What is intensive care and what happens to coronavirus patients like Boris Johnson in ICU?

BORIS Johnson is today facing his second day in intensive care as he battles coronavirus - with hopes mounting that he's through the worst of it.

The Prime Minister's condition is said to be in a stable and he is receiving oxygen treatment at world-renowned St Thomas's Hospital across the river from his Downing Street home.

⚠️ Read our coronavirus live blog for the latest news & updates

6

The 55-year-old was moved from a general ward to intensive care on Monday evening at around 7pm, after his condition worsened.

No10 made clear the PM was in "good spirits" adding he was moved to ICU so he was near to a ventilator, if it becomes necessary.

Last night, stand-in Prime Minister Dominic Raab said his boss is a "fighter" and would recover from his ordeal.

Today, aides are hopeful that Mr Johnson is through the worst of it, as it was reported his fever is at last easing off.

Despite initial fears, it was not necessary to put him on a ventilator to help him breath, and test results have shown he does not have pneumonia.

However, the PM is expected to be kept in ICU where medics can monitor him more closely.

The Prime Minister's move into critical care begs the question, what happens to coronavirus patients like Mr Johnson in ICU, and when might you need a higher level of care?

What is intensive care?

An intensive care unit is a specialist ward set up to provide treatment and close monitoring for patients who are too seriously ill to be cared for on a general ward.

They have fewer patients and more staffing to provide one-on-one care when it is needed.

All of the machines are conveniently arranged in a way that doctors can access them as soon as they are needed.

Prof Paul Hunter, from the University of East Anglia, said: "People are generally not admitted to a critical care bed if they are coping well on a general ward.

"They are very expensive, in high demand and not a pleasant place to be - staff are running around trying to keep people alive and it is not relaxing.

6

"You don’t put patients there unless they are really quite sick.

"By the time a Covid-19 patient is moved to ICU they are very likely to have viral pneumonia."

Professor Mike Grocott, of the Royal College of Anaesthetists and Professor of Critical Care at the University of Southampton told The Sun that intensive care units have more controlled medical equipment.

He added: "The most common reason to admit a patient to ICU is if they need a ventilator or if their condition has deteriorated a lot and medics need equipment that is more controlled.

"Generally, they want all the right people, equipment and drugs there and ready in case they need a ventilator."

What happens to Covid-19 patients in ICU?

Intensive care units allow for better monitoring of Covid-19 patients and the option of a ventilator if they need supported breathing.

This is because coronavirus can attack the lungs and and causes sufferers to develop difficulty breathing.

In ICU, if a coronavirus patient doesn't need supported breathing, there are other options available.

One option is the continuous positive airway pressure mask (CPAP), while another is known as non-invasive ventilation (NIV).

Prof Grocott said: "They can use a tight fitting mask, it's a type of ventilator which can help breathing but avoids the need for full ventilation.

"It's not uncommon to trial this approach first.

"It's likely they will start with either CPAP or NIV before putting a patient on a proper ventilator."

Prof Grocott said the mask was less invasive, and does not require intubation - where a patient is sedated and a breathing tube inserted.

He told The Sun, in the case of Covid-19, the most common reason for patients to end up in ITU is a problem with the lungs, "whether that's technically pneumonia" or not.

Given Covid-19 is a new disease, and every case is different, Prof Grocott said it is difficult to say how patients will respond to treatment.

He said in some cases patients will respond to the tight fitting mask - non-invasive ventilation - but he added, "if this is not working the disease can quickly progress".

In very rare cases, Prof Grocott said patients with Covid-19 may need more than standard ventilation.

6

Extremely serious cases may need a life support machine called ECMO (extracorporeal membrane oxygenation) which replaces some of the function of the heart and lungs.

There are only a handful of these machines around the country.

Dr Sarah Jarvis, GP and medical director of told The Sun in the most extreme cases patients with coronavirus are developing sepsis.

While adding it's unlikely the Prime Minister is at that stage, she said medics will be closely monitoring Mr Johnson for signs of the killer condition, which can lead to organ failure.

What are the different treatments Covid-19 patients get?

Doctors will then decide on the best treatment option to help the patient fight off the virus.

They work through a series of four stages, starting with the least invasive and gradually building as needed, according to the .

6

1. Basic oxygen therapy

Coronavirus patients who have become breathless will be struggling to get enough oxygen into their blood.

So, the most basic form of treatment that can be given in hospital is oxygen therapy.

Patients are fitted with a mask and oxygen-enriched air is piped through to help them breathe.

2. Pressurised oxygen therapy

The next stage is to give the patients a more intensive form of oxygen therapy.

They will remain conscious and be fitted with an airtight mask and the oxygen-air gas given will be pressurised.

Doctors will also be monitoring their vital signs more closely.

3. Mechanical ventilation

If the patient is still having difficulty breathing and not getting enough oxygen into their blood, medics will consider putting them on a ventilator in ICU.

Mechanical ventilation is an invasive procedure which pushes air in and out of the lungs artificially.

Patients are put to sleep - usually on their front to take the weight off the heart and lungs.

A tube attached to a ventilator is inserted into the patient’s mouth or nose and down the windpipe, or sometimes via a surgically-made hole in the neck.

These machines essentially keep the patient alive and give their body time to fight off the virus.

4. Extracorporeal membrane oxygenation (ECMO)

In some patients, their lungs can become too damaged and inflamed for a mechanical ventilator to adequately get enough oxygen into the bloodstream.

If this happens, doctors may have to consider using an extracorporeal membrane oxygenation (ECMO) machine.

But it is one of the most aggressive forms of life support and is always seen as a last resort in respiratory aid.

The ECMO machine is similar to the heart-lung bypass machine used for open heart surgery and works by bypassing the lungs to infuse the blood with oxygen.

How many medics are in ICU?

Most patients in ICU will have at least one specialist nurse who looks after them and them alone.

This may be different in the coronavirus crisis because of a shortage of highly qualified staff - however the ratio of nurses to patients will be lower than on a general ward.

ICU patients are given round-the-clock care given their risk of becoming life-threateningly ill.

6

Intensive care units also have their own doctors - usually called a consultant in intensive care medicine, or similar - who constantly monitor the patients in their unit to decide what level of care they need.

On the other hand, general hospital wards tend to be staffed by a team of less specialist nurses and healthcare assistants who separate the workload among them and check on patients regularly throughout the day rather than round-the-clock.

St Thomas' Hospital in central London, where Mr Johnson is being looked after, has three permanent intensive care units consisting of 42 beds.

It also has four high dependency units and may have more capacity for the COVID-19 epidemic.

What is the survival rate of ICU patients?

A disturbing report revealed half of coronavirus patients who end up in intensive care die from the bug.

Data based on 165 UK patients treated in critical care units showed that 79 had died and 86 were discharged, giving a mortality rate of 47.8 per cent.

The Intensive Care National Audit and Research Centre (ICNARC) study has been running since the end of February and has come out with some shocking results.

6

However, these statistics are likely to be as a result of NHS hospital doctors only sending the most serious coronavirus cases, around five per cent of coronavirus-based hospital admissions, to their intensive care units (ICU's) as a last resort due to a shortage of resources.

“The truth is that quite a lot of these individuals [in critical care] are going to die anyway and there is a fear that we are just ventilating them for the sake of it, for the sake of doing something for them, even though it won’t be effective. That’s a worry,” said one doctor interviewed by .

How did Boris Johnson get coronavirus?

It's hard to know when Mr Johnson caught coronavirus, as he has spent weeks occupied by the government's response to the outbreak.

In recent days, he has been pictured conducting meetings by video call, but before was still attending visits, meeting people, and hosting press briefings in person.

Footage from near the start of the epidemic also shows the prime minister attempting to downplay the severity of the outbreak or the need to take precautions when in public.

"I can tell you that I'm shaking hands continuously," he said.

"I was at a hospital the other night, where I think there were actually a few coronavirus patients and I shook hands with everybody."