The harsh reality of life on a COVID ward
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Over 200 million cases and 4.5 million deaths from COVID have been reported worldwide. Infections are quickly becoming universal to the human condition.
Among all the numbers we hear from press conferences, it is easy to forget that each number represents a unique person from a household within a community.
Nurses working in the intensive care unit at Royal Melbourne Hospital. Credit:Joe Armao
I am one of many healthcare workers caring for those on our COVID wards at the Royal Melbourne Hospital. We have three dedicated COVID wards plus 20 intensive care unit beds. Enough for about 70 patients. We expect patient numbers to increase and have operational plans to increase our capacity.
All staff on these wards wear full PPE – gowns, N95 masks and face shields. We’ve been ‘fit-tested’ to ensure our masks don’t leak. Strategically placed air scrubbers clean the air of aerosols containing viral particles.
It feels safe. It feels calm. It’s much better than last year when aerosol spread was not as well understood and many staff got infected. Critically, we’ve also been vaccinated.
This past week, the patients range in age from 20 to 80. Several are pregnant women. Some have other health problems that place them at higher risk of severe COVID. Many are young and otherwise fit.
Entire multi-generational households are here. Mum and dad, grandparents all sick in the hospital, kids cared for elsewhere. In another instance, mum in hospital, dad caring for a two-week-old baby at home.
Most of those hospitalised are in their second week of illness. The lungs become more inflamed in response to the virus, leading to breathing difficulties and a lack of oxygen getting from the lungs to the bloodstream. Fatigue and high fevers are common. Everyone is absolutely miserable.
Some patients improve without specific treatment as we closely monitor them. Many become hypoxic (low oxygen levels in the blood). Hypoxic patients receive oxygen therapy and we start medications. These include remdesivir (an antiviral drug), dexamethasone (a steroid), and other anti-inflammatory agents.
One of our patients is in her 30s. She is pregnant with her first child. She has been staying home and isolating during lockdown. Her husband got something for her at the chemist, was notified that that was a tier-1 exposure site, was tested, and was positive. She then got infected too. Pregnant women are at higher risk for severe COVID.
Victorian healthcare workers are preparing for a sharp increase in the number of hospitalised coronavirus patients. Credit:Wayne Taylor
It’s week two of her illness and she is becoming hypoxic. We start dexamethasone and oxygen. Her hypoxia worsens and we turn up the oxygen. We ask intensive care to assess her as she might need to go on a ventilator. We give her tocilizumab, a targeted anti-inflammatory drug. Tocilizumab hasn’t been used much in pregnancy for COVID but she agrees that any potential risk is outweighed by the benefit. Over the next 48 hours she makes a stunning recovery.
Was her recovery due to the tocilizumab? The dexamethasone? I can’t truly say from this single anecdote. What I do know is that large randomised clinical trials have shown these drugs to be effective.
Among thousands of patients randomly assigned to drug or no drug (essentially by tossing a coin), those receiving the drug are less likely to die. Randomised clinical trials are the only way to demonstrate a drug works as they remove the influence of other factors.
One of our other patients is in his 40s. A father of four. He’s a tradie. He’s fit. His whole family got infected. I care for him after he leaves the intensive care unit, having been on a ventilator for seven days. It’s day 15 of his hospital admission. He still requires some oxygen and is breathing fast to get sufficient air through his lungs.
We talk footy.
He and his son support Richmond. They swapped allegiances from Essendon when Bachar Houli switched clubs.
We reminisce about the incredible grand final performances of Houli. In my patient’s community, Houli is a legend. Houli’s mother has been in intensive care with COVID and Houli has been encouraging people to get vaccinated.
Both my patients just want to get home. Isolated and alone in hospital, but connected through their phones (all our patients are on their phones), they have been telling their families and communities to get vaccinated.
“We don’t want others to go through what we have gone through. This is not just politicians talking on the TV. This is real for our community. Get vaccinated.”
Steven Tong is an infectious diseases physician at the Royal Melbourne Hospital and the Doherty Institute.
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