Skip to main content

Advertisement

Preparing for COVID-19: early experience from an intensive care unit in Singapore

Dear Editor,

About a third of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) become critically ill and require intensive care unit (ICU) admission [1]. As the COVID-19 (coronavirus disease-19) outbreak spreads [2], ICUs outside of China need to prepare for a potential surge of critically ill patients and counter the high transmissibility of SARS-CoV-2 [3]. Liu et al. have described their important preparations [4], and we would like to expand on their good advice by sharing lessons learnt from our early experience.

By 17 February 2020, Singapore recorded the highest number of confirmed cases outside of mainland China with several clusters of local transmission. All healthcare institutions adopted a common strategy of containment, with isolation of all suspected or confirmed cases of COVID-19 in negative-pressure rooms. We were fortunate that most ICU beds were single rooms—this infrastructure was put in place following the outbreak of SARS in 2003.

We realized preparing ICUs for patients with COVID-19 had numerous other requirements. First, infection control not only involved strict adherence to personal protective equipment for the individual, but also involved changes in group dynamics. We organized our ICU to mitigate the effects of any infected staff by avoiding potential spread between teams (see Table 1). Related to infection control, the medical ICU was given the task to cohort suspect or confirmed cases, including with peri- and post-partum care of pregnant women. Second, evolving information necessitated rapid and regular communications with large, disparate groups of clinicians.

Table 1 Critical care issues and solutions for COVID-19

Third, we had to train non-ICU acute medical staff dealing with critically ill patients prior to ICU admission, especially for resuscitation. Fourth, we had to re-examine specific ICU services. Given that extracorporeal membrane oxygenation (ECMO) for severe viral pneumonia is well-established [5], we prepared to cohort all COVID-19 patients in the medical ICU and have a satellite team from the cardiothoracic ICU manage the ECMO circuit. Lastly, we realized staff morale took an early hit due to multiple factors, including increased workload due to implementation of strict infection control measures, uncertainty over the effectiveness of personal protective equipment, anxiety over the lethality of any infection, concern for the well-being of their family members and stigmatization by members of the public.

To address the various issues of infection control, information flow, resuscitation training, advanced ICU services and psychological well-being of staff, we formulated several principles and solutions, which we hope can help other ICUs prepare for COVID-19 (see Table 1).

Availability of data and materials

Not applicable

References

  1. 1.

    Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.

  2. 2.

    Wu JT, Leung K, Leung GM. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet. 2020;395(10225):689–97.

  3. 3.

    Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth. 2020; ahead of print.

  4. 4.

    Liu Y, Li J, Feng Y. Critical care response to a hospital outbreak of the 2019-nCoV infection in Shenzhen, China. Crit Care. 2020;24(1):56.

  5. 5.

    Arabi YM, Fowler R, Hayden FG. Critical care management of adults with community-acquired severe respiratory viral infection. Intensive Care Med. 2020;46(2):315–28.

Download references

Acknowledgements

Not applicable

Funding

Not applicable

Author information

MFL drafted and revised the main table in the Letter. WTS revised and proof-read contents of the Letter and table. GM revised and proof-read contents of the Letter and table. KCS drafted and conceptualized the main Letter. All authors read and approved the final manuscript.

Correspondence to Mei Fong Liew.

Ethics declarations

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Liew, M.F., Siow, W.T., MacLaren, G. et al. Preparing for COVID-19: early experience from an intensive care unit in Singapore. Crit Care 24, 83 (2020). https://doi.org/10.1186/s13054-020-2814-x

Download citation