Some personal insights into the Covid-19 situation in Malaysia — Amar-Singh HSS

‘This article offers some personal insights into the Covid-19 situation in the country. One concern is that the public in some states behave as though the worsening outbreak is confined to the Klang Valley, or only to selected states. This is a dangerous assumption as the situation is worsening in the whole nation. The lack of adequate data hampers the public’s appropriate response to the deepening crisis.’

The following matters are discussed:

• ICUs bed occupancy is at critical levels nationwide
• Mortality rate is rising
• Younger persons are dying and mutations spreading
• When will the current outbreak peak?
• What are the implications of these trends?
• What is possibly going to happen?
• What can we do as the general public?’

Read here (The Malay Mail, May 23, 2021)

In an Iranian intensive care unit, doctors grapple with Covid-19 and US sanctions

"The most worrying thing for a doctor is to know there are medicines (plentifully) available in some parts of the world but not here," said Dr. Alireza Fatemi. This how the agony of coronavirus differs in Iran: nowhere else in the world faces this monster of a virus with the added scourge of President Donald Trump's "maximum pressure" sanctions, which Iranian officials and doctors insist have hampered their Covid-19 fight.

Read here (CNN, Dec 10, 2020)

Crisis standards of care: Lessons from New York City hospitals’ Covid-19 experience

‘The purpose of this project was to convene a forum in which critical care physicians from a number of hospitals across New York City could frankly discuss their experiences with implementation of crisis standards of care (CSC). The Johns Hopkins Center for Health Security, in collaboration with New York City Health + Hospitals, convened a virtual working group in October 2020 consisting of 15 New York City intensive care unit (ICU) directors.’

Major themes discussed and suggestions moving forward are contained in the 23-page report.

Read here (The Johns Hopkins Center for Health Security, Nov 24, 2020) 

‘No one is listening to us’

‘More people than ever are hospitalised with COVID-19. Health-care workers can’t go on like this...

‘For many health-care workers, the toll of the pandemic goes beyond physical exhaustion. COVID-19 has eaten away at the emotional core of their work. “To be a nurse, you really have to care about people,” Neville said. But when an ICU is packed with COVID-19 patients, most of whom are likely to die, “to protect yourself, you just shut down. You get to the point when you realise that you’ve become a machine. There’s only so many bags you can zip.”...

‘As hard as the work fatigue is, the “societal fatigue” is harder, said Hatton, the Utah pulmonary specialist. He is tired of walking out of an ICU where COVID-19 has killed another patient, and walking into a grocery store where he hears people saying it doesn’t exist. Health-care workers and public-health officials have received threats and abusive messages accusing them of fearmongering. They’ve watched as friends have adopted Donald Trump’s lies about doctors juking the hospitalization numbers to get more money. They’ve pleaded with family members to wear masks and physically distance, lest they end up competing for ICU beds that no longer exist. “Nurses have been the most trusted profession for 18 years in a row, which is now bullshit because no one is listening to us,” Neville said.’

Read here (The Atlantic, Nov 13, 2020)

Back to intensive care, where I notice one major change

‘When I first reported from a Covid intensive care unit in April, I was left haunted by what I'd seen. All but one patient had been on a ventilator, in a medically induced coma. It was eerily quiet, just the rhythmical sound of machines pumping air into lungs.

‘The medical teams were at a loss to know how best to treat a savage condition which was ravaging victims' lungs and other organs. Lives hung in the balance, often for weeks on end. In early April, two out of three ventilated patients did not survive.

‘Today, in this intensive care unit (ICU) at the Royal Victoria Infirmary, Newcastle upon Tyne, only one of the five patients is on a ventilator. The others are sitting up, engaging with the nurses, reading or watching TV.’

Read here (BBC, Oct 27, 2020)

Coronavirus: Just 0.3% of cases in Singapore admitted to ICU

‘While Covid-19 cases in Singapore have surged past 50,000, only a tiny fraction of those who fell ill - just 128, or 0.3 per cent - have been admitted to the intensive care unit (ICU) as of Monday. Experts said years of investment in healthcare, as well as a well thought out and executed strategy to keep infection numbers low, have helped to ensure the Republic has one of the world's lowest ICU admission - and fatality - rates from Covid-19.’

Read here (Straits Times, July 31, 2020)

‘We could see this tsunami of people coming’: Inside the secret world of intensive care

“When dealing with patients at the extremes of life,” writes Aoife Abbey, a doctor at University Hospital Coventry in her memoir The Seven Signs of Life, “there is an onus on doctors to be alert for the time when the burden of treatment outweighs the expected benefit for a patient. It is imperative that medicine knows when it is time to work with death, if it is to work at all. Intensive care, perhaps more than any other speciality, is defined by this specific sort of responsibility.”

‘During these months of treating Covid-19 patients, Abbey has seen patients come in with severe acute respiratory failure. Some patients stood to benefit from intensive care, while for others the escalation of treatments, including invasive forms of ventilation, were not deemed to be in their best interest. The established ethical frameworks used to make these kinds of decisions have remained the same when treating patients with Covid-19.’

Read here (The Guardian, July 30, 2020)

The pandemic broke end-of-life care

‘The first day the palliative-care doctors walked into the ICUs, Thomas [Jane deLima Thomas, the director of palliative care at Brigham and Women’s Hospital and Dana-Farber Cancer Institute] says, “we felt like tourists.” They were dressed in business casual, while their ICU colleagues raced around in scrubs and masks. But the palliative-care team—which includes physicians, nurses, chaplains, and social workers—found ways to integrate themselves. In the early days of the pandemic, when protective gear was scarce, no visitors were allowed. Palliative caregivers, along with ICU nurses, held iPads cocooned in plastic bags so families could say goodbye on Zoom. They were sometimes the only one in the room when a patient died, otherwise alone. I interviewed several members of the Boston-based palliative-care team, and their stories, which have been condensed and edited for clarity, are below...’

Read here (The Atlantic, June 16, 2020)

UChicago Medicine doctors see 'truly remarkable' success using ventilator alternatives to treat COVID-19

‘Doctors at the University of Chicago Medicine are seeing “truly remarkable” results using high-flow nasal cannulas rather than ventilators and intubation to treat some COVID-19 patients. High-flow nasal cannulas, or HFNCs, are non-invasive nasal prongs that sit below the nostrils and blow large volumes of warm, humidified oxygen into the nose and lungs. A team from UChicago Medicine’s emergency room took dozens of COVID-19 patients who were in respiratory distress and gave them HFNCs instead of putting them on ventilators. The patients all fared extremely well, and only one of them required intubation after 10 days.’

Read here (UChicago Medicine, April 22, 2020)