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What to Expect if You Are Hospitalized With COVID-19

Plus: Questions patients and family members should be asking

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Most people who contract COVID-19, the illness caused by the new coronavirus, are able to heal at home without medical care. But for individuals with more severe cases of the disease, a trip to the hospital may be in order.

What happens when you're there? And what does recovery look like once you leave? Medical experts outline what you can expect if you are hospitalized with a coronavirus infection.

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Which symptom is sending most people to the hospital?

There isn't a single symptom; doctors are seeing patients with coronavirus infections come in for a number of reasons. Some are going to the hospital with trouble breathing, says geriatrician June McKoy, an associate professor of medicine at the Northwestern University Feinberg School of Medicine. Others are seeking care for weakness caused by gastrointestinal symptoms, including loss of appetite and diarrhea.

Dizziness, confusion or a sudden change in mental status is another common reason people — especially older adults — head to the hospital. McKoy says one possible explanation for this symptom is that the oxygen levels feeding the brain start to drop, leaving the patient “a little bit befuddled.” In some instances, the onset of dizziness and confusion may cause a person to fall and fracture a bone or two.

"So the presentations are quite atypical,” McKoy says. “The mistake we continue to make is to believe that COVID-19 infection only presents with respiratory symptoms, and that's not true.”

Anyone can get severely ill from a coronavirus infection. However, adults 65 and older and people with chronic health conditions, such as diabetes and heart disease, are at highest risk.

What happens once you are admitted?

Things have changed since the initial surge of the pandemic when most hospitals, especially in the New York City area, “were made up of a lot of ICUs [intensive care units] and patients were coming in in very bad condition,” says Benjamin Salter, an anesthesiologist and assistant professor at Mount Sinai Health System in Manhattan.

Now it's common for hospitals to have “varying levels of COVID-care units,” Salter says, where patients with less critical symptoms receive care — albeit in an isolated area where staff members wear masks and other forms of personal protective equipment. “It's the same as you being admitted to the hospital for a normal, noncritical condition, except that we are going to treat you like you have an airborne disease,” he says.

If your doctor decides that you should be hospitalized for COVID-19 but you are not in need of critical care, you will likely end up in a COVID unit. The type of treatment one receives here depends on the severity of illness.

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Some patients require minimal intervention — they will likely have their vitals routinely checked, including their oxygen levels, and may get fluids to help them stay hydrated. Those with low oxygen levels may need help from a nasal cannula (a lightweight tube that delivers oxygen through two prongs placed under the nose) or an oxygen mask (similar to those worn by people who have sleep apnea) to boost their levels.

What if your symptoms worsen?

In the absence of a federally approved treatment to help patients recover from the virus, a big part of care for patients in a COVID unit is “watching your symptoms to see if they actually get worse” and to keep an eye on any “new symptoms that are super-concerning,” McKoy says.

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If your symptoms worsen or you came into the hospital in a more severely ill state, your health care team will likely admit you to the ICU to be monitored more closely, she says.

Overwhelmingly, the conditions that warrant critical care are “significant respiratory compromise or significant cardiovascular compromise,” Salter says. “If [a patient] is starting to necessitate higher levels of blood pressure support, that will require admission to an ICU; if their respiratory situation is starting to get compromised, and we really need to change the invasiveness of their oxygen therapy, they need to go to a critical care unit,” Salter adds.

Will I be put on a ventilator?

Just because someone is admitted to the ICU with respiratory complications doesn't mean they'll automatically be intubated and put on a ventilator — a machine that moves air in and out of the lungs by way of a breathing tube.

Despite the need for the breathing machines early on in the outbreak, McKoy anticipates that ventilators “are not going to be the treatment going forward.” And that's because recent research shows that ventilators might not always be the best course of care when it comes to coronavirus patients.

A study in the Lancet, for example, found that more than 80 percent of adult patients 80 and older who were put on a ventilator did not survive. (McKoy says in older adults, especially, the pressure of the oxygen from the machine can cause more harm than good to the lungs, including swelling and inflammation that can lead to a cascade of problems.) Similarly, a report published in JAMA found that only a small percentage of patients that had been put on a ventilator (3.3 percent) were discharged alive between March 1 and April 4, 2020. Nearly a quarter of the 1,151 patients who required mechanical ventilation died, and about 72 percent remained in the hospital at the end of the study period.

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All of this isn't to say ventilators aren't ever needed. It's just there are “very, very few cases where you need to be on a ventilator,” McKoy says. Physicians have found that less invasive oxygen therapies, including high-flow nasal cannulas, for example, are successful in treating some COVID-19 patients, especially when the patient is positioned on the stomach. This method delivers warm, humidified oxygen to the lungs through the nose, bypassing the risk of further lung injury caused by ventilators.

McKoy's advice to patients and family members: Ask your health care team about the oxygen therapy options available and their associated risks. If the patient is older, requesting a consult from a geriatrician may also be helpful.

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How long is a typical hospital stay due to the coronavirus?

This, again, depends on the severity of the illness. Salter says some patients in the ICU stay for about two weeks. Others with milder cases of COVID-19 recover in three or four days. There are also patients who have extended hospital stays, followed by an even longer recovery period in a long-term care facility. Often, these are patients who experienced multi-organ damage as a result of the infection.

What about recovery after discharge?

A patient who is discharged from the hospital isn't necessarily fully recovered. Though doctors are still learning about the long-term impact the virus has on the body, it's well known that the effects from time spent in the hospital — and the ICU, especially — can persist for months to years, says Dale Needham, M.D., medical director of the Critical Care Physical Medicine & Rehabilitation Program and a professor of medicine at Johns Hopkins University. Some people never get back to their former state.

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One of the biggest hurdles is overcoming muscle weakness acquired from a hospital stay, which can cause patients to have “problems with doing their activities of daily living,” Needham says. Even routine tasks, such as walking up a home's front steps, become insurmountable for some.

Delirium — a sudden change in the brain that causes mental confusion or disorientation — is another effect of hospitalization that can linger long after discharge. The same goes for depression, anxiety and post-traumatic stress disorder.

McKoy says patients and family members should bring up rehabilitation with their doctor before they leave the hospital. Oftentimes, it can even start in the hospital, including in the ICU.

Avoiding sedatives or using “the lowest dose for the shortest time possible to reduce delirium and confused thinking” is one way health care providers can keep patients both mentally and physically active in the hospital. “If you're in a deep sedation, you can't get out of bed. So we now routinely try to have our patients as best as possible awake and moving,” says Needham, who adds that even patients hooked up to breathing and life-support machines can sit up, walk around and participate in physical therapy exercises.

"We would all envision all this must be very painful, it must be uncomfortable, but patients love it,” he adds. And studies show early interventions can reduce long-term complications.

If in-hospital rehabilitation is not an option, Needham says patients and their family members should “make sure that they're tied into help once they leave the hospital” with an occupational therapist, a physical therapist, a speech therapist and a psychologist, depending on the needs of the patient.

"I feel less concerned about heart, lung and kidney problems being overlooked in [coronavirus] survivors” since “those things are probably likely more often recognized” by primary care providers and specialists in the recovery process, Needham says. “I feel more concerned about the brain, the mind, the nerves and the muscles” that can sustain damage from a hospital stay.

What are some other considerations?

One thing to consider if you are in the hospital is how you might be able to contribute to a better understanding of the coronavirus. If furthering research interests you, talk to your doctor about the possibility of joining a clinical trial to test various treatments and therapies, McKoy says.

Also: Make sure you have your advance directives in order, even if you are young and healthy. This shouldn't be thought of as a grim chore, McKoy says, but rather an empowering one. Advance directives are documents that specify the types of medical care you would and would not want in the event you are unable to communicate your wishes to doctors.

"It just may be a time [to be] looking at what you want done, in general — not as it relates to COVID — but COVID should raise your awareness of the fact that we all, no matter how young we are … we need to have some advance directives made,” she adds.

Finally: Take action to minimize your risks for hospitalization in the first place, Salter says. If you have diabetes, make sure it's managed properly. If you smoke, quit. And if you need more physical activity, think of various ways to incorporate exercise into your routine.

"It's never too late to take your health and your life into your own hands. And this should be a wake-up call,” Salter says.

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