ANATOMY OF AN OUTBREAK – Part II: The Residents
By JOHN HOPKINS, DR.P.H.
(All rights reserved. Names and identifying information have been changed for privacy’s sake)
Louise and Thelma each lived about 90 years before they met as roommates at Bellamy Fields. Among my theories about dementia is “two heads are better than one” (John Haywood proverb).
Assisted living often builds in social isolation by promoting the individual apartment model of elder care. A resident can avoid essentially all social contact.
For elders with dementia, this is toxic.
Whether at camp, college, the military, whatever, roommates and more are the norm. Your mother may like her privacy in old age but her dementia doesn’t. Dementia benefits from two active, aging minds engaging each other, day and night.
Thelma had a double room to herself for a while before Louise showed up. They both have mid-stage presumptive dementia of the Alzheimer’s type. They share a double room in the middle of the second of three wings and are popular among other residents because of their engagement in activities all day, every day.
At 90, with a proclivity for urinary tract and upper respiratory infections, Thelma was found to have a fever on the fifth of April. Urinalysis was sent for testing; chest x-ray was negative for pneumonia signs. Fever around 101 and lethargy are prominent. Antibiotics start on the 7th.
Her age and symptoms trigger a hospice assessment in case she declines further but hospice finds her not to qualify and family agrees to palliative care, which I regard as Hospice-lite. Thelma’s Covid test is positive on 4/8. Time from test to results has improved. Hospice is now indicated.
I call Louise’s daughter to report roommate?s illness and get permission to test her mother. The literature says exposed roommates should stay together. Louise’s daughter demands otherwise.
As far as quarantine for them, Thelma is wiped out and in bed but Louise is a non-stop presence all over the building. Her attention span when I did a clinical interview and phone call with her and her daughter was about 30 seconds. She repeated some questions five times in three minutes.
The means to enforce her quarantine range from unethical use of sedating drugs to illegal physical restraints including locking her in her room. Welcome to life with dementia. Thelma tests positive and looks like a million bucks- did we send the wrong specimen or did the lab mix up the results? reporting?
Meanwhile, personal protective equipment is scarce. We’re debating going to an infirmary model and congregating positive people on one wing. The people we have to move out to do this include some special men who will resort to dementia mayhem under the stress of a move. Their families agree. We stay put.
The space between a rock and a hard place is getting crowded. Staff are working wonders and suppressing panic. I am reminded of fight or flight reactions. Adrenaline is a wonderful neuro chemical in short bursts.
Drum roll: you and I are being chased by a grizzly bear and you scream, “we have to outrun the bear” and I scream back, “no, I have to outrun you!”
That’s adrenaline for you. In our Middle East wars, soldiers in hypervigilance mode for hours and days at a time are having their brains and other organs damaged by relentless releases of adrenaline.
We grovel for our own supply of test kits, instead of getting three at a time. A sketchy looking package arrives for me with 30 test kits.
The Easter egg hunt is cancelled; Skype and FaceTime are great until the activities therapists test positive and go home. Group activities had been eliminated anyway. Dining and main living room accommodations have been spread out and thinned out to promote social distancing when possible.
I announce at a staff meeting that I expect everyone with a fever will test positive. All but one guy do.
