How the ICU braces for a COVID-19 wave

The current Delta wave in NSW has sharply increased the intake of people into Intensive Care Units (ICU). There are currently 62 people in ICUs due to COVID-19 complications in that state, raising concerns about the capacity of ICUs to manage a predicted extra burden.

“Somewhere between 25 to 30% of patients who get hospitalised with COVID-19 develop worsening respiratory failure,” says Chris MacIsaac, director of ICU at the Royal Melbourne Hospital.

“By that, I mean low oxygen levels that require additional support that can most safely be provided in the intensive care unit.”

The ICU provides ventilators, breathing support and access to other equipment, and extra hands-on attention, so is reserved for severe cases.

But COVID-19 isn’t the only condition that can requires admittance to an ICU, and the beds are seldom empty. Patients with major injuries, severe burns, respiratory failure, organ transplants, heart attacks and other critical conditions will all be cared for there.

“In most public hospital intensive care units, there is a balance of elective and emergency demand that unit leaders, doctors and nursing unit managers look at to adjust to make sure that all patients receive safe care,” says MacIsaac.

The time patients spend in the ICU is typically only up to three days, until they require less monitoring and can be safely moved to different wards to make room for new cases. But patients who have COVID-19 are rarely in ICU for only a few days. Instead, they can be there for weeks, which means that the actual burden isn’t accurately represented by citing only the number of beds used – because the number of incoming patients from other emergency conditions won’t change. 

Greg Kelly, a Sydney intensive care specialist, sounded a warning on The World Today. “While we might say we only have 50 or so patients in ICU with COVID in NSW at the moment, and we have over 800 beds in the State, those patients stay a couple of times longer than average, so those 50 patients are actually closer to 150 to 200 patients in equivalent terms,” he said.

“Then you can really see how that affects our capacity. That means we then can’t admit other patients who are sick because they have been in accidents or had a cardiac arrest. We also can’t do the very major surgery and plan the procedures that support all the other health systems.”

For this reason, elective surgeries will be scaled back to provide extra room for the influx.

“COVID-19 is nothing new in that regard, it just has the potential to be on a greater scale,” says MacIsaac. “This is not just an ICU response, but a whole healthcare sector response, as we saw in Victoria during 2020.

“When elective surgery is wound back and lockdowns are in place, the demand for intensive care services from other patients falls. For example, we would expect that motor vehicle accidents will decrease as there are less cars on the road. So, with a reduction in elective surgery [and less car accidents], that generally frees up some capacity.

Read more: What’s it like to have severe COVID-19?

Beyond this, staff in the ICU require specialised qualifications. These nurses and doctors are highly trained particularly for intensive care, and they can’t be readily substituted.

With multiple ICUs located in each state, it means fully trained staff need to share to load to save lives. In countries without this level of healthcare, a higher proportion of people die from COVID-19 that what is presently seen in Australia.

“There’s no doubt that we are concerned that we may be under strain,” says MacIssac, “but we do have contingencies to open up additional intensive care capacity and other areas of the hospital. [We also] make sure that staff are appropriately trained, and we’re able to safely care for patients.

“So there is contingency and planning for unprecedented demand in critical care beds that may be required if the pandemic escalates.”

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