If you are a COVID-19 patient, the intensive care unit is the last place you want to end up.
This is because if you have a virus, you are different from the average intensive care patient.
Australians have been asked to expect an increase in COVID-19 cases and hospitalizations as NSW and Victoria emerge from prolonged shutdowns.
Although this increase has not materialized yet, experts have warned against complacency.
Here’s what it takes to keep you alive if you’m a COVID-19 patient in an intensive care unit.
What is intensive care?
ICUs are wards used to care for and monitor patients with life-threatening illnesses and injuries.
Persons admitted to them are closely monitored and the wards operate with higher staff-to-patient ratios than the rest of the hospital.
ICUs are staffed by specially trained doctors and nurses and filled with life-saving equipment such as fans.
Across the country, there are a total of 194 intensive care units, of which 67 are in NSW.
According to a study by the Australian and New Zealand Intensive Care Society, the number of beds available in these units (currently hovering around 2,180) has fallen by around 200 since the start of the pandemic.
It costs about $ 4,500 a day to keep a patient in intensive care.
“It contributes to salaries, medications, various interventions and pieces of equipment associated with this intervention,” said Brisbane-based intensivist Anthony Holley.
“Depending on what your underlying pathology is and what you need, it can vary.”
How are COVID-19 patients different?
COVID-19 patients typically stay in intensive care units much longer than other patients.
Richard Totaro, from Sydney’s Royal Prince Alfred Hospital, said the average stay for a non-COVID patient in intensive care units was two or three days.
“People come in, they get heart surgery, for example, they take a day or two to get over it, and then they move on,” he told ABC in August.
“With COVID, what happens is that the lungs do not improve … they can stay in a ventilator for days, weeks, sometimes months.”
Data collected in Victoria last year showed that the average length of stay for an intensive care COVID patient was 16 days.
“There are patients who stayed much longer than that, especially with the ventilated patients,” said Dr. Holley.
“And from my own experience in Queensland, those who come to the intensive care unit and are ventilated, their length of stay was closer to 25 or 30 days.”
Mortality is much higher for ICU patients who also need ventilation.
According to Victorian data, more than one in four of these people did not survive.
What resources do COVID ICU patients need?
Dr. Holley said the level of attention and resources required for people with COVID on intensive care was similar to other critically ill patients.
“The care model used for a ventilated patient is to have a critical bedside nurse constantly, and physicians within the unit come in to assess progress and develop management plans and decisions around their care,” he said.
“It would be fair to say that it would be the same amount of work with respect to the patient’s disease.”
However, there is one big difference: personal protective equipment (PPE).
Dresses, gloves, goggles, face masks and shields, including PPE, take their toll on staff who often work long shifts.
“Taking the equipment on and off makes it more difficult to take care of this patient… and adds a significant amount of time to take care of the patient,” said Dr. Holley.
How close is NSW to capacity now?
Right now, NSW is in a much better position than experts had expected to be at this point.
Non-urgent elective surgery was suspended in state hospitals for most of August and throughout September to free up resources for COVID patients, and the federal government purchased thousands of additional ventilators.
The NSW government’s modeling predicted that COVID-19 hospital admissions would peak in mid-October.
However, both admissions and intensive care units hit their highest point in September.
According to figures from NSW Health, on October 2, there were 68 people in intensive care, which occupied just under 8 percent of the state’s capacity of 945 beds.
32 of the intensive care patients needed ventilation.
Why have we not seen that tip?
Even optimistic epidemiologists have been surprised by NSW’s ability to avoid an increase in COVID-19 cases and hospitalizations since restrictions began to be lifted more than three weeks ago.
The state’s rapid vaccine uptake has been credited for keeping case numbers down.
Yesterday, NSW Health said 93.6 percent of people aged 16 and over in the state had received at least one COVID-19 vaccine dose, and 88.3 percent of people in that age group were fully vaccinated.
Dr. Totaro said vaccinations were the best way to prevent intensive care units from getting filled up.
“There is really good evidence from around the world that the vaccinations we have available to us are preventing people from getting to the hospital,” he said.
“Almost all the need for intensive care disappears, and almost all deaths disappear once people have been properly vaccinated.”
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