Growing number of Covid-19 patients dying at home [in Malaysia]

‘In the first week of this month, 10 Covid-19 patients have died before they could receive treatment at a hospital. The youngest to suffer such a fate this month is an 18-year-old girl who was brought in dead at the Selayang Hospital, Selangor. Her infection was compounded by asthma. Her death was reported by the Health Ministry in its daily statistics yesterday.

‘According to Malaysiakini’s tracking, 22 people infected with Covid-19 were brought in dead in December last year. Another 41 people were brought in dead in January this year. That means since December last year, 73 out of the 512 recorded fatalities were brought in dead, slightly above 14 percent.’

Read here (Malaysiakini, Feb 8, 2021) 

Concerned doctors' open letter to Muhyiddin gets a personal response (Full text included)

‘An open letter by a group of 46 doctors has elicited a personal response from Prime Minister Muhyiddin Yassin. The 46 doctors had, in an open letter on Jan 7, expressed worry at the "very bleak" state of the Covid-19 pandemic in the country.

‘Muhyiddin, in his response tonight, noted that several of their proposals have been implemented or are in the process of being rolled out. The prime minister said he will continue to put aside politics and focus on mobilising an all-of-society fight against Covid-19.’

Read here (Malaysiakini, Jan 17, 2021)

Rapid Covid-19 home test developed in Australia approved for emergency use in US

‘A rapid, over-the-counter Covid-19 test developed by Australian firm Ellume has been given emergency approval in the United States. The US Food and Drug Administration (FDA) approved the Brisbane-based company’s 20-minute Covid-19 Home Test on Tuesday as the US battles the virus that has infected 16.5 million people and killed more than 300,000 people in the country.

“By authorising a test for over-the-counter use, the FDA allows it to be sold in places like drug stores, where a patient can buy it, swab their nose, run the test and find out their results in as little as 20 minutes,” the FDA commissioner, Stephen Hahn, said in a statement.’

Read here (The Guardian, Dec 16, 2020)

Knowing Covid-19 was at their door, family of 8 planned strategy to fight it

‘When Aman Gwjwn, 17, developed a persistent cough and cold in July while on holiday at her grandmother's home in Bangalore, her family of eight went to war, preparing themselves for Covid-19 to sweep through their home. Everyone from a 14-year-old eighth-grade student to a near-octogenarian would go on to be infected. But the Chinese-Indian family slowly won their battle against the disease over the next 1½ months, armed with discipline, composure and logistical planning.

"Our approach was: We'll all surely get it, but we'll all survive it as a family. We just made sure everyone didn't fall sick together, so that some people were healthy enough to take care of the others," said Ms Jennifer Liang, 48, Aman's mother and a social worker in Assam who flew to Bangalore immediately. The Liangs formed what they called "a war council" of decision makers, which included Jennifer's husband Sunil Kaul, a doctor and public health activist in Assam. As Aman isolated herself in her uncle's house nearby, the family set up a WhatsApp group called Covid Planning.’

Read here (Straits Times, Sept 26, 2020) 

Covid 19 coronavirus: Kiwi doctor goes 'viral' on YouTube with covid fighting tips

‘Two months ago, Sandhya Ramanathan began posting videos on how to manage Covid-19 at home. They were made for her family overseas, in countries where managing the virus was difficult: the UK, US and India.

‘One went, pardon the pun, viral. She filmed the 18-minute video in one take, trying to get out the key messages before she got onto packing her son's bag for school camp. Her legs were asleep by the end of it. Today, that video has almost 360,000 views on YouTube and millions on WhatsApp, where it was shared first with Ramanathan's cousins and then with the rest of the world, desperate for a way to prepare for the pandemic.

‘She'd been looking into ways to treat Covid-19 at home because she knew this is where most people would be dealing with it. One way to save lives – both directly and by reducing the strain on hospitals – is to keep mild cases mild, instead of letting them get worse. "You have to actively treat it, you can't just lie down in bed," says Ramanathan.

‘When she made the video, she took care to outline methods of treatment that didn't involve trips to the doctor or expensive equipment. "I'm just thinking of the people in India, who have no access to a doctor," she says.’

Read here (NZ Herald, Aug 19, 2020)

Watch video here (Youtube, June 14, 2020)

Unsung heroines: Who cares for the carers?

Even before Covid-19, the world was facing a care crisis. The plight of often neglected, under-appreciated, under-protected and poorly equipped ‘frontline’ health personnel working to contain the pandemic has drawn attention to the tip of the care crisis iceberg. Oxfam’s annual early 2020 Davos report, Time to Care, estimates that 2.3 billion people will need care by 2030, 200 million more than in 2015, including 100 million more older people and an additional 100 million children aged 6 to 14 years.

Read here (IPS News, June 11, 2020)

Wearing face masks at home cuts Covid-19 spread by 79 percent - study

‘While face masks and frequent disinfection is widely assumed to prevent Covid-19 transmission, a new study has lent weight to the usefulness of these measures in ‘real world’ situations. In a paper published in the journal BMJ Global Health yesterday, researchers found that wearing face masks at home before the primary case showed symptoms slashed the risk of secondary infections by 79 percent. Wearing masks after symptoms appeared had no effect.’

Read here (Malaysiakini, May 29, 2020)

What does recovery from Covid-19 look like?

“Eighty to 85% of our patients who are infected do not need to be hospitalized, but they do require monitoring and medical care, most of which is now taking place with telehealth,” Dr. Ellman says. He says it’s typical for these patients to have a telehealth appointment, either on phone or video, at least every other day for 10 to 14 days from the onset of symptoms...

“Generally speaking, most patients can be managed outside of the hospital,” Dr. Sofair says. “But if you start to get sicker, early treatment can prevent complications. If you do need to be admitted to the hospital, that does not mean you will get really sick. Only a minority of patients end up in the ICU. We have had many good outcomes, and our doctors and nurses now have experience treating this.”

Read here (Yale Medicine, May 18, 2020)

Covid-19, ‘silent hypoxia’ and a simple way to identify patients sooner (even do it at home with a ‘pulse oximeter’)

‘We are just beginning to recognise that Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature...

‘There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter...

‘Pulse oximetry is no more complicated than using a thermometer. These small devices turn on with one button and are placed on a fingertip. In a few seconds, two numbers are displayed: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting oxygenation problems and elevated heart rates.’

Read here (New York Times, April 20, 2020)

Boris Johnson recovery shows need for rehabilitation after coronavirus

‘One answer is having more rehabilitation teams – comprising doctors, nurses, physiotherapists, occupational therapists, psychologists, social workers, pharmacists and dieticians – treat patients in their own homes. This can be done via telehealth and online platforms, which allows services to be delivered in a way that minimises risk to health professionals and doesn’t further deplete personal protection equipment.

‘Rehabilitation reduces bed block as patients are discharged more quickly. It also takes pressure off GPs and reduces re-presentations to emergency departments for issues that can be dealt with at home.’

Read here (The Sydney Morning Herald, April 15, 2020)

Caregiving and the soul of medicine: Discussion among Eric J Topol, Abraham Verghese and Arthur M Kleinman

Kleinman: ‘It's surprising that I learned this from my personal experience; I should have known it from my professional experience—but care does not end with the death of the person you're caring for. You're caring for memories after that. A clinician also cares for memories, remembering how to think about the care and how to perhaps use a particular case to improve care in the future. The family member, of course, is rebuilding a story about one's life and one's family. Central to that is the memory of the care you gave and what you've gone through. The attention to those memories, their ordering, the time we spend developing them becomes a very important part of our lives after the practical acts of care no longer need be given because the person has passed. Those are the kinds of things I was concerned with.

‘I came to realize two things: First, that care was disappearing from clinical medicine, that clinicians have become so tied up with technologies, and so tied up with delivering the technologies effectively, that they are forgetting about the role that care plays. And second, there's some question as to whether in the future, even in families, we'll have care, given the limited time that family members have today, the fact that both husbands and wives work—this was women's work in the past—and men in our time, no matter how "woke" and liberated they claim to be, are not picking up the task of care.’

Eric J. Topol, MD, is one of the top 10 most cited researchers in medicine and frequently writes about technology in healthcare, including in his latest book, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again.

Abraham Verghese, MD, is a critically acclaimed best-selling author and a physician with an international reputation for his focus on healing in an era when technology often overwhelms the human side of medicine.

Arthur M. Kleinman, MD, MA, is a founder of the field of medical anthropology. He has written over 40 books, including The Illness Narratives: Suffering, Healing, and the Human Condition. His latest book is The Soul of Care: The Moral Education of a Husband and a Doctor.

https://www.medscape.com/viewarticle/920514#vp_3

View video and read transcript here (Medscape, Nov 19, 2019)