Middle eastern report: After 115 days in the Intensive Care Unit, Bangladeshi expat Abu Taher Ismail made recovery from COVID-19 miraculously, reports Gulf news. The 55-year-old Bangladeshi is probably one of the longest-term COVID-19 patients in the UAE who has been hospitalized while battling complications.
‘The patient, who is diabetic and hypertensive, had complications with his kidney during COVID-19 infection. In such cases, patients face 75 to 90 per cent mortality. So it is amazing to see him on his feet today and we hope he will only feel better and better with time,’ Abeesh Pillai, nephrologist at Lifecare Hospital Abu Dhabi, told Gulf News.
Indeed, Ismail’s battle with COVID-19 was an ordeal for him, and for his 20-year-old son and constant companion, Abu Bakr Siddique. The student said he had taken his father to Lifeline Hospital following 10 days of illness.
‘He had been feeling very weak for more than a week, and did not have an appetite. When he also began complaining of severe breathing difficulties, I took him to the hospital,’ Siddique said.
Severe COVID-19 symptoms
After an examination at the hospital, Ismail was immediately placed on mechanical ventilation, said Karthikeya Chinniah, emergency medicine specialist at Lifecare. The doctor said Ismail had classic symptoms such as fever and cough and his oxygen saturation was as low as 80. He had also complained of severe breathing difficulties, so he was immediately intubated.
At the same time, Ismail was given standard COVID-19 therapy, as directed by the UAE health authorities. This included 10 days of antiviral medicines and two doses of stem cell treatment, recommended for patients with severe COVID-19 symptoms. Placed under close monitoring, the care team noticed that Ismail had no urine output for more than 24 hours.
‘This was when he was transferred to Lifecare and we started dialysis,’ Pillai said. Ismail was, however, unable to bear the dialysis because his blood pressure had dropped a lot. The care team then chose to offer continuous renal replacement therapy.
‘CRRT is usually used on ICU patients who cannot tolerate regular dialysis. It’s a gentle form of cleaning the blood where dialysis is carried out 24 hours a day, unlike the three to four-hour washing of blood in regular dialysis. This offers the kidney a chance to recover. For Abu Taher, we provided 300 hours of CRRT, or about 15 complete days of the therapy,’ Pillai explained.
The CRRT allowed Ismail’s kidney a chance to recover and he finally started producing urine, which is the first sign of proper kidney function.
‘After about a week, his kidneys were functioning normally,’ Pillai said. Meanwhile, by the end of May, Ismail had also tested negative for COVID-19, and continued to remain negative. But he still remained sedated and dependent on ventilation. Siddique tried to visit his father every day, but was not always allowed in. ‘I was so worried. I could not see my father every day, especially as the COVID-19 restrictions tightened, but I tried to visit every day,’ he said.
Meanwhile, Chinniah said the care team had been trying to wean Ismail off the ventilator. ‘He had a tube through the mouth, and this was uncomfortable. So the patient needed to be sedated. He had not gained consciousness even after 30 days, so we performed a tracheostomy so that we could reduce the sedation and help him wake up,’ Chinniah said.
After about 10 more days, Ismail finally regained consciousness. Chinniah said he was initially delirious and extremely weak. ‘He needed fluid replacement and nutrition to overcome this state, which we call critical illness neuropathy,’ the doctor explained. The tracheostomy tube was removed when Ismail had completed about two months of hospitalisation. But the patient continued to receive physiotherapy and nutrition.
Only general updates
Siddique said he never had the courage to tell his mother, and two siblings, back home in Bangladesh about the extent of his father’s illness. ‘I would give them general updates about his condition at that moment, but could never muster the courage to tell them how sick he was,’ he said. The student also continued to weather the COVID-19 restrictions alone, having no one to talk to.
‘I was so afraid, and sad and scared. I had no one to talk to or confide in. I can only thank Almighty that my father came back to us,’ Siddique said.
Gall bladder rupture
After about 100 days of hospitalization, Ismail was finally deemed healthy for discharge. But just before he could be sent home, his gall bladder ruptured. ‘The patient was too weak, and his lungs could not stand anaesthetization again, so we used a pigtail catheter to drain the pus,’ Chinniah explained.
Finally, after nearly four months of ICU treatment, Ismail was discharged on August 31. His doctors said he was able to eat and walk on his own. But Siddique says his father, owner of a mechanical workshop who hails from the Bangladeshi coastal city of Chittagong, is still very weak.
‘I have to serve him food and do nearly everything. The whole thing has been an ordeal and my father wants to visit my mother and siblings as soon as he can. So we are now trying to sort out the details of his travel,’ the student said.
Long haul COVID-19 care
Pillai said Ismail, like other long-haul COVID-19 patients, will have to take special care. ‘Reinfection may occur for COVID-19 survivors, and the second bout can be even more complicated because of the toll on the body. So it is imperative that survivors follow all safety precautions, including mask-wearing, social distancing and sanitization,’ he explained.
In addition, survivors also have to take care not to damage organs impacted during the COVID-19 fight. ‘In Ismail’s case, he faced an ‘insult’ to his kidneys. So taking painkillers, for instance, could injure the organ further, and they must be avoided as much as possible. Other than this, proper nutrition, hydration and sleep are important for a full recovery, as is regular exercise for physical fitness,’ Pillai advised.