Jamie Dyson has been practicing acute care physical therapy for over 25 years and currently practices at Central Florida Regional Hospital in the ICU with patients with COVID-19, among others who need critical care. A few months ago, Jamie contracted a serious case of COVID himself. Here Jamie discusses his experience treating—and recovering from—COVID-19.
What has treating COVID-19 been like for you?
Working with patients with COVID-19 has been an eye-opening experience. As critical care physical therapists we knew how to work with the critically ill and have set parameters that we use to make appropriate clinical decisions regarding the dosage of care we provide. COVID-19 was unique in that patients were presenting much differently. The parameters of care that we have used for years were not allowing us to help these patients. Basically, we had to put everything we knew aside and develop new treatment parameters for these patients. There are several unique physiological changes that occur with COVID, including how our blood cells carry oxygen as well as triggers that tell our bodies to produce blood clots.
Knowing this and what we know about critical care physical therapy, we went headfirst into developing these new parameters. Unfortunately, like everything else having to do with COVID, there was no true evidence to support these changes. We had to rely on clinical experience and patient responses as our guides. As a physical therapist with 30 years of experience, treating COVID was the first time I was making decisions solely based on clinical experience and not drawing from the best available evidence.
One aspect of care that was truly challenging was that patients rarely made steady progress forward. We had to make daily clinical decisions on how much and how hard to push patients. They did not progress as one would expect a critical care patient to progress.
Another challenge was having to wear the PPE. Physical therapy is intrinsically, physical, and wearing the masks and gowns made things uncomfortable. Additionally, we were working very closely and putting ourselves at risk every time we worked with these patients.
Can you talk about your experience as a patient with COVID?
Due to a medical condition I live with, I was advised not to get the COVID vaccine. I saw colleagues come down with COVID left and right, but fortunately for the first year I remained COVID-free. And I thought I was in the clear.
In May 2021 I started feeling sick. It progressed to having a high fever, which led me to get tested, and yes, I was positive. I was sick at home for over three weeks with high fevers and profound weakness. I really had to push myself as a PT to ensure I would not suffer from the multiple complications that can arise. So I made myself walk every day, even if it was just a few feet. I am now four months out and still working to get back to normal. I still struggle with some weakness and shortness of breath but am working on it everyday.
A huge issue we are seeing in the hospital setting is burn out of the healthcare providers. Everyone from physicians to housekeeping are exhausted and that exhaustion is leading to large turn over and many vacancies. Some have left healthcare all together because of this. Those remaining have been trying to fill the voids by taking on additional shifts but the cycle perpetuates. Hopefully we will soon have a light at the end of a very long and dark tunnel and can begin to heal as providers.
How is physical therapy uniquely able to help with COVID-19 recovery?
Physical therapy improves human movement. Many of the sequelae, or consequences, of COVID-19 involve muscle weakness and decreased endurance which is prime for physical therapy. Physical therapy integrates all of the body systems involved in human movement including the musculoskeletal system, the neuromuscular system, the cardiovascular system, the pulmonary system and the integumentary (skin) system. The integrated system-based approach facilitates maximal movement in the shortest amount of time.
Unfortunately, many who have recovered from COVID-19 will have permanent chronic disability. Physical therapy is also uniquely able to maximize function of those with permanent disabilities to allow them to be as independent as possible. Physical therapy is going to have a huge role moving forward both with people who have the acute onset of movement disorders but also those with chronic conditions and may require physical therapy to maintain their level of independence as they transition through life.
What role does physical therapy play for patients post-COVID?
COVID-19 sequelae impact patients during both the acute phase as well as throughout their lifespan. Initially the role of PT will be to maximize an individual’s function post-COVID. This begins at the hospital in the intensive care units and continues through to outpatient and home health. From there, as the individual moves through the phases of life, these sequelae will be a part of their medical history. It will be important to integrate whatever chronic COVID sequelae each patient has into a new plan of care depending on the condition being treated. These sequelae can involve many different systems of the body and no two people are going to present the same. It is crucial that physical therapy professionals integrate these into their plan of care.
What is your advice to people struggling with long-haul COVID symptoms?
Being both a physical therapist and someone recovering from COVID, my first piece of advice is to be patient with the recovery and do everything you can to control stress and anxiety. Evidence shows that for every day someone stays in bed it takes six-to-nine days to regain the strength and endurance lost. Many patients who have recovered from COVID-19 spent weeks in bed. Next, consider multiple system involvement and the prolonged symptoms, which are unique to COVID-19, and the recovery is going to be months instead of days.
Anxiety and stress can facilitate an inflammatory response, which in turn can lead to further cell destruction, which means you need strategies to keep stress and anxiety low. For many, exercise is a great stress reliever, but unfortunately those recovering from COVID may not be able to use that, at least initially. Patients may need new outlets to relieve stress—such as spending time with family, listening to music or even a nice, long, hot shower. Those are strategies that I used in my own recovery. And know that there are going to be good days and bad days.
The main thing is not to give up and keep moving forward. We’ve got this.