Critical Care with Covid-19: Winter is Coming.
We don’t have any Covid patients in ITU right now. But we’ve been seeing the impact of lockdown on people who have other health conditions. There have been a lot more out of hospital cardiac arrests. This means that your heart goes into a rhythm which doesn’t produce an effective heart beat — at this point you are dead. The people we see in ITU have been successfully resuscitated, but sadly having not had a cardiac output for a while there is a risk that a brain injury could have been sustained due to a lack of oxygen. The survival rates for out of hospital arrests are low. It could be due to people becoming deconditioned — they’ve been less active for so many months, when they start moving more again it puts more strain on their heart. Or possibly they’ve been getting warning signs for a while (chest pain for example) and didn’t seek help. We’ve had some people in with nasty infections, some with later stage cancers and some who overdosed. I suspect people have been reluctant to come to the hospital or go to their GP. I can’t tell you how sad that is. It doesn’t matter if it’s a national crisis, it’s still OK to ask for help. We’re still here for you, we can still help. I don’t know if my unit has just been unlucky or if the same thing is happening elsewhere, but a lot of people have died in the last couple of weeks.
With schools reopening and being told it’s ok to go back to work, eat out, meet other people…the message seems to have come across very positive. In my opinion that is just plain wrong. We were on a knife edge. Relax too fast and we’re back to square one. And now cases are on the rise again. A lot of people are quite upset about the imposition of local lockdowns. It’s hugely frustrating and demoralising for the people it’s affecting. But it’s also necessary. I’m not sure how aware people are, possibly due to the unclear messages from the government, but the fluctuation of this virus was inevitable. That’s why people have been hailing a vaccine as the only way out. The levels were always going to rise when measures were relaxed because people mix more, so there’s more opportunity for it to spread. The only way to control the spread is to restrict contact between people — hence restrictions being put back in place. It’s a harsh reality to come to terms with, but if we don’t put measures in place when we start to see a rise, we’ll end up with exponential spread, and potentially a peak that will overwhelm the NHS. I don’t know what would happen to the economy if we went into a second full lockdown, but I suspect it would be bad. I know there are certain industries like gyms and theatres that are right on the edge and I’m pretty sure another lockdown might tip them over. I don’t know if we’ll get another major peak in ITU, I’ve heard that in other countries like France and Spain they’re seeing fewer severe cases. Hopefully this is the case. But I think for the long term good of our society; economy, children’s education and all, we must work to avoid another peak and another lockdown. It seems to me that the smartest thing you can do is avoid unnecessary contact with other people, wear a face mask and wash your hands frequently.
ITU2 (the refurbished old A+E) was sealed up at the end of the last peak, and has been sat waiting for us. It has had more areas converted to make room for larger bed spaces and medical gases supplied to them all (you can’t run an ITU without serious quantities of oxygen and medical air). Our new ventilators have arrived (and are very shiny) and we’re all starting to use them and get familiar with them. Once again we’re back to waiting. Winter is coming (The NHS were using that phrase years before you got there, sorry George) and we just don’t know what is coming for us this year.
P.S. If you are offered one — please get your flu jab. Or pay £20 and just get one. It’s not the most fun thing ever, I’ll grant you. But the last thing the NHS needs this winter is to have to deal with large numbers of flu patients. Because flu patients often present with fever, tiredness, sore throat, possibly a cough. Just like Covid. So every flu that comes in will have to be treated like Covid until proven otherwise. Which means we’ll burn through all the PPE that much faster. At the end of the day the NHS has a finite capacity. There are already concerns that with Covid our capacity will be stretched beyond the norm. We will struggle to cope with flu and Covid.