Battling COVID-19 perspective from the ICU
W
hat is my perspective of the COVID 19 pandemic as viewed as an ICU physician? That is easy. I am tired of it. We all are tired of it. I am tired of the way COVID causes suffering of our patients and their families. I am tired of the ways it effects our personal lives and our community. I am tired of the effect it has on our local businesses, schools and churches. I hate COVID 19. This article is written more out of fatigue and emotion than the regurgitation of known scientific data, although the medical facts presented are true.
I’ll have to admit, in January when the coronavirus was first reported in China, I didn’t think much about it. I was still worried about our current flu season in Arkansas. When COVID found its way on to cruise ships I watched with interest. When COVID overran the Italian medical system in March I began to worry. When New York City was the epicenter for the infection in our country I watched the daily news with horror. Finally, the virus made its way to Arkansas, first arriving in Pine Bluff via Mardi Gras from New Orleans. By then, we knew the statistics and predictions of coronavirus. 60 to 80% of the population could become infected. 20% of infected patients would require hospitalization. 20% of the patients admitted to the hospital would need ICU care. 20% of those admitted to the ICU would require mechanical ventilation. Doing the math, if 10% of those infected required hospitalization in Jonesboro, with a population of 77,000, then approximately 9,000 of them would require hospitalization and of them 360 patients would ultimately require mechanical ventilation, quickly over running our hospitals’ capacity to care for patients (not including area patients from out of town communities). We began preparing. Did we have enough ICU beds? No. The hospital looked for ways to expand our ICU capacity. Did we have enough ventilators? No. Did we have enough endotracheal intubation tubes? Maybe. We watched YouTube videos on how to mechanically ventilate multiple patients on one ventilator. Did we have enough protection equipment and would it protect us? I didn’t know. We received generous donations of face masks and N-95 masks from the public. We watched physicians from Italy explain how they treated their COVID patients and how sometimes decided who would receive care and who would not due to lack of hospital capacity. We learned from New York’s medical care during their crisis. As I waited to care for my first COVID patient to arrive, I was nervous. Would I get infected? Would I bring the virus home to my wife? Would the personal protection equipment keep me safe? Would our medical community be over run? I was impressed with the ICU nurses and respiratory therapist and the other hospital staff 18 NEA HEALTH • 2020
as they didn’t hesitate to provide care for these patients. They were placing their own health at risk to care for others. They were true heroes. I gained emotional strength from their dedicated care and determination. They were a light of hope during this dark pandemic. Fortunately, the predicted numbers did not happen. As everyone practiced social distancing, the infection rate was slowed. A lot of those infected were not, or only mildly, symptomatic. Maybe we had dodged a bullet. This gave our hospital time to prepare. It allowed time to accumulate adequate protective gear and testing equipment for our staff and patients. It allowed the pharmacy time to stock up on various antiviral medications. It allowed our hospital time to increase our number of negative pressure rooms to safely isolate larger number of infected patients. It allowed the staff to become accustom to wearing protective equipment and treating isolated patients. As the COVID cases began to trickle in, they were sick, but not THAT sick. They required higher amounts of oxygen, but they got better. Over time, the number of cases began to increase. The severity of illness increased. Some patients were requiring 2-3 weeks of hospitalization to recover. Some patients required mechanical ventilation. After several months of no mortality we had our first death. Then more deaths. Unpredictably, despite risk factors, some patients would improve; some patients would not improve despite all available therapy. We saw COVID spread into nursing homes and prison systems. We began having multiple prisoners admitted to our ICU and hospital. We watched them struggle through their illness alone, except for the guard outside the door. I remember our first nursing home patient admitted with COVID required mechanical ventilation, not expected to survived, but did. Unfortunately, others did not. As COVID spread through out the southeast region we began taking admissions from as far away as Mississippi and south Arkansas because we had the closest ICU bed available to treat their patients. Their regional ICU beds had been over run. We watched the northwest Arkansas numbers increase. We watched our local numbers increase.
