I have complex medical conditions. If people like me get Covid-19, how will we be treated?

Covid-19 will remain a threat until a vaccine arrives. National Centre for Infectious Diseases executive director Leo Yee Sin conceded during a webinar on May 14 that complete eradication of the disease “is not very attainable at this point”.

Even if we prevent another major outbreak, the virus will likely pop up sporadically and randomly, with “recurring epidemic waves interspersed with periods of low-level transmissions”, she said, adding that it is not sustainable for Singapore to remain in a circuit breaker to stem the spread of Covid-19.

This means that as we gradually resume daily activities and go back to school or work, even with safe distancing precautions in place, we can expect infections to be reported.

An oft-cited piece of good news is that most Covid-19 cases are mild, with healthy adults likely not needing ventilator support and experiencing only mild symptoms which resolve themselves on their own.

We also know that seniors and those with underlying conditions such as hypertension and diabetes are at a higher risk of complications and death.

But there is another group which deserves close attention: Those with chronic or congenital diseases that compromise respiratory function.

This is a diverse group, ranging from people whose respiratory organs are damaged by prior illnesses, chemicals, or physical trauma, to those with other disorders which count respiratory impairment among their symptoms.

I am an example of the latter. Because of a neuromuscular disorder known as spinal muscular atrophy, my lungs are functioning at below 30 per cent of their normal capacity.

I use a non-invasive form of artificial ventilation known as a bilevel positive airway pressure (BPAP) machine to help me breathe at night and when I’m down with colds and flus.

Although inadequate information exists about the effect of Covid-19 on patients like me, the fact that it can cause severe respiratory symptoms including pneumonia means it might be dangerous to us. Our lungs are already weakened and may not be able to cope with the increased strain of an infection.

Medically, Covid-19 patients are given supportive care, which simply means treating their symptoms. There is currently no drug that treats Covid-19 directly.

As yet, there do not seem to be specific treatment protocols for vulnerable groups. This is understandable since we’re still learning about this new disease, but I hope the authorities will develop and make known treatment plans for patients with unique circumstances.

Beyond the medical aspect, it’s also important to consider patients’ other needs.

For example, infected patients are now isolated either in dedicated hospital wards or community facilities to curb the spread of the virus. Only authorised staff members are allowed into these places.

But for patients with other medical problems like me who rely on caregivers for our daily needs such as toileting, washing, dressing, or eating, being isolated is an existential crisis.

If I get infected, I will need plenty of help to do the most basic things throughout my recovery period, putting a significant strain on the staff.

Communication could also be an issue. From prior hospitalisations, I know I lack the strength to press the call button that sends an alert to the nurses’ station. I’m unable to raise my arm high and wave to attract attention.

Another area of concern is ambulance rides. Will the paramedics know what to do with me given my complete reliance on a BPAP machine?

My doctor is sufficiently concerned about this that he has given me a memo advising the paramedics that I will need constant ventilation and oxygen supplementation en route to the hospital. I, or my caregiver, am to give this memo to the emergency responders if necessary.

But my doctor pointed out that he has no power to control the eventual actions and decisions of the paramedics.

In short, coming down with Covid-19 will cause many knock-on problems beyond the viral infection itself, and there are many factors to consider in handling complex cases like mine.

Although I use myself as an example, there are others in Singapore who face similar issues and harbour similar worries.

I have three suggestions that I hope the Ministry of Health (MOH) will consider.

First, prioritise Covid-19 tests for everyone with diminished lung function, even if they do not meet the criteria of having pneumonia, prolonged upper respiratory tract symptoms, or a contact history with affected people or places.

Time is critical with acute illnesses such as Covid-19 and if these patients have to wait until they develop pneumonia or severe symptoms before becoming eligible for the test, the virus would have invaded their already-weakened lungs and it may be too late.

Secondly, afford some flexibility in the way atypical patients are treated. For example, if possible, people with severe disabilities like me can be cared for at home by our usual caregivers. To prevent the virus from escaping, the home is locked down until the entire household is declared virus-free.

If the patient needs hospitalisation, look into giving permission for a caregiver to accompany him at all times. Paramedics and doctors would benefit from the advice of this caregiver, who knows the patient’s medical situation well.

This caregiver cannot leave the hospital until the patient is discharged to prevent the virus from spreading. I understand that KK Women’s and Children’s Hospital already offers this arrangement to parents of children with Covid-19, so it shouldn’t be difficult to extend it to others who need it.

Thirdly, MOH could work with patients from more diverse profiles such as those with rare diseases to identify more areas of concern and co-create solutions that are most relevant to their unique circumstances.

There are also plenty of doctors who specialise in these specific illnesses who are in a great position to give medical advice tailored to these groups. 

For example, I am fortunate to be in the good hands of the Home Ventilation and Respiratory Support Service at Tan Tock Seng Hospital — the experts from this team will be able to advise the ministry on how to deal with me, if I were to be infected.

Covid-19 is here for the long haul and we have to learn to coexist with it, so having treatment guidelines that account for as many types of patient needs as possible would not be a wasted exercise.

They would help our healthcare workers be better prepared to cope with challenging situations and result in a more robust medical system.

ABOUT THE AUTHOR:

Jonathan Tiong is a fourth-year student at the National University of Singapore where he is majoring in Communications and New Media.