The Lived Experience of ICU Clinicians During the Coronavirus Disease 2019 Outbreak: A Qualitative Study.

OBJECTIVES: During the coronavirus disease 2019 pandemic, frontline healthcare professionals were asked to reorganize the provision of critical care in unprecedented ways. Our aim was to gain insight into the lived experience of clinicians who worked in ICUs during the surge. DESIGN: Qualitative study using semistructured, in-depth interviews. SETTING: Clinicians who worked in three ICUs in Paris (France) during the peak of the pandemic (April and May 2020). PARTICIPANTS: Twenty-seven ICU clinicians (12 physicians, 11 nurses, three nursing assistants, and one respiratory therapist). MEASUREMENTS AND MAIN RESULTS: Interviews were audio recorded and analyzed using thematic analysis. Six themes emerged: coping with initial disorganization and creating new routines, the intensification of professional relationships and the development of unexpected collaborations, losing one's reference points and recreating meaningful interactions with patients, working under new constraints and developing novel interactions with family members, compensating for the absence of family members and rituals at the end of life, and the full engagement of ICU clinicians during the coronavirus disease 2019 crisis. CONCLUSIONS: Among ICU clinicians, there was a sense of total professional engagement during the surge. Caring for critically ill coronavirus disease 2019 patients was fraught with challenges and generated a strong feeling of responsibility, as clinicians felt they had to compensate for the absence of family members. Rethinking policies about family visits and safeguarding positive relationships among colleagues are two important priorities for future healthcare crises.

Psychiatric Intervention and Psychiatrist's Role in the COVID-19 Epicenter-Wuhan: Personal Experience and Perspective.

This invited commentary is the personal experience of a psychiatrist who assisted in Wuhan, China during the pandemic. From the personal perspective, it explains why psychiatrists need to go to Wuhan, discusses the psychological problems faced by the front-line medical staff and confirmed COVID-19 patients and the corresponding psychological interventions provided to them, describes the particularity and coping methods of psychological issues related to COVID-19 epidemic.

COVID 19: prioritise autonomy, beneficence and conversations before score-based triage.

At the start of the COVID-19 pandemic, mounting demand overwhelmed critical care surge capacities, triggering implementation of triage protocols to determine ventilator allocation. Relying on triage scores to ration care, while relieving clinicians from making morally distressing decisions under high situational pressure, distracts clinicians from what is essentially deeply humanistic issues entrenched in this protracted public health crisis. Such an approach will become increasingly untenable as countries flatten their epidemic curves. Decisions regarding intensive care unit admission are particularly challenging in older people, who are most likely to require critical care, but for whom benefits are most uncertain. Before applying score-based triage, physicians must first discern if older people will benefit from critical care (beneficence) and second, if he wants critical care (autonomy). When deliberating beneficence, physicians should steer away from solely using age-stratified survival probabilities from epidemiological data. Instead, decisions must be based on individualised risk-stratification that encompasses evidence-based predictors of adverse outcomes specific to older adults. Survival will also need to be weighed against burden of treatment, as well as longer term functional deficits and quality-of-life. By identifying the robust older people who may benefit from critical care, clinicians should proceed to elicit his values and preferences that would determine the treatment most aligned with his best interest. During these dialogues, physicians must truthfully convey the emergent clinical reality, discern the older person's therapeutic goals and discuss the feasibility of achieving them. Given that COVID-19 is here to stay, these conversations aimed at achieving goal-cordant care must become a new clinical norm.

Mount Sinai NY Surgeon on the Front Lines of the COVID-19 Pandemic in Brooklyn, NY, USA.

A surgeon was among the teams caring for critically-ill patients with COVID-19 infection during the height of the pandemic in March and April 2020 in Brooklyn. He recorded his experiences and thoughts as events unfolded, a chronicle of the landmark public health event of the century. Working to exhaustion alongside his colleagues from Mount Sinai Hospital, he encountered tragedy and inspiration.