Frank rang, concerned about his wife. “She’s coming out with some very strange things,” he told me. “Sometimes she doesn’t even know where she is.”
“How long’s it been going on?”
“Ever since she started those new tablets.”
I flicked back through Elsie’s records: she’d been prescribed a different blood pressure treatment a week before Christmas. Confusion in the elderly has numerous causes, and drugs can certainly be responsible, but it wasn’t something typically associated with that medication. Infection is a more common cause. “Has she had a cough, or any change in how her bladder’s working?”
Frank sounded embarrassed. “Well, last night, she went to the bathroom and peed all over the floor.”
It was New Year’s Eve. On top of the heightened pre-bank holiday demand, our primary care network (PCN) had that morning received some long-awaited news. Two provisional dates in December had come and gone without supplies, but we were definitely getting our first batch of Pfizer vaccines on 7 January. A large chunk of my morning had been swallowed up by a video meeting among all nine practices, working out the details of the complex operation in which our first 1,000 patients would be immunised over two and a half days. An unexpected home visit was the last thing I needed, but Elsie was going to have to be seen.
Delirium can sometimes result in paranoia; I wasn’t too sure how Elsie was going to react to a PPE-clad GP appearing in her living room. Fortunately, her confusion turned out to be benign. She sat on the sofa with a bemused expression, as though Frank and I were discussing someone unknown to her. She turned out to have a modest fever; her chest was clear, and her oxygen saturations were acceptable, if a little low. Frank hadn’t managed to get a sample, but a urine infection seemed the likeliest cause.
I was still wiping down my stethoscope when Frank’s mobile chirped. He checked the screen and sighed: “Three days to go.” I gave him a quizzical look. “We shielded the whole year,” he explained. “Then went out for one meal on Christmas Eve. Someone in the restaurant tested positive.” He looked down again at the isolation reminder from the NHS track and trace app. “But we kept ourselves to ourselves, over in the corner. So we should be OK, shouldn’t we?”
I questioned him more closely. No, now I mentioned it, Elsie hadn’t been confused at the time of the meal. And he’d had no idea that Covid in the elderly can present with confusion. I organised a test for Elsie and prescribed an antibiotic, in case urine infection did prove to be the cause, but left Frank strict instructions on what to do if Elsie deteriorated over the long weekend. Her test was still pending on Monday. By then, Frank had developed fever and a cough, and was too weak to keep looking after her. Both had to be admitted; both were Covid positive.
Three days later, our PCN began immunising. Frank and Elsie, in their mid-eighties, should have been among the hundreds of eager elderly being marshalled through our vaccination hub, set up in a nearby community centre. Instead, weary after nine months of strict isolation, they’d been swayed by government messaging that Christmas was a time when restrictions could be relaxed. Even when five days of mixing had been reduced to one, they’d felt their restaurant outing, so keenly anticipated, ought to be safe.
Elsie and Frank are making good progress, but still in hospital. Our second batch of vaccines is due this week, though colleagues elsewhere in the country remain frustrated, yet to receive supplies. The race to provide protection is on, but halting. The vulnerable will need to maintain their guard for a good while yet.
[see also: Journal of a plague year]
This article appears in the 13 Jan 2021 issue of the New Statesman, American civil war