COVID-19 cases were surging in Texas in July 2020, and ACP Member Jayne Garcia, MD, was among the hospitalists who worked seven-day rotations in the dedicated COVID-19 unit at Baylor Scott & White Medical Center-Temple.
By the sixth day of her first rotation on that unit, she started to feel worn out. “I thought, ‘Well, of course I'm tired, I'm working a very stressful week.’” On day seven, she wrapped up her shift and, exhausted, left the Temple, Texas, hospital. Later that night, Dr. Garcia developed a fever.
Dr. Garcia, who tested positive for SARS-CoV-2, said that she primarily experienced fever and exhaustion at first. “The exhaustion was just incredible. It was difficult to even get off the couch,” she said. But once those symptoms eased, about a week after she got ill, a relentless cough kicked in, lasting several more weeks.
“It was fairly continuous, especially if I moved around, walked around the house,” the 50-year-old physician recounted. “I would have to take frequent breaks and just sit down and catch my breath.”
By November 2021, the pandemic had infected more than 740,000 U.S. health care personnel and caused 2,600 deaths, according to CDC data. Dr. Garcia, who didn't require oxygen, counts her blessings that she avoided hospitalization and doesn't have lingering symptoms. But some physicians still have not completely shaken their bout with the virus.
Jeffrey Siegelman, MD, an attending emergency medicine physician at Atlanta's Grady Memorial Hospital, developed a relatively mild case of COVID-19 in August 2020. But even several months later, he was still wrestling with fatigue as well as “a rotating constellation of symptoms,” including fever, headache, dizziness, palpitations, tachycardia, and others, he wrote in a Nov. 24, 2020, piece published in JAMA. Evelina Grayver, MD, a cardiologist at North Shore University Hospital in Manhasset, N.Y., said it took her longer than she had anticipated to regain her prior vitality.
The 43-year-old physician, who directs the hospital's cardiac intensive care unit, describes herself as “sort of a workhorse.” She returned to the hospital Feb. 22, 2021, 13 days after she tested positive. She was still coping with some degree of fatigue, shortness of breath, cough, and dizziness. But she had fulfilled the hospital's quarantine requirement, her fever had broken, and her symptoms were improving.
“I think it was a little bit too soon,” Dr. Grayver said. “But like they say, hindsight is 20/20.” She wasn't the only clinician to jump back too soon, she noted, given the rigors of working in a hospital.
“Coming back fully, seeing anywhere between 20 to 40 patients a day, being in the unit and everything else,” she said, “actually is what I think led to some of my very long-haul symptoms that I felt for months later.”
The viral impact
Dr. Grayver was fully vaccinated—she had gotten her second Pfizer-BioNTech shot on Jan. 12, 2021—when worsening fatigue began to slow down her pace in early February, until “walking down the [hospital] hallway that I usually would sprint down was the longest walk of my life.” She also had severe body aches.
“Everything was hurting,” she said. “It literally felt like somebody took bamboo sticks and beat me with them.”
Worried that she had developed anemia or a thyroid problem, Dr. Grayver got a full blood workup on Feb. 8. A COVID-19 test was also ordered, but she didn't think twice about it, given her vaccination and regular mask wearing. The next day, the result came back positive.
David Burkard, MD, an emergency medicine resident at Spectrum Health Butterworth Hospital in Grand Rapids, Michigan, was diagnosed Nov. 6, 2020, after developing fever, cough, and body aches. But the shortness of breath didn't kick in until six days later.
His boss got him a pulse oximeter, and the 28-year-old resident watched his readings creep lower, starting in the low 90s. When they reached the mid-80s, he called his primary care doctor, who told him to head straight to the emergency department. “I showed up and they said, ‘You don't look so good.’ And I said, ‘Yep, I'm not here to work.’”
Dr. Burkard needed oxygen initially but was able to wean off it prior to discharge. He was treated in the hospital for three days. The hospital had a no-visitors policy at the time, so even his fiancée could not see him. (She also had the virus, but it wasn't clear where she got it, he said.) Dr. Burkard's coworkers would leave goodies outside his hospital room door, yelling “Hi,” from the opposite side. “I went home with way more gummy bears than any one man needs,” he said.
Dr. Burkard had been accustomed to running four to five times a week but didn't recover his previous level of fitness until springtime rolled around. Two months after his hospitalization, he went skiing. “In between every run of skiing, I had to take a little break because I was so exhausted from just skiing,” he said. “I used to be able to ski all day.”
In those days before the vaccine, Dr. Burkard knew that he was vulnerable to catching the virus but thought that his younger age and fitness would buffer him from its severity. “I just thought that if I got it, it would be very simple.”
ACP Member Jeff Krimmel-Morrison, MD, then a chief medical resident at the University of Washington Medical Center in Seattle, was more fortunate. The then-31-year-old physician initially thought he had picked up “a run-of-the-mill cold” when he developed a sore throat and a bit of a runny nose in late March 2020.
To be on the safe side, he took a test and was shocked when it came back positive. Still, he only missed about a week of work and didn't have any other symptoms.
“I really didn't feel that bad,” said Dr. Krimmel-Morrison, who now works as a hospitalist at the University of Washington Medical Center-Northwest. “This felt on the scale of all of the colds I've had, like one of the more mild colds I've ever had.”
Though he did not feel fully back to normal, Dr. Burkard returned to the emergency department 15 days after he became ill. He wasn't pressured into returning, he said. But the cases were surging in Michigan, and he wanted to pitch in. “It felt like I wasn't really doing my part.”
Once he returned, Dr. Burkard worked thirteen 12-hour days straight in the intensive care unit treating patients, nearly all of them sick with COVID-19. While he had not become as ill as many of these patients, given that he wasn't intubated, Dr. Burkard empathized with what it felt like to lie in that hospital bed.
“At least I understood a little bit of the loneliness that comes with it,” he said. “I remember how scared my fiancée was and my parents were” as he updated the loved ones of patients each day. “I went home tired, but it was like a good tired.”
From the start, Dr. Grayver puzzled over how she became ill. She was far more vulnerable to potential exposure when she was not vaccinated and worked many hours on the COVID-19 unit during the spring surge of 2020, she pointed out. She later learned, after sequencing by the CDC, that she contracted one of the then-emerging variants, specifically the alpha variant.
After Dr. Grayver returned to work, her dizziness worsened. It took a while to sort out that she had developed postviral dysautonomia; at first, she blamed her symptoms on not being hydrated or skimping on sleep.
She was accustomed to swinging through the rooms of the cardiac intensive care unit during several hours of rounds without pausing or sitting down. Suddenly, after rounding in one patient room, she would “start to feel so dizzy that if I did not sit down, I felt like I was about to pass out,” she said.
By the summer of 2021, Dr. Grayver's longer-term symptoms were gone, and she had fully resumed her exercise routine. But her personal experience with COVID-19 has been brutal. Both of Dr. Grayver's parents, as well as her grandparents, became ill in the spring of 2020. Her grandfather died in April 2020 in her own hospital's intensive care unit. “In my own hospital, in my own unit, in my own arms,” she said.
A single parent, Dr. Grayver took every step feasible during the spring surge of 2020 to protect her 13-year-old daughter. While she parked her car after work, her daughter would leave a garbage bag outside the front door of their Queens home and Dr. Grayver would nearly completely undress outside before racing for the shower.
Then, a few days after she tested positive, her daughter did too. Thankfully, her daughter's symptoms were mild, she said, but that did not assuage her guilt. “The worst feeling in the world,” she said. “I really just wanted the earth to open up and swallow me whole.”
As of November 2021, 15 months after he was infected, Dr. Siegelman still was not working full-time, could not taste his food, and lived with ongoing symptoms including “brain fog and dizziness which come on with any sustained physical or cognitive exertion,” the 41-year-old physician wrote in an email.
Dr. Siegelman's ongoing symptoms also have shifted his professional perspective regarding chronic illness. “I look well but do not feel well, much like many of my patients,” he wrote. “That does not mean that there is nothing wrong or that a physician should psychologize my symptoms, assuming they come from mental illness. Hopefully, my patients will benefit from my new perspective.”
Similarly, Dr. Grayver said she has become even more attuned to listening to her patients' unusual symptoms. “I think the one thing that this illness could have taught me is that we have to think outside of the box,” she said. “We can't dismiss weird or vague symptoms as just nothing.”
Dr. Garcia, who was back to work after a month, said that she has been open about her COVID-19 encounter as she's treated COVID-19 patients.
“It's not going to make their COVID go away,” she said. “But I think it does help them at least maybe feel a little bit more at ease that here is someone in front of them who survived this thing, got through it, and is now telling them about it.”
But it is certainly not an experience that she ever wants to repeat.
“I've had the flu two or three times in my life, but I have never been as sick as I was with COVID,” Dr. Garcia said. “It was like night and day.”