COVID-19 patients admitted to intensive care have a 60 per cent death rate, despite receiving support from a ventilator, figures compiled by Mater Dei Hospital’s Intensive Treatment Unit doctors show.
And that mortality rate rises to 70 per cent if a patient also develops kidney failure, according to the first comprehensive data on critical care since the start of the pandemic.
These figures, revealed to Times of Malta by the ITU Consultant Group, have been gathered to gain a better understanding of how the disease is impacting local patients.
The group of doctors say that critical care survival rates are similar to other hospitals overseas.
This is particularly significant because the local ITU population includes factors that could worsen chances of survival, including older age; a higher proportion of male patients; a greater incidence of chronic heart and kidney disease; and a higher percentage of patients needing both ventilation and dialysis during their acute illness.
Of the COVID-19 ITU patients on a ventilator, 25 per cent also need dialysis.
Mater Dei’s ITU has admitted 72 patients suffering from COVID-19 pneumonia since the outbreak in March and 18 of these are currently receiving intensive care.
The average age of an ITU patient is 66 and more than 80 per cent are male, the data shows.
All have had severe respiratory failure and while some improved after less than a week with very high oxygen therapy, the majority required mechanical ventilation.
Both those who survived and died in ITU have required ventilatory support for an average of two weeks, but this has varied between four and 50 days.
The consultants group said the survival data must be interpreted in view of Malta’s high ITU bed occupancy as a proportion of the maximum equipped beds available, which, pre-COVID-19, stood at 20, the consultant group said.
Doctors warn of overstretched resources
Since mid-November, between 15 and 18 COVID-19 patients have consistently been treated in ITU, over and above other critically ill patients being treated for health issues such as strokes, trauma and post-op complications.
“This means that ITU resources are already overstretched, and pandemic data has shown that stressed ITU networks are associated with worse survival,” the consultant group highlighted.
“We are learning how to work with lower nurse-to-patient ratios to create more ITU beds and accommodate all critically ill COVID-19 patients, who are currently spread over three ITUs,” the consultants continued.
Although another two areas have been prepared to receive infected patients, taking the number of ITUs up to five, the group insisted it is hard to put a finger on a precise number of ITU beds as they depend on trained and available staff, who could also be out of action due to sickness and quarantine.
The consultant group is aware that nursing these beds to current acceptable standards will be “extremely challenging” and cannot be taken for granted.
European authorities, in fact, are starting to blur the distinction between the number of established ITU beds with appropriate staffing and those that only have the full equipment, including monitor and ventilator, which will be resorted to only if the pandemic is out of control.
Malta has considerably more ventilators than manned beds as things stand.
The consultant group has pointed to a worldwide shortage of trained ITU nurses and doctors, saying the local scenario has been further complicated by additional factors.
These include, primarily, a long-standing lower ratio of nursed ITU beds per 100,000 population compared to most European countries.
With the virus attacking most organ functions and damaging the lungs through COVID-19 pneumonia and acute respiratory distress syndrome (ARDS), the kidneys, muscles and nervous system, the doctors say they have witnessed many survivors suffer from extreme weakness.
As with other patients recovering from severe illness and intensive care episodes, besides psychological trauma, this leads to difficulty with basic activities of daily life, including simply getting out of bed alone, washing oneself and eating, with swallowing taking weeks to relearn.
Post-intensive Care Syndrome could require months of rehabilitation, with the doctors seeing many COVID survivors spending long stretches in hospital after leaving ITU.
The virus damages the immune system, resulting in over half of patients developing severe secondary bacterial infections in the lungs and blood, the consultant group has noted.
‘Avoid dangerous hospital situation’
Predictions of six Coronavirus deaths every day by mid-December would undoubtedly impact all hospital areas and services, the consultant group acknowledged, warning of “severe disruption” as a result of staff redeployment from wards, clinics and theatres to areas not coping with the COVID-19 workload.
Nurses from other areas recently received a period of emergency training to support ITU staff when resources are exhausted due to further ITU admissions. But even though, at that point, the extra equipped ITU beds will be used, the “nursing levels could affect clinical outcomes,” the consultants admitted.
“Hospital staff are well aware of these limitations and can only hope people understand that the medical situation could deteriorate rapidly.
“All we can do at this point is hope that people respect public health measures precisely,” the ITU consultants strongly urged, “as this might be the only way to avoid a very dangerous hospital situation unfolding”.