The Malaysian Insight

CRITICALLY ill younger Covid-19 patients and those with no comorbidities are now prioritised for admission into the Kuala Lumpur Hospital’s intensive care unit (ICU) as the number of beds run out.

ICU specialist Dr Koo Thomson told The Malaysian Insight they were still seeing a high number of ICU referrals despite new Covid-19 cases hovering around 5,000 cases daily after hitting a high of 7,000-plus earlier last month.

Every day, the unit, which can accommodate up to 72 critical patients, receives referrals of between 10 and 20 Covid-19 patients, Koo said.

“Every day the ICU beds are full. If a patient is discharged or dies, the bed is taken by another patient within a few hours.

“From May to date the situation has not improved. Every patient admitted to the ICU can be here for between a week and two weeks, and sometimes even longer.”

Category 4 and 5 Covid-19 patients need intensive treatment such as respiratory assistance due to damage to the lungs, liver and heart.

“Often, not all patients who need to be in ICU can be admitted because we do not have enough beds, so doctors have to prioritise.

“We want to admit all the patients but we lack beds, so we have to choose the one that has the best recovery chance.”

This current predicament is despite the fact HKL ICU has been converted into a Covid-19 special ward since last April with 72 beds instead of 30 previously.

As of yesterday, a total of 899 cases required ICU treatment out of a total of 61,812 Covid-19 patients being treated in the country.

The ICU bed utilisation rate is alarming, rising from 96% on May 25 to 104% over the following two weeks as the number of cases spiked sharply.

This is despite the decline in bed use for non-critical Covid-19 patients, director-general of health Dr Noor Hisham Abdullah had said.

Koo said the condition of patients is monitored once they are admitted to the ICU ward. Here treatment with breathing aids as well as several procedures will be carried out.

This includes intubation, which is the process of inserting a tube through the airway or by tracheostomy, punching a small hole in the throat of the patient.

If a patient suffers from organ failure, such as the kidneys, doctors will have to perform a procedure to allow for dialysis, he said.

In addition, patients are also placed in a prone position for at least 16 hours to allow the lungs to receive more oxygen and medication.

At the same time, patients are supported with respirators and rehabilitation treatment of damaged organs, which include steroids.

“Steroids do have their benefits, but the important thing now is vaccines,” said the doctor who has been caring for patients in the Covid-19 ICU ward at HKL since April.

Helping the families

Doctors also face difficult choices when patients do not show a positive response to treatment.

It usually occurs when a patient suffers multiple organ failure, said Koo.

“Patients like this we know even if we do our best, there is little chance of survival. We try to treat them with medication.

“When their heart stops, even cardiopulmonary resuscitation (CPR, or chest compressions combined with artificial ventilation) will not help because their condition is already very bad. If you do perform CPR, patients will be in more pain.

“It’s not that we don’t want to help. Reducing pain is also a form of treatment. We want to save all patients and not choose,” Koo said.

He added that families will be informed of the situation so that they can be prepared. They are not allowed to visit the patients.

“Doctors will inform the family of the patient’s condition on a daily basis through phone calls or video calls at least once a day,” he said.

“Family support is very important. When patients are in a conscious state, they are not given sleeping pills, and we allow them to make video calls to the family for support and encouragement.

“If patients need to be intubated, they are sedated so they don’t feel sick or pain, we allow them to make video calls before the procedure,” Koo said.

The ICU unit also provides special mobile phones for the use of patients who do not have mobile phones to contact their families.

“If the patient is awake and owns a mobile phone, we allow them to contact their family at any time because encouragement to the patient is very important.

“This is an unavoidable situation, if possible we want patients to be with their families because it is very important,” he said.

The Covid-19 mortality rate has remained high between 50 and 100 deaths a day.

Another 57 people died yesterday, bringing the death toll to 5,001 deaths since Covid-19 was first detected in Malaysia early last year.

For patients who successfully recover from the virus, most of them will remain very weak and the healing process is very difficult.

“It may take a long time because they are weak and their lungs are damaged. So their breathing will not be as before.” – June 29, 2021.