Corona in the City

The integrated facilities take care of people who usually have a lot of problems. Opiate addiction, psychiatry, physical disorders and social problems. It is an extremely vulnerable group.

Working in times of corona: Special isolation locations for vulnerable groups with complaints

Source: Amsterdam Municipal Health Service (21 April 2020)

Homeless and undocumented persons with corona complaints can go to special isolation places. Melissa Diaz is a general practitioner at the GP practice Dr. Valckenier: “Reception locations, GPs and hospitals can refer people who are not ‘at home’ in isolation or who are very vulnerable through us for (preventive) isolation.

Melissa Diaz is a general practitioner at the GP’s practice Dr. Valckenier, around the corner from the GGD. This GP practice of the GGD acts as a safety net for people who are difficult to take or keep in care in a regular setting. “We are talking, for example, about homeless patients, often with psychiatric disorders or addictions, or undocumented people with complex problems. This group needs a different approach when it comes to combating coronas.

This specific group regularly has no home of its own, stays in night care, often in dormitories, stays somewhere with someone on the couch or has no shelter at all. The RIVM’s advice to go into isolation in case of complaints is often not feasible for this group. “That’s why we have drawn up a special coronaplan for this target group, in collaboration with the infectious diseases department, safety net and partners in the field,” says Diaz.

What does the corona plan entail?

“People from this specific target group, who may be infected with the coronavirus, can go to isolation locations throughout the city. Preparations have also been made to be able to provide palliative care to people who are very ill and who are no longer sent to hospital due to treatment restrictions. Fortunately, we have not yet been confronted with this in recent weeks. In addition, those who are extra vulnerable can go into preventive isolation.

How does it work?

“Our team of corona nurses does triage and sets the indication for isolation in consultation with our team of doctors. The team operates daily from 8-23 hours and is available for consultation about patients with complaints and possibly belonging to the target group. Not only reception locations, but also general practitioners and hospitals can refer persons with coronary complaints, who cannot “go home” in isolation or persons who belong to the target group and are very vulnerable, for respectively isolation and preventive isolation. “For example, the team recently received a report from a pregnant woman with complaints. She had been 36 weeks pregnant and had been in contact with an aunt who turned out to be infected. She herself now also had complaints. There was a lot of unrest in the shelter because of the alleged corona infection. There were several women living there who were pregnant or who had small children. There was anger and panic because of fear of infection. It turned out that there were two other women with complaints at the location. Because of the unrest it was decided to transfer two of the ladies to an isolation location. The third person with complaints went into isolation on their own location.

How was the care then arranged?

Patients who have been admitted to an isolation unit come under the care of General Practitioner Dr. Valckenier for the duration of the isolation. This means that the clinical condition on indication is monitored on a daily basis and a clinical assessment is made in case of deterioration. These ladies are visited daily by an assistant to measure temperature, pulse rate and oxygen content. If patients are symptom-free for more than 24 hours, they can be discharged. Fortunately, both ladies were quickly symptom-free and were able to return to their location. For the time being, there are no other women at the location who have developed symptoms, but the staff is well instructed to recognise symptoms and to call in the corona team if necessary”.

How many reception locations are there now in the city?

There are now two sites in operation where patients are isolated. These are buildings with several single rooms, as far as possible with their own sanitary facilities to prevent the risk of contamination. It is possible that someone has been placed with suggestive complaints, but who does not have a corona. Furthermore, two other locations have been prepared to take patients into isolation. In the past 4 weeks, about 150 people, shorter or longer, have gone into isolation because of corona-related complaints. Also, 16 people have gone into preventive isolation in order to reduce the risk of corona. The number of places for preventive isolation is expected to increase even further in the short term.

by Melissa Diaz, geïntegreerde voorzieningen GGD