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ESAIC Newsletter #82: Corona seen from home

Gabriel M. Gurman, MD

Chief editor

gurman@bgu.ac.il

I worked as an anaesthesiologist for more than 55 years, in three continents and five countries. I witnessed a lot of tragedies, and I had the opportunity to be involved in the management of some very severe mass casualties.

I thought that I had already seen everything, so I supposed that nothing could surprise me anymore. I saw each year how influenza viruses killed a large number of patients, each winter being accompanied by numerous deaths, mainly among old patients, with a lot of comorbidities. From time to time I treated a young person affected by a viral infection complicated by serious pneumonia and ARDS.

But what is happening in the last days, weeks and months, does not resemble anything I have lived through before.

Everything I know about the current events comes from the media.

From time to time I call my colleagues, my former pupils, and ask about the things which are happening in their intensive care units (ICU).

I must confess that what I get is more or less the same picture I used to know in the long years I worked in the intensive care field.

But I thought that what makes today things completely different is the easiness the virus passes from one person to another, and this is the explanation for the immense number of affected people.

I am not an epidemiologist, so I would not dare to discuss the tragedy of these days from this point of view.

But I can easily understand the situation in which one cannot foresee the magnitude of this epidemic in the next weeks or months. Too many factors could influence the path the coronavirus epidemic might take, among them the public attitude, the weather, the authority of the governments.

All these factors act differently from one place to another, and most probably this is the explanation for the wide gap between the dates of the impact of the pandemic from one country compared with another.

But one thing is clear. Maybe for the first time in our modern times, the general public is becoming aware of the vital importance of our speciality.

All of a sudden, everybody speaks, writes, talks about ventilators, acute respiratory failure, monitors, infusion pumps, special beds for avoiding decubitus, topics which have never succeeded to penetrate the media, and behind which there is always an anaesthesiologist involved in intensive care.

In almost every corner of the world, there is an acute shortage of intensive care equipment, and I have heard about countries being involved in a fight for acquiring the same batch of ventilators.

But at the same time everybody enquires, and worries, about the number of intensive care physicians, and finds out for the first time the information that, in many countries of the world, intensive care forms part of the anaesthesiology profession.

I read about countries which “discovered” that the number of specialists who could take care of seriously ill patients is too small, even for normal times, not speaking about the current situation of such a virulent pandemic.

In many parts of the world, hospitals are obliged to transform “normal” wards and departments in real ICUs in order to be ready to accept as many critically ill patients as the virus demands. But who is supposed to take care of the patients admitted to such an improvised environment?

Unfortunately, the situation is not wisely managed in all locations.

I heard about the intention to transform overnight physicians from different specialities into….intensivists, by trying to offer them a short and quick course in the domain of management of critically ill patients. It sounds like a joke!

I am amazed by the fact that years after I left the profession and retired from clinical activities the things are more or less as I have left them.

As the French say: plus ca change, plus c’est pareil.

Many people see the current situation as a real tragedy and have difficulty seeing the light at the end of the tunnel. The number of infected patients is in continuously increasing, as is the number of deaths, mainly among the older population.

But I try to be optimistic and think that the coronavirus pandemic represents a wonderful opportunity to open the eyes and see the situation of our speciality as it is.

The time will come that the medical authorities will take into consideration our justified demands, for more positions for doctors, nurses and intensive care technicians, for more intensive care beds, for replacing old equipment with new, and for improving the work conditions of our colleagues, most of them being overworked and underpaid.

The time will come that people all over the world will pay attention to the fact that anaesthesiology is not anymore a narrow medical speciality, but one with many fields of activities outside the operating room, intensive care being one of the most important ones. Because taking care of a critically ill patient is part of our training, from the very first day of an anaesthesiologist.

In a couple of weeks or months, we will leave the peak of the epidemics behind us.

People will return to work, the restaurants will open once again, and the football matches will bring millions and millions of fans every single weekend in the stadiums.

The danger is that once we will be back, healthy and away from the awful disease, the lesson of the current tragedy would be forgotten.

It is up to us to avoid the situation from going back to what it was.

I address all my younger colleagues, who are now in the first line of the battle against the virus. I bless you for everything you are doing for the benefit of your patients and for the fact that you put in danger your own life in order to save the lives of others.

But your task will not be finished with the last patient being weaned off the ventilator.

You must remind the world about the needs of our speciality and make sure that your voice is heard and your advice is followed.

I wish you luck in these difficult times. Be healthy and keep it up.

And let’s meet all this autumn at Euroanaesthesia Barcelona.

 

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