What It’s Like Treating Coronavirus
We need to heed the lessons of the Italian experience
As an ICU doctor, I — along with my colleagues locally and around the country — are diligently working on planning the care of patients with COVID-19. What do we do when a patient comes to the hospital who is suspected to have COVID-19? What do we do if their heart stops? What do we do if there are more patients than the capacity of my ICU? We are, as best as we can, planning “on paper” and getting contingency plans in place so we are ready. I feel good about what we are doing.
Still, given that I haven’t — yet, at least — taken care of a patient with the disease, it is all still theory in my head. Thankfully, there are those who have taken care of these patients, and they are sharing their experience with fellow clinicians.
The Italians are in the midst of a heart-wrenching battle with COVID-19. JAMA published an article describing their experience. In a matter of days, the onslaught of patients quickly overwhelmed the capacity of ICUs in the Lombardy region in Northern Italy. They reported:
There was an immediate sharp increase in ICU admissions from day 1 to day 14. The increase was steady and consistent. Publicly available data indicate that ICU admissions (n = 556) represented 16% of all patients (n = 3420) who tested positive for COVID-19. As of March 7, the current total number of patients with COVID-19 occupying an ICU bed (n = 359) represents 16% of currently hospitalized patients with COVID-19 (n = 2217).
This is quite frightening, and this is a warning for us here in the U.S. They had to quickly adapt to the new situation, and so this is what they did:
1. Create cohort ICUs for COVID-19 patients (areas separated from the rest of the ICU beds to minimize risk of in-hospital transmission).
2. Organize a triage area where patients could receive mechanical ventilation if necessary in every hospital to support critically ill patients with suspected COVID-19 infection, pending the final result of diagnostic tests.
3. Establish local protocols for triage of patients with respiratory symptoms, to test them rapidly, and, depending on the diagnosis, to allocate them to the appropriate cohort.
4. Ensure that adequate personal protective equipment (PPE) for health personnel is available, with the organization of adequate supply and distribution along with adequate training of all personnel at risk of contagion.
5. Report every positive or suspected critically ill COVID-19 patient to the regional coordinating center.
In addition, to quickly make available ICU beds and available personnel, nonurgent procedures were canceled and another 200 ICU beds were made available and staffed in the following 10 days. In total, over the first 18 days, the network created 482 ICU beds ready for patients.
This is excellent information, and we in the U.S. need to take heed of the lessons learned from the Italian experience. I would be lying to you if I said I wasn’t at least nervous, if not outright scared. Still, I can’t cower in fear. As an ICU doctor, I have to prepare for the worst.
But I’m not just an ICU doctor. I’m also a citizen and member of the community. And so, I also have to do my part. This means washing my hands — again and again, and again. That means covering my mouth when I cough and sneeze. That means not shaking people’s hands. That means staying home when I’m sick (I pray constantly that this doesn’t happen).
And we as a society have to do the same thing. And this also includes dealing with the disruptions that this infection has wrought and taking them into stride (my children’s schools have shut down). If we can slow the progression of COVID-19, then we can protect the healthcare system from being overwhelmed (see graph below). This is absolutely critical, as people’s lives are at stake.
It will likely definitely get worse before it gets better. We need to be prepared for many more disruptions. And if they can help “flatten the curve [the blue part of the graph],” then our healthcare system can be prepared to take the onslaught. We are all in this together, and together we can do it.