This week I will be addressing post Covid complications. I think I looked after the first (known) patient at my hospital with post viral delirium due to Covid. It was a rather scary experience as the patient, who will remain anonymous, was usually healthy/non-elderly. Delirium is a dangerous condition in which a persons mental state is altered. This means people can be confused, disorientated, aggressive, restless, incoherent and/or unengaged. Delirium can be due to infection, sepsis and pain. It can also be from other reasons like hypoxia, recent extubation etc. Despite the cause, it is most likely always a sign someone is unwell.
In this particular situation, the patient was experiencing delirium as a viral complication due to a previous infection of the Corona Virus. Delirium is very serious and it can lead to an increase in the chance of mortality. It can also mean patients hurt themselves and do not tolerate treatment interventions they desperately need, such as cannulas, IV fluids, IV antibiotics and oxygen that they may need to reverse the delirium! My patient was being violent, throwing things around the room, trying to turn on the defibrillator in the room and spitting at staff. They needed to be sedated in best interest i.e. for cooperation in care so they were not a danger to themselves and would tolerate the treatment.
More Post Covid Complications
Other post covid complications I have noticed is many patients attending the emergency department with chest pain. When this happens the patient has blood tests, ECGs and chest Xrays (the appropriate investigations). If diagnostic test results show the persons life isn’t in danger from things like an MI (heart attack) or a PE (blood clot in the lungs) or severe sepsis/pneumonia/covid etc affecting the body; and the persons observations are stable i.e. oxygen saturation levels adequate without supplementary oxygen, then the person will be discharged. The doctors inform these people, who experienced Covid a few weeks/months ago that they are experiencing pain from the effects Covid has had on their lungs and it could take weeks to months to resolve.
I have also encountered many patients who are experiencing Covid 19 symptoms saying ‘do you get many people with Covid in this hospital?’, and are worried about catching it in hospital when it is most likely they already have it. Many patients are also wearing gloves, touching their phone, using public transport and touching their face with the same gloves. Thus causing much cross contamination. The importance of following guidelines such as hand-hygiene is important to note here for infection prevention and control.
Innovation within the NHS
Covid has necessitated a lot of innovation within the NHS. Rapid Covid test swabs are one of the newest pieces of innovation I was excited to see rolled out. A limited number of these are now available in some A&Es for testing for patients who fit a tight criteria. For example, for patients who are at risk of becoming particularly unwell from the Corona Virus and need to be ‘shielded’ from Covid in hospital. This includes people who are immunocompromised, have diabetes or may be on chemotherapy.
Ideally, these patients need to be in a ‘non covid area’. The difficulty lies when these people need to be admitted to wards. However, they have presented with symptoms in which Covid cannot be ruled out as the cause of their illness. They also could have post covid complications. Therefore these people cannot go to wards where they could potentially pass Covid 19 onto other people. There is also a limited number of side rooms available in the hospitals as most of them are already occupied by similar patients.
The Rapid Covid swab machine technology is helpful here. As it results in 1 hour, it can dictate if patients are suitable to go to a Covid/Non-Covid area. This saves from breaches in A&E. (Find out what a breach is here)
There has also been the opportunity to have asymptomatic testing for all patient facing staff in the trust. Thus, allowing data collection on Covid 19 prevalence among healthcare staff without symptoms. This means preventing staff working with high risk patients such as on chemotherapy/cancer wards unknowingly spreading Covid to vulnerable patients. If any of the asymptomatic staff test positive for Covid they are to follow self isolation protocols as usual. There is also the opportunity for me to take part in a vaccine trial if I wanted to! I am not taking part in this trial however I am excited to hear more about it. Especially since it is beginning to look like social distancing will continue until a vaccine is found. So I am very much hoping there will be scientific advancements regarding vaccines quickly!
Antibody tests are another thing I am eager to try. I had Covid symptoms in early February. However this was before it was prevalent in the UK and I really want to know if I have had the Corona Virus or not as knowing this would make me feel less worried about catching Covid at work.
In conclusion, as we approach the 10th weekly #ClapforCarers this Thursday I think it is important to reflect on what the NHS has achieved during these times. I have seen an incredible amount of innovation and change in the past few months and I am incredibly in awe of everyone who made it happen and adapted to it so well.