April 11, 2021 Emma Sharp Dalton-Brown

Collateral Damage of Covid: Part 1

Collateral Damage of COVID: Part 1

By: Emma Sharp Dalton-Brown

“I feel pain and a burning in the middle of my chest,” my friend tells me. “I can’t turn left, nor right, and my energy level dies to nothing.” She is one of the luckier asthmatics, whose Ventolin inhaler has given her relief on several occasions. However, there are other adults, and children alike, who cannot afford Ventolin or who simply require more than the inhaler/puffer to save their lives. Someone in this predicament is dependent on being able to go to the Emergency Room, where medical staff hooks him or her up to a nebuliser, a machine which pumps air through a liquid medication to form a misty vapour that is inhaled through a mouthpiece or mask into the lungs of the patient, in order to alleviate the pain and save his or her life.

According to an article published in the British Medical Journal in 2012, “Almost a fifth (19.6%) of Jamaican children aged 2–17 years had current wheeze, while 16.7% had self-reported doctor-diagnosed asthma”(Kawha et al, 2012).  Their conclusions in this particular paper were, “The prevalence of asthma and allergies in Jamaican children is high. Significant risk factors for asthma include chest infections in the first year of life, a history of asthma in the family, allergies, moulds and pets in the home.” Globally, the most common non-communicable disease (NCD) in children is asthma. Some asthmatics in Jamaica, however, are going untreated because hospitals are at their full capacity.

This is part of the collateral damage of Covid. Collateral damage is the elephant in the room that few are openly discussing. It’s the reality for many Jamaicans who live with comorbidity-diseases and chronic illnesses such as Diabetes – Type 1 & Type 2, Cancer – of all kinds, Hypertension, Heart Disease, Stroke, Lupus, Rheumatoid Arthritis, Scleroderma, and of course Asthma. Many of these patients are suffering at home because there is no space in the hospitals to treat them, and nurses and doctors are already working extended hours, which we couldn’t even begin to imagine.

It was nine o’clock one Sunday morning in March 2021 and a critical care doctor with whom I spoke was just getting home from duty, after pulling an all-nighter. To say that she was tired would be underestimating the utterly exhausting task she and the rest of the medical profession have been thrown into March 2020. One could hardly expect, when signing up to train as a doctor or nurse, that work-life would be easy, but the last global pandemic was over 100 years ago, so there really is no one who can tell us how harrowing it was exactly. The few people who were alive then and are still alive today were too young to truly understand the impact on those who were working in medicine at the time.

Any of us who have had the experience of waiting to be triaged in the Emergency Room know that it’s not a short interlude. Regardless of where you are in the so-called ‘line’, your medical condition is sorted between emergent, urgent and non-urgent, as well as weighed against the state of others in said ‘line’. If you need resuscitation, you’ll be first up. If your condition shows an immediate threat to your life, limb or function, you’re next, and so on down to those who need medical intervention, yet can survive without immediate attention. The tricky part comes when there are so many emergent cases in the hospital that the number of patients outweigh the capacity of medical staff and resources. It has nothing to do with the capability or care of the nurses and doctors. It has nothing to do with getting bad service at a hospital. It is the reality of a global pandemic such as Covid-19.

It might be hard to imagine what’s really happening within our hospitals unless we feel it first hand, but why take the chance? Why can’t we simply be informed of the situation, believe the information and conduct our lives in a way that gives us the best chance to avoid being in hospital? We could each potentially catch Covid and potentially require hospitalisation due to complications from Covid. However, there are clear guidelines for us to follow when it comes to avoiding this deadly virus. We can all help hospitals, and the staff working within, by doing what our government has asked us to do, but many of us haven’t done that, have we? Our actions have directly impacted the hospitals. Our actions have directly impacted the collateral damage.

At the end of February this year (2021), Jalisa McGowan died during an asthma attack. She was only 17 years old and a student at Kingston Technical High School. Her mother reported that she was refused treatment at the University Hospital of the West Indies (UHWI). Jalisa was not put on a nebuliser, nor given oxygen. This could have been anyone’s child. This could end up being your child. How would you feel if your child were to have an asthma attack and life-saving nebulisation was not an option?

Nebulisers work with aerosolised solutions. Due to the pandemic, these cannot be utilised in an open area where others might be exposed to contaminated droplets, report several doctors, including Dr. Jacquiline Bisasor-McKenzie, Jamaica’s Chief Medical Officer. Therefore, a patient must be isolated whilst on a nebuliser so to avoid the potential risk of spreading Covid. This means that each person, who would normally be put on a nebuliser in a hospital emergency room, has to be put in isolation while using one. ‘“When you are severely enough asthmatic, Ventolin inhalers do not work. The patient must be put on a nebuliser, but more isolation space is needed to accommodate this,” one doctor told me.

Why was Jalisa not put on a nebuliser? Why was Jalisa’s mother told by medical staff that it was just not possible to give her the necessary treatment to save her life? Why was she not immediately told why they were not able to treat Jalisa or where she could go to get treatment for her daughter? Was Jalisa’s death part of the collateral damage of Covid?

Sources:

    1. Kahwa EKWaldron NKYounger NO, et al Asthma and allergies in Jamaican children aged 2–17 years: a cross-sectional prevalence survey