Family Companion Between Patients with Coronavirus Disease 2019: A Retrospective Observational Study
The global outbreak of coronavirus disease 2019 (COVID-19) has posed unprecedented challenges to healthcare systems worldwide. One of the defining characteristics of this disease is its tendency to cluster within families, with multiple members often infected simultaneously. This familial clustering has significant implications for patient care and management, particularly in hospital settings where isolation protocols are strictly enforced. This study explores the concept of family companionship (FC) among hospitalized COVID-19 patients and its potential benefits in the treatment and management of the disease.
The study was conducted as a retrospective observational analysis, approved by the Ethics Committee of Peking University Third Hospital. It included adult patients admitted to a single ward of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, between February 9 and 29, 2020. Patients were included if they were diagnosed with COVID-19 according to the Chinese COVID-19 clinical guidelines. Those with other comorbid critical diseases or those who survived with extracorporeal membrane oxygenation support were excluded. The study focused on patients who were admitted with family members also infected with SARS-CoV-2, the virus causing COVID-19.
Patients from the same family were housed together in the same room after obtaining verbal consent from themselves and their roommates. This group was designated as the family companion (FC) group. In contrast, patients admitted without family members were housed according to sex, forming the no family companion (nFC) group. All patients were isolated within their rooms, with access to cellphones and routine psychological support. Both groups received the same therapeutic interventions as per the Chinese COVID-19 guidelines.
Data were extracted from electronic medical records, and disease severity was classified according to the same guidelines. The primary outcome measured was patient survival at 28 days after admission. Continuous variables were expressed as median and interquartile range (IQR), while categorical variables were expressed as numbers and percentages. Statistical comparisons between groups were made using the Mann-Whitney U test or one-sided Fisher exact test, with a p-value of less than 0.05 considered statistically significant. Due to the pilot nature of the study and the ongoing COVID-19 outbreak, no formal hypotheses were implemented to drive sample size calculations. Instead, the maximum number of patients possible was included.
Out of 66 patients admitted during the study period, 53 were included in the final analysis. Ten patients (18.9%) were admitted with their family members, forming the FC group, which included four couples and a father with his daughter. The remaining 43 patients (81.1%) comprised the nFC group. Clinical characteristics on admission and treatment during hospitalization were summarized for both groups. Patients in the FC group were significantly older than those in the nFC group, with a median age of 73 years compared to 64 years. Additionally, a higher proportion of patients in the FC group had comorbid hypertension (90% vs. 39.5%). No significant differences were observed in other demographic and clinical characteristics or treatments between the two groups.
The study highlighted several key observations regarding the impact of family companionship on patient outcomes. In the FC group, patients with relatively mild disease assisted nurses in caring for their more severely ill family members, providing support in feeding, cleaning, and toileting. Some patients also provided linguistic support to medical staff by translating local dialects or interpreting body language and writings of family members who required oxygen masks or non-invasive ventilation (NIV). Notably, all four couples in the FC group, including those with severe and critical COVID-19, survived. In contrast, the father-daughter pair experienced a tragic outcome. The father initially stabilized with medication and NIV but became depressed and developed delirium after his daughter discharged earlier. His condition deteriorated rapidly, leading to acute cardiac injury and respiratory failure, resulting in his death six days after his daughter’s discharge.
The overall survival rate at 28 days after admission was 81.1% (43/53). Numerically, the survival rate was higher in the FC group (90%) compared to the nFC group (79%). When considering severe and critical cases together, the survival rate in the FC group was 83.3% (5/6), compared to 57.1% (12/21) in the nFC group. Although statistical analysis of survival rates was not performed due to the limited number of cases, the data suggest a potential positive impact of family companionship on patient outcomes.
The study proposes several mechanisms through which family companionship may benefit COVID-19 patients. First, the presence of family members can alleviate anxiety and panic, which are common in patients facing a novel and severe disease. Emotional support from family members can facilitate physical recovery. Second, family members can improve treatment adherence. For example, in the FC group, patients supported by their families showed better adherence to NIV, contributing to their recovery. In contrast, the absence of family support in the father’s case led to poor adherence and subsequent deterioration. Third, family members can provide linguistic support, helping medical staff understand patients’ needs and feelings, which is crucial for effective care.
However, the FC strategy has limitations. It is applicable only to acute infectious diseases like COVID-19 and cannot be generalized to non-communicable diseases. It also depends on patient consent and may compromise the privacy of other roommates. Cultural and religious factors must also be considered when implementing this strategy in different regions.
The study acknowledges its limitations, including its retrospective design and potential selection bias. Patients in the FC group were older and had more comorbidities, which could have skewed the results. Additionally, the small sample size precluded formal statistical analysis of survival rates. Despite these limitations, the study provides valuable insights into the potential benefits of family companionship in managing COVID-19 patients. It suggests that this holistic strategy can assist healthcare delivery in a resource-efficient manner, particularly in resource-limited settings.
In conclusion, this observational study indicates that family companionship between hospitalized COVID-19 patients may be a favorable factor in alleviating disease severity. It offers a medical resource-saving approach that could be considered in the global fight against COVID-19. Further research, including larger cohort studies, is needed to evaluate the efficacy of family companionship in improving patient outcomes during the COVID-19 pandemic.
doi.org/10.1097/CM9.0000000000001114
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