As COVID-19 pushes up the demand for critical-care facilities, late presentation in hospitals with respiratory distress and other symptoms is emerging as one of the primary reasons why more people are ending up in ICUsand ventilators, according to critical-care physicians.
If such people who are likely to develop complications can be picked up early, appropriate interventions can reduce mortality significantly.
The current problem is two dimensional. COVID patients with mild illness and in home care are ending up in ICUsafter they develop complications past the fifth or seventh day and turn up late in hospitals
But mortality rate is higher in the case of those patients who are rushed to the casualty with serious illness and whose COVID-positivestatus becomes known only at that point in time. These are usually people with uncontrolled diabetes or asthma but who may not recognise their symptoms to be linked to COVID. These are the kind of cases which the system should track, investigate and prevent through active surveillance.
Home care for asymptomatic or mild cases of COVID can be effective only if the system can monitor patients closely. However, many people still have not been made aware of the importance of monitoring oxygen saturation and most do not have pulse oximeterat home too.
“COVID is a complex disease which affects individuals differently and unless the health system is primed to watch out for the various signs and symptoms that signal a patient’s downhill path, a lot of preventable deaths will happen. But the health system is fatigued and its efficiency will continue to slide as the pandemic persists,” a senior public health expert points out.
“Interventions at the right time is the key to reducing patient mortality. But our current problem is the late presentation of people from home on day 9 or 10 with complications. Delay in recognising oxygen desaturation can be dangerous. COVID patients in home care should be taught about the possible danger signs and the importance of immediate medical attention,” R. Anoopkumar, Consultant in Critical Medicine, Baby Memorial Hospital, says.
COVID complications usually set in after seventh and even patients who had mild or no symptoms need to be careful during this time. People with co-morbidities, especially renal disease or asthma, should watch out for excessive fatigue, fever spikes and respiratory issues, which can happen quite suddenly.
High mortality
It is not possible to develop expertise in critical care in a week’s crash course and in many ICUshastily opened up during the pandemic, the management of critically ill patients has been less than perfect.
“The outcome of our patients who go on ventilators have been quite bad because of the lack of trained ICU staff and the absence of 1:1 nursing care. We can try to prevent patients going into ventilators by putting them on high flow nasal oxygen, non-invasive ventilation and awake proning, but all of this requires dedicated nursing care, which we are short of,” a senior doctor at ThiruvananthapuramGovernment Medical College Hospital says.
If Kerala’scase fatality has been low, ICU mortality figures speak differently. About 66 % to 91% of COVID patients who required mechanical ventilation have been dying .
This is quite alarming when compared to other viral pneumonia patients put on ventilators during 2017-19 wherein 78% patients were discharged home and only 22 % died, according to the figures given out by ThrissurGovernment MCH.
“The epidemic pattern here is no different from what happened elsewhere in the world, where system saturation and the shortage of trained professionals led to compromised ICU care and higher mortality. Intensivistscannot be created overnight, which is why the State should have focussed better on improving ICU training right from the initial days of the pandemic. The proposal for setting up teleICUsis a thought in the right direction,” says Dr. Anoopkumar.
