Life on the COVID-19 Frontline: ‘Life and Death Decisions Over Ventilators Will Have to Be Made’

Mark Conrad continues his report on the NHS’ battle to save lives, while early national data outlines those most at risk.

Some NHS Intensive Care Units (ICUs) will only be able to ventilate COVID-19 victims for 24 to 48 hours once the virus reaches its peak in the UK – leaving doctors to make stark choices over who they continue to treat, sensitive guidance has warned.

Byline Times understands that some ICU units have been warned to expect extraordinary demand for ventilation equipment when the virus peaks in between two to six weeks, meaning that unenviable rationing plans are being modelled.

While the Government rushes to get more ventilation and ICU equipment to the frontline of the NHS ahead of the peak, NHS bodies are bracing for a tidal wave of demand – potentially made worse by citizens who continued to flout Government advice on social distancing last weekend. Typically, patients entering ICUs have had the virus for around 10 days, meaning some people who contracted it over the warm weekend could present to accident and emergency departments in early April.

One senior ICU source said: “We already know that we are facing the possibility of giving a patient just 24 to 48 hours on a ventilator, then taking them off it, cleaning it, and giving it to the next patient.”

Privately, a senior NHS doctor acknowledged that “the most extraordinarily tough decisions over ventilation, essentially a choice over life and death, will have to be made if the numbers keep rising as they are”.

Doctors and nursing staff are also concerned that, when the virus peaks, some COVID-19 patients who go into multi-organ and require renal (kidney) support will not necessarily be prioritised.

The doctor acknowledged: “Naturally, these are worst-case scenarios and further advice will be forthcoming. But this is what we are facing. The public need to know this and take measures to stop the spread of this virus.”

A second NHS doctor, a consultant, added: “We had already received stark guidance over who we ventilate in the first place.”

The warnings emerged as the number of deaths due to the virus in the UK reached 355. Some 46 people have died since Sunday – all with underlying health conditions.

Before last night’s UK-wide lockdown was announced by the Prime Minister, Health Secretary Matt Hancock described as “very selfish” the large numbers of people who flouted guidance on generally staying indoors, and on social distancing, after large crowds gathered in public places across the weekend.

“If people go within two metres of others who they don’t live with then they’re helping to spread the virus – and the consequences of that costs lives,” he said.

Meanwhile, a report by the Intensive Care National Audit and Research Centre (ICNARC) has outlined data on all COVID-19 admissions to ICUs up until midnight on 19 March 2020.

At that date, there had been 225 admissions to ICUs linked to COVID-19. Of these, early data covering the first 24 hours of care was available for 199 admissions of 196 patients. Sixteen people had died, 17 people had been treated and discharged and a further 163 were still in critical care.

London was by far the area most affected by ICU admissions – accounting for around two-thirds of admissions to critical care until 20 March, followed by Thames Valley, Mid Trent and Birmingham and the Black Country.

Drawing on the early ICNARC data, UK doctors are beginning to get some idea of the characteristics of those most affected by the Coronavirus – although higher volumes of ICU admissions will change that demographic over time.

Of the 196 patients admitted to ICU before 20 March:

• 57 were women and 139 were male
• The median age of patients was 64
• 155 patients were reported as being able to live without assistance before admission
• 23 patients had required assistance to live before admission

The vast majority of those admitted to ICUs were aged between 50 and 79.

Some 49 patients had a body mass index (BMI) of 18.5-25. A further 56 patients had a body mass index (BMI) of 25-30, while 58 had a BMI of 30-40. Thirteen patients had a BMI of more than 40. Just one patient had a BMI lower than 18.5.

During the first 24 hours after admission to ICU, 132 patients received some form of mechanical ventilation.

One doctor told Byline Times: “We have to be careful not to read too much into early data, but useful information is beginning to emerge. This helps us to understand the threat better, so that we can tackle this virus more effectively.”