Will COVID-19 forever change our view on what conditions can be managed outside of critical care?

 

There are many words that have been used to describe the COVID-19 pandemic but in this short blog we want to focus on two: ‘unprecedented’ and ‘portal’. The former has been used to describe our current state of being: our lack of preparedness, the newness of our experience, the vulnerability and uncertainty that we feel in the face of unpredictable risk. The latter, used by the novelist Arundhati Roy, in an article she wrote for the Financial Times, refers to the idea that ‘pandemics have forced humans to break with the past and imagine their world anew’. It refers to the potential for positive change.

Respiratory diseases impose an immense worldwide health burden as they are also in the deadliest diseases in the world. However, respiratory diseases receive a disproportionately low level of research funding compared to diseases such as cancer. Chronic Obstructive Pulmonary Disease, lower respiratory tract infection, lung cancer, TB, and asthma are in the list of 30 most common causes of death. Moreover, respiratory failure is one of the conditions that require hospital admission. In the UK, one-third of admitted patients have respiratory problems and respiratory failures accounted for the most admissions.

Treating patients in intensive care units (ICU) or high dependency units (HDU) is resource-intensive. An ICU/HDU bed is usually estimated to be three times as expensive as a general ward bed.  While the efficacy of using non-invasive ventilation for respiratory failure on ‘ordinary’ hospital wards is becoming increasing well established, it is still controversial especially for conditions other than COPD.  However, we believe that this may change very swiftly in the coming weeks and months.

We are conducting a research project, using qualitative methods, to understand healthcare professional and public views on the use of non-invasive ventilation for different respiratory failure conditions outside critical care. It also will specifically explore how these views have changed before and after the COVID-19 pandemic and why. Establishing healthcare professional and public attitudes to NIV treatment in wards are important if we are to understand the feasibility of conducting future clinical trials studies for those type of patients.

For further information about our project, or if you would like to be interviewed, please contact Dr Bandar Faqihi

Authors:

Dr Bandar Faqihi, PhD Candidate, Institute of Applied Health Research, University of Birmingham

Prof Alice Turner, Professor of Respiratory Medicine, Institute of Applied Health Research, University of Birmingham and Honorary Consultant Respiratory Physician, University Hospitals Birmingham NHS Foundation Trust.

Dr Nicola Gale, Reader in Health Policy and Sociology, Health Services Management Centre, University of Birmingham