Many Covid-19 patients continue to need home care after they leave the hospital. Mary Blessington’s story illustrates how the road to recovery may involve u-turns, writes Dr. John Wright of Bradford Royal Infirmary.
We have already had our second peak – in nursing homes – and we know that the third peak is looking forward behind the scenes. Outbreaks often have a long, bumpy tail.
If you catch Covid-19, your risk of dying if you are over 80 is 15%. If you are under 50, it’s less than 1%. We have been slow to protect the residents of our care homes and far too many have died far too soon. But most of our seniors live independently, many of them alone.
Our new Covid-era NHS will need to adapt quickly to take care of them, as much as possible by keeping them out of hospitals, where the virus abounds, but also by caring for them when they come out as survivors.
In Bradford, we are fortunate to have an innovative team called Virtual Ward, which has been fulfilling this role for a few years. It’s almost like they knew Covid was coming.
It was a virtual room staff member who noticed that all was not well with Mary Blessington, after she was fired and returned to her loving husband, Michael.
Mary and Michael were both admitted to the hospital with Covid-19 the same day, after having probably gotten the virus during the funeral of one of their sons on March 16. They have been together since the age of 13 and, coincidentally or not, it was when they were placed side by side in the same room that they began to recover. (I wrote about it here.)
Michael was released first and the family was thrilled when Mary was allowed to go home a few days later.
But Elaine Martin, an advanced clinical intern who visited Mary at home, noticed that she still had difficulty breathing and was deeply concerned both for her husband’s health and for her own prospects. of recovery.
“She still had symptoms, she still felt short of breath and tight in the chest, but I think it was largely anxiety. She felt like she was going to die, and her husband had recovered but had an underlying condition, so there was a lot of anxiety, “said Elaine.
The decision was made to bring Mary back to the hospital – which was fortunate, because that night her condition worsened.
We thought she might only have hours to live, so Michael and the couple’s two surviving sons came to the hospital early in the morning, put on PPE, and sat with her, telling them see again.
But I’m happy to say that Mary has recovered again. She remains very ill and receives help for her anxiety, but we hope she is on the mend.
Mary is only 67 years old. We have had many older parents recovering from our Covid-19 wards, but there is good reason to keep the elderly out of the hospital if we can and send them home as soon as possible. it is safe to do so. so. For elderly patients, every day in the hospital results in “deconditioning”, a loss of physical and mental functioning. For some, the strange environment can cause delirium – a condition with symptoms ranging from drowsiness, confusion and disjointed speech to hallucinations.
The virtual room allows elderly patients to stay put in a familiar environment or quickly return to it – perhaps enjoying the company of a spouse, children or friends – while continuing to receive complex clinical care. Staff are available 24/7 and patients remain under the responsibility of the doctors who referred them.
“There are very important clinical reasons for people to be hospitalized, of course, but for many reasons, the elderly simply do better at home,” says Kate Moore, an occupational therapist trained to understand what equipment and adaptations frail people need it at home. after he got out of the hospital.
“People get weaker when they are in the hospital, there is incontinence, they do not eat or drink, all of these things seem to get worse for people when they are in a hospital bed, and especially in a world where people wear masks and they might make us feel very disoriented. So we try to reproduce the care of the room but in people’s homes. ”
Professor John Wright, doctor and epidemiologist, is the head of the Bradford Institute for Health Research and a veteran of the cholera, HIV and Ebola epidemics in sub-Saharan Africa. He writes this newspaper for BBC News and records from hospital rooms for BBC Radio.
- Listen to the next episode of The NHS Front Line on BBC Sounds or the BBC World Service
- Or read the previous online newspaper: Did VE Day Celebrations Spike in Covid-19 Cases?
With an aging population in the UK, many of whom live alone with chronic health conditions, many people need more help than local authorities currently provide – all political parties accept it. Reform has been promised for years. And now we also have to face Covid. The virus has disrupted the support networks on which some frail and elderly people depend and has increased their isolation.
“There is a huge problem and growing up around depression and loneliness, because people do less with family members. They probably don’t walk as far as before. The people we normally refer to as a group for group exercises are not going to group exercises. So people are weakening. So we’re going to see more falls, ”says Kate.
One of her patients, Phyllis Holmes, 81, fell and broke her wrist several weeks ago. Most recently, she developed a cough and diarrhea and was admitted to hospital with suspected Covid-19 – two warning signs seen in many elderly patients – but her swab returned negative. So she is back home, but coping alone is difficult.
“I can’t open my front door or open the faucets properly – I tried to open them and almost flooded the place,” she said. “I haven’t been able to wash my hair since March. I can’t open my pills because I can’t hold the bottle – my neighbors would help me in the past but they stay away because of Covid. “
Before the lockdown, Phyllis also got help from her daughter, but she too stays away in case she catches the virus at the supermarket where she works. The rest of Phyllis’ family isolates themselves for their own health reasons.
Kate says she will do wrist exercises with Phyllis and help her find ways to open the door and go out into the garden.
Another patient on Kate’s call list is Vernon Fearing, who is in the late 1980s.
Vernon came to Bradford from Jamaica in the 1960s to work on the railways. He has diabetes and recently had a minor stroke. A few weeks ago, when his blood sugar dropped, he was taken to the hospital by ambulance and treated. A week later, when he developed a high temperature, he was hospitalized again for an alleged urinary tract infection. But when it was tested, it turned out that it had Covid-19.
Vernon has been sent home to recover, but it is still contagious and it needs to be carefully managed.
“What we are desperately trying to do for him is just to make sure he is not weaker than he already is. He’s upstairs in his house. He can’t get off, so I’m taking him for a walk to see if it helps him at least get out of bed, “says Kate.
“I’m going to try to educate the family a little about the exercises they can do, partly for physical stimulation, but also for mental stimulation because obviously, with Covid, people sometimes have hypoactive delirium, which means as they become less active, they become very, very sleepy. “
If this happens, there is a risk that they will lose interest in eating and drinking.
The person who will help Vernon in his exercises is his granddaughter, Jodie. His wife, Carmen, is in her room, coughing – she is waiting for a test result that will reveal whether she is also HIV positive for Covid.
Vernon finds it difficult to speak. He says he wants to see the sun from his bedroom window, so Kate helps him get up and suggests that he dress every morning. She will try to get him tested again to find out if he is still infectious – which worries Jodie, who suffers from a disease that forces her to take medication to suppress her immune system.
“I can just count my blessings because I know there are many other families going through even worse, where they actually lost family members,” said Jodie. “And I just have to be thankful. I am grateful, even if it is not the best situation. “
Besides the two days she spent at home, Mary Blessington has now been hospitalized for six weeks. It is not just patients admitted to intensive care – like Mohammed Hussain – who need extended treatment for Covid-19. Nor is Mary the only one who returned to the hospital after her discharge.
When Mary feels better, she asks her son, Craig, to bring him food – a shrimp salad, a melon fruit salad or crisps – which he leaves at the hospital entrance to be taken to hospital. I heard good news Saturday morning that Craig was on his way to the hospital with a large lunch order.
When Mary finally leaves the hospital for the second and hopefully the last time, she will likely need additional home care for several more weeks. It will be the virtual room that will provide this, until its recovery is complete.