[AMA] COVID ICU Doctor in Sydney [closed]

Hey everyone, long time lurker here.

I'm a junior doctor in a COVID ICU of one of Sydney's tertiary hospitals.
Wrote this post to hopefully shed some light on what it's like inside the unit, since rarely does the general public have a chance to see or get a feel for what goes on inside the unit.
COVID ICUs are very strictly regulated units - most hospital staff are forbidden to enter (and wouldn't want to be there anyway)

I should probably describe what it's like to be a patient inside COVID ICU.
- there probably aren't good windows, so you don't have much access to natural light and don't know if it's day or night
- we give you dexamethasone which helps reduce the inflammation in your lungs, but it gives you insomnia
- your family cannot visit you at all
- you can't recognise anyone who is coming into your room because of all the PPE we have on
- the usual reason for ICU admissions is oxygen support which can range from uncomfortable (having large volumes of oxygen jetted up your nose - high flow nasal prongs), very very uncomfortable (having pressurised oxygen pushed into you via a tight mask - it feels like trying to breath with your head outside the window of a moving car), or completely intubated.

If there's one thing I want to say, it's please get vaccinated! I have not looked after a single fully vaccinated patient.
If you're in Sydney and eligible for Pfizer and AZ but have to wait 2 weeks for Pfizer, I wouldn't wait.

Some questions I can answer, some questions I can't
I'm studying at the same time as this, so sometimes can take some time to answer, sorry!
Opinions here are my own

Addit - I am closing this AMA, thank you for your questions. There's a number of questions that keep being recycled, which I can't answer eg. Opinion on novel drugs and I am being DM'd for specific health advice. I cannot provide that information to you responsibly on the internet, I am sorry. Please ask your local doctor/attend ED if especially concerned.

closed Comments

            • @Gravy: It was an existing concrete shell that just needed to be fit-out. The fit-out was completed so quickly because their health and safety standards (both construction and for hospital facilities) is much lower than ours, also construction workers working much longer shifts.

          • +1

            @shatter: It’s been done the world over.

            The UK and US as well as Germany had dedicated COVID treatment centres. In Berlin they used a huge fair hall that usually houses international conferences and remodelled that. Had imaging, beds, ventilators, probably a shock area, staff rooms. There’s not really a way around this escalation once the numbers go up. You do need to let go of a 1:1 nursing ratio but at some point good enough (or as close as you can get) will have to be just that.

            We even had that in Melbourne at the beginning of the pandemic, back when we thought the alpha-strain was bad. It was decommissioned before it ever came into action. https://www.9news.com.au/national/coronavirus-melbourne-land...

    • Perhaps it is worth considering that these 'dedicated field hospitals' had electrified wire fences, and security cameras facing in. ("Long Time No See, Wuhan" starting at about 38:30n https://youtu.be/N4ABOJ1y5iM?t=2292)

      And that COVID-19 inpatients were often healthy e.g. able to exercise by running up and down the hospital corridor.
      (e.g. 'The Family Affair' by Channel News Asia, Season 5, Episode 1, starting about 18:53 https://www.channelnewsasia.com/watch/the-family-affair/livi...)

      And that some patients with no symptoms were in the hospital(s), 'shedding virus' (a la 'Typhoid Mary') for months. ("Long Time No See, Wuhan" starting at 35:19 to about 37:50 https://youtu.be/N4ABOJ1y5iM?t=2119). I'm not an especially empathetic person, but that auntie really needed a hug…

  • +2

    How many staff does it take to run one ICU bed?

    I've heard that some people with COVID can be seemingly OK then on about day 10 they take a turn for the worse. What is the treatment protocol in Australia once the patients condition takes this huge dive? Are steroids prescribed to ICU patients with covid?

    • +14

      It's not about running a single ICU bed, as it is running a unit.
      Medical wise, you need the intensivist (the specialist) plus several junior staff (me)
      Nursing wise, it's at least 1 ICU trained nurse for every intubated patient. After that you need a nursing ratio usually of 1:1 for covid patients, maybe 1:2 if you're lucky. Running an ICU with non-ICU trained nurses can be really difficult, so pulling staff from other wards is a less than ideal option.
      I've heard of hospitals where there are nurses all on double shifts (14-16hr shifts) to keep the unit afloat.

      Yes, our drugs are dex, remdesivir and baricitinib/tocilizumab - I should note that the evidence in support of the efficacy of these drugs is less tested than our vaccines

      • Yes, I read an article where a doctor is treating an ICU patient with unvaccinated COVID patient (who later died), and it came to mind that all the treatment (particularly the expensive ones) were far more 'experimental' than the vaccines which the patient had decided not to utilize. Though the patient accepted all the far less tested treatment in ICU.

        (the article is from the United States, where there has been a bit more time for any adult to have a vaccine)

        https://www.latimes.com/opinion/story/2021-08-17/vaccinated-...

  • +1

    What vaccine did you get and when?

    • +2

      I received the Pfizer vaccine as group 1A as I was deemed high risk - I can't really recall - maybe April or May?

      • When do you plan on getting a booster and what will it be?

  • +3

    Thanks for your dedication to serve. Similarly, last year a friend who just had her second child, was keen to go back to ER to help out (her husband is also specialist).

    Are you worried about catching COVID yourself (even if vaccinated)? Or is it because your main focus is on taking care of the sick, this gets pushed down the priority list?

    • +25

      I am worried, but I'm young and don't have comorbidities so the way I see it, if anyone should need to be out on the line, it should be me, rather than some of my friends eg who have asthma.
      We're all in this together. If we could square this out ourselves in the medical community we would, but honestly, I don't think we can at the rate we're going, which is why I'm here today on this forum to get you guys to help us by getting vaccinated

      • Correct me if I’m wrong but I don’t think asthma has been shown to be a risk factor for severe COVID disease or worse outcome.

        Rather, those on inhaled corticosteroids seem to have a shorter time to recovery, which is an interesting finding.

        • I was wondering about the asthma comment too - it seems counter intuitive to me, but also makes me feel a bit more at ease.

  • What can avg joes do to prevent covid exposure from going outside - Should we be looking at p2 masks?

    • Not really a question I can answer well - you could wear P2 masks sure, but from a cost and feasibility perspective, is it viable? I don't know. I would defer to the public health guidelines which can change over time.

      You could however totally wash/alcohol your hands frequently when you touch things other people touch, stay away from other people, which is probably easier to do

    • You could wear a visor or googles as well as a mask. This is mandatory in the hospital I work in when seeing non-covid patients that are not wearing masks. You’d just also have to have alcohol wipes to wipe it down every time you were going to touch it to remove it etc.

  • +1

    Hey doc, have you been given a definitive explanation on the origin of covid19?

    • +12

      I'm not aware of anyone that knows for sure, and honestly I don't think it really matters at this point

      • +24

        If we care about controlling massive disease pandemics in the future - it matters.
        Any country that experiences a deadly, contagious disease has a responsibility to prevent its spread, and to take measures to warn other countries.
        Any country that fails to do that is complicit in genocide.
        Any country that clouds the origins of a disease so it cannot be studies and preventative measures taken in the future is a criminal country.
        It may not matter for treatment, but it matters for this disease, and any future disease.

        • +18

          Ok yeah, that's a good point! You're right, it does matter. But right here and right now we're in the midst of a crisis

        • +2

          Also we gotta send the bill to someone eventually. This pandemic hasn't come cheap.

          • +1

            @trapper: china wont pay, world leaders are too soft

  • +1

    How do you think the government can attract enough staff?

    Did you vote for LNP? (optional question)

    • +13

      If you mean nursing and medical staff - I don't know. If we can it's going to be very very hard. You can't make ICU staff out of nowhere, and training non-ICU staff to work in ICU takes time

      I've not really cared much about politics in all the elections I've voted in. I've always thought Australia is a pretty great country and the left and right are pretty close unlike the states. I've always voted for some small random party who would be unlikely to win, so that people who care more about politics have their voices heard

      • +2

        Hey doc, you should think more about it at the ballot box.
        Which governing party is more likely to fund and support public health? Vote for them, for yourself and your patients.

        • I think its unfair with postal votes where I think you can't leave it blank like at the ballot box .
          Its a bloody shame they force you to vote in this country .

  • Hi there,

    Could you tell me what the nsw health dept advises covid-19 positive patients once their test results are disclosed.
    Is it wait and see, until you're struggling to breathe. Or will they prescribe any medication or vitamins?

    • +1

      No I can't unfortunately, I don't work in contact tracing, and the logistics of isolation are not always easy, especially if you have ten people in a household. If you are concerned for yourself or others, medical attention should be sought. If not unwell, one should seek advice from the public health unit

      • Okay so what are treatment protocols in ICU? At what point is medicine given to patients? In America,
        C-19 patients are being given monoclonal antibodies, to stop people entering the hospitals.

  • +1

    First, thanks for your work - not just now but all the time, I could not do your job and I'm glad people like you exist.

    Second, I'm immune compromised (thanks dodgy DNA) is there anything you can think of that sticks out as the 'must do' for people like me to stay safe? I'm vaccinated, and masked and sanitised if I ever go anywhere.

    • +4

      Sounds like you're a conscientious person doing their best. Glad to hear you're vaccinated and masked. Just doing the things everyone should be doing - keeping away from other people, washing your hands, use of QR codes, being masked, restricting movement as per guidelines, that's really it

      • "keeping away from other people"… thats easy. It's keeping them away from you !

  • What is ICU capacity like at the moment? Are you overwhelmed? Are there enough experienced ICU docs and nurses for the usual ICU cases as well as the COVID cases?

    • +5

      My unit has capacity, but things aren't looking great - we are definitely stretched

  • +2

    How long before @GladysB tells someone to send a C&D notice to OzB to take down this thread?

    Gladys Berejiklian and Kerry Chant can't have insiders disclosing unapproved sensitive information to the public.

  • Hi Doc.
    I hope you can answer this question about non-ICU inpatients.
    Pre-covid, non-ICU inpatients, with any form of respiratory infection, as I understand it, would
    receive some form of treatment, such as antivirals, antibiotics, oxygen etc. depending
    on the condition.
    How does this differ with present day covid patients. What is the general treatment protocol
    patients would expect if they are admitted?
    I ask this because, according to my doctor, covid patients are only monitored and receive no
    treatment. This makes no sense to me.

    • +1

      You're right, it totally depends on the condition. We have some drugs which have some data behind them, but are still considered trial drugs - remdesivir and baricitinib. A lot of it is supportive care

  • Have you worked in a non-covid ICU? If so, is it that different?

    • I have worked in the non-covid ICU before - that is where they try to pull the new COVID ICU staff from. In the non-covid ICU, there is breadth in the diseases we see, but in COVID ICU…it's basically just COVID. A lot of patients have the same story

  • Thanks Doc, both for your everyday work and for taking time out here.

    I want to ask how you personally feel when you see a non vaccinated patient at death's door? Someone who was eligible though decided against it.

    I see in the media reports of anti vaxxers and anti masters dying and it being labelled a tragedy. I'm not convinced that a death that may have been avoidable is a tragedy.

    • +4

      You asked how I feel when I see a non-vaccinated patient on death's door - literally all the patients in the unit are unvaccinated or one dose.
      Nobody has expressed to me that they still firmly rejected vaccination when I saw them in ICU.

      I see avoidable deaths as especially tragic given they were avoidable! We've all made mistakes, believed the wrong things before, done the wrong things before - I've not had any of these patients, but these people actually are pretty unfortunate - they didn't really have the opportunity to change their minds and continue onwards

    • This is such a bad take, people are lining up for vaccines as fast as we can give them.

      Some people are only just eligible to even get the vax at all.

    • +30

      I would urge you to consider getting the much more available AZ after consulting your GP sir! There are not that many contra-indications to AZ and either vaccine would greatly reduce the chances of someone like me ever meeting you!
      If I were not a HCW and not vaccinated, I would be vaccinating myself with AZ right now

      • -6

        I got the Pfizer, have my second dose tomorrow.

        One of my siblings got the AstroZenica

        The other got Sputnik. While my parents got SinoVac and SinoPharm each.

        I decided to get the Pfizer cause we decided it might be useful to try all out (No joke).

        My parent was ill for a day after the SinoVac one. I was really ill for 3-4 days after the first Pfizer dose. Almost contacted the helpline. Dreading the second dose, my doctor said I should be prepared in advance and take work off.

        Personally if I had to trust a Vaccine (Completely anecdotal and no evidence based), I would trust the Chinese one. SinoVac or SinoPharm. The reason is China is trying their hardest to expand business into developing countries. They know their reputation matters so will not send them garbage. Their belt and road initiative will collapse if they send millions of defective doses.

        If SinoVac/SinoPharm or the Russian Sputnik was available here in Australia, I would 100% gotten that. Seriously.

        Anyway, hope you keep safe.

        Also, do you know if we would have to get booster shots for the vaccine in the future? And if so, can we get any other vaccine or just the original one we were injected with?

        Thanks

        • +3

          The chinese vaccines are also using the traditional delivery method (inactivated virus) which has been tried and tested for decades.

          Shame they dont offer it here.

        • +1

          You probably want to read this https://www.bbc.com/news/world-asia-57845644

        • Spudnik data (once they finally released it…) is manipulated. Even many Russian's refuse to take it. They commenced vaccinations after testing it on just 38 people.

  • +5

    How are you holding up? I cannot imagine all the stress you'd be dealing with right now.
    I just wanted to say, thank you for your hard work and hope you are doing OK.

  • How often do you check this site?

    • +9

      Not often enough! Frequently miss out on great deals hahah

  • What happened to the flu?

    • Covid killed it.

    • +11

      got rebranded

    • +1

      Serious question, or conspiracy?

      Because the answer to this question is well known, and not a conspiracy.

    • +7

      Because of the health advise due to covid-19, the spread of flu has been significantly less.

      So for clarification the total number of lab confirmed flu cases in 2019 from 01/01/2019 - 09/08/2019 was 216,389.
      2019 was actually a pretty bad year for flu where 300,000 people were lab confirmed to have flu.

      This year our lab confirmed cases of flu is 462 to date. if you include every confirmed covid case this year being 18,323
      That would be a total of 18,759 flu cases

      Thats a reduction of 1150% with the assumption that every Covid case was actually flu.

      Now say they are separate, based on this, that would mean Covid is roughly 40x more infectious than flu and our health measures are working very very well. (Because this is extrapolated from case numbers it is not indicative of the actual difference in infectivity, instead it is an observation)

      If any of my calcs or numbers are off let me know I don't want to mislead anyone on accident..

      (2019 flu statistics)

      https://www1.health.gov.au/internet/main/publishing.nsf/Cont...

      I used the lab confirmed Excel data set with the formula below to count the number of cases; COUNTIFS(A3:A1000000,">=1/01/2019",A3:A1000000,"<=9/08/2019")

      (2021 flu statistics)

      https://www1.health.gov.au/internet/main/publishing.nsf/Cont...

      (Covid statistics)

      https://www.worldometers.info/coronavirus/country/australia/

      I took the latest total cases figure and subtracted the total cases figure as of 31 December to get the 18323

      • Amazing the flu can still spread at all, I was initially hoping the covid lockdowns would eliminate the flu entirely, as well as a whole bunch of common colds etc

        • Yeah, with all the health measures I'm surprised as well. It would be nice to be flu free.

      • In 2019, flu had 486 deaths

        If covid had the same condition as flu in 2019, that's 248,000 deaths1.

        Obviously this calculation is over generalised but even if it is 10 times less or worse, that's 24,800 deaths or 2,480,000 deaths.


        1. "This year our lab-confirmed cases of flu is 462 to date. if you include every confirmed covid case this year being 18,323"
          Hypothetically, that means COVID is x40 infectious.
          In 2019, that would be equivalent to 12,000,000 COVID cases.
          Currently, there's 989 death out of 47840 COVID cases = 2.067% death rate = 248,000 deaths from COVID if its 2019 

    • +1

      public health measure to control covid means we had an almost non-existent flu season. Even alpha had a higher R-0 than influenza which is droplet spread so that's entirely expected.

    • Another point not mentioned yet - no international travel bringing in new flu strains

  • +2

    Thanks for answering questions here, and your work on the frontlines.

  • Hey Doc,

    When I am in ED for major asthma issues, they dose me with Prednisolone - is that effective for any stage of Covid? Like if I was vaccinated and got Covid, would Prednisolone get me through it? I know it's not a long term option, but would it be enough of a short term boost?

    • +17

      Sorry man, it's not right for me to be giving this sort of medical advice on the internet

      • Everyone else does.

        • +8

          OP identified themselves as a medical professional, so now they cant give specific advice.

        • +8

          Because OP does not know the patient's full history, is not his doctor and prednisolone is not panadol. OP is being responsible which is more than can be said for all the wannabe graduates from the University of google.

          • -4

            @gramoras: Wooosh

            • +2

              @BOGOF: No idea what that is but please don't put me in the same category as StickMan.

              • -3

                @gramoras: Stickman is in a whole category of his own

        • Do you mean non-doctors giving general medical advice?

      • oh no worries, I didn't expect you to. It was more of a generic question about Prednisolone, which seems to be the go-to drug for alot of short term treatments.
        But all cool, again thanks for your work and your AMA

  • Do you think u have been exposed to coivd? And the vaccine saved you?

    How many tests for covid have you done?

    • +3

      Aside from obviously having PPE on, probably not! Nobody really knows right

      A lot, lost count. There was a brief time last year when we were doing surveillance tests every 2-3 days

      • your hands must be dry as

  • +1

    As we get more and more COVID cases, and ICU space and staff are no longer available, would you support prioritising care for those who have had the opportunity to be vaccinated but have not taken it? i.e. Unvaccinated can't access ICU care and it's reserved for those with underlying issues or ineligible to be vaccinated.

    If not, how else would you prioritise access to these limited resources?

    I see it as similar to denying current smokers access to lung transplants. And quitting smoking is a lot harder than getting vaccinated!

    • +6

      This is a really good question, and I honestly don't know how I feel about this!
      If push comes to shove, maybe such a time will come where we have to think about this, but fortunately we haven't needed to yet. I'm sure it scares every doctor to have to think what terrible decisions we might have to make in that situation.

      Imagine having one bed in the state, and a 20yo with significant COVID who has declined vaccinations vs, a 60 year old usually well lady who is fully vaccinated yet still critically unwell…I don't think there is an easy answer in all this

      • -1

        Wow, it would seem an easy decision on paper - in isolation the modified RNA was specious.

    • +1

      Should anyone obese also be at the end of the priority queue?

      They know it puts them at high risk with covid, and have had over a year to lose the weight now.

      • that's hard to judge. I was fit and active until I got sick, then the condition and the treatment caused me to balloon and makes it incredibly hard to shed weight. I eat right, exercise when not sick, yet I'm still 'obese'

        should I miss out just because I'm fat?

        • +1

          No I don't think you should miss out, it was a counter point to this idea of leaving the unvaccinated to die.

          • @trapper: Maybe set up alternative treatments for those who can be, but refuse to be vaccinated.

            Have them attended to by a shaman, some crystals, a lava lamp and equine worming tablets. 🤷‍♂️

      • Surely almost everyone who is obese isn't that weight by choice, there is enough negative social pressure already without COVID.

        • +1

          Everyone chooses how much to eat though.

      • Food is an addiction. Losing weight is very very difficult, but yes it is a choice 99% of the time. Look at your average dietitian over 40, plenty of them are very fat.

        Getting vaccinated is easy. So there is a lot of difference there.

  • First of all, thank you for all your tiring work in ICU; I can't imagine how difficult it must be.

    You mentioned that you have not had any fully vaccinated patients yet but we are hearing small numbers here and there of vaccinated patients unfortunately contracting covid and still ending up in ICU (Israel for example has a high vaccinated population but are seeing increasing delta variant numbers never-the-less).

    I should point out that I'm a strong advocate for vaccination and have been lucky enough to recently receive my first jab. Would the majority of patients already have underlying conditions, or just generally poor health? As an example, the US has seen some staggering numbers and they have a history of poor health, be it due to their health care system and/or poor nutrition. Australia unfortunately has a similar issue with diet and nutrition.

    Vaccination messaging is important, but I fear once we have a high percentage of the population vaccinated, we seem to think that this will be over. In your opinion, will we continue to see variants (stronger and more damaging), continued vaccination boosters with diminishing effectiveness (similar to anti-biotics and already with Astrazenca), and eventually a pandemic of the anti-vaccinated and those of poor health?

    • Very valid concerns, and I guess if you look at how previous patterns have gone then yes there likely will be more variants of concern. It is a very concerning pattern, but on the bright side, we might be more prepared come the next time round. It's all in the crystal ball at the moment..

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