As someone on the frontline
@Hernandez - BFA , how overwhelmed/quiet was your hospital in April?
It's a question that ends up getting a strange answer. We definitely saw less presentations of other medical problems. I recall seems much less heart attacks, strokes, surgical issues etc. We all found this quite bizarre because these medical/surgical emergencies are ticking time-bombs for everyone - they shouldn't have "paused" or had a low incidences of these. For that reason, the hospital didn't really have many non-COVID related issues. For example, my hospital would normally have 4 wards for General Surgical, Orthopaedic and Trauma and Gynaecological patients. During COVID, all patients managed to fit into 1 ward - which goes to show how little acute emergencies we saw in these specialities. Obviously, the lack of elective surgeries played a role, but the actual amount of surgical "emergencies' that presented via the Emergency Department definitely dropped.
Long winded answer to basically say - most of the hospital was COVID, COVID, COVID. My hospital didn't get particularly overwhelmed, because it practically turned into a COVID hospital without even meaning to. I can't say for sure what it was like in April because in all honesty, the last 7 months have genuinely blended into each other. Was it overwhelmed? Not in the sense as it was in Italy - but that was because we had the benefit of foresight and opened up more areas in the hospital that could become an intensive care area.
Another massive factoid in trying to avoid overwhelming the hospital was to change our threshold for admitting a patient into hospital. This felt incredibly uncomfortable at the start and we'd normally have to tell people who'd normally require further investigations or more intense treatment for non-COVID related issues to go home with advice on how to manage at home, (with a prescription of course). For example, we'd send people home with horrible cellulitis, that would typically need 48 hours or so of intravenous antibiotics, with oral antibiotics with advice to return if they basically develop sepsis. It was a dangerous time and ethically it felt very discomforting that people were not being treated properly - but at the end of the day, the hospital was a riskier place to be in than their home.
The days were 700+ would die daily - we're fortunate that those days haven't been seen for a while. But it's unfortunate in the sense that people have lost the fear-factor of it now.
There is so many selfish people in the world who now seem to think that we've got this all under control and that it isn't half as bad at what it's reported to be.
If people are more relaxed about it, more people will catch it - and when more people catch it, the difficult decisions on who deserves an ITU bed becomes an issue again.
I'll always remember a 50-odd year old gentleman who was probably one of the first few COVID patients that I had. He was able to tolerate just high-flow oxygen on the ward for a couple of days after coming in. But decisions had to be made early, no matter what state they were in, on what their ceiling of care would be. Do they go to ITU? If not, do we even try to resuscitate them if their heart stops? I had to write a "Do-not-resuscitate" form for this guy without even discussing it with him because we were told that we didn't have to have these discussions with patients at this stage of COVID if they were deemed not appropriate for ITU.
Slightly off tangent to what was asked, but these last months have been incredibly hard and I haven't really reflected on much of it until recently. I've had severe bouts of depression during the last few months and I've had to stomach it all up because I've felt as if i've had to. It's very easy to ignore how COVID indirectly affects people. As I said in my post from earlier, it's horrendous seeing how quickly people can deteriorate in front of your eyes - and sometimes, there is literally nothing that can be done apart from chuck the kitchen sink at them and hope that it works.