PHOENIX — Charlie Aragon never thought COVID-19 could get him. At least not in the way that it did.
Aragon, 35, lives on the Gila River Indian Reservation in Arizona, and is employed by the tribe as a compliance officer. He shares a home with his parents and his 5-year-old son.
Pictures taken prior to his illness show Aragon had the physique of a bodybuilder, a testament to his favorite activity: weightlifting.
Aragon has always been devoted to gym workouts that include bench presses, squats and dead lifts and kept up a high protein, low carb diet.
But he's not lifting any weights right now, and most of his muscle tone is gone. All he can muster are daily walks near his home.
Aragon lost nearly 60 pounds off his 5-foot-9, 247-pound frame when he was in the hospital and though it's been two months since his release, he still struggles with weakness and has not regained all the weight he lost.
"I was the last person I ever thought would get sick from this," Aragon said.
Phoenix critical care physician Dr. Jennifer O'Hea, who treated Aragon at Banner — University Medical Center Phoenix, said she's found that recovery times for people who have been seriously sick with COVID-19 are lengthy — in general at least three times as long as the patient was hospitalized, if not longer.
"We're just starting to see some studies come out about the neuromuscular complications of this illness. We are definitely seeing patients with profound weakness," O'Hea said.
"Certainly a lot of it is because our patients end up being on a ventilator for weeks and weeks. But I think that there will probably be something special about this illness and the amount of weakness that it leads to for our recovering patients."
Aragon became ill in the early stages of the COVID-19 pandemic in Arizona and believes he caught the virus from a co-worker in his office who tested positive, though he did not find that out until after he got out of the hospital. He's not aware of any public health official ever notifying him of his co-worker's illness via contact tracing.
Because he's in his 30s and does not have any underlying health conditions, Aragon did not think he would get seriously ill.
At worst, it would be a few days in bed with a cough and maybe a fever, he believed.
People over the age of 65 are more likely to die from COVID-19. As of Monday in Arizona, 73% of the state's 1,809 known deaths from COVID-19 had been in people over the age of 65.
As of Monday, 116 people in Arizona ages 44 and younger had died from the novel virus, which works out to about 6% of all known deaths, data from the Arizona Department of Health Services shows.
But doctors and nurses in Phoenix hospitals have reported an increase in younger patients in their 20s, 30s and 40s, including in ICUs.
24% of hospitalized Arizona patients have been 44 or younger
While it's common for critically ill COVID-19 patients to have underlying health conditions, particularly diabetes, obesity and hypertension, Aragon did not have any of those. He'd never been hospitalized before and was rarely sick.
"We know that people of all walks of life can get very bad viral and bacterial pneumonias, whether that is from influenza or bacteria in general. We see it every flu season with very healthy, young people. So we weren't surprised to see that COVID-19 also was not discriminating," O'Hea said.
"We're seeing all kinds of patients Charlie's age and younger, medical problems or not. We have had several post-partum patients. As I said, this virus is not discriminating at all."
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Of the 5,161 Arizonans who as of Monday had been hospitalized for COVID-19-related illness since the beginning of Arizona's pandemic, 24% have been under the age of 45, the state's numbers say.
Vice President Mike Pence, Gov. Doug Ducey and the Arizona Department of Health Services director all targeted COVID-19 messages to younger Arizonans during news briefings last week.
Their point was that while younger people are less likely to get seriously ill from the virus, they could inadvertently spread it to others who are vulnerable.
"We issue a particular plea to young people," Pence said Wednesday during an appearance at Phoenix Sky Harbor International Airport. "I was informed today by the Maricopa County Department of Health that more than 50% of all of those who are testing positive in Maricopa County are under the age of 35.
"I’ve got three 20-somethings in my family, and I know that no young person here in Arizona would want to inadvertently expose a grandmother, or a grandfather, an elderly neighbor, a mom, or a dad to the coronavirus," the vice president said.
Yet as Aragon discovered, spreading the virus to others is not the only concern for people in his age group.
His symptoms began in mid to late March with an overall feeling like he was coming down with something, maybe a cold. Then he lost his sense of taste and smell.
He was sure it wasn't COVID because he hadn't read that losing taste and smell was a symptom. He'd read about fever, shortness of breath and a cough. But he didn't immediately have any of those hallmark symptoms.
He stayed home from work and went to a community health clinic, where he got ibuprofin and an inhaler. But he got worse. About a week later, he went back and got tested for COVID-19. Two days after his test, he found out he was positive.
"Once I tested positive, they said to quarantine and if it gets worse call 911," he said. "I was still taking the ibuprofin and using my inhaler but it was just extremely difficult for me to walk from the bed to the bathroom. Even to brush my teeth it was really hard. It felt like I was running out of breath. Man, it felt like I was doing cardio."
He ended up calling 911 on April 2, told the paramedics he'd tested positive for COVID-19, and was admitted to Banner — University Medical Center Phoenix.
"It was very strange. I didn't know what to expect," he said.
He spent 20 days there, including two weeks on a ventilator. At one point he developed sepsis, which is a life-threatening condition that starts when the body has an extreme reaction to an infection.
Without quick intervention, sepsis can lead to tissue damage, organ failure and death, the U.S. Centers for Disease Control and Prevention says.
"He did have a bout of sepsis and that is not uncommon. Especially when the patient is on the ventilator. Their risk of ventilator-associated pneumonia goes up," O'Hea said. "Just being in the ICU, having multiple catheters in your body, patients are at risk for those catheters getting infected, too."
Clot-busting drug used for treatment
When Aragon was hospitalized, providers were not commonly using convalescent plasma for treatment, nor were they making use of Remdesivir, which is showing promise in treating patients now.
What they did use was tPA — tissue plasminogen activator — a clot-busting medication commonly given to people who have suffered from an ischemic stroke.
"There's probably something to the fact that these seriously ill COVID patients are forming blood clots in their lungs," O'Hea said.
"The day we gave it (tPA) to him we spoke to his family and just said, 'Listen he's very ill and we're worried he could die and we want to try tPA for this disease knowing the risks and hoping it will get him better.' And it did."
Health care providers also used steroids and antibiotics to treat Aragon.
"We've been using steroids on our COVID patients from day one," O'Hea said. "We saw some early data coming out of New York and Italy using steroids for COVID-19 that we thought, you know, we should get going on our patients right away."
There was no Remdesivir, an antiviral, to treat COVID back then. Convalescent plasma — plasma from someone who has developed antibodies to COVID-19 — is now being used as a treatment but also was not widely available in April.
Aragon's most critical day was April 6, two days after he was intubated, O'Hea said. Intubated means inserting a tube into a patient's mouth and airway so that they can be placed on a ventilator.
"He was in pretty bad shape that day," she said. "He was on the ventilator and he was on maximal oxygen, so he was on 100% oxygen from the ventilator, he was really getting as much support from the ventilator as we could give him."
Placing a patient on a ventilator is an invasive measure that doctors try to avoid, O'Hea emphasized.
"Doctors have never been very apt to put someone on a ventilator unless we feel we really need to," O'Hea said. "We know that there are risks of putting people on ventilators and that includes new infections. Even before COVID, it was never something we took lightly."
People on ventilators need sedation so that they can tolerate having a breathing tube, and their situation becomes more complicated to manage, O'Hea explained.
Aragon, who had never been hospitalized before he got COVID-19, recalls waking up once while he was on the ventilator and trying to get out of bed but mostly he was drifting in and out of consciousness. He remembers very little of that time.
He does have one recollection of what he describes as out-of-body experience while he was hospitalized. Out of the side of his eye he could see someone and he wondered who it was, since he wasn't allowed visitors. Then he realized it was himself he was looking at, lying in a bed, hooked up to breathing apparatus.
"At that point I knew something was wrong and something inside me told me I had to fight," he said. "Then I started praying and that was kind of my out-of-body experience. I've never had any experience like that before. It was scary. I didn't know what was going on but it didn't feel good."
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Aragon doesn't remember the moment when he was taken off the ventilator. All he knows is when he woke up and no longer had a breathing tube, he had trouble talking. He had to write on a notepad to communicate with hospital staff.
"Maybe it was from the sedation or the medication but my head felt like it was 100 pounds and I couldn't lift it," he said. "Once I was in the recovery room I couldn't stand up for longer than a few seconds before I started to get winded and my knees were shaking and I felt like I was going to fall down."
The act of standing up and sitting down just once took so much energy that he would require a nap.
"I go on walks now in the afternoon. That's just to build my legs back up so that I can start moving around again and I can start getting back to somewhat of a normal life," he said.
The last time Aragon was tested in May, he was still positive. But he's hoping to get another test soon. If it's negative he wants to donate his plasma to help treat other COVID patients.
"I would like to do everything I can to help people who are ill," Aragon said. "This is way worse than the flu. ... I had pneumonia. I had sepsis, respiratory failure."
So far Aragon's mother and son have not contracted the virus. His father was ill with COVID-19 and was hospitalized for a week but never became as sick as his son. He has since recovered.
"The severity of the virus is so bad for some people. I think over the next few years we'll learn more about why certain people are getting sick and why some people get mild cases," O'Hea said.
"I think there's probably a lot of genetic predisposition that we don't yet understand."
Aragon is looking forward to a time when he can go back to the gym and take his son to Dave & Busters to play video games. He also wants to take him on trips to Disneyland and Legoland.
But he's constantly hearing about more cases among tribal members, and he's watched as the state's numbers continue to rise. He said he hopes his story helps to educate other people that the virus is real and can be dangerous.
"While I was in (the hospital) the palliative team had called my family and they had told them basically, 'What do you want us to do if he passes or if things get worse?'" Aragon said.
"I know usually the palliative team doesn't call unless it's really serious."
Follow the reporter on Twitter @stephanieinnes.