The very long haul: Medical providers consider what happens after vaccination

‘Long haulers’ will strain the healthcare system in different ways

By: - February 27, 2021 10:20 am

Dr. Adam Zelka and his family after his hospitalization and during his recovery (Courtesy Dr. Adam Zelka).

Nine days after he tested positive for COVID-19, Dr. Adam Zelka knew things weren’t going well.

For days, he’d been trying to recover, and each day, things got a little worse. And then worse.

He woke up that day feeling dehydrated and weak. He told his wife, who is a nurse, that after their kids went to school, she’d need to drive him to the urgent-care clinic.

Zelka, a family practice physician at St. Vincent Healthcare in Billings,  was relieved to find out that his lungs looked clear – no signs of pneumonia. He was given some fluids, medications and sent home.

That night, he felt better than he had in days. Certain he was on the mend, he slept.

He remembers waking up the next morning, surprised.

“I couldn’t catch my breath. It was like I couldn’t find air,” Zelka said.

His oxygen was 85 percent and dropping.

He told his wife he had to go to the hospital. He had been staying in his camper, which had been outfitted with a heater and food, quarantined from his wife and their four children. As a nurse, she also knew the drill, putting on personal protective gear and taking him to the hospital.

Volunteers got him in a wheelchair, and they stood there for a moment.

“We looked, and we just started. I didn’t know if this was the last time we’d see each other,” Zelka said.

By the time he got inside, his oxygen had dropped to around 80 percent.

More X-rays and tests were ordered, and they revealed in 24 hours that both of his lungs showed COVID-19 pneumonia.

“You know you’re going to be staying with us for awhile,” he remembers being told.

“Yeah,” he said. He knew what was coming.

Or so he thought.

At first, medical staff gave him two liters of oxygen, then three, then five, then six. The more oxygen he got, the more the oxygen in his body dropped.

He became so weak, he couldn’t even get out of bed to use the bathroom. And six liters of oxygen quickly grew to 60 liters. For that amount of oxygen, Zelka explained, it has to be warmed and comes in much larger tubing. He described it like breathing out of an air hose at a gas station. However, it was the only way of getting enough oxygen into him to keep him alive.

For as many as 18 hours a day, he laid in bed, isolated except for visits from medical providers. He knew the conversation that was going on outside of his earshot — between doctors and his wife: They were probably telling her they were doing everything — which was true — but he wasn’t getting better. He knew what they were preparing for: An ICU bed was on stand-by, as was a ventilator.

His oxygen levels had crashed to 64 percent.

For five days he lingered in bed.

“They had to help me with everything, even rolling over in bed,” Zelka said.

As a doctor, he had known the dangers of COVID, and he had treated people with the disease. But he was 38, with no underlying medical condition. He exercised and had even avoided the disease earlier when his twin daughters contracted it.

Ten days after entering the hospital, he left, weak but alive.

“It took days before my oxygen started to creep back up,” he said. “At first, it was just sitting up. Then standing for a few minutes. Every day after (the oxygen crashed), I got a little better.

Zelka remained on in-home oxygen until Christmas — nearly a month later. He was out of work for two months, and today, five months later, he still needs oxygen during the night.

But the physician is back at work, helping treat many patients with COVID. He can relate to their struggles, and he can talk about the risks and dangers of the disease. Though he doesn’t consider himself a COVID “long hauler,” one of the terms given to patients struggling with the long-term after-effects of the disease, he understands that physicians will be providing care to not-fully-recovered patients long after most people have gotten their vaccinations.

A long, long haul

Zelka considers himself lucky. He knows he could have just been one of nearly 3,000 healthcare workers who have died from the virus.

The medical community is collecting information and trying to understand the lingering symptoms, which many COVID patients report after the disease is no longer detectable. Those symptoms often include aches and pains, a loss of appetite or smell, confusion, headaches or a “brain fog.” Literature has dubbed these cases “Long COVID” or “COVID long-haulers.”

Regardless, after the immediate threat of the pandemic passes, doctors in Montana and beyond will be dealing with the disease for a long time.

Dr. Neil Ku of the Billings Clinic.

Dr. Neil Ku, an epidemiologist at the Billings Clinic and the leader of the infectious disease department, said while the medical community is still researching COVID, “there’s so much less we know about long-COVID.”

He said the phenomenon of lingering symptoms was just started being reported widely in late June or early July. That means scientists, doctors and researchers have only had about a half a year to understand it. That’s a short time for medicine.

The challenge for many of his patients dealing the lingering effects is often shortness of breath and fatigue for tasks that were once routine. The other commonly reported problem is brain fog, or having a hard time concentrating on work.

For some, these long-term symptoms can be debilitating without any certainty life will return to pre-COVID conditions. More serious complications usually center on the heart, with swelling of the muscle or even rapid heart-beating, called tachycardia.

But not knowing, Ku explained, means that there’s no certainty about the future.

“A lot of it we can’t treat,” Ku said.

Often, treatment is based on other known therapies, for example, occupational training or physical therapy.

“A lot of this comes down to rebuilding skills,” Ku said.

The concern for medical providers is: What will happen if the symptoms don’t clear up, and instead persist for months?

“Other diseases we know about. We know what to expect,” Ku said. “We don’t know about this one. We have to better understand how to manage it.”

That inevitably leads to frustration with patients who are accustomed to getting robust medical information at a doctor’s office.

“Because we don’t know the disease, but the public believes we do, we can’t give them answers,” Ku said.

He said he suspects the burden for medical care will transfer from doctors, nurses and specialists in the emergency room, intensive care and hospitals to specialties like family practice, internal medicine, cardiology and rehabilitation.

Zelka said that medical providers are continuing to watch the heart, lungs and brain as the areas most effected. For example, if the lungs are damaged permanently, it will effect the transport of oxygen, but also how well the body can get rid of carbon dioxide.

“Some patients may need supplemental oxygen for a long time,” Zelka said.

Others may need pulmonary rehabilitation, not so unlike those who experience serious pneumonia or even Chronic Obstructive Pulmonary Disease.

“We don’t know why it lingers in the first place,” Zelka said. “But just like chemo for cancer or even a stroke, it’s a major tax on the body, and the brain recovers really slowly, and we see that all the time with stroke patients.”

Zelka said initial indications are that as many as 10 percent of those who contract COVID will wind up suffering long-term complications. Using the numbers, that means that as many as 2,000 people in Yellowstone County — the state’s most populous and where Zilka and Ku practice — could need long-term care.

“That’s not a small number,” he said. “Right now, we’re already stretched.”

Yet, that number pales in comparison to the effect the disease could have on families.

“It may substantially impact the financial abilities of people to provide for the care of their families,” Zelka said. “That takes able-bodied workers out of the workforce permanently who would have otherwise been in.”

His largest concern is that if not enough people get the vaccine, healthcare systems will struggle to keep up with the strain COVID puts on them.

“I want people to know that it’s unfortunate this has turned into a matter of politics,” Zelka said. “People need to take it seriously, and those that have come to the wrong conclusion are those who believe it’s a hoax or being overhyped. The vitriol is completely unnecessary. Their view is skewed because they don’t know anyone close who has had it, so they believe it only happens to the sick or feeble.

“They’re very genuine people, and I try to shed light and not attack the political bent because people need stories and reporting and tangible (evidence). I am now talking people into getting vaccinated because they hear my story.”

That was part of Zelka’s reason for going public with his own struggle with the disease.

“My mission is to protect you,” he said. “It won’t hamper your beliefs, but it will help us put an end to this.”

The next steps

Zelka had assumed if he got the disease that he’d be alright — more or less.

Dr. Adam Zelka in a hospital bed, where he spent 18 hours a day on his stomach trying to recover from COVID. He was nearly put on a ventilator in November 2020 (Courtesy Dr. Adam Zelka)

“I thought, ‘I’ll get it and I’ll be fine,’” he said. “I had patients with (Chronic Obstructive Pulmonary Disease) or asthma or diabetes or who were severely overweight, and they had gotten it and survived. I had the opinion that if they got it and they’re fine, that I would be fine.

“I was totally wrong. I didn’t realize the threat. Each day I was supposed to be better, and I was shocked. No one is immune to it.”

He can now look at those patients who are leery of the vaccine, or don’t believe that healthy people can contract the virus, and tell them differently. He said that having the disease and being out of work for two months should not have changed his perspective, but he admits: It probably did.

“I’d like to think that I had always focused on the patient’s well-being, but when I see a patient out of the hospital and tubing in their nose and they’re struggling to get their breath, I can tell them that I was out of work for two months,” Zelka said. “I can empathize with them. I can said that I was where they were two or three months ago and I have recovered.”

When Zelka was lying in bed, for hours a day, he wondered — in the darker moments — if he would ever see his wife or his four children again. He wondered if he needed to make videos to say goodbye.

“It was terrifying,” he said. “There were all the things I should have said, and I thought that I might not get a chance to say them. But I felt if I did that, you acknowledge that it will happen. Denial, anger, sadness, praying, bargaining — I would rapid cycle through them. Who can I pray to? What can I beg for?”

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Darrell Ehrlick
Darrell Ehrlick

Darrell Ehrlick is the editor-in-chief of the Daily Montanan, after leading his native state’s largest paper, The Billings Gazette. He is an award-winning journalist, author, historian and teacher, whose career has taken him to North Dakota, Minnesota, Wisconsin, Utah, and Wyoming. With Darrell at the helm, the Gazette staff took Montana’s top newspaper award six times in seven years. Darrell's books include writing the historical chapters of “Billings Memories” Volumes I-III, and “It Happened in Minnesota.” He has taught journalism at Winona State University and Montana State University-Billings, and has served on the student publications board of the University of Wyoming.