Corona virus rosakkan paru paru mangsa

Corona virus rosakkan paru paru mangsa

Coronavirus: NHS doctor warns 'a colleague is looking after several patients under 40'

An anaesthetist writes: "Much of the impact of coronavirus is sadly unavoidable."

Tuesday 17 March 2020 

The government is trying to delay people getting COVID-19

https://news.sky.com/story/coronavirus-nhs-doctor-warns-we-are-already-at-breaking-point-11958542

An NHS anaesthetist who is on the frontline in the fight against the coronavirus has spoken anonymously to Sky News.

It is difficult to know where to start describing what is happening in UK hospitals right now. Maybe the most stark is that plans are being drawn up for what to do when we run out of oxygen.

Oxygen is piped through the walls, so when the supply is interrupted it is like turning a tap on and finding you have run out of water.

It doesn't happen. It has never happened. Until it happened in Italy.

As little as two weeks ago my hospital was eerily quiet, with many patients avoiding the place. Now they are coming in quickly.

We have well over 50 cases as of the weekend and our intensive care is nearly full of coronavirus patients on breathing support machines.

One patient is sent for ECMO (extracorporeal membrane oxygenation) at another hospital - a kind of bypass where a machine injects oxygen into the blood because the lungs have become too damaged to sustain life even on a ventilator.

We have just five centres in the UK capable of providing this service and they are very quickly filled.

Patients are not put onto this kind of life support unless they were fit and healthy before their illness.

Requiring this treatment means you are as sick as it is possible to be and it takes an awful lot of time, resources and biological resilience to recover. Essentially, ECMO buys your body time to recover from illness itself.

It is simply not true that only the very elderly who we can imagine "would have died soon anyway" will get sick.

I have looked after more than one patient who is in their early 60s with minor or no health complaints and who exercises regularly.

They are not your grandparents. They are your colleague, your boss, your Pilates buddy. They are people very much still contributing to society who would perform well on any standard measure of fitness.

I want you to know that young people can and do become critically unwell and die from COVID-19. A colleague of mine is currently looking after several patients under the age of 40, all on ventilators.

We know from other countries that most of these younger patients will survive. But they will take a long time to recover - often in a hospital.

The impact of a sudden influx of coronavirus patients affects all parts of the health system.

Last week I looked after an intensive care patient who needed to go to see a specialist in another hospital. The patient was accepted by the specialist, but there was no intensive care bed for him to go to because it is now exclusively for coronavirus patients.

This specific intensive care unit normally serves the whole of my area of the country. For the next few months that service no longer exists.

The same is true of the life-saving operations that patients are normally admitted there for: cardiac bypass grafting, aortic aneurysm repairs.

Operations have, rightly, been postponed to free up staff and beds. My patient as it turned out, could be treated without transfer on this occasion but their situation is not unique.

Two elderly patients in my hospital went directly to the ward after major emergency surgery when ordinarily they would have gone to intensive care for close monitoring alongside a dedicated nurse. This level of care is no longer possible.

Much of the impact of coronavirus is sadly unavoidable. Whichever model of spread the government chooses to adopt, we will be overwhelmed.

However, the coronavirus mortality rate is not fixed, it exists within the context of a healthcare system and a population and has varied up to sevenfold in different countries.

Many factors can explain this but what is within our control is limiting sharp spikes in cases above our health system's capacity.

In the UK, there is already no slack in the system. We have half the number of intensive care beds per head of population as Italy and intensive care beds run at capacity year-round, so much so that lack of a bed is a common reason for on-the-day surgery cancellations.

The fear among my colleagues is that without any nationally led efforts to curb the spread of the virus, too many people will get COVID-19 at the same time and our limited resources will be rapidly depleted.

It is those patients in their 30s to 60s, who with the right care are capable of surviving, that will be failed by a system that cannot accommodate them.

This does not even account for the patients of all ages with all manner of medical needs whose care has been put on hold to make way for coronavirus.

We are urgently planning alternatives to our acute heart attack and stroke networks as well as emergency surgery like broken limbs which can wait but really shouldn't.

We need the operating theatres as intensive care space, and we need the surgeons as intensive care doctors.

This is the data that we do not yet have from China and Italy, the inevitable background increase in deaths from all causes.

I am seeing alarming and unprecedented changes to care.

Coronavirus is going to have a dramatic and sustained impact whatever we do. Please do not think that you or your healthy loved ones will be unaffected.

Yes, most people will not be nearly as unwell as the patients I have described. But it will affect us all. We on the front line are doing all we can within a system already stretched to breaking point.

We are planning for when the oxygen runs out, ordering more ventilators, more infusion pumps and more of the masks and gowns to protect ourselves, which seem to be dwindling every shift.

But we can only make a difference if everyone else does their bit too, by limiting their social contact and slowing down the spread.

Your surgery may be delayed, you may not be able to see your GP in person for a few months and you may know someone you didn't think was frail at all fighting for their life with COVID-19. But please do your best.

Remind yourself that the quality of the care we deliver to those with and without coronavirus will be directly influenced by the number of people who get sick at the same time.

I do not just worry for the very frail and the elderly, I worry for the slightly older but ultimately fit people who could get better, but only with the right care.

https://news.sky.com/story/coronavirus-nhs-doctor-warns-we-are-already-at-breaking-point-11958542

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