Rachel Newman was delivered to the exit of a Toronto hospital on a cold April night in just a hospital gown, with virtually no instructions on what to do next
Rachel Newman had just spent 10 days on a mechanical ventilator in a medically induced coma, then four days alone, scared and disoriented in a hospital ward room.
Countless studies suggest the experience could set her up for prolonged emotional distress and a steep physical recovery.
But when the COVID-19 patient was finally discharged from a Toronto hospital this month, she was delivered to the exit on a cold April night in just a hospital gown, with virtually no instructions on what to do next.
It is distressing to hear when patients and families experience any kind of gap in care
Newman’s husband, Zale, struggled to look after a wife whose stomach had shrunk and psyche had taken a beating, with health-care professionals refusing to see her in person. He had tested positive for COVID-19, too, and the couple seemed “toxic” to the medical system, Zale says. An overseas relative who had been a nurse finally gave some much-needed guidance.
“After somebody goes through something like this, there should be someone who looks after your needs,” Rachel Newman, 61, said.
Her experiences underline both the harsh after-effects of long stays in the intensive-care unit, and the impact of a pandemic on getting the required follow-up help.
Rachel stresses that she received “magnificent” medical treatment at North York General Hospital, especially in the ICU, and is well aware those health-care workers have a tough, dangerous job.
But as increasing numbers of Canadians emerge from such ordeals, the system has to do better at looking after those who survive critical bouts of COVID-19, the Newmans argue.
Zale, owner of a financial services company, is a volunteer rabbi and visits the ICU at another Toronto hospital every weekend. Rachel is a social worker in children’s mental health.
“Most people are not connected like we are,” she said. “I think a lot of people come home, maybe to nobody, maybe to an old aunt who is not resourceful, who doesn’t have this information and it’s the blind leading the blind.”
Nadia Daniell-Colarossi, a North York General spokeswoman, said she cannot comment on individual patients.
But “it is distressing to hear when patients and families experience any kind of gap in care and it is important for us to know when we have not met their needs,” she said. “We of course want to have open and direct conversation with our patients and their families so we can understand and address their concerns.”
Dr. Brian Cuthbertson, critical care head at Toronto’s Sunnybrook Health Sciences Centre, said he has no knowledge of the Newmans’ situation, but suggested lack of aid for patients after they leave the ICU is not unusual.
“There’s a bit of a gap here, and the systems are not yet in place to give the sort of support these patients need,” he said.
And the “harsh reality” is that that gap has widened with the system being under pandemic lockdown, Cuthbertson said.
The Newmans’ encounter with the coronavirus began March 19, when Zale felt chills one day, and more or less fine the next. Then Rachel developed a high fever and nausea. She also had a dry, hacking cough, but that had been around for most of the winter. Acutely aware of the unfolding pandemic, they got tested for the new coronavirus. A day later, the results for both came back positive.
Rachel did not improve and a week later, on March 29, Zale took her to the hospital. By 1 a.m. the next morning, he learned that his wife had consented to being put into an induced coma – given a combination of sedatives and paralytic drugs – so staff could insert a breathing tube down her throat and attach her to a ventilator.
“That was the last time I saw my wife for two weeks,” he said.
Rachel says she recalls being asked for her consent to go on the ventilator, then has “zero” recollection of the next several days.
A week and half after the intubation, she was able to breathe on her own again. As she woke up dazed from the sedatives, staff asked if she knew the date. “Late 2019,” Newman responded.
The systems are not yet in place to give the sort of support these patients need
Conscious now, and transferred to a regular ward that seemed to have few patients or staff, Rachel says the next three or four days were also difficult.
“It was a very, very strange, surreal hospital experience,” she said. “I didn’t know if it was day, I didn’t know if it was night … You could feel completely alone.”
No one explained, Newman says, that she could be contagious and had to stay put.
“Sometimes I would just walk out of my room and say ‘Is there a nurse here?’ … Then I’d hear someone yell ‘Get back into your room now, you’re not to leave your room,’ ” said Newman. “It felt incredibly punitive.”
To make matters worse, Zale slipped and fell on some concrete steps at their house, opening a nasty cut. Back at the North York General emergency department, a doctor stitched up the laceration. The staff, knowing he had tested positive for COVID-19, gave him a pair of scissors and tweezers. He was told to remove the sutures himself so he didn’t have to return.
On April 11, Zale learned that his wife was ready to be picked up, immediately.
Research has shown that patients spending days in an ICU, especially if placed on a ventilator, often suffer from what’s called intensive-care syndrome, symptoms that can include muscle weakness, cognitive deficiencies and depression or post-traumatic stress. The Newmans say they were told none of that.
I definitely feel anxious, more anxious. It’s very lonely, isolating
Rachel was wearing a “flimsy gown” on a “freezing” night when delivered to a hospital entrance by wheelchair, Zale recalls. The hospital staff member handed over a discharge notice that listed her diagnosis, the doctors who had treated the woman, her most recent lab results and medications she’d been given.
There were also six lines of instructions on what to do next: isolate until at least 14 days after onset of symptoms and contact her family doctor to follow up on the hospital stay and her “mental health.” Because she had hypertension while in hospital, they should also monitor her blood pressure, the note said. It did not specify how they were to do that.
But there were more immediate problems. Rachel could hardly eat without feeling nauseated and could barely move. She was clearly suffering psychologically, too, at one point even expressing survivor’s guilt, says her husband.
“I definitely feel anxious, more anxious,” says Rachel. “It’s very lonely, isolating.”
As per provincial guidelines issued to physicians not involved directly in the COVID-19 campaign, neither her family physician nor any other doctor would see her in person. Nor would a physiotherapist. Worried about Rachel’s blood pressure, Zale had to call paramedics on Monday to measure her vital signs.
Finally, Zale’s sister, Judith Berger, a retired head nurse at an Israeli hospital, sent instructions noting that Rachel’s stomach would have constricted during the 10 days of feed tubing. She should eat small amounts several times a day, and exercise for only a few minutes at a time.
Rachel wonders why it took someone on another continent to provide some of the most practical advice she’s received since leaving hospital.
“I think it’s a simple thing that when you leave a hospital with an illness that’s really rampant today, there has to be some material you just hand the person,” she said. “ ‘Know that this is what to expect, and this is what you work with.’ I had none of that, none of that.”
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UPDATE: No new cases in Guelph, Wellington County for second straight day – GuelphToday
For the second consecutive day there have been no new COVID-19 cases confirmed by Wellington-Dufferin-Guelph Public Health in Guelph and Wellington County.
The numbers of cases and the number of those resolved cases remained the same.
Guelph (cases/deaths): 150/9
Wellington County (cases/deaths): 70/2
Guelph resolved: 111
Wellington County resolved: 48
Intensive care unit: 2
'No benefit' from hydroxychloroquine for virus: U.K. trial – CTV News
A major British clinical trial has found hydroxychloroquine has “no benefit” for patients hospitalised with COVID-19, scientists said Friday, in the first large-scale study to provide results for a drug at the centre of political and scientific controversy.
Hydroxychloroquine, a decades-old malaria and rheumatoid arthritis drug, has been touted as a possible treatment for the new coronavirus by high profile figures, including U.S. President Donald Trump, and has been included in several randomised clinical trials.
The University of Oxford’s Recovery trial, the biggest of these so far to come forward with findings, said that it would now stop recruiting patients to be given hydroxychloroquine “with immediate effect”.
“Our conclusion is that this treatment does not reduce the risk of dying from COVID among hospital patients and that clearly has a significant importance for the way patients are treated, not only in the UK, but all around the world,” said Martin Landray, an Oxford professor of medicine and epidemiology who co-leads the study.
The randomised clinical trial — considered the gold standard for clinical investigation — has recruited a total of 11,000 patients from 175 hospitals in the UK to test a range of potential treatments.
Other drugs continuing to be tested include: the combination of HIV antivirals Lopinavir and Ritonavir; a low dose of the steroid Dexamethasone, typically used to reduce inflammation; antibiotic Azithromycin; and the anti inflammatory drug Tocilizumab.
Researchers are also testing convalescent plasma from the blood of people who have recovered from COVID-19, which contains antibodies to fight the virus.
Researchers said 1,542 patients were randomly assigned to hydroxychloroquine and compared with 3,132 patients given standard hospital care alone.
They found “no significant difference” in mortality after 28 days between the two groups, and no evidence that treatment with the drug shortens the amount of time spent in hospital.
“This is a really important result, at last providing unequivocal evidence that hydroxychloroquine is of no value in treatment of patients hospitalised with COVID-19,” said Peter Openshaw, a professor at Imperial College London, in reaction to the results.
He added that the drug was “quite toxic” so halting the trials would be of benefit to patients.
Hydroxychloroquine has been in use for years but it has a number of potentially serious side effects, including heart arrhythmia.
‘IT DOESN’T WORK’
Researchers from the Recovery trial said they would share their data with the World Health Organization (WHO), which on Wednesday restarted its own trials of hydroxychloroquine.
They were temporarily halted last month because of a now-retracted observational study in The Lancet medical journal that had suggested hydroxychloroquine and chloroquine, a related compound, were ineffective against COVID-19 and even increased the risk of death.
Authors of the Lancet research said on Thursday that they could no longer vouch for the integrity of its underlying data, in the face of serious concerns raised by fellow scientists over a lack of clarity about the countries and hospitals that contributed patient information.
The scandal cast a shadow over The Lancet and another top medical journal, but it did nothing to clear up the increasingly politicised question of whether or not hydroxychloroquine works as a treatment for COVID-19.
Openshaw said the Recovery trial should be credited with continuing the research until they could reach a definitive conclusion on hydroxychloroquine.
“Everyone regrets that it doesn’t work, but knowing that allows us to focus on finding drugs that actually help recovery from COVID-19,” he added.
Oxford professor Peter Horby, the lead investigator on the Recovery Trial, said there was probably a “very large number” of people around the world taking hydroxychloroquine for COVID-19, with countries including the U.S., China and Brazil authorising it.
A separate clinical trial on Wednesday in the U.S. and Canada found that taking hydroxychloroquine shortly after being exposed to COVID-19 does not work to prevent infection significantly better than a placebo.
City asking people to wear masks on buses, but not mandatory – GuelphToday
As the city prepares to allow more riders on Guelph Transit buses, it is asking riders to wear a non-medical mask or face covering.
They are not mandatory.
Free 30-minute Guelph Transit service will continue for the rest of June but the city says thta with more businesses reopening and more people heading back to work, Guelph Transit is preparing to resume fare collection and regular schedules later in the summer.
In a news release Friday morning, the city said the request is based advice from Wellington-Dufferin-Guelph Public Health.
“According to health officials, wearing a homemade face covering/non-medical mask is not a substitute for physical distancing and hand washing. Wearing a mask has not been proven to protect the person wearing it, but it can help protect others around you,” the release said.
“As the buses get busy again, physical distancing may not always be possible. We’re asking riders to wear a non-medical mask or face covering to help prevent the spread of COVID-19,” says Robin Gerus, general manager of Guelph Transit.
Guelph Transit is encouraging face coverings, not requiring them.
“It’s becoming more common to wear a mask on public transit in other cities, but it’s new for Guelph. Some riders may not be aware of or understand the latest guidelines from health officials. Some may not have resources to purchase or make a mask, or they may have a medical reason for not wearing one,” added Gerus. Everyone is welcome to use Guelph Transit, and we’re asking people to protect and respect each other as ridership increases.”
Since March, Guelph Transit made the following adjustments to slow the spread of COVID-19:
- free 30-minute service allows passengers to avoid using the farebox and board from the rear door
- plastic barrier between the driver and passengers
- hand sanitizing stations and cleaning supplies for drivers
- no more than 10 people per bus
- blocked several seats to encourage physical distancing between passengers
To prevent the spread of COVID-19, the City and Guelph Transit encourage riders to continue following the latest advice from Wellington-Dufferin-Guelph Public Health:
- wash your hands regularly or use hand sanitizer
- stay at least two metres away from people you don’t live with
- when you can’t maintain physical distancing, wear a non-medical mask or face covering
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