data exists on how large this group is, but based on prior waves, some information shows what they can expect. At least a quarter of ICU COVID survivors are too weak to carry on daily activities for months after their discharge. Another 10 percent will suffer permanent disability, and some may have PTSD for years, according to research on survivors published in The Lancelet, a medical journal.
"We don't have a handle on the magnitude of this problem," said Dr. Paul Wischmeyer, of Duke Health. "We know that ICUs were overwhelmed. We can guess that there are many survivors out there and that number will only continue to grow. But there's been little attention on the plight of the COVID ICU patients.
"Many are in physical and emotional pain. They think their life is never going to be the same again. That doesn't have to be true."
In August, with Florida reporting 95 percent of its 6,618 ICU beds occupied, critical care doctors said about half of the COVID patients in those beds would not survive. Delta differed from previous waves. Hospital patients got sicker faster, were younger and mostly unvaccinated. Even people in their 20s who landed in intensive care spent time on ventilators or other invasive breathing devices and suffered damage to the heart, lungs and brain.
In Hollywood, Dr. James Salerno treats new COVID ICU survivors who arrive daily at Memorial Rehabilitation Institute at Memorial Regional Hospital South.
"These survivors of the delta wave were the sickest of the sick who make it to rehab," Salerno said. "A lot of them have lost tens of pounds of muscle and they are debilitated." Some have nerve injuries, lung damage, and trouble swallowing and speaking, he said.
Salerno said even previously healthy COVID ICU survivors struggle: "If they were stronger and healthier before it happened, they have better odds of coming out the other side and recovering faster. But getting hit by Mack truck is still getting hit by a Mack truck."
To be admitted to rehab, patients must be weaned off their feeding tubes and well enough to receive up to three hours of physical, occupational and speech therapy a day. Usually, they need assistance to walk, eat, dress and use the bathroom. "Even the younger ones," Salerno said. They typically stay three to four weeks, then go to a skilled nursing facility or home to continue therapy.
At the height of the recent delta wave, when Florida had more than 17,000 patients in its hospital with COVID, as many 5,000 people were in the ICU, with close to 3,000 on ventilators. Those who survived previous waves offer these newcomers a glimpse into the long road ahead.
Lawal contracted COVID in August 2020 and still hasn't fully recovered. On most days, he battles pain, lack of movement in his left hand and intense frustration. He wants to drive and dress himself and hold regular conversations with his family. But each day he is grateful just to take steps on his own and speak in a croaky voice. He said prayers and shakes off the brain fog that once reduced him to tears.
"I scheduled therapy for every day they would come," Lawal said. "It just takes time."
David Vieira, a 57-year-old ICU nurse manager at University Hospital and Medical Center in Tamarac, was in the ICU in his own hospital with COVID in July 2020. "I know what patients are experiencing because I have been there," he said.
Vieira said he still has difficulty breathing, suffers short-term memory loss and tires easily. "With this disease, no one knows how long it lasts. I guess we will learn as we go along."
The more researchers study the effects of COVID, the more they recognize how differently the disease can affect people. Because of that, said Dr. Vincenzo Novara, a pulmonary care specialist at University Hospital and Medical Center, each person's recovery differs.
"Obviously they are facing an uphill recovery battle, but we are learning how to deal with that population right now," Novara said. "Most of the sickest patients that survive the ICU initially must carry a tank of oxygen around 24 hours. But it's possible they can regain lung function over time."
Novara said he and other physicians are monitoring this group of patients to learn more. "We are watching how much function those patients regain, how much independence in daily living they get back and what their performance status develops to over time."
At Duke Health, Dr. Wischmeyer has obtained a $4 million federal grant to study how best to help COVID ICU survivors recover physical functions through targeted exercises and monitoring. Wischmeyer said the rehabilitation study will use Apple watches and iPhones to personalize exercises for strength, balance and cardio training.
The goal is to enroll 140 patients in the trial. "If this study is positive, it's possible that exercise training could be implemented as the standard of care at hospital discharge," he said.
Wischmeyer said the medical profession has increased its knowledge of saving COVID patients but still hasn't figured out how to help them regain quality of life. "This is the true challenge that now faces critical care," he said.
Dr. Enma Poveda, an internist at Cleveland Clinic Florida in Weston, works to stabilize COVID patients when they leave the ICU at her hospital. Recovery is only partially physical," she said.
"They get depressed. They need help going to the bathroom and even eating is hard," she said. "They also are fearful. Thoughts go through their head, "Can this happen to me again?'
"It's a long, slow process, and I encourage them to take it day by day," Poveda said. "I think people are a lot stronger than they think they are."
Within the medical profession, doctors disagree over whether these COVID ICU survivors will be long haulers, or fully recover with time and therapy. "We are not going to know for sure for a while," said Salerno at Memorial.
Mo Lawal, the wife of Dimeji, said she is hopeful for her husband, who owns a Davie pharmacy. He has gone back to work a few hours a day. She offers encouragement for families of new ICU COVID survivors.
"It's going to get better," she said. "Compared to where my husband was nine months ago or even three months ago, he's in a much better place."