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GMIL: grandmother in law ICA: Inter Community Hospital, a Hospital in Whittier WHMC: Whittier Hospital Medical Center. SNF: Skilled Nursing Facility. UTI: Urinary tract infection. o2: Oxygen
It is pretty well known that I am on the mask & caution side of this debate, but I want to be pretty clear that I am not sharing this to bolster one side of the argument or another. We can debate policy, and I believe we should, but in this description the purpose is simply to describe the process in as much detail as possible so that anyone who has to go through this has some idea of what to expect. I will do my best to answer questions as best as I can and will not be offended if doubted or questioned. This is the first close-circle person that I know who has tested positive.
On June 5th, the SNF (Sierra View CC) sent the family this letter. One resident member had tested positive. Another letter arrived dated June 11. An employee tested positive. The next day, another letter arrived, dated June 12. Two more residents tested positive. On June 13, which is the first time I was informed about GMIL's condition, the LA County page listed 6 staff and 3 residents. This morning, the same page listed 7 and 7. Last night, GMIL and several other residents were sent by ambulance to the ER. None of them had tested positive as late as last Wednesday when they were all given a blood test. In short, when this virus hits an SNF, it spreads like wildfire.
SNF staff caring for GMIL 20 hours before emergency transport. Note the non matching PPE. It is possible staff are bringing privately acquired equipment.
06.13 GMIL has a fever and is unable to keep food or water down. at this point the family asked me to be the primary medical contact. Lung scan in the afternoon showed no lesions and blood test a few days prior was negative for COVID19. The SNF ordered everyone tested for COVID19 again on 06.13 evening. GMIL is 90 years old. Only pre existing health issues are weak legs and advanced age.
06.14 GMIL's fever subsided but she began having difficulty breathing. 06.14 10AM blood pressure dropped. Her daughter begged staff to have a doctor look at her. When an nurse came to meet with the daughter, GMIL has cardiac arrest. the nurse determined that it was time to call 911. GMIL was taken to a nearby hospital, ICA Hospital.
06.14 afternoon. Fever gone. On o2 but no ventilator. diagnosed with UTI, pneumonia, low blood pressure, lowered blood o2. troponin levels in blood high, indicating possible recent heart damage. given azrith + another antibiotic for the pneumonia and the for the UTI. at this point she is assumed positive but maybe not.
06.14 evening, transferred to Whittier Hospital MC. Fever still gone. breathing better, o2 is reduced. same treatment. can track movement with eyes but no speech and very weak body movement.
06.15 morning. breathing improved again. heart tests ordered due to high troponin levels. more alert. eyes open when awake now. tries to cooperate with nurses attempting to move & feed her. same treatment in terms of antibiotics.
06.15 evening, 10:30PM. breathing more improved, o2 reduced again. echocardiogram came back with OK results. blood pressure now near normal. blood o2 stead at 95-98% using a rebreather type o2 supply; staff determined non rebreather no longer needed and not worth risks. temperature good. test for COVID19 comes back and is confirmed positive. staff at both ICA and WH inform me that they are seeing other positives from SVCC as well right now.
I did not even know that GMIL was at an SNF because previously she had lived with her daughter. Since she is an in-law I do not see her all the time like my parents or wife's parents, but still this is someone who I'd see at all the big family get togethers. obviously she is high risk due to age. it is not good that she is fighting two infections from two different bugs at the same time. but we are glad that at least for now she is doing as well as could be hoped for.
06.16 morning. breathing still good. nurses hope to remove her from o2 later today or tomorrow. no fever. still on the two antibiotics. blood o2 good, hydration good (saline iv). very weak, can't move much or talk, but appears aware of surroundings. poor appetite; not sure if that is a symptom of the disease. informed that the SNF will likely not take her back unless she tests clear twice and after 14 days. this will present some difficulty as we are not sure what will happen to her as a result. cross that bridge when we get to it.
06.16 evening. same. breathing improved, now on 4L o2. food now becoming a problem. she can't or won't eat more than 1/4 of what's given her. decision regarding feeding tube may need to be made soon, with major consequences either way.
06.17 day. The best man at my wedding was found dead this morning. The guy was awesome, we would go buying guns and shooting and fishing together. he was 1 month shy of 33. I hope it was not COVID19 related. He drank and smoked like a russian out of the movies, but those were his only preexisting conditions. Anyway. GMIL the same. No change. Just hanging in there. For how long, who knows. I got the family together and we have submitted a DNR. Hospital suggests we make familiar food at home and bring it to her. We are to give a sealed container to the security guard who will bring it up. don't bother with spices since she can't smell anyway. but at least the sight might be comforting.
06.18. family members were able to drop off a container of pureed food from home, sealed. a note with name, room & bed, and the contents was clearly labled on the front of the bag. given to security guard who took it up. no one got within 6 feet of each other. walk up, put down, step back. family members went with face, eyes, covered up. they are anxious to not add to an already bad situation. I looked up the LA county stats this morning. I have to say LA is doing a really good job with tracing. you can really get a handle on how bad the situation is. not perfect at all, not accurate at all, but close. remember on the 16th stats listed 7 staff / 7 residents sick, 0 deaths. today it looks like this, and I expect there are quite a bit more uncounted. that is 3x more residents in just 2 days, and 1 more staff.
06.19. informed that she will be transferred back to her SNF because she is no longer in immediate danger. she is still very much infectious, she still has pneumonia and UTI, very weak, but they want her bed cleared for another patient (or just don't want to rack up costs anymore). that is really bad, even though the truth is that there is no choice. where else can she go? it's the place best prepared to deal with this, but it also means all the remaining residents and staff are at severe risk.
06.20 SNF informs WHMC that they will indeed take patients back, but only after they have been non-febrile for at least 72 hours. GMIL has been having fevers of ~99.2 every 8 hours or so. They break, then come back. She has been transferred to med-surg. O2 further reduced. BP is up slightly more than yesterday. WBC count is low so infection does not seem to be rampaging. pnuemonia and UTI still present.
06.20 o2 reduced to 2liters. seems slightly better. bp up a bit more, but could be from IV pressure. doctors ask family if they wish to use a feeding tube, as the DNR submitted for her specifically says no feeding tube or ventilator. surprisingly, the doctor also offers remdesivir.
06.21 family spends the day torn. half want to just let things go, the other half feels that she is essentially doing well except for food and it would be a horrible way to go to let her starve to death. the latter wins out. I call the hospital and give permission for both the feeding tube, knowing it will likely be stomata type (hole in abdomen) and also permission for remdesivir. I am surprised that a 90 year old is able to get remdesivir.
06.22 the doctor determines that GMIL does not need remdesivir after all because she has been ok, no fever for almost two days, her o2 is like 92% with 2liters, so brought back to 4liters and she is 95% o2 saturation. dr feels she is doing ok as it is, she seems alert, so no need for the additional risks of remdesivir especially since it is not guaranteed to have a good effect. GI dr reviews GMIL and determines she does not need a stomata tube, NG is good enough. there is a lot of risk with NG, risk to staff, because patient often coughs a lot. but surprisingly the NG goes in with no problems and everyone is delighted at how well it is going. GMIL finally now has food after nearly six days of basically starving.
06.23 NG tube is holding well. patient is holding well. lung scans show NG tube is well seated and not perforating lungs. more blood testing, covid19 related.
06.24 late night fever of 100.1. given tylenol, brought back down to 97.8.
06.25 dr has placed an order for GMIL to be given serum treatment! I was very surprised because it can only be obtained from the mayo clinic and air expressed. I said that the family would like this precious resource (whether it works or not) to be given to younger patients first. but nurse said that it is ok, the dr has given orders, so he has his reasons. the dr is concerned about the little fevers and believes she has a good enough chance to put serum treatment into play.
It is pretty well known that I am on the mask & caution side of this debate, but I want to be pretty clear that I am not sharing this to bolster one side of the argument or another. We can debate policy, and I believe we should, but in this description the purpose is simply to describe the process in as much detail as possible so that anyone who has to go through this has some idea of what to expect. I will do my best to answer questions as best as I can and will not be offended if doubted or questioned. This is the first close-circle person that I know who has tested positive.
On June 5th, the SNF (Sierra View CC) sent the family this letter. One resident member had tested positive. Another letter arrived dated June 11. An employee tested positive. The next day, another letter arrived, dated June 12. Two more residents tested positive. On June 13, which is the first time I was informed about GMIL's condition, the LA County page listed 6 staff and 3 residents. This morning, the same page listed 7 and 7. Last night, GMIL and several other residents were sent by ambulance to the ER. None of them had tested positive as late as last Wednesday when they were all given a blood test. In short, when this virus hits an SNF, it spreads like wildfire.
SNF staff caring for GMIL 20 hours before emergency transport. Note the non matching PPE. It is possible staff are bringing privately acquired equipment.
06.13 GMIL has a fever and is unable to keep food or water down. at this point the family asked me to be the primary medical contact. Lung scan in the afternoon showed no lesions and blood test a few days prior was negative for COVID19. The SNF ordered everyone tested for COVID19 again on 06.13 evening. GMIL is 90 years old. Only pre existing health issues are weak legs and advanced age.
06.14 GMIL's fever subsided but she began having difficulty breathing. 06.14 10AM blood pressure dropped. Her daughter begged staff to have a doctor look at her. When an nurse came to meet with the daughter, GMIL has cardiac arrest. the nurse determined that it was time to call 911. GMIL was taken to a nearby hospital, ICA Hospital.
06.14 afternoon. Fever gone. On o2 but no ventilator. diagnosed with UTI, pneumonia, low blood pressure, lowered blood o2. troponin levels in blood high, indicating possible recent heart damage. given azrith + another antibiotic for the pneumonia and the for the UTI. at this point she is assumed positive but maybe not.
06.14 evening, transferred to Whittier Hospital MC. Fever still gone. breathing better, o2 is reduced. same treatment. can track movement with eyes but no speech and very weak body movement.
06.15 morning. breathing improved again. heart tests ordered due to high troponin levels. more alert. eyes open when awake now. tries to cooperate with nurses attempting to move & feed her. same treatment in terms of antibiotics.
06.15 evening, 10:30PM. breathing more improved, o2 reduced again. echocardiogram came back with OK results. blood pressure now near normal. blood o2 stead at 95-98% using a rebreather type o2 supply; staff determined non rebreather no longer needed and not worth risks. temperature good. test for COVID19 comes back and is confirmed positive. staff at both ICA and WH inform me that they are seeing other positives from SVCC as well right now.
I did not even know that GMIL was at an SNF because previously she had lived with her daughter. Since she is an in-law I do not see her all the time like my parents or wife's parents, but still this is someone who I'd see at all the big family get togethers. obviously she is high risk due to age. it is not good that she is fighting two infections from two different bugs at the same time. but we are glad that at least for now she is doing as well as could be hoped for.
06.16 morning. breathing still good. nurses hope to remove her from o2 later today or tomorrow. no fever. still on the two antibiotics. blood o2 good, hydration good (saline iv). very weak, can't move much or talk, but appears aware of surroundings. poor appetite; not sure if that is a symptom of the disease. informed that the SNF will likely not take her back unless she tests clear twice and after 14 days. this will present some difficulty as we are not sure what will happen to her as a result. cross that bridge when we get to it.
06.16 evening. same. breathing improved, now on 4L o2. food now becoming a problem. she can't or won't eat more than 1/4 of what's given her. decision regarding feeding tube may need to be made soon, with major consequences either way.
06.17 day. The best man at my wedding was found dead this morning. The guy was awesome, we would go buying guns and shooting and fishing together. he was 1 month shy of 33. I hope it was not COVID19 related. He drank and smoked like a russian out of the movies, but those were his only preexisting conditions. Anyway. GMIL the same. No change. Just hanging in there. For how long, who knows. I got the family together and we have submitted a DNR. Hospital suggests we make familiar food at home and bring it to her. We are to give a sealed container to the security guard who will bring it up. don't bother with spices since she can't smell anyway. but at least the sight might be comforting.
06.18. family members were able to drop off a container of pureed food from home, sealed. a note with name, room & bed, and the contents was clearly labled on the front of the bag. given to security guard who took it up. no one got within 6 feet of each other. walk up, put down, step back. family members went with face, eyes, covered up. they are anxious to not add to an already bad situation. I looked up the LA county stats this morning. I have to say LA is doing a really good job with tracing. you can really get a handle on how bad the situation is. not perfect at all, not accurate at all, but close. remember on the 16th stats listed 7 staff / 7 residents sick, 0 deaths. today it looks like this, and I expect there are quite a bit more uncounted. that is 3x more residents in just 2 days, and 1 more staff.
06.19. informed that she will be transferred back to her SNF because she is no longer in immediate danger. she is still very much infectious, she still has pneumonia and UTI, very weak, but they want her bed cleared for another patient (or just don't want to rack up costs anymore). that is really bad, even though the truth is that there is no choice. where else can she go? it's the place best prepared to deal with this, but it also means all the remaining residents and staff are at severe risk.
06.20 SNF informs WHMC that they will indeed take patients back, but only after they have been non-febrile for at least 72 hours. GMIL has been having fevers of ~99.2 every 8 hours or so. They break, then come back. She has been transferred to med-surg. O2 further reduced. BP is up slightly more than yesterday. WBC count is low so infection does not seem to be rampaging. pnuemonia and UTI still present.
06.20 o2 reduced to 2liters. seems slightly better. bp up a bit more, but could be from IV pressure. doctors ask family if they wish to use a feeding tube, as the DNR submitted for her specifically says no feeding tube or ventilator. surprisingly, the doctor also offers remdesivir.
06.21 family spends the day torn. half want to just let things go, the other half feels that she is essentially doing well except for food and it would be a horrible way to go to let her starve to death. the latter wins out. I call the hospital and give permission for both the feeding tube, knowing it will likely be stomata type (hole in abdomen) and also permission for remdesivir. I am surprised that a 90 year old is able to get remdesivir.
06.22 the doctor determines that GMIL does not need remdesivir after all because she has been ok, no fever for almost two days, her o2 is like 92% with 2liters, so brought back to 4liters and she is 95% o2 saturation. dr feels she is doing ok as it is, she seems alert, so no need for the additional risks of remdesivir especially since it is not guaranteed to have a good effect. GI dr reviews GMIL and determines she does not need a stomata tube, NG is good enough. there is a lot of risk with NG, risk to staff, because patient often coughs a lot. but surprisingly the NG goes in with no problems and everyone is delighted at how well it is going. GMIL finally now has food after nearly six days of basically starving.
06.23 NG tube is holding well. patient is holding well. lung scans show NG tube is well seated and not perforating lungs. more blood testing, covid19 related.
06.24 late night fever of 100.1. given tylenol, brought back down to 97.8.
06.25 dr has placed an order for GMIL to be given serum treatment! I was very surprised because it can only be obtained from the mayo clinic and air expressed. I said that the family would like this precious resource (whether it works or not) to be given to younger patients first. but nurse said that it is ok, the dr has given orders, so he has his reasons. the dr is concerned about the little fevers and believes she has a good enough chance to put serum treatment into play.
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