Why COVID-19 Can Make Someone Critically Ill

Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Loved ones in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!

This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another question from our readers and the question was

Why Does the ICU team Say my Brother Will Not Survive When He Managed to Be Off the Ventilator for 8 hours?

You can check out last week’s question by clicking on the link here.

In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer questions that we get quite frequentlyas part of my 1:1 consulting and advocacy service!

Why COVID-19 Can Make Someone Critically Ill

Management of Patients with Confirmed 2019-nCoV | CDC

Such an unprecedented occurrence that caused the world to change drastically. It has impacted over a hundred countries all around the world. It gripped the global community by fear as cases continue to mount every day and containing the virus seems impossible. Billions of lives are at risk and people are dying. Most hospitals are at breaking point. The culprit– CORONAVIRUS DISEASE 2019.

How Covid-19 started?

The outbreak began in Wuhan, China – a city with a population of over 11 million. The virus is believed to have originated from a “wet market” where animals such as bats, snakes, rabbit and birds are illegally sold.

As the coronavirus is known to be transferred from animals to humans, it is believed market stallholders, who came into contact with animals were the first people infected with the strain. A 61-year-old frequent shopper at the wet market was the first person to die from the virus.

This new virus called the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been identified as the cause of a disease outbreak which began in China in 2019.

On February 11, 2020 the World Health Organization announced an official name for the disease that is causing the outbreak. The disease is called Coronavirus Disease 2019, abbreviated as COVID-19. In COVID-19, ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease. Formerly, this disease was referred to as “2019 novel coronavirus” or “2019-nCoV”. This particular strain of coronavirus is referred to as novel, as in it has not been seen or identified in humans previously.

There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses. COVID-19 is a new disease, caused by a novel (or new) coronavirus that has not previously been seen in humans.

The virus is a type of coronavirus — a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).

How COVID-19 Spreads?

COVID-19 is a new disease and we are still learning about how it spreads and the severity of illness it causes.

Person-to-person spread

The virus is thought to spread mainly from person-to-person.

Between people who are in close contact with one another (within about 6 feet).

Through respiratory droplets produced when an infected person coughs, sneezes or talks.

These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

Some recent studies have suggested that COVID-19 may be spread by people who are not showing symptoms.

Maintaining good social distance (about 6 feet) is very important in preventing the spread of COVID-19.

Spread from contact with contaminated surfaces or objects

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes. This is not thought to be the main way the virus spreads, but we are still learning more about this virus. CDC recommends people practice frequent “hand hygiene,” which is either washing hands with soap or water or using an alcohol-based hand rub. CDC also recommends routine cleaning of frequently touched surfaces.

How easily the virus spreads?

How easily a virus spreads from person-to-person can vary. Some viruses are highly contagious, like measles, while other viruses do not spread as easily. Another factor is whether the spread is sustained, which means it goes from person-to-person without stopping.

The virus that causes COVID-19 is spreading very easily and sustainably between people.

Information from the ongoing COVID-19 pandemic suggest that this virus is spreading more efficiently than influenza, but not as efficiently as measles, which is highly contagious.

COVID-19 is thought to spread mainly through close contact from person-to-person in respiratory droplets from someone who is infected. People who are infected often have symptoms of illness. Some people without symptoms may be able to spread virus.

People are thought to be most contagious when they are most symptomatic (the sickest). Some spread might be possible before people show or experience symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads (3).

Studies indicate that the SARS-CoV-2 virus (which is the virus responsible for COVID-19 infections) can survive on hard surfaces like plastic and stainless steel for up to three days, on cardboard for up to 24 hours, and on copper for up to four hours (6).

Fortunately, regularly cleaning and disinfecting these surfaces is effective for removing and destroying the virus, respectively

What are the symptoms?

Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus disease 2019 (COVID-19) cases.

These symptoms may appear 2-14 days after exposure (based on the incubation period of MERS-CoV viruses).

Fever

Cough

Shortness of breath

Severe symptoms of COVID-19 that require immediate medical attention include difficulty breathing, persistent pain or pressure in the chest, confusion or inability to arouse, or bluish lips or face, the latter indicating a shortage of oxygen in the bloodstream, according to the CDC.

COVID-19 has the potential to cause even more fatalities because it’s easily transmitted, the population lacks any immunity to the disease, and complications in serious cases may include life threatening pneumonia. Others develop sepsis or a syndrome of multisystem organ failure with renal and endothelial collapse, making it difficult to maintain blood pressure. Like with so many pathologies, it is a vicious circle in which everything gets overworked which then leads why your loved one needs to be in the intensive care (ICU) as they become critically ill because of COVID-19.

COVID-19 and the critically ill in the ICU

Severe Covid-19 leads mostly to multiple organ failure starting from lung failure to kidney failure up till cardiovascular failure. Intensive Care (ICU) treats patients who are on these life-threatening conditions and whose organs have failed. These types of conditions need the intense and prompt treatments which can only be provided by the ICU as these are rapidly fatal.

In simple terms, treatments include a ventilator taking over the patient’s breathing while the patient is placed in an induced coma, a dialysis machine cleaning the blood and drugs, giving of inotropes or vasopressors that supports heart function, prone therapy which is basically turning critically ill on their stomachs to allow gravity to remove mucus buildup in their lungs which then opens both the airways and gets more oxygen into air sacs and improves circulation to the lungs. Of course, they need to be in an induced coma, and they often need to be paralyzed as well to tolerate such prone therapy. And there is ECMO which is an advanced life support that provides long-term breathing and heart support and is used only when all of the standard treatments for these problems have already been tried. The reality of care is, of course, considerably more complex and highly intensive.

The challenge from Covid-19 to ICU services globally is enormous and pressing due to these unexpected surge of COVID-19 patients needing ICU. Now the reality is, ICUs don’t have enough beds. ICU is a precious and scarce resource in terms of beds, staff and equipment. Most ICUs therefore run at or above 90% bed occupancy and often can only admit new patients only by discharging others – even when workload is normal. Covid-19 will increase pressures not only because of weight of numbers but because intermediate treatments for pneumonia and lung failure are “aerosol-generating” (ie they risk spreading the disease) so cannot be used and early recourse to ICU is required.

It is very alarming to think, but one way to unfortunately manage beds in ICUs is to deny some patients treatment and eventually worst comes to worst, let them die. We can see now that this is already happening and has been in the news.

With the rapid increase in the cases of COVID-19, it demands for more provision of ventilators and ICU beds which then equally equate for the need of more ICU nurses and doctors. Skilled ICU nurses and doctors are a limited resource. ICU is such a highly specialized area and ICU needs only ICU nurses that are well trained to operate machines like the ventilators and perform medical interventions that only skilled ICU nurses can do. It is not going to be overnight that we can create and train ICU nurses because it takes a lot of profound practice at bedside and many years of experience in order to hone the skills and be well equipped for both the patient and nurse’s safety.

It’s not only that you can’t train ICU nurses or ICU doctors overnight. They also have to be the right fit for the environment. Shift work, unsocial hours, dealing with difficult personalities, death, end of life and the list goes on… It’s not for the faint hearted and if they think it is, they’re probably not carved out for it. Just because there will be increased demand doesn’t mean you can just grow ICU nurses and ICU doctors on trees, because you can’t.

Other concern is, relatives are locked out of the hospitals and are not allowed to visit their loved ones due to the fear that they might be bringing the virus inside the hospital. And relatives are left in awe.

But is it also possible that they won’t allow relatives to come visit their loved ones so that they can run their agenda? The biggest challenge for families in intensive care is that they don’t know what they don’t know. And they often don’t even know what questions to ask. And so our consulting and advocacy for families in intensive care will guide families how to manage intensive care teams to get the outcomes that they want and deserve for their loved ones.

Once you know what questions to ask and once you know what to look for, the dynamics change because then the ICU knows, “Oh, you’re actually talking to someone that understands intensive care and that is really important.” And this might then save your loved one’s life.

The coronavirus can go on for many months perhaps until a vaccine becomes available. It is likely such measures – most notably, large scale social distancing – will need to be in place for many months. The effects on countries and the world will be profound. Scientific developments were on the horizon. Everyone is praying and hoping that this crisis we are facing right now will soon end. What we are after are for thousands of lives to be saved. Keep strong amidst this trial. Everything will come to pass.

REFERENCES:

1. Coronavirus disease: What is it and how can I protect myself?

https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/novel-coronavirus/faq-20478727

2. Coronavirus (COVID-19) for Nursing Professionals

https://intelycare.thinkific.com/courses/take/COVID-19-Best-Practices/texts/10964809-covid-19-signs-symptoms

3. Coronavirus Disease 2019 (COVID-19)

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Ftransmission.html

4. Coronavirus Disease 2019 Basics

https://www.cdc.gov/coronavirus/2019-ncov/faq.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Fchildren-faq.html

5. So You Have a COVID-19 Patient; How Do You Treat Them?

https://www.medscape.com/viewarticle/926794?src=wnl_tp10n_200410_mscpedit&uac=318698HK&impID=2340633&faf=1

6. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

https://www.nejm.org/doi/10.1056/NEJMc2004973

7. Coronavirus outbreak

https://www.theguardian.com/commentisfree/2020/mar/03/icu-doctor-nhs-coronavirus-pandemic-hospitals

8. Prone Therapy

https://intensivecarehotline.thrivecart.com/11-counselling-consulting/

How can you become the best advocate for your critically ill loved one, make informed decisions, get peace of mind, control, power and influence quickly, whilst your loved one is critically ill in Intensive Care?

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How to ask the doctors and the nurses the right questions

Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests

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