Covid-19 one year on: doctors relive experiences of life on intensive care wards

Twelve months on from the first UAE coronavirus deaths, frontline medics offer hope for the future

On March 21 last year the UAE reported its first two deaths from Covid-19.

A year on, the country’s death toll is approaching 1,500 from more than 450,000 recorded infections.

This remains one of the lowest death rates globally, but doctors are still striving to learn more about the virus to save more lives.

During a hugely challenging 12 months, much has been learnt about how to tackle the pandemic on the front lines of healthcare and, more importantly, how to give the most critically ill patients the best chance of survival.

Three doctors who continue to lead the fight against the virus shared their experiences with The National.

Surviving 'the storm' is critical for recovery 

Abu Dhabi, United Arab Emirates, March 23, 2021.  ICU doctors give their view on what lessons have ben learned and what has changed one year on from Covid. 
SUBJECT NAME:  Dr. Igbal Mubarak Sirag
Victor Besa/The National
Section:  NA
Reporter:  Nick Webster

Covid-19 was a new disease, with new symptoms and without a specific treatment, says Dr Igbal Mubarak Sirag, of Bareen International Hospital in Mohamed bin Zayed City, Abu Dhabi.

“All we could do was treat the symptoms, while oxygen was very important for ICU patients,” Dr Sirag says.

“We are a small hospital, but quickly we doubled our bed capacity and were soon full up.”

Quote
In the second to third week they would get what we described as 'the storm'

The first patient admitted to Bareen International was on March 20

The woman, 35, had pneumonia and was placed on oxygen. She was not among the typical demographic of patients requiring intensive care at the time.

A steady flow of patients diagnosed with the disease continued for two months.

“I did not know what to give my first patient, if she needed antiviral medication or something else,” says Dr Sirag, who is from Sudan.

“My patients used to come without any severe lung damage. Most would recover from the virus and then carry on with life as normal.”

But some would continue to have shortness of breath.

A steady flow of patients diagnosed with the disease continued for two months.

“It was not something we could explain as X-rays did not suggest an obvious reason,” Dr Igbal says.

She discovered that patients’ response to the virus would often differ.

“Some had a mild form of the disease and recovered well . Others had moderate symptoms but then, in the second or third week, they would get what we described as ‘the storm’,” she says.

It was when the body’s immunity was severely depleted and the virus would take hold.

“It was a tough time and we were scared for ourselves and our patients.

“What we have learnt from this experience has prepared us for the future.”

'Miraculous' vaccine and co-worker support 

DUBAI, UNITED ARAB EMIRATES , April 26– 2020 :- Dr. Adel Alsisi, Consultant Critical Care Medicine, Chief Medical Officer, Prime Hospital wearing PPE kit during the interview at the Prime Hospital on airport road in Al Garhoud in Dubai . (Pawan Singh / The National) For News/Standalone/Online/Instagram/Stock.  Story by Nick Webster

Dr Adel Al Sisi, an Egyptian critical care consultant at Prime Hospital Dubai, oversaw the transformation of regular medical wards into special isolation units for Covid-19 patients.

“This virus is very smart, and it is changing,” he says.

“It has become a race between human intelligence and nature.”

In the beginning, he says, the hardest part was detecting the virus and understanding it.

“We had seen similar viruses before with Mers and Sars, so we had an idea of what symptoms to expect.”

An early discovery that the number of deaths from the virus was significantly lower than diseases like Ebola gave Dr Al Sisi hope that many lives could be saved.

He was still concerned about its contagion.

“In the first wave there were very strict government rules,” he says.

“Because of smart services we were all able to work from home and then the country reopened gradually.

“Rules were respected while social distancing and a responsible community helped keep infections low.”

He says when the virus mutated and brought a second wave of infections, more people were admitted to hospitals and placed in intensive care.

“They stayed there longer in the second phase, had more complications and required more ventilation.

“More people died in the second wave than the first, and suffered lung complications.”

The rapid development of a vaccine and its application for emergency use across the world within just nine months was nothing short of miraculous, Dr Al Sisi says.

A balanced diet, good sleep habits, managing stress and exercising are important to strengthen one’s immunity against future viruses, he says.

“What is consistent is those recovering have a strong immune system.”

“If we are strong, we will recover. There will always be the threat of a new virus so we need to be ready and stay as healthy as we can.”

Supporting each other as co-workers during a critical 12 months saw them through the worst, Dr Al Sisi says. He was also the leader of a team.

“This virus had an emotional and psychological impact on us,” he says.

“If we treated a patient, it was very important to share the emotional responsibility.”

They involved patients’ families, even if it meant seeing loved ones through a window in the isolation ward.

“That connection was part of their recovery,” Dr Al Sisi says.

“After my daily rounds I would sit with families to answer any questions they had .”

In a year, the situation will look very different, he says.

“I am very optimistic that normal life can return.”

Still much to learn from 'long Covid'

DUBAI, UNITED ARAB EMIRATES , March 24, 2021 – Dr Elie Abdallah at the ICU ward in Mediclinic Welcare Hospital in  Garhoud in Dubai. (Pawan Singh / The National) For News/Online. Story by Nick

Dr Elie Abdallah is a consultant pulmonologist in the Critical Care Centre at Mediclinic Welcare Hospital, Dubai.

Many medications that were thought to be of benefit at the onset of the pandemic have been dropped from the treatment regimen, he says.

“The only treatments retained from last year’s experience were the steroids, blood thinners and oxygen support,” he says.

“But there hasn’t been a ground-shattering new medication in terms of [reducing deaths from] the disease.”

New antiviral drugs were added to treatment plans under an emergency use authorisation order by the US Food and Drug Administration to help curb deaths.

They included Remdesivir, an antiviral drug previously used to treat symptoms of HIV.

Although not a magic bullet in the early months of the battle against Covid-19, doctors were keen to grasp anything that improved survival rates.

Dr Abdallah, from Lebanon, says in the second wave there have been more Covid patients with air leaking from the lungs – an issue that can be life-threatening.

“We have seen much sicker patients in the hospitals, with much more severe disease,” he says.

“Mild cases have been quarantined at home, leading to only moderate and severe cases in the hospitals.”

The incidence of blood clots also seems to have increased, he says, be it in the lungs, heart or brain. These can lead to heart attacks or stroke.

“The biggest success story has been the release of effective vaccines to the public and the front-line workers,” he says.

“Our most valuable lesson has proved to be that social distancing and wearing face masks works.

“You just have to look at what happened to countries who relaxed these measures prematurely compared to the ones who didn’t.”

While more research is still required to fully understand the long-term effects of the virus on patients, Dr Abdallah says some patients who spent time in intensive care have struggled to fully recover.

“The jury is still out on the long-term effects of Covid-19,” he says.

“The most devastating adverse event we see in the post-ICU care is patients with very weak muscles to the point of almost being paralysed.”

Another long-term complication is lung fibrosis, where normal lung tissue is replaced by scar tissue rendering the patient dependent on supplemental oxygen.

“In addition to these extreme side effects of the disease, we are seeing a huge number of patients with long-lasting anxiety and sleep disturbance.

“Gastrointestinal effects are also observed, from loss of taste, decreased appetite to severe diarrhoea.

“I think in the few months to come we will see new studies about the long-term effects of this ... pandemic.”

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