Sandra Pearce, M.S., R.R.T., of Mecklenburg County, has been on the front lines of caring for adult patients with COVID-19 since the beginning of the pandemic. She’s been a respiratory therapist at VCU Health Community Memorial Hospital in South Hill, Va., for 35 years and was recently promoted to respiratory supervisor.

Pearce sees COVID-19 patients from the moment they arrive in the emergency department and throughout their hospital stay. Here, she describes the three stages of COVID-19 she witnesses everyday among her patients, depending on their ability to fight the virus. Please not that not everyone experiences these same symptoms.

Stage 1: Flu-like symptoms

Stage 1 is the early viral response. Symptoms range from mild to severe and may include fever, chills, cough, shortness of breath, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion, runny nose, nausea or vomiting, and diarrhea.

"Forty-seven percent of people are asymptomatic, which is a major problem for unknowingly spreading the disease," Sandra said. "It can take anywhere from two to 14 days for symptoms to appear, which explains the need for quarantining after exposure."

If you experience these symptoms, visit the Virginia Department of Health for a list of COVID-19 testing sites near you. Seek emergency medical care for difficulty breathing, persistent pain or pressure in the chest, confusion, inability to stay awake, and pale, gray or bluish-colored skin, lips or nail beds, depending on skin tone.

Stage 2: Pneumonia/respiratory symptoms

Stage 2 is when the virus moves into your lungs and causes pneumonia. This is the critical stage where you must watch closely for trouble breathing, chest pain and confusion.

"When you’re constantly coughing and can’t take deep breaths, your oxygen level can decrease," Sandra said. "If the oxygen saturation in your blood is not at a satisfactory level, you will be admitted, and we’ll start treatment."

Respiratory therapists work closely with hospitalists and pulmonologists to treat COVID-19 patients. They will try to increase your flow of oxygen first with non-invasive equipment similar to what some people use at home for sleep apnea. You can also perform breathing exercises and receive anti-virals, steroids and other medications deemed appropriate by your doctor.

"Our pulmonologists, Dr. Shivaram and Dr. Adarkwah, do everything they can to keep patients out of the ICU unless medically necessary," Sandra said.

In addition to pneumonia and other severe respiratory problems, at this stage you might require emergency care for blood clots. If you can't walk across the room without getting winded, seek emergency care immediately. The Emergency Department physician will order blood work and other tests to determine the proper treatment for your condition.

Stage 3: Organ failure

Stage 3 is when your lungs go into a hyperinflammatory response, which can lead to sepsis and organ failure. "This is when we call your family because it may be the last time you're able to talk to them," Sandra explains.

If you require a ventilator, a long tube will be inserted into your trachea, in addition to multiple IVs and catheters. Pressure can build up in your lungs, requiring the insertion of a chest tube through your ribcage.

Sandra notes that at the beginning of the pandemic, CDC statistics showed that only one in 10 patients on ventilators survived. Of those who did, many required rehab and home oxygen.

"I've cried," Sandra admitted. "It's hard to watch when they are close to the end. So, when patients do recover and are discharged, it gives hospital staff a big boost of morale."

Dealing with the stress

How does Sandra deal with the stress after 18 months of caring for COVID patients?

"I relish my days off," Sandra said. "I enjoy relaxing at home, cooking and spending time with my family and friends."

Sandra still orders her groceries for pickup and wears a mask in public indoors. With the positivity rate in the Southside Health District still at 11%, she's not taking any chances.

The best way to prevent COVID-19 is to wash your hands, stay 6 feet apart, wear a mask and get the vaccine.

"I'd recommend everyone, with few exceptions, get the vaccine," Sandra said. "After seeing what I see every day, and the fact it can be prevented, I just wish people would understand."

Since July 1, 51% of the patients admitted to VCU Health CMH with COVID have been less than 60 years of age. Of those who died from COVID since then, 38% were less than 60.

To find a vaccination location near you, visit www.vaccines.gov or call 1-800-232-0233. You can also text your zip code to 438-829 for a list of vaccination sites near your home. Vaccination is free!