• Fear of quarantine is keeping patients from hospital until their condition is critical
• Many hospitals lack capacity for Covid-19 and distrust institutions, jeopardising lives
Image: FILE
My friend nearly died two days ago. It was a series of unfortunate events that led him to the ICU, where he is still admitted, and it all has to do with the coronavirus, or should I say, the fear of the coronavirus. Let me share with you his story.
He gave me a call three days ago and asked a question: What are the worst symptoms of the coronavirus? This has become a common question for me from my friends because I think they believe that all doctors can treat coronavirus.
I am an orthopaedic surgeon, so believe me, I am the last person you want treating you for coronavirus. But this is not commonly apparent to those who know me. Anyway, back to the story. I asked him why he wanted to know.
He told me he had been feeling unwell for last one week. He had a cough, some heaviness in the chest, and for the past few days, had been feeling extremely breathless when exerting himself, for example, when climbing stairs.
I advised him that he needed to come in to the hospital for an assessment so we could determine what was going on with him. He agreed but insisted that because he knew me, I should be involved in his care, and I agreed.
He came in the next day and I proceeded to examine him, taking the necessary precautions. I did a few tests, which showed he had a bacterial pneumonia. However, in the era of Covid, it was still advisable that he still do a test for possible Covid-19 infection.
His first question when I told him this was whether if he were positive he would be locked up in one of those places? I managed to convince him that even despite the risk of being “locked up”, it was still worth knowing the results.
And so he agreed to have the test, which was done at the Lancet laboratory. I started him on some antibiotics and advised him to stay home until the results were out. The results were out the next morning and thankfully were negative.
BAD TO WORSE
Despite the antibiotics and other medication, his condition worsened and I advised him that he needed to be admitted. Since Hospital A* (name withheld for legal reasons) on Ngong Road was close to where he lives, I advised him to go there. This was at about 11 pm the next day.
His girlfriend drove him to the hospital but upon arrival there and being initially screened and giving them copies of his test results, Hospital A proceeded to deny him admission.
I then advised him that he should go to Hospital B* in Westlands. Upon arrival there and despite once again giving his history and test results, the team in the accident and emergency department insisted on treating him as a possible Covid-19 patient and placed him in isolation as they proceeded to do another test for Covid-19.
The effect of this was a significant delay in the start of treatment as they waited for someone to collect a sample for the test. As he waited, they recognised he was desaturating and required supplemental oxygen. This was, however, several hours after he had arrived.
The sample was finally collected and around 3am, the managing team recognised he was really struggling to get oxygen into his body and decided he needed to be put on a ventilator. He was admitted to the ICU.
They were at this time still working under the assumption that he has a Covid-19 infection and, therefore, he was placed in isolation. His condition continued to worsen rapidly with the requirement for high flow oxygen and medicine to support his blood pressure, which was dangerously low.
The results for the Covid-19 test at Hospital B came back the next day, and was still negative. They, however, still insisted on testing one more time, this time from a sample which needs more invasive procedures to obtain.
At this time, his kidneys had started to fail, and in addition to being on a ventilator, requiring high flow oxygen and on support for his low blood pressure, he now required dialysis.
Fortunately, after dialysis, his kidneys opened up and he started to pass urine. The second Covid-19 test was also negative. Finally convinced this was not a Covid-related infection, the managing team at Hospital B started to focus on other possible causes for my friend's condition.
Now on the third day of treatment, he is still in ICU but has notable improvement, with less oxygen required, less support for his blood pressure and thankfully functioning kidneys. He is not out of the woods yet, but things are looking promising.
LESSONS LEARNT
There are some lessons I have learnt from my friend's story that I would like to share. First, there is a general fear most Kenyans have about being diagnosed with Covid-19. This is that they will be locked up in a quarantine facility.
They are, therefore, avoiding hospitals like my friend and only going when they get worse, which might often be when it’s too late.
We must encourage people to seek health services and reduce the stigma around being Covid-19 positive. We must also show these quarantine and treatment centres in better light to remove the fear of being admitted there.
Secondly, many hospitals have not set up the capacity to manage possible Covid-19 infections and are, therefore, turning away patients. This is, unfortunately, a fallacy because inevitably, they will receive patients who, though not initially having evidence of Covid infection, may end up being positive for the coronavirus.
They must enhance their capacity to receive and manage these patients and, if necessary, arrange for their transfer in a more organised manner.
The third thing I noted is that institutions don’t seem to trust each other. A Covid-19 test from Lancet, a very reputable laboratory, was not good enough for Hospital B, necessitating repeat tests that only delayed treatment.
Just to be clear, I am not saying that a repeat test was not warranted in this patient’s case, but once the second result came back negative, maybe this should have been enough to move on since a previous test from Lancet was already available.
Institutions must co-ordinate better and maybe develop acceptable common standards for the tests so they can be used in all treating centres without having to repeat them.
My fourth point is more of a question. How many patients out there are being misdiagnosed with Covid-19 when they have other conditions? As a result, how many patients may have been lost in the process who were suffering from conditions that could have been possibly treated as we wait for Covid-19 test results?
Covid-19 is going to be here for a while. Our healthcare system must adapt so that other illnesses are managed as we continue to manage the pandemic, and so that the public can have the confidence to continue seeking healthcare for other conditions.
I am sure my friend's story is not the first one to have turned out like this, and some have had even more tragic endings. If changes are not made soon, I am sure it will not be the last time we hear of such an occurrence.
Dr Nicholas Okumu is a Consultant Orthopaedic and Trauma Surgeon at The Nairobi South Hospital. Email: [email protected]
Edited by T Jalio