Natalie Sinkew has worked her way through more word searches than she can count in her weeks of bedridden isolation at Queen City Nursing & Rehabilitation in Burlington.
Meanwhile she clings to a singular hope: To return home to her St. Albans apartment, so she can see her companion dog, a 15-pound poodle-terrier mix named Mi-mi, and resume her job at Goodwill.
But as the pandemic stretches on and she remains locked down in her room, that future only grows more distant. Sinkew’s health has deteriorated rather than improved, according to her friend and advocate David Przepioski.
“They’re trying to protect her, and it just makes it worse,” Przepioski said. “On one hand, they’re saving her from Covid-19. That’s admirable and honorable and what we have to do. On the other hand, they’re figuratively and almost literally killing her, because she’s not getting the care she needs.”
Sinkew is likely just one of a growing and hidden population suffering under the secondary effects of the pandemic: The isolation restrictions instituted to prevent the spread of Covid have also caused health declines, especially among older Vermonters and people with disabilities.
The causes are varied and compounding: the lack of social contact, the absence of visitors who can identify emerging health problems and lower quality or less medical care by doctors who want to minimize exposure to the virus.
“Isolation is deadly,” said Ruby Baker, executive director of the advocacy organization Community of Vermont Elders. “We don’t tend to think of it in those terms, especially in our culture that underplays the value of mental health on our physical well-being and on our well-being as humans.”
In a rural state with the fourth-oldest population in the nation, Vermont may grapple with the impacts of quarantine for years after Covid has dissipated, says Angela Smith-Dieng, director of the state unit on aging. She anticipates higher health care costs and more serious health problems for Vermonters, though “it’s hard to project.”
In lockdown at Queen City Nursing & Rehabilitation, Sinkew, 56, who’s disabled and legally blind, is mourning the delays in her recovery.
She arrived at Northwestern Medical Center on July 13 after a fall. It had taken hours, perhaps days, for a support person from Champlain Community Services to find her lying on her kitchen floor.
Sinkew hasn’t been in her apartment since. Instead, she has been ferried between two hospitals for surgeries and treatment, and spent time in two nursing homes. After each move and follow-up appointment, she spent 14 days in bed in quarantine.
“She didn’t fall on to the floor; she fell into an abyss — one with seemingly no hope of recovery or end that has been very painful and extremely traumatic,” Przepioski said. Sinkew has been almost completely alone and bedridden for about half of the last 25 weeks, he estimates.
The time she’s spent nearly immobile caused her legs to cramp painfully and grow stiff, leaving her unable to walk. Sinkew hasn’t been to a physical therapy office or received rehab for her legs, she said. She struggles to swallow.
“I am trying to figure out, OK, when are the people at the rehab going to get going? They’re very slow,” she said. “I have to wait until I can walk again and walk out of here.”
For others, isolation has compounded and exacerbated ongoing health problems.
Larry Laquerre, 55, a Berlin resident with severe diabetes, got gangrene from an ingrown toenail when he didn’t get foot care during the first months of the pandemic. Laquerre ultimately had two toes amputated, then the other three.
Things only got worse.
When he arrived in rehab at Birchwood Terrace Rehab & Healthcare after his first surgery, he could walk using a walker and the help of someone’s steadying hand, according to his wife, Rosie Laquerre.
Larry spent weeks in isolation after each follow-up visit and doctor’s appointment. During one visit in August, he was delirious and could hardly respond. By the time he left the facility to go to the hospital in September, he was on a gurney.
His 21-year-old son was so upset when he saw his father’s deterioration last summer, “he cried half the way home,” Rosie Laquerre said. She attributed the declines to isolation, inadequate staffing and treatment, and her inability to visit and check in on her husband. “He cannot advocate for himself,” she said.
By December, Laquerre still hadn’t improved. The lower part of his leg was removed two days before Christmas.
Laquerre is part of a larger trend. Nationwide, diabetic foot amputations have increased during the pandemic. Cancer diagnoses have become less frequent.
Loneliness, too, is likely taking its toll. A 2010 study reported that isolation can be as harmful to a person’s health as smoking 15 cigarettes a day and twice as deadly as obesity. Other researchers have found that lack of social contact can lead to suicidal ideation, Alzheimer’s disease, decreased immune response and worsened heart health.
The people suffering the most may be the ones we don’t know about and aren’t tracking, said Allan Ramsay, a doctor and interim hospice medical director at the University of Vermont Medical Center. “We don’t know what we don’t know,” he said.
The elderly and people with disabilities are particularly affected by long-term isolation, according to Baker, of the Community of Vermont Elders; they tend to have fewer social contacts and they’re also more likely to live in rural areas. Some may have trouble arranging transportation or making social connections online.
With few resources and supports, one “little wrench in the system” can cause a tenuously built sense of well-being to collapse, she added.
It took weeks for family members to notice when one elderly Vermont woman’s dementia worsened in April, Baker said. By the time the woman’s granddaughter showed up to check in, she found that her grandmother had stashed weeks’ worth of Meals on Wheels deliveries in a cabinet, leaving them to decompose.
The woman had developed an advanced urinary tract infection, had lost weight, hadn’t showered in a month and had become delusional — in part due to the infection, Baker said.
Many of the people suffering the most remain behind closed doors, making the impacts more difficult to measure and track, Smith-Dieng said. She’s heard anecdotally that physical therapists have noticed that their elderly clients have lost strength and muscle mass since the pandemic began. In the future, older Vermonters may be more susceptible to falls, she predicted.
Joan Higgins, 92, who lives alone with her golden retriever Penn in Brookfield, Vt., said she used to go to the gym five days a week. Now she spends most of her time reading on the couch.
Higgins said she feels healthy — though “I miss people.” She prefers loneliness over losing her independence; she chafed at her grandson’s suggestion that she consider moving into an elder care facility.
“It’s wonderful for people who need to have that kind of living,” she said. “Maybe I won’t have to. Maybe I’ll just stay here.”
Sinkew, too, is trying to stay optimistic. She received the first dose of a COVID-19 vaccine in early January. She hopes to be transferred from Queen City Nursing & Rehab to a place where she can receive more intensive rehab. Last week, she took “a spin around the block” in her wheelchair, zipping around the circular hallway of the nursing home.
“Yes, I’m set back right now until I can walk. I have to try to get my legs going,” she said. But, she added, “I know I can do it.”