This is not a scare tactic or crying wolf to get everybody to adhere to the recommendations regarding Covid-19 but hopefully it will have the required salutary effect. Having had a wife who was intubated for six and  half weeks, I can comprehend what these patients are experiencing. For them it is far worse as unlike Janine, these patients are not in a coma. And the ICU was 50% full.

This is a Facebook post pasted from a doctor in the Eastern Cape.

Main picture: An intubated patient

For those who are questioning the severity of the situation in South Africa, the author of the report below works for in ICU at a state hospital. This is what a friend of this doctor posted onto Facebook.

Please read these words CAREFULLY:

Today – there are no ICU beds left. Not. One. Bed.

Also:

Paying for medical aid does NOT equate to having a bed in a private hospital – be it an ICU or high care or ward. Medical aid payments do not equate to a reserved bed for you or your dependents.

There are NO beds left.

We have a waiting list for patients who qualify and need ICU care – there are not enough beds, or ICU trained staff (doctors or nursing staff) which means there are NO BEDS LEFT. People are DYING on our waiting list.

ICUs in PRIVATE are FULL. In the last week, young (and I mean 30-40-year olds) patients who were intubated could not get a bed in ICU. THEY DIED.

Let me describe what could happen to you if you get COVID-19:

Young people, again between 30-40 years old, with no medical conditions (NOT ONE) are getting sick. You will get to hospital, you will be put on oxygen, prescriptions for a whole bunch of IVI vitamins, steroids, immune modulators, and anticoagulants are written up and we pray it starts to help. You are breathing at a rate of 35-40 breaths per minute. For days on end. Normal breath rate is 12-20. Try this: try & breathe at 40 breaths a minute – that is a full breath in an out in 1.5 seconds.

People are tired of not getting out, of not getting back to social norms. People are being pushed to extremes who need to balance the risk of work in order to survive economically against the risk of infection and they are not equal, but please understand something:

Breathing is a NATURAL, subconscious act. Almost every organism on earth does not have to consciously breathe. Patients are telling us that they are TIRED of breathing! Understand that. A natural subconscious autonomic bodily function is TOO MUCH.

It is at this point where we scurry to intubate you. Your saturations are at 80% maximum on 100% oxygen. Normal is above 88 and that’s on room air which contains 21% oxygen) and this is with High Flow Nasal Oxygen (which is a set of tubes *FORCING* heated, humidified air in at a rate of 60l/minute – like air being forced at the rate of air coming out of your nose when you sneeze). All this while you are on your stomach to try and improve the ventilation to the basal areas of your lungs. Now we prepare everything for the intubation, for the invasive lines, and basically to take control of every body function we can. We turn you on your back. Your effort of breathing becomes infinitely harder. We put up a central line and an arterial line (WHICH IS EXCRUCIATING). And now we are “ready” to intubate.

A normal intubation is done ONLY WHEN YOUR SATS ARE AT 100% for at least 3 minutes so that if there are issues we have some time to fix the problems.

When we intubate a COVID-19 patient this is what happens:

Max sats at induction (when we give the drugs to put you asleep, so you are not aware of the tube being put through your windpipe) are 80%. We give you a drug to sedate you, followed IMMEDIATELY by a muscle relaxant (in a normal settings – it is only given once a patient is ASLEEP, which is about 10-30 seconds after being given the induction agent depending on the type of agent) because the sats start dropping INSTANTLY. We have to “wait” for the muscle relaxant to work or else we will not be able to intubate. You are still somewhat aware (awake) and now we have paralysed you. Your sats are now 60%. We cannot bag ventilate. We can do nothing but wait for the drugs to take effect. We try to intubate and in the process your saturations deteriorate to 40%, some even as low as single digits. The tube is in and your heart slows down to a rate of 30-40 (normal is 60-100, in extremis its above 100 (which is where you started)). Now we have to give you adrenaline to try and stop you from having an arrest because if you have a cardiac arrest you will die.

Let us say you do not crash, the adrenaline works, and you are now intubated. We ram air into your lungs are pressures SO high it could cause a pneumothorax because we CANNOT oxygenate (get O2 into your body) or ventilate (get CO2 out of your body) and it is a risk we have to take. We then place a tube in your nose and try and feed it into your stomach so we can feed you. Often it fails, we inadvertently cause trauma to your nasal passages and we have to try the other nostril.

Now we try and ventilate you while you are on your back. When that all fails we prone you. Six people have to disconnect EVERYTHING but your ventilator and turn you onto your stomach with pillows under your chest and pelvis and try to ventilate. Now on your stomach you develop pressure sores over your chest or stomach. Your face and your eyes swell. And this is all in an attempt to save your life.

We are not treating COVID-19. There is no treatment. We are at best, modulating the immune response. We are literally supporting organs in an attempt to help you. We are trying to stop your body from attacking itself.

Please understand that the above is not a scare tactic. This is the reality.

Yes, not everyone who has been infected with COVID-19 has gone through the same experience. But this disease does not care about who you are, where you come from, your medical aid, your skin colour, your wealth, or any other attributes. If you have the ACE-II receptor on your respiratory epithelium then you are a target. And EVERY human is a target.

No one can begin to fathom the stresses experience by those who have been out of work for the last 120 days. Nor can anyone better understand the difficulties each one will face.

But these messages serve to inform you all of the reality of the situation, and the possible outcome of infection. So that every choice you make from here on out is an informed one. Every risk you take is a calculated one. And there are going to be choices made to protect your livelihood that supersedes the risk to your life and that is the unfortunate reality.

In closing, no doctor, sister, healthcare worker or anyone working in a medical institution is there to judge. We will endeavour to help every single patient. There are no “told your so’s” or anything of the sought.

We will continue to help. But we need you to help us, help your family. Because as it stands, we have no space to help, and this is only the beginning.

From a concerned healthcare worker who is literally begging you to minimise your risk of infection.”

So, in my view, the bare figures are essentially unimportant. Extrapolating the amount of effort in trying to save one patient with extreme symptoms to even a handful of others, highlights the difficulties likely to be faced. And looking at the experience worldwide, the extrapolation can lead to scary numbers very quickly.

Perhaps the best modus operandi is to scare people into being consistently vigilant. However, there is also the danger here of “crying wolf”.