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A Covid-19 story*: “The Index Patient”

June 1, 2020

‘The index patient’ is a Covid-19 story* that describes how, in these anxious times, health workers are quickly exposed to infection.

The woman had run in crying and shouting “Help me! It’s my mother”.

The new guidelines published since the onset of the Covid-19 pandemic meant patients should have assessments before they entered the emergency room.

Medical workers dressed in PPE, The index patient

Nurse Sandra had been on a 10-minute break, relaxing with a drink for the first time since her shift began hours earlier.

Hearing the distress call ringing shrilly in the otherwise quiet building so late at night, she quickly slipped on her shoes and hurried out of the break room.

She met the patient in the reception area, lying on a couch, apparently unresponsive, with a female relative weeping at her side.

“Her temperature is 37°C., But she’s breathing fast, and she can’t talk”.

That was Mustapha, the ward attendant heading back to his uncomfortable post at the entrance, all hope of any sleep lost.

Sandra instead directed him to get an on-call doctor from the call room and began to take the patient’s vital signs.

Everything else was off the charts.

The old lady’s oxygen saturation was 87%, indicating she had very low circulating oxygen, which could lead to death very quickly.

In addition, her blood sugar levels were unreadably ‘High’. No one knew, they were treating the ‘index patient’!

When it First Began

Dr Sharon was one of the most efficient doctors in the hospital, and Sandra enjoyed working with her.

Some of the other nurses thought she could occasionally be too much, but they generally got on well.

She came to the ward kitted out as though she was prepared for battle.

Her assessment began straightaway, all the while asking questions and firing out instructions.

All that mattered to Sandra at the time were the instructions – most of which she had anticipated: Intranasal Oxygen, Urethral catheter, Intravenous fluids, Blood tests, and ECG…..

Sandra liked to know as much as she could about patients under her care because she prided herself in her impeccable bedside manners.

This old lady was Madam Fatima, a 76-year-old diabetic, and they were now treating her for a severe complication of the condition known as Diabetic Ketoacidosis.

It was time to check her vital signs again.

Worried, she saw the lady now looked quite sweaty.

She now had a fever of 38.9 deg C.

Her blood pressure level had increased, and she was breathing faster.

This didn’t look good.

Concerned, she approached the Dr, who also looked quite worried.

“Sandra, let’s isolate and start barrier nursing this patient”, the doctor began as soon as she reported the latest observations.

From then on, the night took a dramatic turn spent monitoring Madam Fatima’s blood sugars, worrying about her sudden temperature spike and consistently low oxygen saturation.

Looking back now, she should have been more suspicious.

A few hours later, Dr Sharon requested an urgent Chest X-ray.

The technician standing in for the radiologist promised they would have the report by 7 am the next day.

Anxiety and Rising Dread

By 8 am, Madam Fatima had become a suspected case of Covid-19.

She was the third ‘suspect’ case they had treated in the last two weeks.

The two previous cases had turned out to be negative eventually.

Sandra wasn’t bothered when Madam Fatima was eventually transferred to an isolation facility with an Intensive Care Unit.

After all, their state had recorded very low cases of Covid-19 so far, and it looked as if their lockdown measures had been relatively successful.

She’d been off duty that morning and planning a trip to get groceries when Nurse John, her colleague, called.

“Nurse Sandra, please ring the matron’s office as soon as you can. It’s urgent, and you need to come into the hospital.”

John, with whom she’d shared a night shift two days before, sounded distraught.

“What’s wrong, John? Today is my day off”, Sandra murmured angrily.

She heard John take a deep breath.

“The diabetic lady you attended to a few nights ago tested positive for Coronavirus, and the NCDC team is here for contact tracing.”

“They want to start with everyone who worked on her that night”.

“Ewo!”  Sandra exclaimed as she switched off the phone.

Her heart was thundering.

She thought of all the times she treated the patient without a mask before they started to suspect Covid-19 hours after she had been admitted.

Bitterly, she acknowledged to herself moments when she’d been in too much hurry to even wash her hands properly… All her lapses.

She wished she hadn’t even been there that day.

Thinking of Don and their three kids, she wondered how to break the news to them……

When you eventually realise how close you’ve been with the index patient, the floor seems to drop away.

Key Takeaways

Being a healthcare worker during this Coronavirus pandemic could be a daunting experience.

If you work in a region that hasn’t yet been hard hit, forgetting to maintain a high index of suspicion is possible.

Your safety is the first priority, and this remains the case even with an emergency – are you safe enough to provide care?

Regardless of the number of cases reported in your area, all health workers must assume everyone they treat may be an asymptomatic carrier of the disease.

This means they may even appear well at the time they are being seen, only to start showing symptoms later.

Or they may not even fall ill at all.

It is important to maintain adequate infection prevention and control measures when health workers are attending to all patients.

This means wearing PPE (Personal Protective Equipment) and minimising their exposure to illness.

The ‘Index Patient’ is a person affected by the first known case of an infectious disease in a particular area.

*Health fiction story based on true events

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