What happens to a COVID-19 patient in ICU?

By Medha de Alwis

Last week the Daily FT brought insight into the functions of a specialised coronavirus hospital, as to how a COVID-19 positive patient, once admitted, would be managed. Today we throw light onto the instance if a COVID-19 patient needs intensive care treatment, how would he or she be managed? Is it the same intensive care unit (ICU) that one would come across in a standard hospital? If not, how different is a coronavirus ICU? What are the special features? What are the differences in management?

Daily FT spoke to Polonnaruwa District General Hospital Consultant Anaesthetist Dr. Wevage Kosala Dep. Dr. Dep has been instrumental in setting up the coronavirus specialised ICU at the Welikanda Coronavirus Hospital, of which the main medical functions were discussed in yesterday’s article. Polonnaruwa District General Hospital is the closest district general hospital to Welikanda, the next closest District General Hospitals being at Anuradhapura and Batticaloa, which are Teaching Hospitals. 

Who are the patients in a coronavirus ICU?

According to the national guidelines, as well as the guidelines of the College of Intensivists and Anaesthetists of Sri Lanka, there are specific criteria upon which a patient who is in a normal ward should be transferred to the intensive care unit. 

With regard to a COVID-19 tested positive patient, it could be one or many factors that would necessitate admission to the ICU. However the experience so far shows that it is mostly impending respiratory failure. Some of the many symptoms would be high fever, increase in respiratory rate, and difficulty in breathing, among many others. 

How is a coronavirus patient managed in the ICU?

A coronavirus ICU is different from a normal ICU due to many factors. The two main factors are the virulent nature and the contagious nature of the disease. Dr. Dep explained that ‘virulent’ means that once an infection sets in, there is a higher tendency for the patient’s condition to worsen.

The contagious nature of a COVID-19 positive patient is already known by the readership. The healthcare worker faces very high risk when treating such a patient. 

Due to the contagious nature, distance monitoring is advisable in a coronavirus ICU, as a healthcare worker catching the virus poses an imminent threat to other patients, the community, and the individual healthcare worker. And due to the virulent nature, it is a must that the patient is closely monitored. It is the experience and the skill of the medical staff that creates a fine balance in this management, making it the best modus operandi to save the lives of the infected patients and the non-infected members of the community. 

Multi-disciplinary approach

The coronavirus ICU is coordinated by one or more consultant anaesthetists/intensivists along with a group of consultants who are consultant physicians, cardiologists, microbiologists, virologists, nephrologists, respiratory physicians, and chest physicians.

Depending on the particular condition of the ICU patient, treatment will be administered. For instance, if the patient is a cardiac patient, the consultant cardiologist will be monitoring the patient round the clock in coordination with the other specialists mentioned above. 

Risk to the healthcare workers

Doctors and all other supportive health staff are at an extremely high point of risk when treating a coronavirus patient in the ICU. An ICU would have a heavy viral overload in general, and a coronavirus ICU in particular. Healthcare workers are dealing with a high viral overload, which is highly contagious in this instance. Given the high risk faced, proper personal protective equipment is to be worn, and stringent hygiene measures are to be adopted around the clock.

How is a patient discharged from the coronavirus ICU?

The patient is closely monitored in the ICU. Assessment is done by the multi-disciplinarian specialised medical team as illustrated above. Hence if the team arrives at a level of satisfaction that the patient does not require intensive care any longer, and normal care in the coronavirus ward would suffice, they could be transferred to the ward. For this transfer, it is not necessary that the coronavirus test is negative, because all the patients in the coronavirus ward are already COVID-19 positive.

Medha de Alwis is a freelance lawyer/mentor and journalist. She can be contacted at [email protected]