Care in hospital for coronavirus

If a person needs medical treatment for severe COVID-19 this will mean going into hospital. Read our advice on hospital care for someone with dementia. You may find some of this distressing, but it can help to be prepared.

This information will also apply to a person who goes into hospital from a care home.

You can find further advice on what to do if a person with dementia falls ill at home. This explains when a person may need hospital care for coronavirus infection, and who to contact if they are unwell.

Hospital care for coronavirus

New treatments from clinical research have improved survival rates compared with early on in the pandemic, but COVID-19 is still a potentially very serious disease.

Drugs against coronavirus such as remdesivir have a role, but medical treatment relies mainly on easing symptoms and supporting the person’s body while their immune system fights the virus. Someone can be in hospital for several days or – for a few people – several weeks.

Doctors will start with a full assessment of the person. Unless they are very seriously ill, the person will generally be admitted first to a COVID-19 ward. They will be treated and monitored regularly in case they get worse. If this happens, they may then be moved into a critical care unit for closer monitoring and intensive care.

Medical staff, family and the person themselves, as far as possible, will all be involved in deciding that person’s treatments. Some of the more intensive treatments won’t be appropriate for some people, for a range of reasons. We have advice on decision-making in hospital that covers this.

Treatments for severe COVID-19

The most common problem in someone with severe COVID-19 is serious difficulty breathing. A person may also have sepsis or problems with other organs (including kidneys, liver, heart, brain).

Depending on the person’s condition, hospital treatment may include:

  • paracetamol – for fever
  • medical oxygen or ventilation – with remdesivir and dexamethasone (see below)
  • management of delirium (see below)
  • antibiotics – in case the person also develops a bacterial infection
  • anticoagulant drugs – to prevent blood clots
  • fluids pumped into a vein – to keep them hydrated
  • sedatives – to relieve distress caused by breathlessness
  • other drugs – to maintain blood pressure, for example
  • management of other long-term conditions – for example, diabetes
  • nursing care – for example, regular turning to prevent pressure ulcers or maintaining nutrition by inserting a thin tube from nose to stomach.

For the most ill patients in critical care, the medical team may be treating several very serious conditions at once. Some people will respond well to treatment and get better but for some this will not be possible and not everyone will survive.

Oxygen therapy for COVID-19

Some people with coronavirus don’t have enough oxygen in their blood or they have fast or difficult breathing. On a COVID-19 ward, extra oxygen can be given by a face mask or tubes in the nose. If the person needs more support, they may be fitted with a special mask connected to a machine. This pushes oxygen into their lungs.

A person in a very serious condition may need mechanical ventilation. They will first be given drugs to sedate them heavily. Then a tube is passed down their windpipe into their lungs, and the ventilator breathes in and out for them. This is an invasive procedure and may be upsetting for you to see.

Anyone given oxygen, by any route, may also be treated with the antiviral drug remdesivir and dexamethasone. Patients on oxygen given dexamethasone who have evidence of inflammation may benefit from the anti-inflammatory drug tocilizumab. 

As the person gets better, the medical team will try to bring them off the ventilator by reducing sedation and encouraging the person to breathe for themselves, perhaps by a mask.

Once the person is stable, they will be transferred from critical care to a ‘step-down’ ward. Here they will continue to recover before being discharged from hospital. They will generally need rehabilitation to help their recovery.

Treatment for delirium

If the person develops delirium, doctors will look for the cause of this. Dementia and older age make delirium much more likely. For many people with dementia and COVID-19, delirium may largely be the body’s response to the infection. Other factors that can cause delirium include:

  • disturbance in metabolism (for example, blood sugars)
  • other infections
  • a change in medications
  • low oxygen levels
  • dehydration
  • constipation or retention of urine
  • pain

There are various aspects of treatment for delirium, and drugs may be necessary if a person with coronavirus has severe agitation.

Non-medical approaches are also important. For example, face-to-face contact from the person’s family would normally be a key part of delirium support in hospital. This may be much harder with restrictions on visiting.

However, staff will provide valuable support to help the person recover by paying attention to the following aspects:

  • Environment – ideally the person will have a calm and peaceful room for rest and sleep with good, natural lighting during the day and ways to keep the room dark at night.
  • Sensory aids – the person needs to wear clean, comfortable glasses and working hearing aids (if appropriate).
  • Orientation – moving wards, being ill and sleeping all the time can be very disorientating. A 24-hour clock and calendar may help the person keep track of the time of day.
  • Interaction with carers or hospital staff – offer gentle reassurance and communicate in short, simple sentences.
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