Critical Care in Covid-19: Here We Go Again
Title kinda says it all really. We knew it was going to happen, the question was always not if but when, and more importantly, how badly?
I’ll be honest, it looks bad. I’m struggling to interpret the numbers compared to Mar/Apr, what with the increase in testing. I’m inclined to listen to the experts personally, and their warnings for weeks now have been pretty dire.
I’m afraid for the people who won’t present to the hospital. We saw a lot of them after the last peak and they were all so sick. And the people whose treatment has been delayed. Many people are not in imminent danger, but living with long term pain or illness takes a different toll. And of course, the longer they wait the closer they might be to actual danger. Hospitals are desperately trying to keep business as usual going. The backlog from the last disruption is huge and we don’t want people to struggle to get the help they need. I do wonder how long we can keep it going with the numbers of cases that are being discussed though.
The trouble, once again, is nurse numbers. Specifically, Intensive Care Nurse numbers. The only reason we managed last time was because of all the redeployed nurses. Other services were stopped, so the nurses were free to help us. But the other services won’t be stopped this time. And we haven’t managed to magic up any new ITU nurses. Last time we maybe stretched to 1 ITU nurse to 4 patients with support. If we get similar numbers again (let’s not go there with numbers being higher) but we don’t have the support…
1:4 might just be enough to keep people alive. But to give them the best care we can? Not even close. This is the thing that hurt the most in the last wave, I think. In particular for the nursing staff. These people are brought to us, we sedate them, their lives are completely in our hands. Normally we clean their mouths religiously, moisturise any hint of dry skin, comb their hair, straighten their sheets, try to make them look as if they are just sleeping comfortably. They are small things, they are not critical, but they are the things that show we care. That they are still a person to us. Sure, we clean people’s mouths because it reduces the risk of a nasty pneumonia, but every time I do it, I’m thinking about waking up with week-old morning breath and how much that would suck. These are the things that we lose when we are stretched. Not so much the mouth care, because as I said, pneumonia. But the moisturising, the neatly combed hair, the straight sheets. They won’t kill you if we miss them. Missing antibiotics or blood pressure support drugs or sedatives might. Rationally we know you have to prioritise. I think most people would prefer to make it out alive, and if that means messy hair, then so be it. But I feel like you lose a bit of something every time you have to leave that little bit of care and carry on.
We go back into Lockdown again soon. I helped re-open our Covid ITU yesterday. Things are going the wrong way. Do the best you can to be sensible. Follow the rules, wash your hands. This is going to last a lot longer if we are half-hearted in our attempts to control it, and more people will not come out the other side the longer it goes on.