Mater Dei’s intensive care consultants have spoken out for the first time in the pandemic to warn the public and political leaders they must do all they can to stop the virus overwhelming the unit.

With 18 coronavirus admissions and a further 10 to 15 patients admitted to intensive care for other reasons, the system has never been so stretched and is just about coping with the workload, the ITU Consultant Group warned, describing the current feeling in the unit as “a major incident with no clear end in sight”.

From today, a fresh round of health measures will come into force with all bars closed until December and groups in public reduced to a maximum of six people to help stop the spread of COVID-19.

But the ITU consultants urged the country’s leaders not to shy away from taking further difficult decisions.

“Hospital workers are doing what they can with the available resources and energies,” they said.

A delay of even one week in controlling the spread can have a devastating effect on the health system

“We expect politicians to do the same in leading the country out of this unprecedented situation by sending the correct messages and taking the – often difficult – decisions in a timely manner.”

“A delay of even one week in controlling the spread can have a devastating effect on the health system, particularly in such a small country, with no neighbours to resort to for immediate assistance.

“We cannot afford to get this wrong.”

Speaking about triage – where the focus is on the patients most likely to benefit from care – the ITU consultants said that, so far, the right decisions have been made for every patient, bearing in mind the disease’s unpredictability.

“However, situations may arise where patients can overwhelm the health system,” the ITU consultants warned. 

Like a major incident with no clear end in sight

They compared the situation to other European ITUs, which were already at breaking point when they faced a similar number of cases in March. Their systems collapsed when the numbers rose by another 25 per cent, which locally would mean five to 10 patients more.

ITU admissions follow a rise in positive cases by seven to 14 days, with two to three expected on a daily basis, following last week’s high numbers.

But other admissions must also be considered as the same doctors, nurses and equipment must be used to care for them, the consultants said.

Moreover, patients remain in ITU for about 10 to 15 days, so it is about the cumulative number and not just the daily admission rate.

The pandemic has been more challenging than any other past situation because patients can go from asymptomatic COVID-19 positive to full respiratory failure in a very short time and, sometimes, without many tell-tale signs, the consultants explained. 

“We have come across many situations when the patient is talking to you and not visibly distressed, but with clinical findings of a very advanced disease that could lead to rapid deterioration if not picked up early,” the ITU consultant said.

The European intensive care community has never faced a virus that spreads so fast and causes so much damage, with unprecedented devastating effects particularly on the lungs within days, they highlighted.

COVID-related Acute Respiratory Distress Syndrome (ARDS) – severe lung damage – is proving to be more critical than other forms of this disease. 

“Younger individuals without underlying medical conditions are still at risk of severe lung damage and death,” the consultants stressed, saying they have cared for patients ranging between 30 and 85, with an average age of 65.

The disease can lead to weeks on a ventilator and a prolonged hospital recovery, following discharge from ITU.

Human tragedy

From a family perspective, the situation is even more difficult because of relatives’ inability to be physically close to their loved ones during the most critical days of their life, the consultants acknowledged.

They are being allowed a glimpse of them thanks to the organisation of short visiting hours, while patients can use mobile devices to communicate when still conscious.

The ITU policy also currently includes a daily medical update by a consultant to one relative.

“Our staff are doing their utmost to compensate for this human tragedy by dedicating extra commitment to families to deal with the fact that their relatives could be at the end of their life in this surreal environment.”

They have risen to the occasion and their “understandable” initial fear has changed to a determination to respect their vital role – “taken for granted for too long”. 

As the health system’s last line of defence, they too are overwhelmed with the workload and are starting to show signs of fatigue, as well as experiencing frustration at the “selfish behaviour” of sections of the community.

“The majority have young families, are in relationships and building their careers,” the consultant group said.

“They are making a huge personal sacrifice to keep patients alive.

“The least the nation can do is respect this effort by obeying Public Health regulations.”

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