Freddy Fernandez was almost not here, sitting on his couch in his Missouri home with his baby on his lap, gnawing on the pulse oximeter he uses to check his oxygen levels after a months-long battle with COVID-19.

Vanessa smiles as the girl works to cut two teeth on the device that Freddy wears like a necklace, a blue ribbon tied around it, months after being warned that her partner might never hold his daughter.

Freddy spent five months on the most intensive life support available in a hospital four hours away from the couple’s home in the southwest Missouri town of Carthage. The 41-year-old father of six almost died several times, and he, like so many others who survived COVID-19 hospitalizations, has returned home changed.

While more than 1 million people died from COVID in the United States, many more survived ICU stays that left them with anxiety, PTSD, and a variety of health problems. Research has shown that intensive therapy beginning in the ICU can help, but it was often difficult to provide due to hospital overcrowding.

Freddy’s memories of those long months come in snippets — moments when he regained consciousness, hooked up to machines that breathed for him, clinging to life. He occasionally asked for his mother, who died from COVID-19 in September 2020.

He missed his daughter Mariana’s birth and the first four months of her life. He might never be able to work again in construction. His other young daughter is terrified that he will go away again..

COVID-19 is not going away as the world changes and mask mandates fade away.

Vanessa, 28, was still pregnant with Mariana when the delta variant struck unvaccinated southwest Missouri last summer. She was skeptical of the vaccine, but after her obstetrician assured her that it was safe, she decided to get it.

Freddy was warming to the idea as well. The native of Mexico City had moved to the United States around 20 years ago to work in construction — primarily cement jobs — and was now a permanent resident. He would sometimes work from 5 a.m. to 8 p.m., and he would frequently work at least one weekend day. His throat began to ache on the day they planned to schedule a vaccination appointment in late August. COVID was the name.

Vanessa rushed Freddy to the emergency room at the local community hospital days later, when he was coughing and struggling to breathe. Despite his concern for his family, Freddy recalls thinking, “it’s only a little bit.”

But he had pneumonia in both of his lungs. The next day, he was transferred to a larger Springfield hospital, which was overcrowded, and placed on a ventilator. That, too, was insufficient.

He ended up in St. Louis, nearly 270 miles away from his two young daughters; Vanessa’s 10-year-old son, Miguel, who considers Freddy to be his father; and three other children with his ex-wife, 10-, 8-, and 7-year-old boys.

It was a dark period when many people hoped the pandemic was over, but the delta variant flooded the healthcare system once more. Filling shifts was a daily battle, and death was all around, Dr. Sermadevi recalls. At the start of the pandemic, she said, everyone was “stunned and astounded that this was even happening.” However, she claims that grief has a “cumulative effect,” and that by the time the delta surge arrived, “there wasn’t even room for those emotions.”

But Freddy was fortunate. ECMO, or extracorporeal membrane oxygenation, was in short supply during the delta surge, despite all the talk about ventilator capacity. When a ventilator is insufficient, it is used to pump blood out of the body, oxygenate it, and then return it.

Some of the most important factors in critical care recovery aren’t medical. Visits from family members, as well as physical, occupational, and speech therapists, have long been shown to make a difference for the sickest patients.