INFECTIOUS DISEASES

Coping with a particularly vicious virus

Nuala O’Farrell, through the story of two families, provides a practice example of how virulent and long-lasting Covid-19 and its sequelae can be

Dr Nuala Farrell, GP, Dublin, Ireland

December 9, 2020

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  • When our first patient died of Covid-19, all of us in the practice were devastated. Jim was a funny, kind, appreciative man with a great sense of humour. Every nurse and doctor in the practice thought he had a special “grá” for them. He made everybody feel special.

    Instead of having a huge celebration of his life, only the bare bones of the immediate family could attend Jim’s funeral. The day after her husband’s funeral, Joan, Jim’s courageous, non-complaining wife, who also suffers from leukaemia, became short of breath and quite unwell. She too was positive for Covid-19. She needed to go to hospital.

    Naturally the family were terribly upset. Their elderly father had died and now their elderly mother was in danger. Both were in their 80s. Five out of six family members also tested positive for Covid-19, but none of the others were at all ill at the time of the funeral.

    One of Joan’s daughters, Jacinta, had moved in to look after her ill mother. For two weeks after testing positive, Jacinta was perfectly fine. But then she suddenly became very ill with severe breathlessness and fatigue. From doing spinning classes four times a week, Jacinta could hardly walk up the stairs. Her head was splitting; she had no sense of taste or smell; she had a fever and every bone in her body was aching. Like her mother, this is a woman who seldom, if ever, complains. It is almost a family failing! I had no choice but to send her to hospital also. Her x-ray showed Covid pneumonia and she was admitted. 

    Meanwhile, another patient in the practice, Anne, who is a young, dedicated ICU nurse, developed fever and chills.  She had been nursing a confirmed Covid-positive patient two days before she herself developed symptoms. This was despite being in full PPE and donning and doffing carefully and correctly. She had headache, fever, cough, chills, muscle pain, her eyes felt hot and dry and she had no sense of taste or smell. Five days later she began getting very breathless and was given a letter for casualty. But apart from being a brilliant nurse, Anne is the mother of two small children and she was still breastfeeding. She could not go to hospital, she felt, and leave the children, because her husband was also quite ill with Covid.

    Four days later Anne’s fever was beginning to settle and her cough was resolving. At that stage she also had diarrhoea, which lasted for four days. On day 22 after testing positive, Anne felt she was better and on the advice of the occupational health department in her hospital, she returned to work. Her family, thankfully, had all recovered.

    But a week after returning to work, Anne woke in the early hours of the morning with chills and fever and coughing and feeling exactly the same as on her first experience of the virus. Anne was now over four weeks since diagnosis. We sent her to casualty. While in casualty Anne was treated for her underlying asthma and had nebuliser treatment. She then developed a fast heart rate of 150/min and she was admitted for treatment and observation. After two days she was discharged home to self-isolate with a SpO2 monitor for two weeks. 

    While at home Anne developed cold sores, mouth ulcers and eczema plaques on her scalp. Anne was now six weeks since initial Covid diagnosis. She was sleeping 14 hours a day and napping with the baby in the afternoon when she could. She was still waking up coughing at night and had occasional night sweats. During all this time, Anne still had no sense of smell or taste.

    Meanwhile Jim’s wife, Joan, was in hospital for eleven days but survived her leukaemia, the ‘terrible hospital food’, and Covid-19. When she came home Joan also developed cold sores around her mouth and mouth ulcers on her tongue and gums. They responded to antiviral treatment in the form of Zovirax orally. Despite her age, the loss of her beloved husband Jim, and her underlying condition, Joan is making a good recovery. But at the time of writing it is almost 10 weeks after she tested Covid positive.

    Three months after her initial diagnosis, Anne still had ongoing severe fatigue. Her husband made a good recovery and the baby is fine. Anne still has shortness of breath on exertion and ongoing dry cough and muscle pains. She tells me her sense of smell and taste are slowly beginning to return. She can only taste strong flavours, she says, like jalapeños.

    Jim’s death was the first from Covid in our practice. Unfortunately, it was not the last. As Joan said, “Jim was a huggable type of man.” The best type of man, who will be so much missed. 

    May he rest in peace. 

    All names have been changed to protect anonymity

    © Medmedia Publications/Forum, Journal of the ICGP 2020