As an ICU nurse during the COVID-19 pandemic, I am torn in two. I see the world from both the eyes of the general public and the standpoint of a healthcare provider. Likewise, I am both shocked by the recent changes in our society and normalized to the ethical dilemmas of critical care. It is a strange and familiar place to be in.
I also find the sudden interest in my workplace disarming. I never once thought the area where I work, my nursing specialty, would be put on a global stage like this. Words like intubation, respiratory support, and ventilators are sprinkled throughout mainstream media. Family members not employed in health care call to tell me what are the current trends in ICU. I am taken aback, worried, and feel outpaced by the coronavirus.
One story of an elderly Belgian woman, who recently passed away from COVID-19, is truly a striking example of how much the world is looking at critical care units.
Save It For The Young
In Lubbeek, Belgium, 90-year-old Suzanne Hoylaerts passed away on March 21, 2020, from complications of COVID-19. Two weeks earlier, she had fallen ill. Initially she lost her appetite, and then felt short of breath. Her daughter, Judith, took her to see the doctor and worried she was having a relapse of pneumonia. “She had pneumonia and was hospitalized last year,” her daughter told Het Laatste Nieuws.
Once at the doctor’s office, Suzanne was found to have low blood oxygen saturation (SpO2). Concerned for her well-being, Suzanne’s doctors sent her to the hospital where she tested positive for COVID-19 and was placed in isolation. Sadly, Suzanne’s condition declined shortly thereafter and she was faced with the choice of going on a ventilator. According to reports from the hospital, Suzanne told doctors she wanted them to save the ventilators for the younger patients and did not want to continue treatment.
For Judith, this story is likely bittersweet. Her mother is being praised for her bravery and selflessness. However, Suzanne’s family was unable to bid her farewell or properly lay her to rest. “I can’t say goodbye to her, and I don’t even have a chance to attend her funeral,” her daughter said to the media.
It is not known how Suzanne contracted the virus. (1)
90-year-old Suzanne Hoylaerts
Who Gets A Ventilator?
Talking about stories like Suzanne’s is important because ventilator rationing is becoming a reality worldwide. From watching other countries like Italy, China, and Spain experience population-wide outbreaks of COVID-19 we know that critical care beds and ventilators will be of the utmost importance. Even in the United States, New York, Washington, and Louisiana have nearly depleted their statewide ICU resources. Due to COVID-19, medical teams are having to decide who can and can’t be intubated. (2, 3)
So what are the guidelines for getting access to a ventilator? Although nothing is set in stone, various states are leaning towards a model that favors healthy people who are able to recover quickly from COVID-19. Ethically and legally, these models of decision-making are still shaky by favoring those without disabilities and of higher income brackets. But public feedback is welcomed, and doctors look towards older healthcare tools to help prepare for any incoming ventilator shortage. For example, some doctors are proposing the use of the Sequential Organ Failure Assessment score (SOFA score) to grade the need for intubation and weigh patients’ care against one another.
These choices are incredibly hard to talk about and hear about in the news but are just as (if not more difficult) for the healthcare providers who will have to carry out these choices. (2)
Getting Creative With ICU Care
To help further diminish the need to choose between care and no care for COVID-19 patients, healthcare providers may have to get creative with equipment. Italy and Spain recently showcased a snorkeling mask set up, paired with a 3D printed valve, on a non-invasive respirator. The design allows two patients to access one type of breathing machine (or BiPAP) at the same time for treatment. Such ingenuity will allow ICU resources to go further. (3)
From the ICU I work, we continue to push new ideas, expand our resources, and learn from other critical care units around the globe. In the last two weeks, the layout, function, and staffing of my unit has changed dramatically based on what we have seen happen elsewhere. In some ways, the mainstream media coverage has made it easier for every ICU out there to communicate and make the challenges of managing COVID-19 known. Working as a team, the public and the ICU, I am hopeful we can get through this together.
