Eleven days into her isolation at a quarantine facility, a COVID-19-positive nurse on Grand Bahama is calling for adjustments she believes can aid in keeping healthcare workers and the general public safer.
Her diagnosis was the first for Grand Bahama after a two-week period where no new cases were reported.
In a phone interview with The Nassau Guardian, case #89, whose name is being withheld to protect her identity, provided details of her symptomatology that go to the heart of ongoing research regarding the case definition for COVID-19 and the duration of the disease.
Experiencing weakness and muscle aches in the days since her May 5 diagnosis, the nurse, who is assigned to the Rand Memorial Hospital, said, “Somewhere around the end of February is where the vomiting, diarrhea and chills started, and it was so bad I had to make an appointment on March 2.
“I was home for about three to five days; returned to work and within a week after that I left work with a busting headache; went home and woke up the next morning with a headache and a temperature that was very high, at points at around 102.9.”
It was at this point that she phoned the COVID-19 hotline, and after being screened at one of the post-hurricane modular tents at the Rand Memorial Hospital, she was given two weeks off from work and was asked to self-isolate at home.
She shares a home with her daughter, son-in-law and their two young children, and pointed out that apart from occasions when her rambunctious two-year-old grandson would burst into her room, she was able to remain fairly isolated.
“I couldn’t eat because my taste buds were out of whack, and I could not smell,” she added, acknowledging the symptoms as being tell-tale signs of a COVID-19 infection.
She did not wear a mask during her self-isolation period at home, and the family would practice wiping down surfaces whenever she ventured outside her bedroom.
Her fever, she said, lasted for about 10 days, and with pre-existing conditions of diabetes and hypertension, she took no chances and checked both her temperature and pressure regularly.
“Around the time that I was having the high fevers, my daughter had a sudden onset of asthma/wheezing,” she stated, “and she hasn’t had asthma since she was three and she is 30-something now; and she was scared to go to the hospital so she stayed home and used the nebulizer.
“At the end of the 14-day period, I was checked at [the outpatient clinic] and they told me I was fit to return to work, bearing in mind that they never, ever swabbed me; so I went back to work.”
Over time, extreme fatigue set in and she began suffering new symptoms of chest discomfort and a scratchy throat that lasted “several days”.
Friends urged her to seek a checkup and she did, once again at the modular unit of the Rand where she was told by the attending physician to return home and isolate for another five days.
She admitted that before going back into isolation, she went grocery shopping and carried out other errands because she did not expect to be returned to isolation and had to “take care of my needs”.
Two days later she was called back to the Rand to be swabbed, was informed of her positive test result the following week, May 5, and was prescribed a regimen of Panadol and the antibiotic Azithromycin 500mg for five days.
“I had a sinking in my stomach, I felt a hollowness in my stomach when he said I was COVID-19-positive,” she shared.
And by then, her health status was not the only thing that had changed.
“When I was in isolation the last time, there were two bathrooms,” she pointed out, “but there were problems with one of the bathrooms, so all of us were using my bathroom.”
Having advised her doctor of this, she was told that she would need to be taken out of her home and placed into a quarantine facility for the safety of her family.
Passing the time in quarantine by sleeping, praying and communicating with friends and family via telephone, the local nurse said she is leaning toward the view that all of her symptoms, notwithstanding the time span, are connected.
Her range of symptoms spanned approximately 10 weeks.
“I’m not sure if the stomach issues were a part of it because they are trying to say that the time period was too long,” she offered, “and they are doing their investigations as well, but I believe one is connected to the next.”
Her belief may not be far-fetched, considering that research shows considerable variability in the kinds of symptoms associated with COVID-19 and how long the illness can last.
Case #89 is one of nine nurses in The Bahamas who have tested positive for COVID-19.
She said that from her understanding, a number of healthcare workers had to be quarantined because of their exposure to her, but that none had tested positive for COVID-19 to date.
Last week, COVID-19 Task Force Coordinator Dr. Merceline Dahl-Regis said the Ministry of Health remained concerned about the number of frontline healthcare workers becoming infected, and that plans were in place to investigate the reasons for the regionally high percentage of infections so as to formulate appropriate infection prevention and control measures.
When asked how she thinks she may have become exposed to the virus, the nurse surmised that it could have been during periods of going back and forth unmasked to the Rand with her diabetic brother who suffered a severe case of food poisoning.
She claimed that while on rotation, she was not provided with N95 masks, and would triple-up on the masks she did have when working “the sicker wards” of the hospital.
Additionally, she pointed to the current pool system for the limited number of nurses on rotation, which she believes could pose its own share of risks in the COVID-19 fight.
In the aftermath of Hurricane Dorian’s damage to the Rand, wards such as maternity and special baby care where case #89 has been assigned, were transferred to the Sunrise Medical Center miles away.
“I don’t think all safety measures are being met [at Sunrise]. I think they need to do more,” she insisted. “They have to assign someone to man the main entrance because most of the time people come there and you have to be sent out from off the floor to them.
“When you come in you are supposed to sign a form and have your temperature checked, but a lot of times that wasn’t being done because there was no one there to do it.”
She further maintained that static stationing of nurses could provide better controls.
“They need to stop moving the nurses up and down,” she asserted.
“If I work on the maternity ward, leave me in maternity ward because we are in a pandemic and with [contact tracing] if you had me stationed somewhere, you would not have to be trying to find out whether I passed through this ward or the next ward, but we are all over the place so your contact tracing is just like you are on a wild goose chase.”
The health and safety of healthcare workers is paramount not only in the COVID-19 fight but for the ongoing delivery of healthcare services nationwide, and even with personal protective equipment, those on the frontline are not impervious to fear, as case #89 revealed.
“One of the healthcare workers who came to bring me food was acting a little strange,” she reckoned, “and then one of the nurses who came to take my temperature was visibly shaken, but I didn’t let her know that I could see her shaking, like she was fearful to come and check me.”
With so much uncertainty about the pathogen at the center of the current pandemic, fear can be expected, but looking ahead to the end of her quarantine period when she will be re-swabbed, the nurse said she is not afraid to return to work.
“I am hoping the next test is negative,” she said.