On 22 January 2020, a 65-year-old Chinese man with a history of hypertension, type 2 diabetes, coronary heart disease for which a stent had been implanted, and lung cancer was admitted to the emergency department of Cho Ray Hospital, the referral hospital in Ho Chi Minh City, Viet Nam, for low-grade fever and fatigue.
He had become ill with fever on 17 January, a total of 4 days after he and his wife had flown to Hanoi from the Wuchang district in Wuhan, where outbreaks of 2019-nCoV were spreading. Throat swabs obtained from the patient tested positive for 2019-nCoV.
He was identified the first Covid-19 patient in Viet Nam.
His 27-year-old son living in Long An, a province 40km southwest of Ho Chi Minh City met and accompanied his parents from central Vietnam during this time.
On January 20, a dry cough and fever developed in the son. He also reported having had vomiting and loose stools one time before the admission. This suggests that the incubation period for 2019-nCoV may have been 3 days or less in this case.
When the son presented at Cho Ray Hospital with his father on 22 January, his illness, characterized by a fever (39°C), was recognized and he was immediately isolated. (Phan et al., 2020)
The patients are both Chinese and could not speak any Vietnamese. When admitted, the 65-year-old patient protested again the diagnosis of Covid-19 and refused to quarantine and take the test. He was aggressive and could not comprehend the care team’s conversation due to his resistance and the language barrier. The problem was not only their Covid-19 infected conditions but also how to apply immediate quarantine for the patients.
Patient with high-risk comorbidities exhibited severe symptoms and need intensive care. After a convincing effort, explanation and family discussion, he agreed to the care.
However, this is only the first case in Viet Nam, and there are shortages in treatment guidelines, experience, facilities, etc.…
Learning from the past epidemic (ex: SARS 2013) and with the new WHO guidelines, the care team applied several methods such as: opening the ward’s windows for fresh-air circulation, physical movement and rehab like walking, sunbathing to maintain body’s warmth and respiratory.
Since admission the elder patient become depressed and the care team done their best to comfort him by chatting to him frequently and bringing him their own traditional food during the Lunar New Year occasions. The patient gradually accepted his SARS-Cov-2 infection and became more friendly to the care team.
"All we are doing is to encourage patients to rely on our team. If they don’t trust us, we cannot deliver effective care for them. This fight is the most valuable experience that each healthcare worker will confront." Dr. Nguyen Ngoc Sang, the Department of Infectious Diseases.
Author: Dr Phan Thanh Phuc, University Medical Center, Ho Chi Minh City, Viet Nam/ Taipei Medical University, Taipei, Taiwan; ISQua Member & Fellow.