ICUs Are Changing To Meet The Needs Of The Coronavirus Patients

Apr 27, 2020
Originally published on April 27, 2020 8:32 pm
Copyright 2020 NPR. To see more, visit https://www.npr.org.

MARY LOUISE KELLY, HOST:

We're going to step back for a moment now and talk to two of our science reporters who have been covering the pandemic's effects inside American hospitals. NPR reporters Jon Hamilton and Rebecca Hersher have been talking to front-line medical workers since the outbreak began in the U.S. And they have watched as intensive care units have transformed into spaces increasingly focused on just one disease - COVID-19. That has meant everything from redesigning the physical hospital rooms to rethinking who touches patients and how. Jon and Rebecca are here with me now.

Hello, you two.

JON HAMILTON, BYLINE: Hello.

REBECCA HERSHER, BYLINE: Hi.

KELLY: I mean, I guess one of the biggest changes is that ICUs do not usually see patients with highly communicable disease. And now suddenly, they are overwhelmed with them. Jon, you first. This is just such a big change so fast.

HAMILTON: Yeah, it really is. And it's meant that everybody has had to adapt sort of on the fly. ICUs tend to be run by pulmonary physicians, you know, lung doctors, so they're trained to keep people alive and breathing after they've had surgery or a stroke or been in a car crash. And, of course, they also take care of people with pneumonia. But it's not usually the kind of pneumonia that requires, like, extreme protection measures. So you have ICU staff who used to be more worried about accidentally infecting a patient. Now, they're worried about infecting themselves. And I talked to Dr. Tiffany Osborn. She's at Washington University in St. Louis. She's been taking care of COVID-19 patients at Barnes-Jewish Hospital there. And I asked her, what has changed in the ICU? Here's what she said.

TIFFANY OSBORN: Everything - you have to think about, like, everything that you touch if it burned, right? So you have to wear something that keeps you from burning your hands every single thing that you touch, like the phone, the doorknob. Every single thing you do has to have that in mind.

KELLY: What else has changed, Jon, about how ICU staff are doing their jobs?

HAMILTON: Well, the most obvious thing, of course, is how they use personal protective equipment. Since COVID-19 arrived, working in an ICU means that you're really spending most of your day with not just a regular mask and gloves but maybe also a gown and one of those N95 masks, you know, that fits so tightly around the mouth and the nose. And Dr. Osborn told me that this is a list that just keeps getting longer.

OSBORN: Sometimes I wear a mask over the N95. I've got a pair of goggles. I've got a face shield. And you wear it so much now that you start to wear away the skin on the bridge of your nose.

HAMILTON: Yeah. And another thing is that in many ICUs, they're actually limiting the number of people who go in and out of a patient's room to reduce the chance that somebody will get infected. And they're thinking about how many people it takes to do something as simple as rolling over a patient to help their breathing. Another thing you've seen is that they've started borrowing these tactics that were used during the Ebola outbreak. So, for instance, when you take off your protective gear, there's somebody watching you to make sure you don't dispose of anything in a way that could infect you or someone else. And all of this takes a lot of time and a lot of concentration.

KELLY: Yeah, I can imagine. I mean, just taking all of those measures into account, are doctors still able to perform the basic medical procedures they need to do without putting themselves at risk?

HAMILTON: There's really little question they are putting themselves at risk. What they've done is come up with ways to try to manage that risk. So, for example, when a doctor needs to put in a breathing tube in an ICU, ordinarily this is a procedure where the doctor has to get within a foot of the patient's open mouth and then carefully guide this tube down through the esophagus through the vocal cords. And, of course, what's coming up through that tube is coming directly from the patient's lung where the infection is. So in a lot of ICUs, they've created these plexiglass boxes that are placed over the patient's head and shoulders. And then they actually reach inside the box to place a breathing tube.

KELLY: Rebecca, let me bring you in and focus on the situation specifically in New York City hospitals because I know that's where you've been doing a lot of your reporting. In these hospitals, basically everybody in the ICU these days has COVID-19. Does what Jon is describing square with what you are learning through your reporting about how hospital staff there are doing their jobs?

HERSHER: Absolutely. One thing that actually may sound strange but one thing that gets easier when you have all of your patients with COVID-19 is that you have to worry a little bit less about patients infecting each other because everyone has the same disease. So taking off, putting on PPE as you go from room to room, you can share personal protective equipment if everyone has the same disease. But you have to get creative about other things. So, for example, one COVID-only hospital - so explicitly only COVID-19 patients - they got plastic sheeting like you'd see at a construction site and tacked it up in the rooms to create barriers between patients so that when nurses were treating one patient in one room doing maybe one of those procedures that Jon was talking about that could expose people to the virus, everyone in all the rooms wouldn't be exposed. There's something hanging there to protect you.

KELLY: Wow. So we've been talking about trying to limit contact between patients and health care staff. What about between patients and their families? I mean, that's another big shift here - right? - that a lot of these patients are coming to the hospital, are being checked into ICUs, and they're alone.

HERSHER: Yeah. And that's - it's challenging emotionally for doctors, and it also makes it harder to treat patients. You know, doctors and nurses, they have to help patients communicate with their families. A lot of the basic conversations that would usually happen kind of passively at the bedside, you know, if you're in there as a patient and your family member is there, none of that is happening. And so now doctors and nurses have to add to their already more complicated lives figuring out how to use a cellphone safely, how to help a patient use a cellphone safely with all that PPE. I checked in with the head of intensive care at a hospital in the Bronx about this last week. His name is Dr. Chris Grantham of St. Barnabas Hospital. And he said it's a lot of extra work.

CHRIS GRANTHAM: The resident doctors, the attending doctor, the nurses at bedside all trying to communicate well with the patient while they're there and also on the other side communicating with their families.

KELLY: Isn't something lost, too, Rebecca? Just - families are often useful in terms of helping be a bridge between the patient and the doctor, helping that communication.

HERSHER: Exactly. You know, I heard it over and over. Patients and their families - the families are part of the care team. And especially for elderly patients, some of these people who are coming in very sick, it might be disorienting to be in the ICU. And you're missing that familiar voice from your family member to help ground you. And I talked to Dr. Grantham about this, too.

GRANTHAM: You know, for a lot of our patients who may be slightly confused or have some issues with dementia, those families are great for that in helping us, you know, decrease the amount of medicine that we need.

HERSHER: And he's talking there about medications that can help people not get dangerously agitated in the ICU. And doctors don't want to use those when they have to. They have side effects. And it's harder when you don't have family members.

KELLY: Well, let me throw this last question at both of you, which is, just how are doctors getting around this new state of reality?

HERSHER: Well, it just requires getting creative and flexible. So one thing you can do is help patients video call, for example - even if they can't talk, they can see that familiar face - setting aside time at the end of each day to make all of the calls to family members, that you're not taking off PPE in between calls to family and just getting really flexible about what you do and when.

HAMILTON: And let me just add something that Dr. Osborn wrote in a note to her colleagues in St. Louis. Part of it said we have our ways of doing things. That is not the way of this world right now. Our strength is in adapting.

KELLY: That is NPR's Jon Hamilton and Rebecca Hersher, both colleagues from the science desk reporting there.

Thanks to you both.

HAMILTON: My pleasure.

HERSHER: Thanks. Transcript provided by NPR, Copyright NPR.