Coronavirus: Case study shows Covid's psychological impact

This week, St Helens and Knowsley’s Teaching Hospitals NHS Trust’s board heard how COVID-19 left a healthy 33-year-old alone and fearful that he would never see his family again.

Board members heard how the man, who has not been named, first presented to Whiston Hospital’s A&E department on March 23 – the same day the UK went into lockdown.

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Sue Redfern, the trust’s director of nursing, midwifery and governance, said the man had become unwell following a trip to Japan.

She said: “He attended our A&E department on the 23rd March with a fever, a cough, reduced smell, vomiting and diarrhoea.

“So obviously clear symptoms of COVID. He’d recently returned from Japan. 

“He’d been self-isolating for four days and then developed a really bad abdominal pain, with a score of eight out of ten, had a high temperature and shivering.

“So he attended our A&E department.”

The 33-year-old man first attended Whiston Hopspital's A&E department on March 23

The man was formally diagnosed as having COVID pneumonia following chest X-Ray.

Ms Redfern said that, despite appropriate treatment, the man’s condition deteriorated, and he needed to be transferred to Whiston Hospital’s ICU department on the March 31.

She said he was nursed in isolation and required constant monitoring.

During this time, he was unable to see his partner or his children, something that proved to be a great cause of anxiety.

“After 10 days of being in the hospital he had significant improvement and he was transferred down to a ward and received a normal level of oxygen,” Ms Redfern said.

“While on the ward he continued to improve and was assessed by the therapist and was able to walk and shower independently, but was very fatigued.

“By the 12th April he no longer needed oxygen, was really keen to go home and was discharged with a plan to follow him up in six weeks’ time.”

The board heard that after just four days at home, the man’s health suddenly deteriorated and he remained in bed for long periods of time.

On May 4th he returned to Whiston’s emergency department, where he was showing symptoms of lethargy, left-sided weakness, shortness of breath and poor mobility.

Ms Redfern said he also had some intermittent confusion and was struggling to put his sentences together.

“He was diagnosed with post-infection acquired weakness and shortness of breath,” she said.

“On examination they couldn’t really find another cause neurology-wise for his weakness in his limbs, other than fatigue related to COVID.”

At this point, the man was transferred to the Seddon Suite Rehabilitation Unit at St Helens Hospital.

During that time he revealed that he was suffering from fears and anxiety and flashbacks to when he was in ICU.

“They recognised that his mental health was contributing to his preliminary recovery and he was referred to a clinical psychology who supported him during his admission,” Ms Redfern said.

“During that, he talked about the traumatic memories of being in ICU. The fact that he couldn’t see his family. It was really important that he wanted to have contact with them.

“The fear that he may not come out of ICU. And also about the anxiety that was causing because he couldn’t pay attention and he had really poor concentration.”

Following two weeks of intensive rehabilitation, the man was discharged from St Helens Hospital.

He is now receiving respiratory treatment and support in the community.

The man was transferred to Seddon Suite Rehabilitation Unit at St Helens Hospital

But the trust’s director of nursing said the man’s case demonstrates the physical and emotional consequences of COVID-19.

Ms Redfern said that, at the start of the crisis, the NHS did not know what the long-term consequences of COVID were going to be.

She said the social isolation is potentially affecting the ability of patients to recover as quickly as the trust would have thought.

Follow the man’s case, Ms Redfern said medical staff are now looking more closely at the potential psychological impacts of COVID on its inpatients.

She also said six weeks wait for a follow-up appointment following discharge for COVID patients, something that is routine practice, is a “long time”.

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Ms Redfern also revealed the 33-year-old man did not receive a welfare call on discharge or a home visit from the critical care outreach team, due to the level of activity going on in the ICU department around this time.

She said the trust is “back on track” with this and has put everything back in place.

Ms Redfern stressed that the man was happy with the care he received while with the trust, but his case has been highlighted to demonstrate the psychological impact his experience has had on him.