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CICM 2021 ASM: Respiratory
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Session 6: The new COVID normal

Session Description
SESSION CHAIR: Dr Lewis Campbell
Session Sponsor: Pfizer
Session Program
The influence of ethnic background on incidence and outcomes in COVID-19 is an evolving story with strong socio-political as well as clinical repercussions. Definitions and perception of ethnic background is an enormously complex topic which vary greatly within and between countries. Given the importance placed on ethnic identification and the persistent healthcare inequalities experienced by minority ethnic groups in many nations it is important to address these issues in the context of the current pandemic.
To illuminate these issues, we present a summary of analyses describing disparate outcomes between ethnic groups in almost 2000 COVID-19 associated admissions during the first wave to Barts Health NHS Trust. With a catchment of around 2.5 million people living in east London, Barts Health serves one of the most ethnically and economically diverse communities in the UK. In the first wave patients from (South) Asian and Black backgrounds had higher age-adjusted mortality from COVID-19 infection despite controlling for all previously identified confounders and frailty. These patient groups suffered disproportionate rates of premature death from COVID-19 and greater acute disease severity.
Importantly since the first wave of COVID-19 there have been changes in public behaviours, COVID-19 treatments and processes of care. Analysis of patients admitted in the second wave demonstrated that although hospital outcomes and overall mortality were improving, increased risk of death associated with Asian ethnicity persisted. Furthermore, Asian and Black patients continued to have higher rates of admission and acquired more severe disease at a younger age. Comparative analysis of acute hospital admissions over a 6-year period preceding COVID-19 showed an earlier age at presentation and distinct and earlier burden of comorbid disease in patients from minority ethnic groups. Some of these features may explain the adverse outcomes seen in COVID-19 in our community.
As part of the NSW response to COVID-19 Pandemic we explored what was required to quadruple ICU capacity. It involved hospitals identifying surge capacity, ordering of essential equipment and the Intensive Care Operations Team as part of the overall Health response having visibility of all aspects of planning. As expected, true ICU capacity is not dependent so much on the physical ICU bed and ventilators but workforce (skill mix as well as availability), baseline non-COVID ICU activity as well as availability of PPE. Further, the impact of COVID on ICU capacity would not be uniform across the state. Lead by the Agency of Clinical Innovation, in conjunction with the Ministry of Health and the Sax Institute, modelling was developed to demonstrate predicted ICU capacity using ANZICS Adult Patient Database and workforce information in response to different levels of COVID surge as well as staff availability. The proof of concept modelling has far reaching potential for ICU service planning beyond responding to threats such as a pandemic.


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