Covid: Back to intensive care, where I notice one major change

Covid: Back to intensive care, where I notice a big change


Coronavirus pandemic


A nurse treats Brian in the ICU
image caption Brian Clamp says he had some traumatic days
We have complete PPE in one of the hospital’s two intensive care units that are exclusively for Covid patients. This is a modern, lighted infirmary – sunlight coming in.

At one end, there is a large black plastic barrier glued to an opening. On the other hand, none of the patients has Covid-19. The makeshift partition is a reminder that all of this is still relatively new. It is the first winter in which the NHS response to the usual high demands will have to be adjusted for the coronavirus.

At the Covid unit, something else is immediately apparent: the sound of a conversation.

When I first reported to a Covid intensive care unit in April, I was startled by what I had seen. All but one patient was on a ventilator, in an induced coma. It was strangely quiet, just the rhythmic sound of machines pumping air into the lungs.

Medical teams did not know how best to treat a wild condition that devastated the victims’ lungs and other organs. Lives were at stake, 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 in Newcastle upon Tyne, only one of five patients is on a ventilator. The others are sitting, talking to the nurses, reading or watching TV.

“The Jedi is my nickname,” says Brian Clamp. The 62-year-old man is a butler at a social club, where he works behind a bar.

He was getting better, but he was readmitted to the ICU when his breathing got worse. It is still a little difficult, despite the supply of nasal oxygen, but his sense of humor and laughter are intact. Brian admits that the experience was “absolutely terrifying”, but adds, with a smile: “They will help us improve, I know that”.

He is determined to return home to watch his granddaughter, Millie, play football.

At least half of the patients here are in clinical trials. Brian received convalescent plasma, filled with antibodies to the coronavirus, donated by someone who recovered from the infection. It is unclear whether blood plasma works against Covid-19, but tests are ongoing. I donated plasma earlier this year and there is an urgent need for more adults to do this.

Further up the wing is Edmund Derrick, who is relieved to have his taste buds back. He’s enjoying an egg sandwich.

“For days, I felt an unpleasant, acrid, burnt taste in my mouth that invaded everything”, he says. His other symptoms included violent and uncontrollable tremors and sudden changes in temperature.

The 71-year-old retired local government official is, like everyone here, looking forward to returning to his family. His wife contracted the coronavirus at the same time as he did, but she did not become seriously ill. Men are still twice as likely as women to go to intensive care with Covid-19.

“I think I’m lucky I got it in the second wave,” he says, “now doctors know a lot more.”

There is no doubt that more patients are surviving Covid-19, although it is too early to provide accurate data. Fans are used more sparingly and there is a greater reliance on other non-invasive means of delivering oxygen.

About 1,000 Covid patients a day are being admitted to hospitals across the UK, about a third of the numbers at the peak. Covid-related deaths are at about a fifth of the level in early April.

“Now, we know the beast that is Covid’s pneumonia,” said Dr. Lewis Gray, an intensive care consultant. “We know how it develops, how it is treated, how people can and recover.”

Patients receive dexamethasone, a cheap steroid that has been proven to reduce the risk of death by up to a third. They also receive remdesivir, a fully approved antiviral in the United States, although its effectiveness is still under review.

Patients also receive increased doses of anticoagulant medication to prevent blood clots, which can be a serious Covid complication. And they are often breastfed on their backs, as this helps with breathing.

But Covid’s impact is felt at the hospital far beyond the ICU. The more Covid there is, the greater the impact on other non-emergency care – hip prostheses, eye operations and a myriad of other illnesses.

In March, there was a concern that hospitals would be full, so all non-urgent surgeries were canceled. This time, the goal is to ensure that patients not belonging to Covid do not lose. But each bed allocated to Covid’s care requires specialist nurses. The Royal Victoria Infirmary (RVI) has already had to close four of its 50 operating rooms to relocate nurses to intensive care.

Dame Jackie Daniel, chief executive of the Newcastle Hospitals NHS Trust and a former nurse, says the situation at the hospital is balanced.

“At the moment we are succeeding, but we are not complacent, because it will be difficult.”

Like other funds, the waiting time for non-life-threatening surgeries, from hips to hernias, has increased. Newcastle’s confidence has maintained cancer services, but elsewhere there is an accumulation of “tens of thousands of patients,” says Dame Jackie.

“Cataracts are a good example – a relatively simple procedure, but if you are an elderly, fragile, isolated, afraid person, we are pushing these patients into deeper anxiety.”

Kathleen Lawson, of Durham, had undergone a thyroid operation in March. Only now did the 67-year-old man have the surgery.

“I am happy that this happened. I am absolutely elated, ”she says.

In another ward, I talked to several patients who were recovering from a serious Covid infection.

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