Inside an ICU ward: Two-thirds of patients admitted to intensive care with Covid-19 need ventilation within 24 hours – as one expert says ‘the NHS doesn’t just give up intensive care beds for people to be “looked over”‘
- Boris Johnson was taken into intensive care at St Thomas’s Hospital last night because of the coronavirus
- Concern is growing as beds are reserved for the some of the most dangerously ill patients in a hospital
- The units have high ratios of staff to patients, life support machines and constant vital signs monitoring
- A report on NHS patients revealed 62 per cent on ICUs will need a ventilator within 24 hours of transfer
British Prime Minister Boris Johnson was moved to an intensive care unit at a London hospital last night in a frightening turn in the UK’s coronavirus outbreak.
The PM is reported to be in a stable condition, breathing on his own and ‘in good spirits’. He is said not to have been diagnosed with pneumonia and is receiving only minimal extra oxygen.
But there are still fears he could become seriously ill. One disease expert, the University of Reading’s Dr Simon Clarke, said: ‘The NHS, particularly at this moment, doesn’t give up intensive care beds just for people to be looked over. It doesn’t work like that, even for prime ministers.’
One-on-one nursing, life support machines and constant monitoring are the order of the day in an ICU and are what hundreds of stricken COVID-19 patients across the country – and the world – now face on a daily basis.
The units cannot cure the coronavirus any more than medics anywhere else, but they can buy seriously ill patients vital time by keeping their organs running while the immune system battles the virus naturally.
An audit report of NHS units has found that almost two-thirds (63 per cent) of patients admitted to ICU are put onto ventilators within 24 hours of arriving, and around half of those whose outcomes are known have died.
These are the features of an ICU which make them so suited to lifesaving treatment:
A bed in an intensive care unit is staffed by small numbers of specialist staff who give round-the-clock care using machines able to replace the functions of the hearts and lungs
Hospitals offer varying degrees of breathing support for patients whose lungs aren’t working properly, such as people with severe COVID-19. The treatments vary from basic breathing masks to machines which force oxygen into the blood and pump it round the body themselves
Ventilators and life support machines help overwhelmed organs while the body fights infection
The Government launched a drive to boost the numbers of ventilators available for the NHS. The machines are crucial for keeping coronavirus patients alive
The most vital pieces of equipment in intensive care units, particularly for people infected with the coronavirus, are ventilators and life support machines.
All beds in an ICU will have their own ventilators on hand in case the patient’s organs start to fail.
For COVID-19 patients and Mr Johnson, there is a risk that the virus will overcome their lungs and make them unable to get enough oxygen into their blood.
A ventilator works by pumping oxygen directly into the lungs through a tube which is put down the patient’s throat.
This procedure is usually done while the patient is sedated as they would be if they were having surgery. After the tubes are in place, the patient may awaken or they could be kept in a medically-induced coma if they are fighting for their life.
The process is described as ‘particularly invasive’ by Reading University’s Dr Clarke, and is only used if the patient becomes unable to breathe well enough on their own.
More seriously ill patients may require even more support – machines called extracorporeal membrane oxygenation (ECMO) can remove blood from the body and artificially pump oxygen into it if the heart and lungs start to fail completely.
Two-thirds of ICU patients need ventilation and survival is 50/50
The death rate of coronavirus patients hit 50 per cent for those admitted to intensive care and whose treatment had finished, recent figures show
A report on COVID-19 intensive care patients in NHS hospitals found that two-thirds of those taken into critical care (62.9 per cent) had to be moved onto mechanical ventilation within 24 hours.
And half of those whose outcome was known at the time of the audit had died in hospital.
The Intensive Care National Audit and Research Centre (ICNARC) found in a report published on April 4 that, out of 690 ICU patients whose treatment was finished, 346 died and 344 survived.
This gave the ICU patients a 50.1 per cent chance of dying with the coronavirus, but 1,559 out of the 2,249 people in the audit were still being treated in hospital.
Doctors say that many of the patients who died were seriously ill and could have been expected die soon anyway, regardless of whether they caught the coronavirus.
But there are also young, otherwise healthy people dying – 396 people under the age of 60 have been killed by the virus, and there are daily reports of healthy older people succumbing to it.
One of the most dangerous mechanisms of COVID-19 is its ability to send the immune system into overdrive and trigger sepsis, which is when the body’s own attempts to get rid of the virus end up destroying healthy cells and organs.
Linda Bauld, a public health professor at the University of Edinburgh, said: ‘The admission of the Prime Minister to intensive care is of huge concern and illustrates just how indiscriminate this virus is.
‘Anyone anywhere, including the most privileged in our society, can be affected and can become seriously ill. It is imperative now, more than ever that the rest of us comply with government guidelines to stay at home and not put others at risk.’
Dedicated team of critical care specialists at a high staff-to-patient ratio
Specialist staff work in teams which would usually have a ration of one nurse to one patient, although they may need to be relaxed in busy units (Pictured: Staff on a ‘coronavirus ward’ at the Royal Bournemouth Hospital)
Most patients in an intensive care unit will have at least one specialist nurse who is tasked with looking after them and them alone.
This may be relaxed in the coronavirus crisis because of a shortage of highly qualified staff, but the ratio of nurses to patients – which may stretch up to six-to-one in busy hospitals – will be lower than on a general ward.
Other hospital wards tend to be staffed by a team of less specialist nurses and healthcare assistants who split the workload among them and check on patients regularly throughout the day and night instead of watching them for 24 hours a day.
Because of ICU patients’ risk of becoming life-threateningly ill, they are given dedicated round-the-clock care.
Intensive care units also have their own doctors – usually called a consultant in intensive care medicine, or similar – who constantly monitor the patients in their unit to decide what level of care they need.
St Thomas’ Hospital in central London, where Mr Johnson is being looked after, has three permanent intensive care units consisting of 42 beds. It also has four high dependency units and may have more capacity for the COVID-19 epidemic.
The lung specialists at St Thomas’ Hospital are some of the best in the UK and the hospital now has a dedicated team set up to handle COVID-19 patients.
One of them, Dr Luigi Camporota, a consultant in intensive care medicine, last week held a seminar explaining to other hospitals the best way to attach a coronavirus patient to a ventilator, The Times reports.
And St Thomas’ was one of just five hospitals in the country which was used to treat patients at the start of the coronavirus outbreak because it has a highly trained team expert at tackling infectious diseases.
CPAP: Pressurised oxygen delivered through a face mask to help patients whose lungs aren’t weak enough to need a ventilator
PM Boris Johnson is believed to be receiving CPAP therapy, which pushes pure oxygen into the lungs through a face mask (Pictured in a video he filmed before being hospitalised)
Mr Johnson is not believed to have been hooked up to a ventilator yet, Michael Gove confirmed this morning, but has received oxygen therapy of some kind. It is possible he is having a different kind of breathing support called continuous positive airway pressure (CPAP).
This involves a constant stream of pure oxygen being pumped through a tight-fighting mask while the patient is still awake and inhaling on their own.
The pressure helps to open up the lungs and force air in where the weakened lungs are unable to draw it in themselves, while the high purity of the oxygen makes it easier for the body to get it into the blood rather than trying to filter it out of air.
CPAP machines are also now being used on normal wards in some hospitals because of the COVID-19 crisis, doctors say, instead of being limited to intensive care units.
Oxygen is piped directly to a valve at the ICU patient’s bedside from a central supply tank somewhere else in the hospital. This gives the ward a constant supply on demand for the patients who need it most.
The reason coronavirus patients may need help breathing is because the SARS-CoV-2 virus infects people by latching onto cells inside their lungs.
As it does this, the immune system triggers swelling in the lungs in its bid to attack the virus, constricting the airways and leading to a tight chest and shallower breathing.
Viruses also die inside the lungs and may kill off lung tissue as it reproduces, causing dead cells and debris to fall into the airways and block parts of them, making oxygen absorption less efficient and causing a cough as the body tries to get material out.
Constant monitoring of pulse, breathing and oxygen in the blood watches for deterioration
Patients on intensive care wards are attached to machines which constantly monitor and track their heart rate, breathing and levels of oxygen in their blood – the vital signs.
BORIS JOHNSON’S HOSPITALISATION ‘TRULY FRIGHTENING’
Michael Gove admitted Boris Johnson’s intensive care battle is ‘truly frightening’ today as he said ministers are ‘praying’ for his swift recovery.
Mr Johnson was moved to ICU at St Thomas’ Hospital in central London and given oxygen after his health deteriorated sharply over just two hours, leaving doctors fearing he will need a ventilator.
The 55-year-old was transferred to intensive care at 7pm because of breathing difficulties – forcing him to ‘deputise’ Foreign Secretary Dominic Raab to take the reins of government.
In a round of broadcast interviews this morning, Cabinet Office minister Mr Gove said Mr Johnson was getting the ‘best care’.
‘As we speak the PM is in intensive care being looked after by his medical team receiving the very, very best care from the team in St Thomas’ and our hopes and prayers are with him and with his family,’ he told BBC Breakfast.
He said Mr Johnson’s plight should demonstrate the need to follow social distancing rules, as the virus ‘has a malevolence that is truly frightening’.
Mr Gove played down concerns that the government will be paralysed with the leader out of action, insisting that Mr Johnson had already been on a ‘stripped back diary’ for days and ‘Cabinet is the supreme decision making body’.
However, within hours it had emerged that Mr Gove himself had also been impacted by coronavirus, as he has gone into self-isolation following a family member displaying symptoms.
Mr Gove also dodged questions about whether Mr Raab has been given crucial national security responsibilities such as control of the nuclear deterrent and military.
The Queen is being kept informed about Mr Johnson’s condition. The monarch appoints the PM, choosing the individual who is best placed to carry a majority in the Commons.
Meanwhile, Donald Trump revealed he has offered to send Mr Johnson experimental drugs to treat his coronavirus.
‘I’ve asked two of the leading companies … They’ve come with the solutions and just have done incredible jobs – and I’ve asked him to contact London immediately,’ Mr Trump said.
‘The London office has whatever they need. We’ll see if we can be of help. We’ve contacted all of Boris’s doctors, and we’ll see what is going to take place, but they are ready to go.’
The PM’s sharp downturn came 11 days after he first suffered coronavirus symptoms and went into isolation. He looked increasingly unwell when glimpsed in public and in ‘selfie’ videos posted on on social media, and ministers were then shocked by his grim appearance at a Zoom conference on Sunday.
Downing Street sources confirmed Mr Johnson is not yet on a ventilator – but was moved to intensive care to be near one if needed. Some medical experts forecasting this course of action is now ‘very likely’.
These are shown on a screen at the patient’s bedside so nurses and doctors can keep track of how well their organs are performing.
Large or constant declines in any of those three measures could be a sign that someone’s health is deteriorating and they need more support from machines.
Oxygen saturation – how much of it is in their blood – is a big point of focus for very sick coronavirus patients because the virus is able to stop the lungs drawing in enough of the vital chemical.
Too little oxygen in the blood can starve the muscles and organs of energy and eventually lead to life-threatening organ failure.
Dr Ron Daniels, an intensive care doctor in Birmingham, explained to Sky News: ‘Most of what we’re seeing in terms of referral to intensive care is about people who have very low levels of oxygen in their blood.
‘People seem, with this condition, to be able to cope with low levels of oxygen better than they would with, for example, a normal bacterial pneumonia.
‘But when those levels dip to a dangerous level that might threaten other organs in the body then we bring them to intensive care.’
Critically ill patients put into induced comas
Patients who need to be put onto ventilators or other life support machines may be put into induced comas if they are life-threateningly ill.
This is a dramatic step which is essentially intended to shut down any functions of the body which use up energy for purposes other than fighting infection and staying alive.
Induced comas are started in the same way that patients are put under for surgery, with an anaesthetic such as the drug propofol.
Specialist anaesthetists administer the drug at a level which reduces someone brain to and then they maintain the dose to stop the patient waking up.
This stops the patient from wasting energy on brain functions and muscle movements that aren’t needed, and also allows machines to take over and breathe or even pump blood in place of the patient’s organs if this is necessary.
People who have to be put into induced comas will likely take longer to recover than those who are kept conscious.
Some patients may see improvements within days, while others will have to stay on the ward for weeks. Some people with COVID-19 have needed hospital treatment with two to three weeks or longer.
Drip-feed of water, nutrients and medication
Patients in intensive care will often be connected to intravenous fluids, also known as a drip, which feed water, nutrients and sometimes medication into their veins.
This is done to make sure someone doesn’t become dehydrated or starved if they become unable to eat or drink as often as they need to.
Patients who have to be sedated (knocked out) will not be able to swallow so must have all the fluids, food and drugs they need injected directly into their body.
The medicines given to coronavirus patients may include painkillers if they’re still awake, antibiotics if they develop a bacterial infection such as pneumonia.
Coronavirus survivor, 39, says ‘I want people to realise you can survive this’ after his ‘horrible’ experience in intensive care
Matt Dockray spent a week in intensive care fighting the coronavirus infection. He said his time in hospital was a ‘horrible, horrible experience’
A father who battled coronavirus on an intensive care ward has warned it is the ‘most horrible experience you will go through,’ as Boris Johnson battles the killer infection in hospital.
Matt Dockray, 39, was speaking to Good Morning Britain on Tuesday after Boris Johnson was admitted to intensive care on Monday evening.
The father-of-one said: ‘It’s a horrible, horrible experience. You’re very lonely. You don’t have any friends or family there so you don’t have that emotional, personal support you rely on in your hardest times.’
But another dad has issued a rallying cry to the PM, saying: ‘I want people to realise they can survive this’.
Boris Johnson has received oxygen support at the intensive care unit at St Thomas’ Hospital in London, but has not been moved onto a ventilator, Michael Gove said this morning.
As well-wishers offer messages of the support for the PM, father-of-two Andrew Hodge sent a message of a hope on Good Morning Britain.
The electrical engineeer, who spent six days in intensive care, said: ‘I don’t want to dilute the seriousness of it, but I want people to realise they can survive this.
‘There is so much negative communication about how many people have died, as opposed to how many have survived.’
He praised the treatment and care he received during 10 days at St Peter’s Hospital in Chertsey, describing the team there as ‘phenomenal and attentive’.
Mr Hodge, husband to Dawn and father to Isabella, 17, and Genevieve, 11, also paid tribute to one nurse on Aspen ward at the hospital who simply held his hand for a while, the trust said.
The team at St Peter’s are “delighted” to see Mr Hodge recovering so well back at home, and wish him all the best, the trust added.
Andrew Hodge, 54, from Laleham, near Staines, who has recovered from coronavirus, celebrating his birthday back home on April 3
Mr Dockray, from Marlow, Buckinghamshire, told Piers Morgan and Susanna Reid about the treatment he received while in critical care: ‘The main thing is getting oxygen in your system.
‘I’m assuming Boris is at that stage now, they register your oxygen levels and they start getting critically low so they’ve got to get as much oxygen in you as possible.
‘They start with a regular mask, then they try all sorts of different contraptions and ways to get 100% of oxygen into you.’
Now recovering at home, Mr Dockray spent a week in isolated room, where he said he saw patients of all ages being admitted.
He admitted he had dark moments as he struggled to overcome the life threatening virus, saying: ‘There was a point where you sort of started to lose hope and thought that was it, because you’ve seen this on the TV, you’ve seen the pictures of Italy.
‘In my head that was the time to say “You’ve just got to fight as much as you can,”
He added: ‘To go from that extreme a couple of weeks ago, ICU for a week and come out breathing, talking is a testament you can get to that point.
‘There’s people who have been on those ventilators for a lot longer and they’ve come out and lived to tell the tale.There’s quite a few of us getting clapped out of the hospital that prove you can get back to normal.
‘There’s still a long road of recovery, it takes about six to eight weeks, but you can sit here and tell the tale and fight this.’
When he arrived back at his Marlow home, Mr Dockray said there were ‘a lot of tears and emotions’ as he hugged his wife and child, while celebrity chef Tom Kerridge sent him a special gift package to help him get on the mend.
Your questions answered as Boris Johnson is moved to intensive care in his battle against coronavirus
Why did Mr Johnson first go to hospital?
He was admitted to St Thomas’ in London at around 8pm on Sunday, ten days after testing positive. Doctors advised him to seek treatment as his ‘persistent symptoms’, including a cough and a temperature, had not improved. His slow recovery is a red flag for complications including pneumonia. No 10 said it was a ‘precautionary step’ so Mr Johnson could have routine tests, which are likely to include procedures which can only be done in hospital.
What happens in intensive care?
Downing Street said the Prime Minister remained conscious last night and was moved to intensive care ‘should he require ventilation’.
There are two types of ventilators used: non-invasive ventilation and invasive ventilation. Non-invasive ventilation means the patient stays conscious and is given a specialised mask which pumps air at high pressure into the lungs.
These are called continuous positive airway pressure machines. If this does not work, patients are intubated – have a tube put down their throat into their airway – and placed on an invasive ventilator. They have to be placed in a drug-induced coma and paralysed while the mechanical ventilator takes over their breathing. ICU ventilators have built-in sensors to adjust the amount of oxygen the patient needs.
How common is it to be hospitalised and how high risk is he?
The Prime Minister, 55, is one of 17,911 people to have been admitted to an NHS hospital with coronavirus so far.
Latest research estimates between five and ten per cent of those who get the virus end up in hospital. The older you are, the more likely you are to need hospital treatment.
A study found that eight per cent of people in their 50s with the virus need hospital treatment and 0.6 per cent die. Mr Johnson has no known underlying health conditions. But he has struggled with his weight and in December 2018 revealed that he weighed 16 and a half stone.
Obesity is a risk factor for complications and men are more likely to be hospitalised than women.
How long could he stay in intensive care?
Some patients spend just a day there before recovering and going to a general ward. Others have spent more than three weeks in intensive care units.
What initial tests and treatment did he have and why?
Coronavirus is a respiratory disease so initial tests will have focused on establishing how badly his lungs were damaged. Most patients admitted to hospital with coronavirus have difficulty breathing and get oxygen support.
Mr Johnson’s oxygen saturation levels will have been monitored by a sensor clipped to a fingertip. Doctors will also have scanned his lungs.
Other tests establish if major organs have been affected by a lack of oxygen. This includes an ECG and blood tests for the liver and kidneys.
Patients have their white blood cell counts monitored to show immune response.
His move to ICU suggests these key measures, most importantly oxygen levels, were continuing to deteriorate yesterday.
What treatment could he receive?
The highest level is mechanical ventilation, which requires patients to be fully sedated. There are no established drugs for coronavirus and antibiotics do not work on viruses.
Could continuing to work make it worse?
The Prime Minister did not take any time off and vowed to continue leading the Government from his hospital bed.
But this went against NHS advice urging those with coronavirus to get plenty of rest and sleep.
Exhaustion is a common symptom of coronavirus. Previous studies have shown that a lack of sleep and high stress can suppress the immune system.
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