Who Gets Critical Care when Resources are Scarce? 

Daily thoughts & numbers on the COVID-19 pandemic from a M.D. working in the front lines at the Emergency Department in a hospital in Stockholm, Sweden. 

There are no margins left.

We are at maximum capacity.

Weeks of preparation and mobilisation and we’re already at the brink.

Our ICUs have almost filled up.

Our emergency wards keep filling up but soon there will be no beds or respirators left at the ICU to move the critical Covid-19 patients to from our wards.

Most of my colleagues are exhausted after their shifts.

Many of my colleagues have called in sick, presumably infected with Covid-19.

A few of my colleagues are being treated in the ICU for their Covid-19 pneumonia, presumably with severe ARDS.

This is the closest Sweden has gotten to wartime medicine in modern times.

Our resources are almost depleted.

What comes next is damage control.

What comes next is also choosing who should get intensive care, not only who needs it.

What comes next is a kind of prioritization of resources most of us never been forced to do before (notwithstanding those who worked in certain areas outside of Sweden or in warzones).

To help guide clinicians, The National Board of Health and Welfare (Socialstyrelsen), has created ethical guidelines to help us decide who gets the finite resource of intensive care. *

The guidelines are titled:

‘National principles for prioritization in intensive care under extraordinary circumstances.‘

This is a time of extraordinary circumstances.

This is not a drill, it’s not a dream, and it’s not an April fools’ joke.

This is a global emergency.

This is happening right now, it’s happening to us, it’s happening to our jobs and financial systems, it’s happening to our loved ones, it’s happening to our health care workers – it’s happening to you.

We are at the point of damage control and we must do all we can to mitigate that damage in the best way we can.

As emergency physicians this is no different from what we have always done, what we have trained for, only now it’s more critical and in a larger scale than it has ever been in our lifetime.

The state of play has changed and now we must change the state of play.

COVID-19 Numbers Sweden 2020-04-01 *

• 239 deaths nationally
  • 148 of them in Stockholm
• 4 947 confirmed cases nationally
  
  New confirmed cases daily in Sweden. 
  (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  
  New confirmed cases accumulated over time in Sweden. 
  (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
• Intensive care Sweden: *
  • 402 COVID-19 confirmed patients treated in the ICU in total so far
  • 9,3 days from symptoms to ICU
  • 25,0 % women
    
    Total number of recorded of COVID-19 patients needing ICU care each week. From Week 10 it seems to more than triple each week, 5 →  24  → 130 → 413 → (501 this week up until now, however since it’s only weednesday this weeks numbers are yet incomplete)

COVID-19 Numbers Globally (updated today 2020-04-01 at 10:00 CET) *

• 37 203 confirmed deaths
• 783 360 confirmed cases
• 205 countries, areas or territories with cases

Financial Times New Deaths in the Past Week Selected Countries (updated yesterday 2020-03-31 at 19:00 GMT) *

New Resources Added to ※ CTSOP

• [SWE] National principles for prioritization in intensive care under extraordinary circumstances – made in March 2020 by Socialstyrelsen (The National Board of Health and Welfare of Sweden).

Image [SWE]: Number of COVID-19 Deaths in Sweden Daily in March *

That’s it until tomorrow, keep calm and stay safe!