Kristo Erikson: Middle-aged people with severe cases arriving in ICUs

Head of the Intensive Care Center of the North Estonia Medical Center (PERH) Kristo Erikson says that Estonia should impose a lockdown as the country is on course for a situation where hospitals will no longer be able to help everyone in need.

How serious is the situation in hospitals today?

Both Covid wards and ICUs are fast nearing maximum capacity.

Recent news suggests hospitals have started getting young people, people in their forties and fifties, with extensive lung damage and who can no longer breathe on their own. What is happening?

Indeed, the average age of patients has come down in our ICU. If the average age of patients was still around 70 three weeks ago, it is around 60 years today. We have quite a few patients in their forties and who have a very severe case of the disease. They can no longer cope with the help of nasal cannulas and need more serious assistance, down to being taken to the ICU. Every single hospital in the northern region has boosted the number of stage 2 ICU beds after which comes stage 3 where resources are even more limited. Our ICU is currently treating a 41-year-old patient whose lungs are not working. A previously healthy person with no chronic illnesses who needs a machine to breathe for them today.

Is it possible to recover from such a situation?

It is and that is why we have these machines to get people through the toughest time during which their own lungs cannot cope. Recovery and returning to normal life take time, while in some cases, the patient might need a lung transplant.

What is it a sing of when younger people come down with severe cases?

It suggests that illness has become so widespread that the number of younger people who need intensive care is also growing, whereas it is likely this trend will persist and we will start seeing even younger patients. Another reason could very well be that the British strain and mutations of the South African strain are becoming more widespread in Estonia.

Prime Minister Kaja Kallas said on Wednesday that around 13 percent of all positive tests in Estonia are for the British strain. How much more contagious is it?

The relative importance of the British strain went from 10 percent to 75 percent in just two weeks in the greater Helsinki area, which is why the Finns are talking about a curfew and shutting the place down – the problem is serious.

Should we also be discussing a curfew?

I dare not say as we have the Health Board and other state institutions in charge of such decisions. However, returning to the spring lockdown for a time would probably not be in vain. The current trend suggests that early summer will be very difficult.

Could we end up with an army of middle-aged disabled persons?

Indeed. It is a completely realistic scenario. We can talk about long-term side-effects or lasting symptoms over one year as that is when the disease started spreading. It is a great personal tragedy when a person in their twenties never recovers their sense of smell and taste, not to mention more serious problems, such as heart disease, chronic lung problems and myasthenia that may never go away.

How many of those who are hospitalized end up with long-lasting complications?

I would say that around a third of ICU patients will experience more serious problems after recovering from Covid. It is difficult to say in terms of everyone who has had the disease. Lung damage could mean that the person might need help breathing for the rest of their life. General myasthenia and weakness may also last a very long time.

How serious are these new strains for children?

The British mutation could be far more aggressive in children than the strain we initially had in Estonia. Luckily, most children still have mild cases, while the general case rate ballooning will bring children with serious and even very severe cases. A post-Covid syndrome in children has also been described where an inflammation develops a few weeks after recovering from the virus that leads to organ failure. Sweden had around 400 children who needed intensive care after the spring wave of the virus. There will be some cases in Estonia.

Have there been children with this syndrome in Estonia?

My information suggests that the Tallinn Children’s Hospital has had two cases of the syndrome. They did not need intensive care and recovered with the help of symptomatic treatment and supportive care.

How real is the danger that we are moving toward where Italy was in spring when people died without ever getting hospital treatment?

Provided the reproduction rate (R) does not start going down, there is a good chance we will have the highest case and mortality rates in Europe. We are moving on that course today. If our measures will not work and if we stay on this worst-case scenario track, it could mean ICUs receiving dozens of people in need of immediate intensive care every day for which no medical system in the world is prepared.

It is not just a medical crisis or a crisis of the healthcare system. It is a broader social crisis and absolutely everyone will have to contribute to overcoming it.

How far are we from such a situation today?

Personally, I believe we are getting there. A few more weeks and our hospitals will be treating no one except Covid patients, meaning we will lose the ability to offer timely care, not to mention planned treatment. We will not be able to admit new patients. Major traffic accidents or fires that have more victims could mean we cannot admit everyone, while the number of patients might be so high that they will end up being together.

What will happen once the situation deteriorates to that point?

Things could get as bad as what we saw in China or Italy – and that seemed so far away then – where hospital corridors are filled with people whom we will not be able to help.

Were you left feeling confident in that the state has understood the situation and things are under control after learning about the recent restrictions?

I believe that these measures will prove insufficient considering the prevalence of the virus today. Their effect will become clear over the next two weeks. I would still prefer to have a temporary lockdown.

Ten people with Covid died yesterday (Wednesday – ed.). Are ICUs losing people every day now?

Luckily, it is not that bad yet and ICUs exist to get people through the worst of it and send them back to other wards.

Who is in charge of informing loved ones and how in a situation where patients cannot be visited in the ICU?

Exchange of information is daily and usually takes place over the phone. If the patient is capable of talking, we also offer video calling. Relatives have been allowed to visit patients in cases where we cannot be sure whether they will recover.

When should people who are treating themselves at home absolutely call an ambulance?

The main signs are growing weakness, trouble breathing. Lack of oxygen and feeling out of breath are serious signs and when the fever no longer responds to antipyretics. Emergency response teams still have the capacity to check on people today.

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