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Hospital ICUs Are Adapting To COVID-19 At 'Light Speed'


Hospital intensive care teams are trained to care for people with traumatic injuries, heart attacks, strokes and life-threatening infections. But until COVID-19 arrived, most had never encountered patients with a disease that's so hazardous to health care workers. NPR's Jon Hamilton reports on how ICUs are now adapting.

JON HAMILTON, BYLINE: For the people who work in intensive care units, COVID-19 is providing a crash course in pandemic medicine. Dr. Craig Coopersmith is director of the critical care center at Emory University in Atlanta.

CRAIG COOPERSMITH: Things that previously might have taken us years to learn, we're learning in a week or two. Things that might have taken us a month to learn beforehand, we're learning in a day or two.

HAMILTON: And many of the lessons involve personal safety, says Dr. Tiffany Osborn, a critical care specialist at Washington University in St. Louis.

TIFFANY OSBORN: There is a true and real probability of infection and exposure.

HAMILTON: The hazard is invisible, and it could be anywhere. Osborn says that means she has to treat her entire workplace as a hot zone.

OSBORN: It's everything. So you have to think about, like, everything that you touch if it burned, right? So you have to wear something that keeps you from burning your hands - every single thing that you touch, like the phone, the doorknob.

HAMILTON: Which means extra layers of protection, like isolation gowns, hoods, double gloves and an N95 respirator. During a video chat, Osborn shows me items that have become a part of her daily routine.

OSBORN: Sometimes I wear a mask over the N95. I've got a pair of goggles. I've got a face shield. And you wear it so much now that you start to wear away the skin on the bridge of your nose.

HAMILTON: Many of the measures now in COVID ICUs were developed for patients with diseases like SARS or Ebola, and they were tested in a handful of medical facilities known as biocontainment units. Dr. Angela Hewlett directs the unit at the University of Nebraska.

ANGELA HEWLETT: We received several patients early on in the pandemic who were medically evacuated from the Diamond Princess cruise ship.

HAMILTON: But Hewlett says as the trickle of cases became a torrent, the university began converting regular hospital wards and ICUs into COVID units.

HEWLETT: And so our nurses, our respiratory therapist, our physicians that normally work on our biocontainment team are now working within those COVID units to make sure that all of our principles and protocols are continuing to be followed there.

HAMILTON: Hewlett says these protocols involve detailed instructions on things like how to safely remove protective gear.

HEWLETT: If you take off a contaminated piece of equipment and touch your face or that sort of thing before washing your hands, then you can potentially acquire the illness that way. So we have very strict steps to follow.

HAMILTON: And a designated observer to make sure each step is carried out. Dr. Kira Newman, a senior resident at the University of Washington Medical Center in Seattle, says even standard ICU procedures, like inserting a breathing tube, now require a lot more planning and preparation.

KIRA NEWMAN: The first step that we all would take as a medical team is to get all of the personal protective equipment that we need in order to safely have that patient intubated and to safely care for them.

HAMILTON: And Newman says one lesson from this period of rapid change is that sometimes you have to slow down.

NEWMAN: It usually takes on the order of, I'd say, 30 minutes or so in order to get all of that equipment together, to get all of the right people there. And that would be a particularly fast intubation.

HAMILTON: All for a procedure that, by itself, takes less than 30 seconds. Newman says ICU staff are also pausing more often to speak with their patients, who usually can't receive visitors.

NEWMAN: Time and time again, myself and other people of the medical team would take the extra time while we were there to say words that family had told us to tell them, whether that was to deliver a message or call them a nickname or just to say that they were loved.

HAMILTON: Newman says patients need to know that the people behind all that protective gear really do care about them.

Jon Hamilton, NPR News. Transcript provided by NPR, Copyright NPR.

Jon Hamilton is a correspondent for NPR's Science Desk. Currently he focuses on neuroscience and health risks.