A month ago, Mohammad Akram was driving his taxi around the streets of London. Now, after Covid-19 ravaged his previously healthy body, he struggles even to lift a pen.
Sitting up in bed in the intensive care unit (ICU) at Northwick Park Hospital, Mr Akram, a 53-year-old father-of-three, is just beginning the painfully slow process of recovering from coronavirus.
Unable to speak thanks to the tracheostomy feeding oxygen into his lungs through a hole in his neck, he begins to write on a little whiteboard held up by a physio, who asks how he is feeling today. “Ok but tired,” he writes.
Mr Akram was admitted on Jan 19 and spent over two weeks sedated and on a ventilator. Over the past couple of days he has emerged from an induced coma, been weaned off the sedatives and had his ventilator swapped for a tracheostomy.
Mr Akram is one of the lucky ones. Though he is still in intensive care and continues to require respiratory support, he is making good progress and staff say he seems sharp, which isn’t always the case for Covid patients.
He is beginning a programme of rehabilitation – learning how to move his limbs again, building strength, and regaining his balance by being helped to stand for a few moments at a time by his bed.
The road to recovery after ventilation is long and gruelling.
Most people are left with physical and cognitive impairments, with some regaining strength and clarity quickly, while others suffer longer lasting effects.
Ioan Morgan, a specialist neurological physiotherapist, explains that when people emerge from sedation they are often delirious, “either from the drugs, the period of time in hospital or the effects of Covid itself”.
“If you’ve ended up in ICU, your recovery is going to take a while. It takes a long time to recover from an ICU stay, regardless of the reason you ended up there.”
Some Covid patients, he says, experience “longer-term cognitive impact” and require help “getting used to thinking straight”.
Gemma Korff, a specialist respiratory physiotherapist, says we “don’t actually know yet what the long-term effects of Covid are”.
“We’re only 12 months from our first case, so the next 12 months are going to be critical in seeing what the survivorship long term is, but also what long-term impairments these patients have.
“It’s not uncommon for someone who has had a long ICU stay to struggle with a cognitive impairment for some time after their admission. But some of the characteristics from Covid seem to amplify that.”
Mr Akram, from Harrow, is well enough now to FaceTime his wife and three sons. He can’t talk, but can mouth to them and wave.
He looks exhausted, and is clearly finding it frustrating not being able to communicate. “I want to get rid of this,” he mouths, gesturing at the many tubes coming out of his body. “I want to speak.”
In the first wave, Northwick Park was the hardest hit hospital and the first to declare a critical incident when they came close to being overwhelmed.
Last year, the whole hospital was reorganised to almost exclusively treat Covid patients.
Now, occupational therapists and physios who were previously redeployed to be an extra pair of hands on Covid wards can bring in their usual specialisms to help rehabilitate patients.
“Within that first wave it very much felt like for the first couple of months it was just firefighting,” says Mr Morgan. “To start to have a bit of a chance to do therapy with people to help them start to get better is quite a nice turn around.”
In a second Covid ICU, 47-year-old Ahmed Bariz is a little further ahead in his recovery. A valve has been fitted in his tracheostomy so that he can speak, and he is sitting in a chair.
His speech is laboured and he coughs frequently, apologising as he gasps for air.
“When I woke up, once I got all my senses back and the medication went out from my body, I was afraid of asking them what damage had been done,” he says.
“I didn’t dare ask because when they put me to sleep I had these nightmares that my lungs were all gone, that they would keep me on a machine.”
Mr Bariz’ entire family, including his wife, three young children and elderly mother, all got Covid just after Christmas.
Mr Bariz, who owns grocery shops, was admitted to hospital on Dec 28 and ventilated five days later. While his family recovered, he lay in a coma. His wife only found out he had been on a ventilator a couple of days ago, as before going under, Mr Bariz had phoned and begged his brother not to worry her while she was sick too.
He describes the ventilator as a form of “torture”.
“I said to my wife when I die I want to have a quick death, not end up in the hospital with breathing problems. The ventilator is a foreign body. They are fantastic, they keep you alive, but the last few days it was torturing me. All night. It was torturing me.”
After more than 20 days in a coma, and a few more spent slowly coming to, Mr Bariz is beginning to improve.
The rehab team does daily exercises with him, getting him to do simple things like raise his arms above his head, or move a cloth in a circle on his tray table, first clockwise, then anticlockwise.
It takes Mr Bariz a moment to work out what the instructions mean, but slowly he begins to move. “Look what Covid has done to me,” he says. “I was like a spring, faster than anything. I would walk for hours and hours. Now I have become like a baby. I cannot even move things.”
As the second wave finally shows signs of dipping in the packed intensive care wards, staff say this wave was different, with many of the patients much younger than in the first one.
“It is a lot younger this time,” says Helena Whitfield, a specialist occupational therapist, who says the youngest patient she has seen in ICU was just 25.
“There’s a 30-year-old lady I was helping out with on Friday. One of the nurses said she’s a YouTuber.”
It’s why continued rehabilitation (even after they leave hospital) is so important, she says. “So many of them are working age adults.”
Additional reporting: Heathcliff O'Malley