After COVID Discharge
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After COVID Discharge

According to the New England Journal of Medicine’s Journal Watch, “Researchers conducted an observational study that included 1,250 COVID-19 patients.” All were discharged from one of 38 Michigan hospitals between March and July 2020. Thirteen percent of patients were treated in intensive care units, and 70% required supplemental oxygen. The median age of the subjects was 62, and the median length of hospital stay was 5 days. About half of the patients were black. At 60 days after discharge, the scientists collected chart data and contacted 488 patients via telephone to gather more information on clinical, financial, and mental health outcomes.

The health outcomes alone were sobering. Seven percent of the patients had died, and 15% had been rehospitalized. Among the group, 33% had persistent symptoms related to their illness, and 20% had new or worsening symptoms. Forty percent had not yet returned to their normal activities. These statistics show just how long and serious a COVID diagnosis can be. But the effects of COVID extended far beyond the patients’ physical condition.

The researchers also asked about the patients’ emotional, work, and financial lives.

  • Three quarters of those reached on the phone reported that they had been mildly or moderately emotionally affected. Six percent had sought mental health care for the emotional and mental distress that they had experienced.
  • Among those employed before COVID-19, 40% were unable to return to work, primarily due to health reasons or job loss. Of those able to return to work, 25% had reduced hours or modified duties.
  • Sixty-two percent of telephone respondents were mildly or moderately financially affected, and 10% had used up all or most of their savings. Six percent were unable to pay for necessities.

This study suggests that we have not yet fully realized the toll that COVID-19 takes on patients and their families. Researchers suspect COVID-19 may have an even greater cost to patients than other serious illnesses requiring hospitalization. COVID patients may be isolated long after their recovery and may even be stigmatized, which could lead to less optimal social, career, and financial prospects.

Researchers throughout medicine no doubt believe as I do; that this topic requires further investigation. Anyone can get COVID. For many, it is a serious illness and requires a long and arduous recovery. No one should suffer societal, emotional, professional, or financial harm in addition to the physical impact of this dangerous disease.  

Marie George, MD, FIDSA, is an infectious disease specialist at Southwestern Vermont Medical Center.

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Cautious Entertaining

After almost 3 months of staying home and with the weather getting nicer, many of us are itching to invite friends over and catch up. While this is a natural inclination, it should be approached with significant caution. COVID-19 is still circulating. If you are planning to host, follow these helpful tips for a safe gathering at your home.

Keep the numbers small. Invite as few people as possible. One-on-one meetings are safer than group gatherings. The recommendations from Vermont Governor Phil Scott recommend 25 or fewer. I would still aim for fewer than 10, especially depending on the size of your entertaining space.

Choose invitees carefully. You should know almost everything about the socializing habits of the people you are inviting. Your guests should be as careful in their social interactions as you are in yours. You should also trust that your guests would be cancel if they were feeling ill, as should you if you are suddenly symptomatic. Those at high risk, due to age or a medical condition, should be very careful about hosting or accepting invitations.

Stay outside. Outdoor air movement disperses aerosolized particles more readily than indoor environments. And plenty of space outside allows guests to stay distanced. UV light, like the rays found in sunshine, may also provide some small benefit. It has been shown to decrease the viability of the virus on objects, but it is not yet clear how intense the light must be and for how long the object needs to be exposed in order to kill the virus.

Keep it short. Duration of exposure to others has been identified as a key risk factor. The longer you are near someone shedding the virus, even if they don't have symptoms, the greater your likelihood of catching it yourself. While it is awkward to say that you are inviting people over for a 10-minute chat in the driveway, this is certainly among the lowest-risk types of socializing.

Clean beforehand. If you expect guests to touch anything, the arms of patio chairs, for instance, wipe them down in advance. Ask everyone to sanitize or wash their hands as they arrive, if they touch their face, and about every hour or so.

Stay distanced and masked. People standing tend to drift. Place chairs 6 feet apart so that people will be more likely to stay apart. Unless you are eating, keep your masks on. Share this expectation in advance, so your guests bring their masks with them.

Limit contact points. If you are preparing food, be sure to wash well before cooking and ensure everyone has a portion of his or her own. Forget about platters of vegetables or bowls of chips everyone shares and even buffets, where people share spoons and tongs.

Clean after. Wipe down anything your guests may have touched after they leave.

Keep track. Be sure to take note of who was there, the date of the social event, and each guest's contact details. If any one of the attendees becomes ill with COVID-19 or learns that they may have been exposed at the time of the event, they will be able to reach out directly to the others and to share information readily with contact tracers.

With these tips, you can host a relatively safe get-together and relieve some of the social isolation of the past several weeks. Do know, however, that no party—regardless of how careful—is risk free. Weigh the risks, decrease those you can, and then, try to have fun.

Donna Barron, RN, is the infection preventionist at Southwestern Vermont Medical Center.

 

 

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