April 6, 2020

expert reaction to Boris Johnson being admitted to ICU

Downing Street has announced that Boris Johnson has been moved to intensive care at St Thomas’ Hospital.

Professor Mike Grocott, Consultant in Critical Care Medicine and Vice President of the Royal College of Anaesthetists

“It’s important to understand that being in an intensive care unit isn’t all about being on a ventilator.

“Intensive care is where life support takes place. This involves a highly experienced multi-disciplinary team of doctors, nurses and support staff with a wide variety of skills. They make use of highly sophisticated monitoring equipment to keep track of the patient’s blood oxygen levels, as well as blood pressure and heart rate.

“Medical teams within intensive care units will always carefully assess as to when, and whether the use of full ventilation support is needed for any patient. A skilled team will carry out all procedures necessary including intubating the patient’s windpipe and inserting tubes or catheters into veins and arteries in order to enable second-by-second monitoring and support the administration of complex drugs. In extremely serious cases, the use of an extracorporeal membrane oxygenation (ECMO) machine (like a heart lung machine used for cardiac bypass surgery) which takes over some of the function of the lungs.

“St Thomas’ has seen some of the highest numbers of COVID positive patients of any hospital in the UK, and is a specialist centre for advanced respiratory support and ECMO services.

“The Prime Minister – along with all other COVID positive patients being looked after by NHS staff – will receive the best and most compassionate care from intensive care staff who have access to highly specialised medical technology.”

Dr Alison Pittard, Dean of the Faculty of Intensive Care Medicine, said:

“The Prime Minister is in all of our thoughts as he enters intensive care. As an ICU patient, he will have a fantastic multiprofessional team looking after him – it is the intensive care team, their experience and their training, that will be the central component of the treatment he receives. The experience will give him a special insight into what intensive care is and its importance for the future. I know he will receive the highest quality of care.”

Dr James Gill, Locum GP & Honorary Clinical Lecturer, Warwick Medical School, said

“For some people the Coronavirus outbreak just became real. Numbers on a report and lines on a graph can be intellectually challenging, but for a not insignificant proportion of the British population the COVID19 infection didn’t really have teeth. A virus that affects other people. Boris Johnson is not other people. Whether we agree with it or not, as the Prime Minister of this country, he will have had access to the best medical advice possible, and has still regrettably fallen ill. Boris Johnson’s revelation of his positive result for COVID19 initially caused a degree of concern, but his appearance on TV and social media likely tempered that concern of some people over this deadly virus. Without a doubt, the deterioration, and now admission of the British Prime Minister to hospital and now intensive care must underscore for everyone, across the world, how indiscriminate this virus is. Ignoring, class, character, wealth and position. So far we have seen a deterioration in line with other cases of COVID19 infections – whilst admission to ITU is a worrying news, this is not all together uncommon with this disease, and may be looked at from a positive that the PM is getting the very best care that the NHS has to offer. As is the case for all patients admitted into the care ITU, who are without doubt, the best of the best.

“We do not have enough information to, nor should we speculate about the condition of Mr Johnson. He is just another patient who is currently running the marathon of the COVID19. Without a doubt for all patients in his situation, this will be one of the most physically demanding challenges of their lives. The support of the ITU team will be crucial over the next few hours and days to increase the chances of a successful recovery, completing this marathon challenge.

“This shocking news should certainly be taken as a sign to reinforce the existing advice to maintain social isolation and distancing in order to weather this pandemic.

“On behalf of GPs, the NHS, and people everywhere we wish him a speedy recovery, back through those ITU doors, and to good health.”

Prof Derek Hill, Professor of Medical Imaging, University College London (UCL), said:

“It seems clear that the Prime Minister went to hospital because he had difficulty breathing. It seems he was initially put on oxygen, and was conscious. But as often happens with COVID-19, his condition has now deteriorated so he has been admitted to intensive care. We understand the PM is on a type of breathing support called Continuous positive airway pressure (CPAP), which is commonly used in treatment of obstructive sleep apnea. Experience in Italy and other European countries has shown that CPAP can be effective in COVID-19 patients, at least initially. Many COVID-19 patients progress to invasive ventilation. Invasive ventilation involves a tube being put down the patient’s airway. Intensive Care Ventilators have sophisticated software and sensors to enable them to adjust the way they work around the needs of the patient, and to change the amount of oxygen inhaled with the air.

“One of the features of COVID-19 in all countries seems to be that many more men become seriously ill than women – especially in the over 40 age group. Also we know that people under about 60 seem to have a higher chance of making a recovery from critical illness with COVID-19 than older people. But there is no doubt this turn of events means Boris Johnson is extremely sick.

“It illustrates three of the important healthcare needs of COVID-19: Firstly many patients need help breathing, and there is a shortage of the mechanical ventilators that can do this – and in particular a shortage of the high quality intensive care ventilators most suitable for COVID-19 patients who might need help breathing for over a week. Secondly, COVID-19 patients need a huge amount of oxygen to help them breath – which is potentially going to be in short supply. Thirdly, looking after people in intensive care requires skilled staff, and the experience of New York has been that finding enough skilled staff has been the greatest challenge.”

Prof Linda Bauld, Bruce and John Usher Chair in Public Health, Usher Institute, University of Edinburgh, said:

“The admission of the Prime Minister to intensive care is of huge concern and illustrates just how indiscriminate this virus is. Anyone anywhere, including the most privileged in our society, can be affected and can become seriously ill. It is imperative now, more than ever that the rest of us comply with government guidelines to stay at home and not put others at risk. Questions will be asked in future about whether the UK government acted appropriately in keeping parliament open and face to face meetings going while the rest of the country was already following advice to shut down. For now, however, all our thoughts will be with the Prime Minister and his family, and the many other families who are facing similar circumstances with critically ill relatives.”

All our previous output on this subject can be seen at this weblink: https://www.sciencemediacentre.org/tag/covid-19/

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