Sepsis and COVID-19: Some ethical considerations in an African ICU

ABSTRACT

Background Sepsis (S) is one of the most important reason to be admitted in ICU in Malawi. ICU is a precious ressource in developing countries. The Covid (C) pan-demic added pressure on us. In this country (<1 anaesthetist per 2.5 mio) ICUbeds are allocated with clinical officers (Cos) and medical assistants (Mas). Not much is known about the non-physicians ethical convictions. In Queens Hospital we tried to find a basis for decisions. Object To enhance our knowledge about the rel. weight of sepsis (S), C. and non-septic diseases for our 19 COs and MAs and to compare it with our future doctors, (34 fourth year medical students [MS]. Methods A questionnaire (Q) presents 17 existing patients in critical care was given to 19 Cos/Mas and 34 MS. All 17 were needed ventilation. Reasons Covid (twice), sleeping sick-ness, haemorragic shock after cesarean section (CS), malaria, tetanus, Guillain-Barre-Syndrome, rabies, traumatic brain injury (TBI), measles, typhoid fever, Tb, bowel resection, PCP with HIV, bact. pneumonia, meningitis and polytrauma. Pat. were devided in 7 groups. Group 1 Patients suffering from S or very much prone to develop S. G. 2 Covid patients. G 3 Groups 1 plus 2 (Covid as S) G 4 S. after an infection. G 5 S. after a non-infect. disease. G 6 Pneumonia (main culprit for sepsis), G 7 Patients, not likely to develop S.The CO and MAs ranked them for ICU admission. First to be admitted got 1 point, the last 17 points. Lowest scoring one admitted first. Results 53 Q were filled out, representing 66.6 % of the colleagues. CO &Ma Group1 8.58 points, G2 11.55 p, G3 9.24 p, G4 9.6 p, G5 6.44 p, G6 10.04 p, G7 8.13 p Med. stud. Group1 9.77 points, G2 7.47 p, G3 9.26 p, G4 10 p, G5 6.59 p, G6 9.48 p, G7 8.71 p. Overall Group 1 9.34 points, G2 8.93 p, G3 9.25 p, G4 9.88 p, G5 6.54 p, G6 9.68 p, G7 8.50 p.The most important admission for CO/MAs were 1. CS (2.16 points), 2. TBI (4.68 p.), 3. Malaria (7.05 p.). The least important Last Covid (12.37 p.), 2nd last Rabies, (12.1 p.);Second Covid pa tient shared 3rd last with a PCP patient who was HIV+ (10.74 p.). For our MS 1. Polytrauma (4.56 points), 2. TBI (5.0 p.). 3. Malaria (10.26 p.). LeastRabies (13.85 p.), 2nd last Bact. Pneumonia (13.21 p.), 3rd last Covid (12.59 p.). verall 1st admission is TBI, 2. CS, 3. Malaria. Least important Rabies. Gender did only play a minor role as criterion for ICU admin.MS. admitted male patients 1 place earlier, COs and MAs it made no diff. Conclusion S. after non-infect. is more important than S. to infections or C. This is the difference between MS and our non-academics. Mothers and TBI scoredhigher than infect. &plain S.