Covid19 ICU numbers remain high

High levels of intensive care unit (ICU) occupancy continue to concern the Health Ministry. Principal Medical Officer Dr Maryam Abdool-Richards said 51 of 52 available covid19 ICU beds are occupied, with seven people in accident and emergency wards waiting to be admitted to an ICU.

Speaking at the ministry’s covid19 briefing on Wednesday, Abdool-Richards said 50 patients, or 98 per cent, in the ICU were not fully vaccinated.

She said there were 24 patients awaiting transfer into the parallel health care system from accident and emergency departments, seven of which needed ICU level care

Health Ministry officials continued to emphasise the need for the population to get vaccinated. Abdool-Richards reminded vaccination reduces the risk of catching covid19, reduces transmission, especially as the delta variant is present in TT, and reduces serious illness, hospitalisation, and death.

Thoracic care medical specialist Dr Michelle Trotman said most people admitted for ward, high dependency unit (HDU), and ICU care were unvaccinated, over 60, and facing health challenges such as asthma, hypertension, diabetes, and heart disease. She said a high BMI (body mass index) as well as undiagnosed comorbidities also contributed to serious illness, and urged people to get vaccinated.

Trotman said the length of stay in the parallel healthcare system was determined by many conditions, including comorbidities and how ill someone was when they were admitted.

“The average time of stay is six-14 days, but in rare instances can be weeks or over a month. They can fluctuate between HDU, ICU and ward levels. Some people are so sick when they come in that they bypass ward level entirely.”

She said triage systems are always used to assess patients to determine the best level of care to get the best outcome.

“There are some formalised systems of triage used. One is the ABC system, where we look at your airway, your breathing, and your circulation, and make a decision as to what level of care you need.

"Another is the CTAS system that looks at the urgency of your care that is required, whether you need resuscitation right away, whether you are emergent, urgent, not so urgent, and classify treatment based on this.

"On top of that, we use our clinical judgement. Each clinician would look at the patient and say where this patient is, based on their numbers, their comorbidities and other factors, to decide whether or not they need to go beyond ward care. These assessments are guided by guidelines for different levels of care.”

She said referrals were often done within and across facilities and across regional health authorities depending on the needs of a patient. She said the more ill a patient is, the more complex it was to transfer them between facilities.

Trotman addressed certain myths about the parallel healthcare system. She said healthcare workers are dedicated to the care of patients, regardless of whether they were vaccinated or unvaccinated, despite belief to the contrary. She said having taken the vaccine did not mean people could congregate, discard masks, or stop following public health measures.

She also said an increasing number of patients did not mean that the level of care would increase, as the system would become strained.

Trotman said while she did not have the numbers of people who had been treated with tocilizumab, an Interleukin 6 (IL-6) receptor blocker, which was used to treat inflammation in seriously ill patients, those figures would be provided.

Health Minister Terrence Deyalsingh said people were being managed at home and did not access the healthcare system until they were extremely ill.

“If you come into accident and emergency or your health centre as soon as you start showing symptoms, this will significantly drive down demand in the wards. It will also enable people to be transported more easily.

"The deaths we are seeing are avoidable," he added. "It is not too late for people to make the decision to be vaccinated, so we can come back in a few weeks and say the ICUs are not filled.”

He said assigning more healthcare staff to the parallel healthcare system would mean reassigning them from the regular healthcare system, which would put people using that system at a disadvantage.

Deyalsingh said the field hospital at the Jean Pierre Complex, Mucurapo, may have to be reopened to accommodate ICU patients, although it was originally closed to rationalise staff.