Time to flatten the curve, once again
Throughout the COVID pandemic, critical care teams have stood as the last line of defense for patients when all other measures have failed. With cases again surging in Connecticut, we are once again seeing signs that this line of defense is threatened. For this reason, more than 40 other critical care physicians and I sent a letter to Gov. Ned Lamont expressing our grave concerns that the capacity of our intensive care units (ICUs) is becoming saturated.
Based on what we are seeing, we strongly believe that it is again time to limit non-essential indoor public gatherings to slow COVID spread, “flatten the curve” of ICU admissions, and preserve our capacity to save lives.
Winter hasn’t even arrived yet and we are already filling up our intensive care units (ICUs) with a second wave of severely ill COVID-19 cases similar to what we experienced in early spring. This time, those huge numbers are superimposed on a full census of patients with severe non-COVID illnesses whom we are equally committed to serve. As a result, ICU beds are growing scarce, leaders are calling for physicians to volunteer for extra teams and extra shifts, and the supply of nurses and therapists is becoming exhausted.
This time we cannot rely on traveling providers who bolstered our numbers last spring because they are now needed in every state. At the current pace, available critical care beds may fill up by early December and force a repurposing of post-anesthesia care units and operating rooms for ICU care. Postponing important non-COVID care such as surgeries will likely further increase the substantial excess non-COVID mortality that has been attributed to delays in care.
Meanwhile, it is being widely reported in the media that the lower COVID mortality rates reflect dramatic advances in care. This is simply not accurate. While our understanding of COVID has improved, there are only a few therapies available for severe cases, and their benefits are modest. Instead, we can attribute most of the survival gains of recent months to our ability to deliver attentive, high-quality supportive ICU care. That model requires fully staffed teams of critical care physicians, nurses, and therapists working in the familiar environment of our traditional ICUs. We know from the spring that ICU admissions and mortality were lagging indicators, and, in the coming weeks, ICU admissions, length of stay, and deaths will inevitably rise. These trends will be exacerbated if our ICUs are overwhelmed.
Capacity projections often underestimate how challenging it is to care for COVID patients and this brutally unpredictable disease. Many COVID patients are extremely sick compared to other critically ill patients, and many are in the prime of life without existing major medical problems.
The duration of illness is much longer than for other ICU patients with pneumonia, and survivors will need to spend weeks if not months in the ICU. Unlike other conditions that have a more predictable trajectory, COVID patients can suddenly take a sharp turn for the worse and death can occur at any time. An extraordinary level of vigilance is required. Patient rooms must be visited repeatedly throughout the day, necessitating frequent, time-consuming changes of personal protective equipment. Patients and families feel especially frightened and it is essential to take the extra time at the bedside and over video conferencing to comfort them and explain what is happening.
We are grateful for the strong public and hospital leaders who have shown resilience and creativity during these challenging times. Their actions have allowed us to open up new units, procure extra personal protective equipment, and acquire additional life-saving ventilators and oxygen delivery devices. However, because floor beds and ICUs are also full of non-COVID patients, it is not necessary to reach the huge inpatient COVID censuses we saw last spring to be overwhelmed. As ICU providers, we are prepared to do whatever we can to care for, comfort, and heal as many individuals as possible, and want every patient who needs our care to seek it. However, we also want everyone outside to know what we are up against, and not to assume that ICU capacity is limitless. It is not.
Now is the time to change our individual and group behaviors to prevent hospital admissions that we will see in the coming weeks, so that we don’t return to the higher mortality rates we saw in the spring. Based on what we know about the epidemiology of COVID-19, we are confident that committed personal choices and strong policy actions to temporarily halt indoor dining and exercise and other unnecessary indoor public gatherings would protect our citizens from this lethal disease, keep our hospitals and caregivers from becoming overwhelmed, and save lives.
With a vaccine likely just weeks away, these courageous decisions would help us to turn our attention back to the preventive measures that are needed to end this pandemic and get our lives and our economy back on track as quickly as possible.
Luke Davis, M.D., is an Associate Professor at the Yale School of Public Health and the Yale School of Medicine and a practicing pulmonary and critical care physician. *The opinions expressed are those of the writer and are not intended to reflect the opinions of Yale University or of Yale New Haven Health.
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