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CICM 2021 VIRTUAL ASM | RESPIRATORY
CICM 2021 ASM: Respiratory
CICM 2021 VIRTUAL ASM | RESPIRATORY
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Session 1 continues: COVID Responses around the world

Session Description

Session Sponsor: Pfizer

Session Chairs

User Headshot
Andrew Udy
Deputy Director (Research), Department of Intensive Care & Hyperbaric Medicine - Alfred HospitalMelbourne

Session Program

STAYING APART KEEPS US TOGETHER
Victoria reported its first case of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on 25th January 2020. What followed was a roller coaster ride for Victorians involving hard lockdowns, curfews and border closures.
 
Over the course of the year, 20,000 people were infected, 271 patients needed ICU and 820 lives were lost. 2599 health care workers (HCW) in Victoria were infected with SARS-CoV-2 in the healthcare setting the majority of whom worked in aged care, as nurses or aged-care workers. 
 
Both the virus and the restrictions affected the most vulnerable. The economic and social inequalities were laid bare. Melbourne’s northern and western suburbs, home to a majority low income, casualized workforce, bore the brunt. One health service in the western suburbs managed 21% of Victorians requiring ICU. The Victorian Cluster Response, initiated by ICU Directors and supported by ANZICS worked closely with Adult Retrieval Victoria (ARV) and transferred patients within the state to ensure best care. Consequently, no ICU in the state operated above capacity.
 
Everyone stepped up. The general public, who stayed home and the frontline workers, who showed up to work.  A drive to improve the workplaces and protect HCWs led to innovations. The ‘Patient Isolation Hood’, invented for use in an open ICU was TGA approved and shown to reduce aerosol counts by 98%. 
 
In the ICU, nursing and medical staff worked 12 hour shifts and skillfully managed the critically unwell, providing reassurance to families over a computer screen. They juggled patient care with information overload from constantly changing guidelines and the fear of lack of PPE in the early days. Anxiety, fear, dread, exhaustion- just some of the emotions many described.
 
All Victorians have worked hard. Currently, there are no cases of community transmission. Perhaps, it is now time to bravely reflect on 2020 to address the social inequalities in our community and the systems that struggled to protect our HCWs. The work needs to continue to keep us together

Western Australia has been extremely fortunate in the COVID pandemic with almost no community transmission due to our relative isolation and hard border.  However, we did have a cohort of sick cruise ship patients relatively early in Australia’s experience including the first COVID death.  Preparation in WA brought unique issues trying to cover such a large area with multiple small communities.  At the end of the day, like elsewhere, this involved a lot of logistics, luck and good will from the critical care and wider medical community 

The Queensland Intensive Care Network Covid-19 Pandemic response centred around minimising avoidable loss of life in Intensive Care Units due to the Virus. 
Paramount was protecting the Intensive Care Workforce  through provision of adequate and appropriate knowledge of the ever-evolving disease, equipment for care, potential rationing of care, and improving centralised organisation, communication and support to all ICUs, to as such “make the whole greater than the sum of its parts’.
The relationship between Clinicians and Politicians was rapidly cemented to facilitate flexibility and adaptability to the emerging threats

Perhaps contrary to popular belief, COVID-19 did not spare Singapore. Not long after a relatively good start at keeping the disease at bay, the number of cases ballooned across the island nation, in large part due to outbreaks in dormitories for migrant workers. This notwithstanding, Singapore’s case fatality rate and number of deaths per 100,000 population remained by far some of the lowest in the world. This talk will describe Singapore’s public health response, with a focus on its intensive care community’s approach, towards the pandemic.  

While the COVID-19 pandemic has resulted in an unprecedented challenge to healthcare systems and ICU resources mainly for adult patients, the ways the pandemic affected critically ill children globally have often received less attention. Contrary to previous pandemics such as the H1N1 flu, direct COVID-19-related critical illness in paediatric age groups has remained rare. Large epidemiological studies from the US and Europe indicate that the vast majority of children infected with COVID-19 remain asymptomatic. We will discuss phenotypes of COVID-19 manifestations in critically ill children and neonates, but then focus more on a unique paediatric-specific phenomenon associated with COVID-19, namely Paediatric Inflammatory Multisystem Syndrom (PIMS-TS, or MIS-C), and highlight lessons learnt from this condition. Finally, we will explore indirect impacts of the pandemic on critically ill children, including aspects such as the dilemma of restricting parental access to acutely ill children, altered non-COVID epidemiology, socioeconomic issues, and finally, how the pandemic may change the future of paediatric research.
 

In order to distinguish moderate treatment effects of a treatment from no effect, randomization of large numbers of patients is required. The RECOVERY trial was set-up rapidly as the COVID-19 pandemic reached the UK to ensure that large numbers of patients from hospitals across the UK could be recruited without interfering with the clinical care of the patients while the hospitals were under significant stress. By keeping the trial procedures simple and only asking hospitals to do what was absolutely required, the RECOVERY trial randomized 10,000 patients in 8 weeks and provided robust information on three potential treatments within 3 months. The methods used in RECOVERY could and should be applied to many other diseases beyond COVID-19 and address many of the important uncertainties in patient care and population health.

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