CoVID-19 is all about lungs and breathing. As the infection increases in seriousness so the need for breathing assistance becomes greater. Critical and intensive care units (ICUs) provide the optimal support for these life-threatening breathing problems. But are they ready for the expected surge in cases?
There will never be enough ICU beds.
Overall, critical care accounts for a significant portion of health care costs, as 11% of hospital admissions now incorporate a stay in the ICU and this ratio is increasing. So, as the number of cases CoVID-19 increase worldwide, so will the strain on these units.
There will never be enough ICU beds with respirators. The number of ICU beds varies from country to country and it doesn’t relate to a country’s wealth, but rather its health care priorities. For example, the UK has 3 ICU beds per 100,000 people, whereas the USA has 20 ICU beds per 100,000 people.
These beds are just too expensive. On average, the daily cost of an ICU bed is threefold higher than a bed in a general ward. In Ontario, the average daily cost in the ICU at a teaching hospital is $4,186, while an acute care bed is valued at $1,492 per day.
Nor is the way they are used always optimal. Many patients entering ICUs simply do not need to be there. Quite often this is determined by admission practices, for example, whether a patient is admitted by their usual physician, a specialized intensivist or a co-ordinator. ICU patterns in the US Veterans Affairs Health Care System identified that up to one third of the patients admitted to their ICUs were at low risk of dying.
The role of the ICU in the CoVID-19 age needs to change to meet the demand. Rather than just a focus on drive-by testing of the worried well or those with minimal symptoms, governments should be setting up specialized respiratory ICU units for those who are seriously ill. There has been a 12% increase in ICU utilization over the last decade, with up to one-third of these patients requiring invasive mechanical ventilation — and that was before CoVID-19.
Ventilating patients is very complicated and where there is a novel infectious agent like this Coronavirus, sterilization procedures for the respirators remain untested. Also, optimal sterilization, such as gamma radiation, can negatively affect the performance of respirators. New respirator systems are launched each year, technically improving, but often more and more complicated concerning hygiene and infection control.
Now that mass hysteria has mobilized effective public health practices, it is time to refocus our acute services.