PATIENTS with irreversible lung damage don’t usually survive, even when on oxygen —Dr. Akinpeloye
According to the NCDC, COVID-19 has killed 1,905 people out of the total 155,417 confirmed cases in Nigeria since the country recorded her first case on February 27, 2020. An expert with the Infectious Diseases Unit at the Lagos University Teaching Hospital, Idi-Araba, Dr. Oluwafemi Akinpeloye, shares what it means to manage coronavirus patients from the time of admission until they passed away. ANGELA ONWUZOO reports
One of the medical experts treating and managing COVID-19 patients is Dr. Oluwafemi Akinpeloye, who works at the Internal Medicine Department, Infectious Diseases Unit of LUTH.
Akinpeloye says though the virus has no cure yet, people who test positive for it and seek treatment early survive more than those who visit the hospital late when their condition might have deteriorated and requires oxygen.
Sharing his clinical experience with PUNCH HealthWise on the various stages leading to some patients’ death, the infectious disease doctor says some of the victims, even before they eventually died, “knew they would not make it, especially those that presented late.”
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He narrates, “My experience in managing COVID-19 patients is one that I will never forget in a lifetime.
“Managing COVID-19 patients has been on my lap since April 1, 2020, when the first case presented itself at LUTH.
“From that moment, my life changed. We have been managing cases of Lassa fever, other communicable and infectious diseases, but COVID-19 is different. It is my unit — Infection Diseases Unit — that manages infectious diseases and COVID-19 happens to be an infectious disease. So, it is our responsibility to treat COVID-19 patients.
“Now, talking about what I saw in those that died, the fact is that most of them presented when their condition was already bad. People have been dying from COVID-19 and they usually die as a result of breathlessness.
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Breathlessness and low oxygen concentration, signs of danger
“When they come, you will see that physical sign of breathlessness. For some, when we check their specific oxygen concentration, we will find out that it is abnormal.
“Normal specific oxygen concentration should be between 95 and 99. But when you check their oxygen concentration, you find it to be 75. It is breathlessness that kills COVID-19 patients. Once they present with breathlessness and low oxygen concentration, then there is a problem.”
Giving further insight, Akinpeloye said, “The disease itself is just a viral infection, like many viruses that affect the body. But this one attacks and destroys the lungs and makes it impossible for the person who is infected to be able to take up oxygen.
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“The nose itself requires oxygen, distributing oxygen to the rest of the body. So, the disease makes it impossible for the nose to get oxygen. Once the lung fails in getting oxygen, it cannot distribute what it does not have and the person dies.
Oxygen therapy, key in patient survival
“So, the mainstay of treating COVID-19 patients has been, and will always be, oxygen therapy.
“Oxygen therapy is the only way that we can really manage COVID-19 patients. If the patient suddenly develops breathlessness, there is no other means of managing that patient other than ensuring that the patient gets oxygen.
“The idea of admitting patients in the hospital from the beginning has been that most of the people that contracted the disease who end up having issues are those that naturally have underlying illnesses.
“They have hypertension, diabetes, asthma, ulcer, among others. So, COVID-19 comes and worsens their original problem.
“When we admit them, we now have to manage their original problem, which has now become worse and then still manage the COVID-19 itself by giving oxygen.
“I see a lot of patients who come in requiring oxygen to survive. I have seen a lot of them die from the infection.”
He went on, “But If COVID-19 is picked up early; the chances of survival are high. Most of the patients that died had presented badly. As health workers, we already knew that their case was bad.”
Akinpeloye said that patients that died were “those that came in bad.”
“There were some patients whose relatives I quarreled with for allowing their health to deteriorate before bringing them to the hospital.
“Once their oxygen concentration drops below 90, it is a problem. They will not make it.”
‘Second-wave patients sicklier’
According to Akinpeloye, in this second wave, patients are sicklier. “They are very sick and require a lot of care. The virus is changing the way it attacks and there are even new variants.
“The patients were devastated because, in most cases, they came to the hospital when some damage had been done to their lungs. When the damage is irreversible, the person will not do very well and the person will die,” he explained.
The Minister of State for Health, Dr. Olorunnimbe Mamora, had, in January, blamed private health facilities for the death of many COVID-19 patients.
Mamora, while speaking at one of the Presidential Task Force on COVID-19 briefings in Abuja, accused private facilities of referring patients to approved treatment centres late.
The minister had said, “The report that many of those who died reported late for treatment at the approved centres because they were referred late from private facilities, is alarming.
“We, therefore, once again seize this opportunity to urge healthcare practitioners to promptly send all suspected cases for testing and when positive, refer them to isolation centres for treatment.
“Attempting to treat suspected or confirmed cases not only exposes the health workers in such a facility to risk of infection, but also denies the patient early access to effective treatment in an approved treatment centre.”
I didn’t know it would come this far —Dying patient
Sharing some painful experiences of the final moments of some of the deceased, Akinpeloye said, “In their last conversations before they passed on, they usually said that they didn’t know it would come this far.
“Many of them that had died knew they would not make it. But beyond the knowledge of their demise was the delirium they manifested at the point of death.
“They usually become very confused. When the oxygen concentration becomes low, they usually don’t talk before they die,” the specialist said.
He noted that, in fact, many of them would already have given up before they died, stating, “When you are unable to breath, it is not an experience anybody should have.
“I go into the wards, I see my patients sitting up, they can’t sleep because if they lie down to sleep, they will pass on from their sleep. They sit up and continue to ensure that they are getting oxygen.
“Such people are breathing but the virus has destroyed their lungs. So, they are not getting the oxygen despite the fact that it was provided.”
Fighting a virus psychologically
Concerning their mental state, the infectious disease doctor told our correspondent that most of the patients became hopeless the moment they were told they have the disease.
“But some people have a fighting nature. They begin to fight psychologically that they will make it the moment they are told they have the virus.
“When you have that mentality that this disease will not kill you and you have that natural mechanism, the brain will be controlled. Once the brain is continually saying ‘I will fight this,’ the tendency that the person will get out of it is always high because of the psychological component.
“Loneliness is not really an issue. In this period, they encourage each other and isolation is not an imprisonment. If they are feeling lonely, it is because they are missing their loved ones. But most people don’t do well with isolation.
“Now, in some patients, the disease can produce psychosis. But some believe that it is not a death sentence, especially the educated ones,” he said.
The physician also noted that those that died at home still had to do with issues around breathing.
Akinpeloye urged those who tested positive for the virus to go to hospital for treatment and avoid self-medication.
“If you have symptoms of malaria, go for COVID-19 test and avoid presenting late at the hospital,” he counselled.
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