ESICM: COVID-19 DIspatches From Northern Italy ICUs

#15,042

It is pretty obvious that a great many people are still not taking COVID-19 seriously enough, either suffering from denial - or cognitive dissonance - or both.  On twitter, many treat it as a joke, a hoax, or simply meme-worthy. 

I suppose, until it hits your community - and hits it hard - this is something that is going to be hard for most people to fathom.  

So far, most of the world has been spared.  Life goes on, pretty much as usual. But on the front lines -- in places like Hubei Province, aboard the Diamond Princess, and across much of South Korea, Iran, and Northern Italy - the impact is serious, and at times overwhelming. 

Late yesterday Sharon Sanders at FluTrackers posted a thread with a communications from the ESICM (European Society of Intensive Care Medicine), which describes the impact of COVID-19 on ICUs in northern Italy.  

It makes for sobering reading, and should be taken to heart by every hospital and emergency planner, whether their community is currently reporting COVID-19 cases or not.   Only 15 days ago, Italy only knew of 3 cases - now they have thousands.

First, a bit about the ESICM, then the dispatch.

The European Society of Intensive Care Medicine is an Association of individual persons. Founded in March 1982 in Geneva, Switzerland, ESICM is a non-profit making international association.

Objective

ESICM supports and promotes the advancement of knowledge in intensive care medicine, in particular the promotion of the highest standards of multidisciplinary care of critically ill patients and their families through education, research and professional development.

COVID-19 – UPDATE FROM OUR COLLEAGUES IN NORTHERN ITALY

March 5, 2020

Preparing for COVID-19

Shared experience & guidance from our colleagues in Northern Italy

Dear Colleagues

Everyone is closely watching and monitoring the COVID-19 outbreak. This global emergency is presenting major challenges for our profession as we attempt to anticipate, tackle and eventually get ahead of it.

As there are many new experiences with this type of virus, we need to learn from those with more experience. Information is vital. As you will have seen, Northern Italy is in the middle of a crisis and Lombardy in particular has been severely affected. Our colleagues coordinating the emergency ICU response in Northern Italy have sent me the following message which they wish to convey to all our members.

I salute all the work our colleagues are doing, globally, faced with this situation. ESICM will endeavor to do its part to share accurate information and resources.

Wishing you all the strength needed in the coming months,

Yours respectfully
Prof. Jozef Kesecioglu
President, ESICM

Milan, 4 March 2020

Dear friends,

At this moment in time, we believe it is important to share our first impressions and what we have learned in the first ten days of the COVID-19 outbreak.

We have seen a very high number of ICU admissions, almost entirely due to severe hypoxic respiratory failure requiring mechanical ventilation.

The surge can be important during an outbreak and cluster containment has to be in place to slow down virus transmission.

We are seeing a high percentage of positive cases being admitted to our Intensive Care Units, in the range of 10% of all positive patients.

• We wish to convey a strong message: Get ready!
• We also want to share with you some key points from our experience:
• Get ready now – with your ICU’s networks – to define your contingency plan in the event of an outbreak in your community
• Don’t work “in silo”. Coordinate with your hospital management and other healthcare professionals to prepare your response
• Make sure your hospital management and procurement office have a protocol in place about which personal protection equipment (PPE) to stock and re-stock
• Make sure your staff is trained in donning and doffing procedures
• Use education, training and simulation as much as possible
• Identify early hospitals that can manage the initial surge in a safe way
• Increase your total ICU capacity
• Get ready to prepare ICU areas where to cohort COVID-19 + patients – in every hospital if necessary
• Put in place a triage protocol to identify suspected cases, test them and direct them to the right cohort
• Make sure you set clear goals for care with the patients and their families early on

With our best regards

COVID-19 is expected to be a mild or moderate illness for 80% of those who get it, but for a significant (but poorly quantified) percentage of mostly older individuals, it can be quite serious.

But even if you are young, and healthy, and at relatively low risk from COVID-19, an unprepared and overwhelmed healthcare system could still pose a serious threat to your well being. 

How well we fare as individuals, and as a society, will depend in large part on whether we can keep our healthcare delivery systems operational amid this crisis.  During a pandemic, people will continue to have heart attacks, get in car wrecks, develop appendicitis, or need chemotherapy or dialysis . . . the list is endless.

Simply put, if our healthcare system gets sufficiently overwhelmed, catching COVID-19 virus will be the least of our worries.