In New York’s hospitals, we need all the help we can get

I hear it said now and again that Covid-19 is just a nasty winter bug, nothing more than a new form of flu. From what I’ve seen in New York’s intensive care units in the past few days, I can assure you this is not true. Last month I was still doing my usual job, treating patients with sleep disorders. But my training — and for many years my work — was in critical care medicine. As the coronavirus crisis developed, it was clear to me that I was needed back in the hospital, so I volunteered before the call came. Soon I was making decisions about keeping blood pressure going, when to use ventilators, whether a patient’s organ systems are functioning normally or whether support is needed. Almost every patient seemed to have remarkably rapid and severe lung injury. Most Covid-19 sufferers needed more than 70 per cent oxygen — three times the level present in the air. Many struggled on 100 per cent, delivered at high pressure. Dozens were on the respirator but belly down (‘proning’), a position which improves lung volumes and redistribution of the blood supply to the better-ventilated parts of the lungs. I’ve used these techniques before in Riyadh, London, and Charleston, South Carolina, but not very often: lung injuries are rarely so bad. Normally, there would be — at most — two patients in an intensive care unit every few months who needed these pretty extreme techniques. In my hospital, entire units of patients are being ventilated face down, some even before we placed them on ventilators. Dozens are on extremely high levels of oxygen, even when awaiting evaluations outside the intensive care unit.

It was watching a colleague intubate a patient of mine with a ‘GlideScope’ — a fibreoptic camera that places a tube into the patient’s airway to connect them to a respirator — when I first saw the coronavirus effect.