Care in the Time of COVID
“I cannot do everything, but I can do something”
Siavonga District
5,000 miles stretch from the UK to our colleagues and patients in Zambia. But we bridge the gap with our Telemedicine. We cannot do everything from where we are. But we can do something.
Over the last 15 months, as well as providing Wash Stations, The Virtual Doctors has dealt with referrals about many aspects of COVID management. Early on, most of the case queries were around practicalities of testing, isolation and community care. It gave the Clinical Officers a chance to discuss and understand principles of management, as we learnt together and shared our knowledge. Signposting them to local guidance and protocols was really important. As well as answering individual case queries, we tried to point them to useful and relevant resources for their setting.
“45-year-old man with cough and fever. COVID test done. It will take days for the results. Should I isolate this patient?
What else can we do for the management of community isolated cases?
Are there any drugs that can help in the
prevention of COVID 19 acquisition?”
During wave two in Zambia the number of case referrals to us about COVID positive patients increased; previously it seemed our rural populations had been relatively spared and now many of our Zambian clinicians were encountering the disease for the first time. We could sense the anxiety across our WhatsApp Support Group.
“This 43-year-old man had a cough and shortness of breath 6-weeks ago. He was positive for COVID. He is well now. His COVID PCR test remains positive today. What should I do?
Kindly help me read the X-rays (attached) for this patient with COVID.
What can be done to help with loss of smell in a COVID infected individual?
Which steroids can I use in the treatment of a COVID patient?”
Patients requiring hospital treatment for COVID in Zambia are referred to designated facilities, so not all our team members are involved in the ongoing care of such patients. But we were certainly receiving referrals from some of these isolation units. To share learning quickly across the group, we put together a COVID case scenario, with the help of one of our fantastic Zambian Physicians, outlining the typical symptoms and signs of a patient with severe COVID and describing the standard management available in a District Hospital. Whilst following up-to-date National guidance, we tried to keep it simple and to reflect what was possible on the ground, reminding them that we can always ‘do something’ even with limited resources. It was shared with the whole team via the Support Group (it can be read on our forum here).
At the moment, as a terrible third wave tears through Zambia, our clinicians are seeing increasing numbers of sick COVID patients. We have advised on both young and elderly patients, on patients with co-existent disease such as diabetes and HIV and also on sick pregnant patients. We have been consulted about management of symptoms and complications, about treatment options and need for escalation of therapy and about end-of-life care.
“The patient is COVID positive. He is not known to be diabetic, but the blood sugar is 30. So, has he
developed diabetes from being infected with coronavirus?
This 28-year-old lady is 6 months pregnant. She has a fever and is short of breath. We have followed standard COVID guidelines so far but what do we do when the patient is pregnant?
This 56-year-old man has been treated for COVID with high flow oxygen, steroids and antibiotics.
There has been no improvement and his saturations are still dropping. What else can we do?
The patient is 80 years old. Saturations have not gone above 85% despite being on oxygen for 3 days now. They sometimes drop below 40%. Wanted to refer but the relatives refuse, what do we do?”
As we learn, so we hope to share our knowledge with our colleagues. Hearing back that a patient has improved and been discharged is invaluable. Sometimes we know that none of us can change the inevitable outcome, but we can still share valuable experience through the consultation, whilst at the same time bridging the distance, reducing the isolation of these Front-Line Health Care Workers. Isolate. Quarantine. Distance. Separation in the pandemic. But through this also a sense of togetherness, with shared challenges, shared goals and shared fears.
“Take care. Stay safe.” - “Thank you and you stay safe too.”
We have reflected above on our involvement in COVID care over the last 15 months. But importantly during this time our core service has continued as usual. One of the major threats from the pandemic is the disruption to Essential health care services and the long-term problems this will bring worldwide. The WHO Pulse Survey looking at the impact of COVID on Health Care describes the ‘substantial disruption to essential health services across the globe’. It notes that access to Telehealth technologies was limited in 70% of countries that they surveyed(1). The Virtual Doctors model has allowed us to continue giving expert advice to Primary Health Care Workers throughout. Whether it is by advising on stroke care, or management of malnutrition, treatment for hypertension, or assessment of a patient with halitosis, interventions following a snakebite, or review of a patient with intractable hiccoughs, expert opinion on complications of HIV, or management of a patient following an overdose, we believe we can do something.
(1) https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS-continuity-survey-2021.1 Accessed June 2021