27 April 2020
As millions across the world quarantine at home, keeping a safe distance from a deadly virus, healthcare workers on the front line of the pandemic are risking their lives every day. Moustafa Mortada, an anesthetist and intensive care unit (ICU) specialist in a hospital in Yorkshire, United Kingdom, speaks about the new normal for doctors and nurses around the world.
Speaking at a webinar held by Nature Middle East, the regional branch of Nature, Mortada shared his experience fighting a disease that killed more than 170,000 worldwide, and infected well over 2.5 million, including more than 10,000 in Saudi Arabia.
“I always left work behind when my shift was done, and I never carried work home with me. Now, the situation is different, it’s the first time my work affects my home, my family and my entire life,” says Mortada, who has 17 years of experience in the field.
Keeping calm and carrying on
All the beds in the hospital Mortada works for are now filled by people with COVID-19, as is the case in many ICUs around the world.
Patients admitted to the ICU are always in a serious condition, so this is a reality ICU workers are used to; but the unprecedented numbers being admitted in critical conditions are daunting. “We’re almost in a state of war; it is a huge burden on anyone to see large numbers of patients admitted at the same time, with the same diagnosis, and with high mortality rates,” says Mortada. “We’re trained to compartmentalize and separate work from personal response to deal with critical conditions. But it is extremely hard to do that with such high mortality rates.” Mortada and his colleagues around the world have different ways of coping, but second guessing themselves to assess whether they’ve done everything they could to save the patient remains a challenge.
In England, for instance, 5% of COVID-19 cases require ICU care. Of those 165 patients admitted to the ICU in England, Wales and Norther Ireland throughout February and March, 79 died, according to data released by the Intensive Care National Audit and Research Center (ICNARC) on March 28.
In addition to feeling responsible for the cases he treats, Mortada explains that healthcare professionals also fear for their own lives and the safety of their families given COVID-19’s alarming contagion and fatality rates. Whereas a virus like MERS-CoV, the virus causing the Middle East Respiratory Syndrome, has a fatality rate of 34%, since it was discovered in 2012, it has only affected 2,500 people around the world, according to figures from the World Health Organization (WHO). SARS-CoV-2, the virus causing COVID-19, has a lower mortality rate of an estimated 3.4% by early WHO estimates, to 6.5% when calculated based on the ratio between deaths and confirmed cases. SARS-CoV-2, however, has already affected 2.2 million around the world in four months. A single COVID-19 patient can infect two to 2.5 people, according to WHO, with some reports from the Center of Disease Control (CDC) estimating the transmission rate in the early days of the outbreak in Wuhan to be over five. A single Influenza patient, by comparison, only transmits the disease to 1.3.
Its contagion and fatality rate, means that medical staff need to wear full protective gear, completely covering the eyes, nose and mouth. Usual surgical masks do not provide proper protection for medical professionals dealing with COVID-19 patients.
Some hospitals, including Mortada’s, had to triple the number of doctors in ICUs to deal with the volume of cases, and because a doctor can’t remain in the protective gear for more than 90 minutes at a time. The gear is tightly fit and can cause blisters, and is also difficult to communicate in, so ICU workers often have to rely on writing for communication inside the unit.
“[These protective measures] keep us from being able to deal with patients as quickly as we are used to, and when a critical case arrives to the emergency room, we’re no longer able to tend to them immediately as we used to,” he explains. Now, first respondents have to wear the proper protective gear before they can tend to any suspected COVID-19 case. It is not enough to take these precautions for confirmed cases alone, he says, because by the time they’re confirmed, a doctor or a nurse would have already become infected. One of Mortada’s patients, for instance, was tested negative three times before the fourth time finally came positive for COVID-19.
Despite their best efforts, and rigidly following hospital protocols, two of Mortada’s colleagues tested positive for the virus. “There are so many aspects about the virus that we still do not fully understand,” he adds.
Mortada’s key message to his fellow health workers is never to forsake their own safety, even if this goes against the instinct and training of emergency respondents who are used to rushing to deal with incoming cases. “There is no emergency in treatment with these cases, so don’t forsake your own health thinking this might save the patient. It is far more valuable for you and for the sake of other patients you need to treat to take the proper procedures and wear your protective gear before dealing with a potential COVID-19 case,” he says.
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