Lessons on COVID-19 from Italy medscape.com/viewarticle/92…:
Average patient time in ICU is 15 days, minimum 10.
The number of patients in intensive care initially doubles every 2 to 3 days.
Average patient time in ICU is 15 days, minimum 10.
The number of patients in intensive care initially doubles every 2 to 3 days.
This slows fractionally every day until, after 3 to 4 weeks, the doubling time is 4 to 5 days. Around day 18, the rate of increase steadies for 3 to 4 days--the inflection point--after which the rate of increase in ICU cases begins to drop.
After the inflection point, overall numbers increase steadily, but the rate of increase slows progressively until it flattens, 38 to 40 days after the admission of the 1st ICU patient.
Lombardy reached the inflection point 19 days after the outbreak began, but the rest of Italy won't reach it until the beginning of April. (I guess France will reach it about April 10-12.)
It will depend how many Italians have actually been obeying the quarantine orders. Reports on this are discouraging.
"If other countries want to have enough ICU beds to treat all the COVID-19 patients that are going to be arriving at their hospitals, they have to decrease the peak of the tsunami of cases," i.e., #staythefuckhome.
The UK "is believed to be just 12 to 15 days behind Italy." UK clinicians have "very strict, very well-defined practices, and this is a very good point in peacetime but it might become a very critical point in wartime, and this is wartime." They must become adaptable.
"You cannot apply the good practices you use, for instance, in terms of intubation, because intubation must happen much faster. It will not be optimal, it will not be the best intubation, but if you apply the standard approach...people die."
It isn't over when the patient leaves the ICU. "They are not capable of breathing alone like normal people ... It's not that they can go out and can start living again. It is [still] very tough."
You have to convert standard wards to ICU wards now.
You have to convert standard wards to ICU wards now.
"Very important" to realize that as a consequence of rapid change, "the quality of ICU beds [decreases daily] ... when you create a new [ICU] bed, it is not a very good one. ... It's not as good as a dedicated ICU ward, and can be "worse than in a field hospital."
Then: "Although the latest numbers suggest the situation has stabilized, this is partly because ICU patients are being moved out of the region." Well. How do we know any of these numbers are good, then? It would have been nice if they'd mentioned that at the start.
CPAP devices may help delay respiratory failure. You wouldn't usually use them in an ICU, but they may be a good option: less risk of infection, and not all doctors know how to intubate.
CPAP can be done by nurses and might reduce the number of patients requiring intubation, saving ICU beds. Limiting factor may be the oxygen pressure in distribution lines.
ICU beds are rationed, usually according to the patient's age.
"Medical doctors swear to treat everybody independent of their age, sex, gender, religion, and so on, but now they have to choose."
"Medical doctors swear to treat everybody independent of their age, sex, gender, religion, and so on, but now they have to choose."
Warning: in some regions, it may seem the number of ICU cases has stabilized. Not necessarily: It may mean two people died and two were admitted. You have to disambiguate between "a slowing pandemic" and a "steady-state condition." If it's the latter, it may increase rapidly.
The lesson overall: HCW must be prepared to be flexible, adapt, forget about doing things by the book, and choose who lives and dies.
