Hey.
Hi, Dr. Hardin, how's it going?
- It's good, how are you?
Good to see you. I'm wonderful.
Nice to see you as well.
So now that you've joined us,
I'm going to welcome everyone once again
and again my name is Steve Mizek,
I'm a social media specialist at Rush.
Today I'm going to be talking with Dr. Abigail Hardin,
who is a rehabilitation psychologist at Rush
and the author of "The COVID Survival Guide."
Dr. Hardin and again, thanks for joining us.
To get things started,
tell us a little bit why you decided to write the book.
Yeah, so during the beginning of the spring pandemic,
we were seeing a lot of COVID survivors
going into our Rush rehabilitation units.
And in fact, at one point in the spring pandemic,
we actually were only seeing COVID patients.
And as I was treating these patients
and helping them get home to their families,
and trying to get them back to work and back to their jobs,
it was becoming more and more clear to me
that survival was really only the beginning of all of this
and that there was going to be a very significant amount
of long-term recovery post-COVID
that folks were going to have to have to deal with.
And so I realized looking around the country
that there wasn't yet a good infrastructure
for post-COVID clinics.
There wasn't yet a rehabilitation psychologist
in every hospital.
And so I wanted to write something
that people could take with them through this process
almost as if they had a rehabilitation psychologist
in their pocket to take with them through the process.
And so that's why I wrote the book,
because I knew that it was so new
and there were few resources out there for folks.
Sure.
And so what's the general structure of the book?
What are the main topics that you're discussing?
Yeah, so the book talks a little bit at the beginning
of just the basic stuff that I think we all know by now,
how to protect yourself, the basic CDC recommendations.
But then the rest of the book really focuses
very much on what to expect if you do end up with COVID
and if you do need to go to the hospital.
And then how to make the most
out of your time in the hospital,
how to get the best care, how to work with the physicians
and the other team members that you might be working with.
And then how to approach the recovery after survival.
I use the phrase, "Survival is just the beginning,"
and it really is.
Surviving COVID is really just the opening gate
of this whole other marathon of recovery for a lot of folks.
And so I walk people through how to approach that,
what to expect in the different phases of rehabilitation,
and how to approach some of the cognitive
and emotional recovery that seems to go along
with COVID recovery.
Gotcha.
And so in the book when you talk about
what it's like to have COVID,
does there seem to be different outcomes
or symptoms for people who have to be hospitalized for COVID
versus those who are able to recover at home?
Yeah, yeah, it's a great question.
So the longer that we've been able
to see survivors come through COVID,
it's becoming clear that there are, in essence, two groups.
There's folks who have had what we call severe COVID,
meaning they had to be hospitalized
and they maybe were in the ICU itself.
And then there's this other group of folks
who maybe weren't needing to go to the hospital
and they had what we call mild COVID,
mild in the sense that they didn't need an ICU physician
overseeing their care quite seriously.
And they seem to be having different outcomes.
The folks who were in the hospital or in the ICU,
a lot of them are experiencing a common syndrome
associated with being in the ICU
called post-intensive care syndrome.
And that is a syndrome that includes
things like physical changes and weakness,
difficulty with cognition or thinking skills
and emotional concerns like depression,
anxiety, post-traumatic stress disorder.
So we're seeing a lot of that
with the folks coming out of the hospital.
And then for the folks who fortunately,
didn't need to be hospitalized,
they are also though, still having some long-term effects.
And those are the folks who I think
are referring to themselves now as long haulers,
not necessarily people who are in the hospital
but are still having very serious symptoms.
And so, yeah, there seems to be kind of two different groups
in two different pictures.
Gotcha.
And so what are the symptoms of long COVID, if you will?
Yeah, so I just talked a little bit
about the people who are coming out of the hospital
post-intensive care syndrome,
that really the three threesome symptoms of that
are physical body weakness.
So that can be difficulty moving around,
difficulty standing, even difficulty with small muscles
like the swallowing muscles.
It also can come along with cognitive changes,
like difficulty remembering,
paying attention, delirium being confused,
and then emotional changes like PTSD, anxiety, depression.
But then let's talk a little bit about the other people,
because there's this long hauler group
who don't have post-intensive care syndrome
but they're also reporting a good amount of
what they're calling brain fog,
kind of the sense that they're not quite moving
as quickly as they were before cognitively,
but also some emotional changes like depression or anxiety.
They're also talking about
what we call post-exertional fatigue.
That's getting really, really tired,
very, very quickly just doing something simple
like walking up a flight of stairs in your house
or trying to take your dog out to use the bathroom.
Those kinds of things are exhausting people
in a way that they weren't before.
So those kinds of symptoms seem to be together.
And that is very consistent with a type of disorder
that we already knew about called chronic fatigue syndrome.
Interesting, I didn't realize that those two
had an overlap, that's something new to me.
Yeah, it's really interesting because
we have known about chronic fatigue syndrome for decades.
It's something that we know can come along
with post-viral syndromes.
And it seems to be,
it seems to have a lot in common
with what the long haulers are expressing.
And of course there's some uniqueness to COVID,
especially with how much it affects the respiratory system,
but the other symptoms, the cognitive fatigue,
the physical fatigue, some pain, the depression,
all of that seems to be very consistent
to chronic fatigue syndrome.
And so after someone does survive COVID,
what is the recovery process typically like?
Is it a gradually sort of decreasing thing
and how long does it usually take
for those symptoms to start fading?
Yeah.
So after someone is in the hospital with COVID,
the first step is to determine if it's safe to even go home.
So if you're not able to do things like get to the bathroom
or make yourself breakfast.
Those are things that you have to be able to do
in order to be able to be safe in your own house.
So if you're not able to do those things
because you have very profound weakness,
then it would be appropriate
to go to an inpatient rehabilitation floor,
which is what a lot of these folks ended up doing
and that's how I came to see them.
So that usually lasts for a couple of days
to a couple of weeks where you're getting
almost like bootcamp therapies to get stronger
to the point where you can be safe at home.
But then the journey really doesn't end there.
So even after you're discharged
from the intensive rehabilitation program,
you might have another several months
of outpatient therapies or home health therapies.
So we're talking about a period of time
that can extend for weeks to months, not days,
for these folks who were in the ICU.
Now, some get lucky and that's not necessary,
but for quite a few folks, that's the timeline.
And so Rush recently launched its post-COVID care clinic
which you're involved with,
for people who were still experiencing symptoms
after being infected.
Tell us a little bit how you're involved
with that clinic exactly.
Yeah, so I am just so excited about this post-COVID clinic.
So there are COVID clinics popping up all over the country
because of the tremendous need
and because these long haulers have been
such good advocates for themselves
in trying to get their needs addressed
and that's appropriate.
So what was really exciting about the Rush COVID clinic
is that it is multidisciplinary.
And what I mean by that is there are lots of different kinds
of physicians, doctors, providers,
who are all coming together so that any given person,
whether they were in the hospital or not,
can get their whole body addressed.
So they've got a nephrologist,
pulmonologist, a cardiologist,
basically any part of the body you can think of,
they've got an expert in it.
And that includes cognition and emotions,
which is very, very cool
because as we know in the US health healthcare system,
there isn't always a strong focus on thinking and feelings,
those sometimes get left in the dust.
So that's exciting.
So my part of that is as the psychologist on that team.
So I meet with folks and I take their brain out
for a little cognitive screen
or a little mini test drive, if you will,
to see how their brain is healing.
And then I also talk to people
about the emotional effects COVID
and how to start putting their lives back together
in a way that is healthy and kind of taking it slow,
one day at a time, but also is going to get them
towards their individual goal,
whether that is going back to work
or just kind of getting back into the swing of things
with parenting, whatever that looks like.
And interestingly, to dovetail off that,
what are the the risks of trying to recover
from something like COVID without the help of a psychologist
or paying attention to mental health?
Yeah, I worry tremendously about this.
So there are certainly folks who can recover
on their own and who won't need to see a psychologist.
Maybe they have family support,
maybe they've got other resources that they can use.
But then again, I also have seen,
any kind of critical illness
or any other kind of long-term symptoms
that are not addressed can really derail people.
For instance,
I've seen folks never really get their cognition tested,
but start to feel fuzzy or to feel foggy.
And as a result, they start making errors at work
and maybe they get let go
because they didn't have the knowledge
of what was going on in the brain and how to compensate it,
compensate for it so that they could be successful
going back to work.
I've also seen marriages fall apart.
I've seen, people slipping into depression
and really not be able to get themselves out of it.
And all of these things, it can affect families right now
but it can affect families for generations.
These kinds of serious illnesses
can really derail communities, families.
And so
I think my message that I repeat a lot
is that if you're having emotional concerns
or cognitive concerns,
the head is connected to the body as part of your body.
So if that's part of what you're feeling,
then that needs to be addressed too.
And I'm so glad that the Rush COVID clinic
is including that because it is so important.
And so, when would someone consider
going to a clinic like this,
like what would be the threshold
that they would want to do this
versus maybe just seeing a psychologist
on top of recovering at home?
Yeah, that's a good question.
So if you have access to a psychologist
like let's say you were already hooked up with a therapist
and you've got a really good relationship with that person
and you trust them,
then you can certainly bring your post-COVID concerns
to them as well,
and that might be a great place to start with that.
I always think about this in terms of function.
So the questions I ask are,
"Have you had any trouble getting back to work?
"Are you having any trouble in your relationship?
"Is this affecting you in a way
"that it's making it difficult for you to do the things
"that you want to do?"
And if any of those are the case,
then it is a good time to go get seen in a clinic.
Gotcha.
So now we're going to move on
to a couple of the frequently asked questions
that you've received in combination
with some of the questions we received through Instagram.
Thank you, by the way, to everyone who submitted those.
So first, COVID's very new,
but is there any research on past viruses
that can help us help COVID survivors
understand what they're going through?
Yeah, I talked a little bit earlier
about post-intensive care syndrome
and chronic fatigue syndrome.
So those syndromes are really, really useful to us now
in understanding COVID.
Because they've actually,
we've known about them for a very long time.
So chronic fatigue syndrome is one
that is really fascinating.
And chronic fatigue syndrome tends to show up
after some types of viral infections,
just things as simple as the flu
can cause it for some folks.
And it seems to just disregulate the body
in such a way that people have long-term effects.
And I think that's a kind of exactly
what we're seeing with COVID.
So on the one hand,
I think survivors of COVID are really unique,
but on the other hand,
we're not really starting from zero here,
we actually have lots and lots of literature
on how to treat chronic fatigue syndrome.
We have some initial evidence
about what works and what doesn't work.
And so that's kind of where we're starting.
So these clinics have some background literature
that they're leaning on.
And then with the folks coming out of the hospital
with post-intensive care syndrome,
that's one that is just very clearly reflected
in the literature.
It's something that we saw after SARS
in the early 2000s.
It's something we see with severe flu.
We see post-intensive care syndrome really
with any kind of serious illness
that will bring someone to the ICU.
So both of those are really helping inform
all of the research and all of the treatments
that are being provided now within the COVID clinic.
Gotcha, and when someone's recovering from COVID,
are there any things that people can do
to sort of mitigate the symptoms that they're experiencing?
I know we talked about understanding them as a big thing,
but people talking about the loss of smell
or the brain fog or the body aches,
is there anything that people can do to help cope with that?
Yeah.
Well, so to start with,
there's a few things that they can do actually
while they're even still in the hospital
to help mitigate some of those symptoms.
Those can be really simple things like
making sure that you've got your glasses
and your hearing aids.
Making sure that you are staying on the phone
and FaceTiming with family members and friends
so that you're really getting support
and staying grounded through the process.
Then after survival, yeah, there's quite a few things
that we can do for the chronic fatigue syndrome/ long COVID
that people are experiencing.
One of them is
a process called pacing,
in which people start low and slow,
but kind of commit to doing a certain amount of activity
per day as long as they're cleared by their physician.
One of the traps of chronic fatigue syndrome
is
almost having a great day and then overdoing it
and then falling into the trap of doing nothing the next day
and so you end up with these waves of activity.
And pacing tries to help the patient start to
do the same amount of activity a day,
and then slowly increase that over time.
So there aren't as many ups and downs in their activity.
And that seems to really help
with increasing your tolerance for exercise.
And it also seems to help
with clearing up the cognitive fog.
Great, I'm so glad to hear that there are things,
cause I think there's a lot of concern
that people are just going to experience this
and there's certainly not a lot you can do.
And for someone who isn't experiencing COVID
but maybe has a family member,
even if they can't go to the hospital,
what can they do to help someone who has COVID
or is recovering from COVID?
Yeah, yeah, so I mentioned a little bit before
that when someone's in the hospital,
there's actually some things that you can do
that are helpful.
One of the things that family members can do
is to call regularly or to get on some kind of video chat
and to check with the loved one
while they're in the hospital.
That does two things,
it, one, makes sure that they feel supported and cared for
during this extremely scary time.
And two, it can also help people
literally ground themselves in reality.
And what I mean by that is keeping track of who they are,
where they are, what's going on,
because this virus can cause
pretty serious inflammation in the brain
that can make people feel very confused, very disoriented.
It can even make them hallucinate.
And by getting that grounding regularly
from somebody who you trust and you love,
that can actually really help limit
how severe that disorientation gets,
which makes the ultimate recovery a lot better.
The other thing we always recommend,
is if you have young kids
and someone's in the hospital with COVID,
of course the kids can't come to the hospital,
but keep them involved.
They can actually feel very helpless
if they don't have something to do to contribute.
And so it can be really helpful to ask them to make posters,
make cards, sing a song over video chat,
just give them something to do to help them feel like
they're helping through the situation.
Yeah, that's great advice.
Well, we actually have to wrap it up,
so thank you so much, Dr. Hardin,
for taking the time to chat with us.
Where can people find your book,
"The COVID Survival Guide"?
Yeah, it's on Amazon.
Wonderful.
And you can do it as a digital and the physical book?
Yeah, you can choose.
There's a Kindle version and there is a hard copy version.
Awesome.
Well, I hope people get to check out your book.
It's wonderful and it's been providing great guidance
to a lot of people.
And I want to thank everyone for tuning in,
and this has been a wonderful first experiment
with Instagram Live for Rush.
Please stay tuned or go to Rush.edu
if you have any more questions
about the vaccine, about COVID.
Again, thank you Dr. Hardin for joining us
and thanks everyone for joining us.
Have a great rest of your day.
Take care.