Palliative care expert on the symptoms of COVID-19

How does COVID-19 affect the body and how you address the symptoms.

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Our friends over at the Centre for the Art of Dying Well have released a podcast on care and accompaniment during the COVID-19 pandemic. This clip features Dr Kathryn Mannix – a Palliative and End of Life Care physician and author of the excellent book ‘With the End in Mind: Dying, Death and Wisdom in an Age of Denial’. Kathryn’s a woman who’s on a mission to get us all better acquainted with the idea of dying well and, having retired, has returned to work to led her expertise to tackling the COVID-19 pandemic.

This segment explains how COVID-19 affects the body and how you address the symptoms.

TRANSCRIPT

The virus does a variety of things. We know that in the early days, people feel hot – very hot, extremely hot – and we also know that those peaks of temperature carry on flipping up and down for quite a long time, sometimes for more than a week, sometimes for more than two weeks, even while the person is actually getting better. And then if it’s going to cause them a lot of bother in their respiratory system, it starts mainly with a cough. It’s an irritating dry cough.

Now, people can deal with being hot and having cough at home – neither of those is an anxiety inducing symptom from a medical point of view. We just advise people who are very hot to keep themselves well hydrated. If they’re getting so hot that it makes them feel cold and shivery – you know that old thing where when your temperature is very high, you then get very, very shivery.

They use paracetamol to keep their temperature down a bit; tepid drinks to stay hydrated. And for coughing, we’re advising just linctus, honey, or just something that soothes the throat.

But some people will go on to get an infection lower down in their respiratory tract and it will start to cause problems in their lungs. That can start to make people have not only a cough, but also to feel breathlessness. And people can start to notice that they’re breathless when they’re trying to get up the stairs for example. At that point, if they’re starting to feel breathless and the breathlessness is starting to trouble them, that’s the point at which we’re being advised to use the NHS 111 advice line – online if you can do that, and if not by telephone. And eventually you will talk to a GP through that system who will talk to you in more detail and will give advice about how you carry on managing at home or who will say, actually, I think that you’re struggling enough with your breathing that it might be a good idea if you come into hospital.

The invitation to hospital, of course, can be declined – and there are people who know that “even if I’m so sick that I’m risking my life by not going to hospital, I don’t want to be separated from my wife of 60 years, particularly if I might die when I’m away. I’m going to stay home and take my chances.” And their primary care team will help to look after them if that’s their decision.

But there are more options for comfort care in hospital. It’s easier to have access to oxygen. It’s easier to have access to a machine called CPAP, which works by blowing oxygen at high pressure through a mask across your names or across your nose and mouth. So it’s a kind of ventilator, but it’s not an intensive care unit sort of ventilator. And of course, there are some people who are so sick that they need their breathing to be taken over by a ventilator until their lungs have recovered or until, sadly, their lungs are not able to recover.

And it becomes apparent that the person isn’t going to survive. And most of the people who die from COVID die from this lung inflammation and a septic-type condition where actually their body organs just can’t cope with the onslaught of being so sick for so long.