The Impact of COVID-19 for Patients Receiving Palliative Care

The Impact of COVID-19 for Patients Receiving Palliative Care

An interview with Heather Hartman, CNP, Transitions Home Medical Group from Dr.Kuljit Kapur

We are more than seven months into a global pandemic stemming from COVID-19. While the death toll has risen worldwide, so has the number of those who have recovered from the hallmarks of the disease.

As of August 24, 2020, there have been more than 23 million cases worldwide, with nearly 5.7 million of those in the United States. It is estimated that over 15 million people have recovered since statistics have been tracked. (source: Johns Hopkins, Coronavirus Resource Center)

Recently, I connected with Heather Hartmann, CNP, a leader in symptom management in end-of-life and complex palliative care and hospice care with Transitions Home Medical Group, to gain her perspective about caring for dozens of COVID-19 positive patients since March 2020. 

How do you assess Transitions’ palliative care patients that present with COVID-19?

Clinically, we monitor our patients for a fever. COVID-19 often presents with multifocal adventitious lung sounds. The chest x-rays often present with opacities, but you cannot confirm a COVID-19 diagnosis with a chest x-ray. Patients often have acute shortness of breath, fatigue and fevers that can spike. The treatment isn’t clear-cut, so we have to work with evidence-based practices. The focus is on providing hydration and treating any secondary infections like pneumonia. Having advance directives in place is critical to know the level of medical support the patient wants. 

How are you connecting with the families during this process?

Families aren’t always able to be with their loved ones during this time due to restrictions and isolation in communities, so I’ve spent a lot of time using FaceTime and Zoom to help patients connect with families. For example, I had one patient who made the decision to be a DNR knowing that her time was limited, but was lucid and wanted to speak to her daughter on the East Coast. We used FaceTime to connect with her daughter  to have a last conversation  and say “Good-bye” and “I love you.” She passed away two hours later.

You’ve seen a lot of loss with COVID-19, but what about some of the success stories?

I cared for a 96 year old woman, weighing around 100lbs, who contracted COVID-19 with all the hallmark symptoms, and survived. One facility had greater than 50% of its residents with COVID-19 positive symptoms. Through the use of Plaquenil (hydroxychloroquine), antibiotics and steroids, as well as IV hydration, most survived. 

What are you seeing with the patients who have recovered from COVID-19?

We’re not seeing any long-lasting sequela, and all of my patients are back to their baseline pre-COVID-19. At the same time, my patients have only been COVID-19-free for a few months, so we won’t know the long term effects of this illness until years of research are conducted. I continue to manage their conditions that brought them to palliative care in the first place, and we will manage however they present in the future.

If you could tell the world something about your experience, what would it be?

For 8 to 10 weeks I was knee-deep managing active COVID-19 cases, even testing patients with nasal swabs. The entire time I was in full PPE, including a N95 mask, gown and shield, and I’m grateful that I’ve been spared from contracting COVID-19. My family stayed healthy as well through following best practices. If I could say anything, it would be to maintain your social distance, wash your hands frequently and wear a mask to help minimize the spread of the virus.