Health systems monitor COVID-19 patients at home as virus hospitalizations grow
The number of hospitalizations for COVID-19 in Delaware stands at 177 and is expected to rise swiftly over the next few days. State emergency management officials are coordinating the preparation of alternative hospital space in case hospitals become overwhelmed.
Meanwhile, several health systems in the state are monitoring COVID-19 patients remotely to help them manage their symptoms at home.
Susan Felicia worked as a nurse practitioner at A.I. DuPont High School’s school-based health center before schools closed in response to the coronavirus.
She says she was “anxious” to help with the health crisis — and started working at ChristianaCare’s virtual COVID-19 practice.
Patients who have symptoms of the virus or have been diagnosed can be referred to the practice, and are then monitored by text message or video call by healthcare workers.
Patients are coded green, yellow or red based on their symptoms. Felicia says ChristianaCare’s team maintains more frequent contact with the more severe cases.
For example, a patient coded green will receive a text message with several questions in the morning. Their responses will be reviewed by healthcare workers.
“That’s critical, because if a patient is fine in the morning when they answer their question, then later in the day they spike a temperature, this process is bi-directional,” Felicia said. “The patient can then send a message to the Carevio team, and the team will then escalate the patient and put them back on the schedule to have another virtual COVID visit.”
Felicia says video technology can help with assessing patients’ level of respiratory distress to determine when they should seek emergency care at a hospital.
“I'm doing a visual assessment of their respiratory patterns, what they look like, … how fast are their respirations.” she said. “If I notice any pallor around their lips or any signs of decreased oxygenation … They could have retractions— [at] the base of the neck, if they're breathing and they look like they're sucked in like a lizard. That would be a sign that they're really using accessory muscles to breathe and not just using their diaphragm.”
Felicia says the team is providing more than just medical advice.
“This is an extremely emotional and physical journey for these patients,” she said. “The virus itself, it can be a mild case to something severe, and I feel like I’m here to reassure them that they have a constant connection with a healthcare provider.”
Bayhealth has a similar program in Kent and Sussex Counties to refer patients for COVID-19 testing and to monitor virus patients at home.
Bayhealth has not instituted video calls yet. But officials say their Coronavirus Management Team consisting of 20 physicians, advanced practice clinicians and nurses has fielded more than 4,000 calls so far— around 300 per day.
In addition to referring patients for testing, the team is following up with patients while results are pending and after results are in.
“If somebody does have a positive test, we’re absolutely continuing to follow those patients to give them advice on self-care issues and maybe some advice on when and if things got worse, when would be the time to seek more higher level care at the emergency room,” said Bayhealth medical director Dr. John Fink.
Fink says over 80 percent of COVID-19 patients can ride out the course of the illness at home. His team asks patients to monitor their temperature several times per day and stay hydrated— and advises them on when to seek care in an emergency department.
“When we call people with a positive result, there's always immediate fear and nervousness that things are going to get worse,” he said. “We have to reassure them that based on their symptoms and overall health, for the majority of folks, they do okay. [But] we also have to make sure that they know that even healthy folks can get worse quickly.”
Bayhealth has tested more than 1,000 people for the virus.
Fink says due to the limited availability of tests, the coronavirus management team is prioritizing for testing people with symptoms as well as a known exposure to the virus or underlying health conditions. Still, he says the hospital has been able to test every patient they think fits criteria for testing.
But Fink thinks testing for the virus should be more widespread.
“We should be testing way more people than we are to really help know the extent of this disease right now. I'd love to be able to test anybody with a cough or even people who aren't symptomatic, so we could really have an idea of the prevalence in the community— so we can get about an expectation about who’s immune and who's not immune.”