Thread by @NeejaB

Long (but necessary) Thread on Hospitalizations: GIM (Internal Medicine) and ICU, and what it means to be "COVID Recovered"

We have gotten used to the slew of numbers thrown at us daily. Active cases. Deaths. ICU and hospitalizations. And over the last few weeks, we have seen a very slow decline in these numbers.

But I caution us all not to get excited or comfortable with these numbers. They do not tell the whole story.

When a patient is in hospital with COVID, they are typically acutely ill- needing oxygen, steroids, and many times - ICU support. On the ward, patients often become deconditioned, requiring supplementary nutritional support via feeding tube or IV.

In the ICU, patients often require heavy sedation to give lungs a chance at recovery, may have other organ involvement requiring dialysis and feeding tubes. If they require a protracted time on the ventilator, they may require a tracheostomy.

At 14 days, however, these patients become classified as "COVID recovered." Unfortunately, this is a bit misleading without provided context.

COVID recovered simply means that their period of infectivity has lapsed, and that they do not need to be on isolation anymore.

What this DOES NOT mean is that they are recovered and back to their pre-illness state.

As I mentioned above, COVID patients have significant deconditioning, sometimes multi-organ involvement, prolonged supplemental oxygen requirements-- all which lend to increased hospital length of stays.

At any given moment, we may have multiple "COVID recovered" patients who have tracheostomies, on dialysis, not able to swallow (so reliant on enteral tube feeds), too weak to walk unaided. These patients still require acute care, rehab, and multiple specialists.

These are still "COVID patients," even though daily news updates do not count these patients in their stats. The volume of recovered COVID is often HIGHER than those with acute illness, particularly at this stage of a wave.

(And remember, this is on top of our pre-pandemic patient numbers.)

So while 400 inpatient COVID patients seems like we are "winning" compared to a few weeks ago, the disproportionate # of COVID recovered still requiring inpatient care needs to be highlighted. As this is still healthcare resources being utilized.

And if we are to learn to "live with COVID," then I challenge our government to understand what that truly means. Not just acute or active COVID, but the downstream and long term effect.

Asking us to do more with the same resources is just not feasible.

Resumption of surgeries, ambulatory care and other diagnostic interventions all are affected, not only by acute COVID, but COVID recovered. Getting to 100% surgical activity is impossible when nurses and clinical staff cannot be repatriated back to the OR or wards.

Transparent reporting of the true impact of COVID patients on acute care is needed... and the appropriate support from our leaders should reflect the whole picture, the reality that so many of us see on the ground.
#COVID19AB