Italy imposes quarantine on millions to contain coronavirus

‘Get ready’: Italian doctors warn Europe of coronavirus impact on hospitals

‘It will be tough’, British doctor admits after Italian experts warn one in 10 of those infected need intensive care

Shaun Lintern
Health Correspondent
@ShaunLintern
Saturday 07 March 2020 17:51
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Italian doctors have warned medics across Europe to “get ready” for coronavirus in a letter revealing up to 10 per cent of all those infected with coronavirus need intensive care, with hospitals becoming overwhelmed.

The letter, seen by The Independent, reveals the scale of the impact on hospitals in Italy where 5,883 patients have been infected with the virus and 233 people have died as of 6pm on Saturday.

In the note, sent to the European Society of Intensive Care Medicine, critical care experts Professor Maurizio Cecconi, Professor Antonio Pesenti and Professor Giacomo Grasselli, from the University of Milan, revealed how difficult it had been to treat coronavirus patients.

They said: “We are seeing a high percentage of positive cases being admitted to our intensive care units (ICUs), in the range of 10 per cent of all positive patients.

“We wish to convey a strong message: Get ready!”

They said Italian hospitals had seen “a very high” number of intensive care patients who were admitted “almost entirely” for severe lung failure caused by the virus and needing ventilators to help them breathe.

They said hospitals across the UK and Europe needed to prepare for a surge in admissions and cautioned against working “in silos”. They said it was vital hospitals had equipment to protect staff and that staff were trained in wearing the kit.

They added: “Increase your total ICU capacity. Identify early hospitals that can manage the initial surge in a safe way. Get ready to prepare ICU areas where to cohort Covid-19 patients – in every hospital if necessary.”

There have been concerns the NHS will struggle to cope in the event of a sustained coronavirus outbreak where large numbers of patients require intensive care. The UK’s chief medical officer Professor Chris Whitty has said critical care units may struggle.

Latest figures show NHS intensive care units were running at around 80 per cent capacity at the start of March. Overall the NHS has one of the lowest ratios of hospital beds per head of population in Europe.

UK hospitals are already discussing how they will need to ration care to those most likely to survive in the event there are not enough beds, ventilators or staff to care for the numbers infected if the worst case scenario predictions prove accurate.

A senior consultant at a major London hospital told The Independent the letter was a concern.

He said: “It will be tough. It’s going to be hard. My worry is staffing. If a lot of doctors and nurses become sick that will be the crunch. If a third of staff are self-isolating that is the time when we stop being able to cope.”

He added that while the NHS was as prepared as it could be for the virus patients could suffer.

“What I am more worried about is if the intensive care unit is full and we don’t have enough nurses, the anaesthetists will be called on to look after patients outside of the ICU in theatre and recovery areas. If that happens we won’t have the capacity for patients who need urgent surgery for appendicitis, blood clots etc and that’s when patients will start getting worse care as a result. These are the people who will die unnecessarily.

“The big challenge will be keeping the anaesthetic service going. Anaesthetic staff are most at risk because we deal with patients airways.”

In a separate note, Italian intensive care doctor Giuseppe Nattino, from the Lecco province in northern Italy, has shared a clinical summary of the patients his unit has been treating, which doctors described as “frightening” in terms of what it could mean for the UK.

The technical note spells out how patients with coronavirus experience a severe infection in all of their lungs, requiring major ventilation support. It also reveals the effect of the virus, which affects blood pressure, the heart, kidneys and liver with patients needing sustained treatment.

Dr Nattino said: “A week ago we opened a six-bed ICU for Covid-19 critically ill patients. In two days our unit filled up and we extended it to 10 beds on 3 March which filled up during the same afternoon. Now we’re planning to merge the cardio and general ICUS to use the general ICU beds for 10 more Covid-19 patients.”

In an alarming development, Dr Nattino said younger patients were being affected, saying the ages of patients ranged from 46 to 83 with only a small number having important underlying conditions.

He added: “The last days are showing a younger population involved as if the elderly and weaker part of the population crashed early and now younger patients, having exhausted their physiological reserves, come to overcrowded, overwhelmed hospitals with little resources left.”

One UK doctor said this latter point needed careful consideration by NHS hospitals, adding: “We need to be careful to have some ICU capacity for younger patients. This is where important difficult decisions need to be made.”

Another intensive care doctor from the north of England said Dr Nattino’s note showed coronavirus patients suffered a lack of oxygen in their blood, meaning they need a ventilator, with large parts of the lung affected by the virus.

The doctor added: “The inflammation in their lungs carries on for a long time. Patients need strong drugs in high doses to maintain their blood pressure. Kidney failure requiring a kidney machine is common and the patients later in their stay are starting to have blood tests showing liver damage.”

A spokesperson for the NHS said: "Every country is responding to this new virus, and as the chief medical officer has said, routine non urgent services could well come under pressure, so it’s right that the lessons and recommendations from Italy are now being put into practice in England.

“As the whole world continues to understand more about this virus, its impact on people and the likely demand on health services, it’s important to remember that the NHS in England has world-leading, expertise and every hospital across the country and the healthcare professionals who run them are now actively planning to respond flexibly to manage new demand.”

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