Tag Archives: ventilator

At Oklahoma COVID ward, staff fight to prevent lonely deaths

By Nick Oxford

OKLAHOMA CITY (Reuters) – The patient alarms ping constantly in the COVID-19 ward at a hospital in Oklahoma City, signaling to pulmonologist Dr. Syed Naqvi and the rest of the ICU team that yet another person needs help.

The sheer volume is exhausting, Naqvi said, but the emotional toll is even more draining, given that each time he puts a patient on a ventilator he knows there is little chance that person will recover.

“The disease is real. Unfortunately, the misery is real. We have and still see patients die every day,” Naqvi said from an intensive care unit set aside for COVID-19 patients at the SSM Health St. Anthony Hospital.

At the same time as coronavirus vaccinations are being rolled out across the United States, the post-holiday spike in cases appears to be easing.

In Oklahoma, the number of COVID-19 patients hospitalized has fallen 34% in the last two weeks, with 1,375 admitted as of Thursday, according to a Reuters tally.

The state’s rate of infected people to population of 9.6% is higher than the overall U.S. rate of 7.9%, but the fatality rate for those with the coronavirus is lower, at 0.8% compared with 1.7% nationally.

But the pandemic is never taken lightly in hospitals like St. Anthony, where Naqvi frequently sees patients die alone, their loved ones kept at a safe distance.

“I still remember one guy, his last message was to tell his son he loves him… Most of those stories stick with you,” Naqvi said.

Naqvi wears two pairs of gloves and two face masks before entering the COVID-19 ICU, in addition to a cap and a gown over his scrubs.

Suited up, he makes the rounds treating patients like Brenda Rex, 77, who has been hospitalized twice over the past week after catching COVID-19 at her nursing home.

She admonished the skeptics who have refused to take the disease seriously.

“You’d better take it seriously because you’re going to spread it,” Rex said, speaking through a respirator supplying her with oxygen.

“And pay attention to those around you,” she said. “If they’re not doing what they should be doing… run the other way.”

(Reporting by Nick Oxford; Additional reporting by Anurag Maan; Writing by Daniel Trotta; Editing by Rosalba O’Brien)

Prayers and faxed letters: Texas woman buries husband who died of COVID-19

By Callaghan O’Hare and Maria Caspani

HOUSTON (Reuters) – As hundreds of thousands of people in Texas fled their homes ahead of Hurricane Laura on Wednesday, Michelle Gutierrez was in Houston burying her husband David, who died of COVID-19 on Aug. 14.

The couple would have celebrated their 10th wedding anniversary on Sept. 4, a few days after David’s 54th birthday. Michelle and David met at a mechanic’s shop in Houston in 2009, when he had stepped in as a translator to help her with a mechanic who only spoke Spanish.

He then offered to fix her computer, and the rest is history. They built a life together in Houston, where they raised five children and he worked as a software engineer.

In early July, David was hospitalized after his symptoms of COVID-19, the disease caused by the new coronavirus, worsened. His wife and two daughters had tested positive but showed no symptoms.

David would fight the virus for over a month at Houston’s St. Luke’s in The Woodlands hospital, where he eventually died of heart failure.

“It’s been a roller coaster, every day is different,” Michelle said on the day of his funeral, her voice breaking with emotion. “One day you’re fine and the next day, you walk around and memories flood your mind… You just wish this was all a dream.”

About a week after her husband was hospitalized, Michelle and her daughters gathered under his hospital window to pray for him.

“And then after that first night I was like, ‘You know what, I’m gonna come in every night, honey, I’m going to be here every night, praying for you and just being there in spirit’,” she said.

And so she did, until the Friday in August when David passed away.

Michelle said she kept trying to communicate with her husband as his condition worsened. At first, before he was put on a ventilator, they managed to text one another, she said. But once he was in a coma, she began faxing letters to the hospital, and nurses would read them aloud to him.

David is one of thousands who have succumbed to the coronavirus in Texas, where a spike in cases in June and July strained hospital systems as the virus engulfed many southern states.

Nearly 180,000 people in the United States have died from COVID-19, the highest in the world, with 5.8 million cases recorded nationwide, according to a Reuters tally, also the highest in the world.

At David’s wake, a bottle of hand sanitizer and social distancing signs were prominently displayed as masked mourners walked to the casket to bid their farewells.

As for the future, Michelle said she was enrolling in a college nursing program. She had already planned to do so before her husband’s passing, but feels more motivated now.

“That’s more so now than before after seeing how these nurses took care of David and they were wonderful… And I could not have done it without them.”

(Reporting by Callaghan O’Hare in Houston, Texas and Maria Caspani in New York; Writing by Maria Caspani; Editing by Bernadette Baum)

One ventilator, two patients: New York hospitals shift to crisis mode

By Jonathan Allen and Nick Brown

NEW YORK (Reuters) – At least one New York hospital has begun putting two patients on a single ventilator machine, an experimental crisis-mode protocol some doctors worry is too risky but others deemed necessary as the coronavirus outbreak strains medical resources.

The coronavirus causes a respiratory illness called COVID-19 that in severe cases can ravage the lungs. It has killed at least 281 people over a few weeks in New York City, which is struggling with one of the largest caseloads in the world at nearly 22,000 confirmed cases.

A tool of last resort that involves threading a tube down a patient’s windpipe, a mechanical ventilator can sustain a person who can no longer breathe unaided. The city only has a few thousand and is trying to find tens of thousands more.

Dr. Craig Smith, surgeon-in-chief at New York-Presbyterian/Columbia University Medical Center in Manhattan, wrote in a newsletter to staff that anesthesiology and intensive care teams had worked “day and night” to get the split-ventilation experiment going.

By Wednesday, he wrote, there were “two patients being carefully managed on one ventilator.”

New York Governor Andrew Cuomo, who says his staff is struggling to find enough machines on the market, has touted the adaptation as a potential life-saver. “It’s not ideal,” he told reporters, “but we believe it’s workable.”

The U.S. Food & Drug Administration, which regulates medical device manufacturers, gave emergency authorization on Tuesday allowing ventilators to be modified using a splitter tube to serve multiple COVID-19 patients, though manufacturers still must share safety information with regulators.

Some medical associations oppose the unproven method.

On Thursday, the Society of Critical Care Medicine, the American Association for Respiratory Care and four other practitioner groups issued a joint statement saying the practice “should not be attempted because it cannot be done safely with current equipment.”

It is difficult enough to fine-tune a ventilator to keep alive even one patient with acute respiratory distress syndrome (ARDS), the statement said; sharing it across multiple patients would worsen outcomes for all. They proposed doctors instead choose the one patient per ventilator deemed most likely to survive.

At Columbia, Smith noted that they could not split a ventilator across just any two COVID-19 patients, but were only pairing patients with sufficiently similar respiratory needs.

Across Manhattan, Mount Sinai Hospital told staff in an email that officials were “working to figure out” whether they could split ventilators. The hospital has ordered the necessary adapters, a nurse there said in an interview on condition of anonymity because she was not authorized to speak to reporters.

Experts at Columbia pointed to a 2006 study where researchers, using lung simulators, concluded that a single ventilator could sustain four adults in an emergency scenario.

One author of that study, Dr. Greg Neyman, cautioned against the application in COVID-19 cases in part because the lungs themselves are infected. If one patient’s lungs were deteriorating faster, he said, it could cause imbalances in the closed system. One patient could starve for oxygen while the other patient’s lungs would get increased pressure.

“Unless they were very very closely monitored, such a set up may end up doing more harm than good,” Neyman wrote in an email to Reuters.

(Reporting by Jonathan Allen and Nick Brown; Editing by David Gregorio)

Who gets the ventilator? British doctors contemplate harrowing coronavirus care choices

By Stephen Grey and Andrew MacAskill

LONDON (Reuters) – The coronavirus pandemic is forcing senior doctors in Britain’s National Health Service to contemplate the unthinkable: how to ration access to critical care beds and ventilators should resources fall short.

The country’s public health system, the NHS, is ill-equipped to cope with an outbreak that is unprecedented in modern times. Hospitals are now striving to at least quadruple the number of intensive care beds to meet an expected surge in serious virus cases, senior physicians told Reuters, but expressed dismay that preparations had not begun weeks earlier.

With serious shortages of ventilators, protective equipment and trained workers, the physicians said senior staff at hospitals were beginning to confront an excruciating debate on intensive care rationing, though Britain may be a long way from potentially having to make such decisions.

Rahuldeb Sarkar, a consultant physician in respiratory medicine and critical care in the English county of Kent, said local NHS trusts across the country were reviewing decision-making procedures drawn up, but never needed, during the 2009 H1N1 flu pandemic. They cover how to choose who, in the event of a shortage, would be put on a ventilator and for how long.

Decisions would always be based on an individual basis if it got to that point, taking into account the chance of survival, he said. But nevertheless, there would be difficult choices.

“It will be tough, and that’s why it’s important that you know, that two or more consultants will make the decisions.”

Sarkar said the choices extended not only to who was given access to a ventilator but how long to continue if there was no sign of recovery.

“In normal days, that patient would be given some more days to see which way it goes,” he added. But if the worst predictions about the spread of the virus proved correct, he suspected “it will happen quicker than before”.

Britain is by no means the only country that faces having its health system overwhelmed by COVID-19, but the data on critical care beds – a crucial bulwark against the disease – is concerning for UK authorities.

Italy, where the coronavirus has driven hospitals to the point of collapse in some areas and thousands have died, had about 12.5 critical care beds per 100,000 of its population before the outbreak.

That is above the European average of 11.5, while the figure in Germany is 29.2, according to a widely-quoted academic study https://link.springer.com/article/10.1007/s00134-012-2627-8 dating back to 2012 which doctors said was still valid. Britain has 6.6.

‘MANY TIMES MORE’ VENTILATORS

Estimates of the potential death toll in Britain range from a government estimate of around 20,000 to an upper end of over 250,000 predicted by researchers at Imperial College. As of March 19, 64,621 people had been tested, with 3,269 positive.

The NHS is preparing for the biggest challenge it has faced since it was founded after the ravages of World War Two, promising cradle-to-grave healthcare for all.

It was stretched long before COVID-19, struggling to adapt to the vast increase in healthcare demand in recent years. Some doctors complain that it is underfunded and poorly managed. About a tenth of its more than one million staff roles in the health service are vacant while almost nine out of 10 beds are occupied.

The department of health referred a request for comment to NHS England, which said it was crucial to reduce the coronavirus’s infection rate to ease peak pressure on the health system.

“Unmitigated, there is no health service in the world that would be able to cope if the virus let rip,” said NHS England head Simon Stevens. “In the meantime, what the NHS is doing, of course, is pulling out all the stops to make sure that we have as many staff, beds and other facilities available.”

So how many life-saving ventilators are needed?

Health Secretary Matt Hancock said on Sunday that hospitals had around 5,000 but that they needed “many times more than that”.

The physicians interviewed by Reuters said, if ventilators were secured, the aim was to increase intensive care beds from around 4200 to over 16,000, partly by using beds in other parts of hospitals.

Rob Harwood, a consultant anesthetist in Norfolk who has worked in the health service for almost four decades, said access to critical care could ultimately have to be determined by patient scoring systems for survivability. Systems developed for SARS, another coronavirus that broke out in 2003, could for example be refined, he added.

“Once you have exhausted your capacity and exhausted your ability to expand your capacity you probably have to make other decisions about admission into intensive care.”

But he emphasized that, for now, admission criteria would stay unaltered: “We are a country mile from that at the moment.”

‘BECOME CANNON FODDER’

While shortages of critical care equipment may be most alarming, the coronavirus has exposed how generally ill-equipped the health system is for a pandemic.

The British Medical Association said doctors have been asked to go to hardware stores and building sites to source protective masks.

Some doctors are worried about Public Health England’s (PHE) new advice last week which reduces the level of the protective equipment they need to wear.

Previously, staff on ward visits were told to wear full protective equipment, comprising high quality FFP3 face masks, visors, surgical gowns and two pairs of gloves. But the new advice recommends only a lower-quality standard paper surgical face mask, short gloves and a plastic apron.

PHE referred queries about doctors’ worries to the health department, which did not respond to requests for comment on the matter.

A senior NHS epidemiologist, who was not permitted to be named, told Reuters this advice was based on a sensible assessment of the biohazard risk of the virus. “It’s not Ebola,” the doctor said, pointing out the risk to medical staff without underlying medical conditions was low.

Matt Mayer, head of the local medical committee covering an area in south of England, said GPs had been sent face masks in boxes that said “best before 2016” and that have been relabeled with new stickers reading “2021”.

“If you are going to lead people into a hazardous situation then you need to give them the confidence that they have the kit to do a decent job and they are not just going to become cannon fodder,” said Harwood the anesthetist.

The department of health said that they had tested certain products to see if it is possible to extend their use.

“The products that pass these stringent tests are subject to relabelling with a new shelf-life as appropriate and can continue to be used,” a spokesman said.

RAPID GUIDELINES

Dr Alison Pittard, dean of the Faculty of Intensive Medicine and a consultant in Leeds, northern England, said there had been chronic underinvestment in critical care in Britain. But she said the country was not yet at the stage where it had to make calls about rationing patient resources.

She said, if rationing became necessary, medical ethics should still prevail and guidelines needed to be issued on a national level so that no patient was worse off based on where they lived. The NHS might need also need the advice of military leaders, she said, on how to effectively triage.

“If we got to a difficult position where we had to exhaust every bit of resource in the country then, yes, we may have to change the way we approach the decision-making.”

Stephen Powis, the National Medical Director of NHS England, said there were plans to issue new guidance to give doctors advice on how to make difficult decisions if there was a surge in coronavirus cases, like in Italy.

The National Institute for Health and Care Excellence (NICE) said on Friday it would shortly announce a “series of rapid guidelines” on the management of people with suspected and confirmed COVID-19, including in critical care.

The guidelines are not, however, expected to be prescriptive but to suggest leaving key decisions to individual doctors.

Pittard said patients with pre-existing conditions who already had life-threatening health difficulties should be having conversations with their family about how they wished to spend their last days, in the event of them being infected.

“If I get coronavirus now I’ve got a very high chance of dying of it,” she said, putting herself into the shoes of such a patient. “So do I want to die in hospital and when my relatives can’t come in to visit me because it’s too risky, or would I like to die at home?

“And if I do want to go into hospital, do I then want to go to intensive care where my chances of surviving are minimal?”

(Editing by Guy Faulconbridge and Pravin Char)