Intensive Care Medicine, Editorial:
Published: 11
May 2021
Intensive care units (ICUs) worldwide continue to struggle
with the massive influx of patients with critical illness associated to coronavirus
disease 2019 (COVID-19). Their capacity is overwhelmed and there is clearly a
need to act to implement a crisis standard of care, in an attempt to mitigate
disparities in access to intensive care. The process of characterizing the
natural progression of a disease and the pathophysiological differences between
different categories of critically ill patients requires many years of in-depth
study. And even when such characterization is available to help us make
clinical judgments, we, as intensivists, continue to face challenges in
achieving consensus and implementing critical care guidelines. The COVID-19
pandemic has led to a complete change in the way we conduct research, interpret
results, and make recommendations. Over the past year, immediacy has become the
dominant theme, favored over quality.
One particularly important feature of the current emergency
has been the change we are seeing in the type of patients being admitted to
ICUs. At the start of the COVID-19 pandemic, reports indicated that the disease
mostly affected older adults and that young people were more likely to have
milder disease. At that time, we were warned that our main focus should be to
reduce infection and subsequent transmission to persons at higher risk of
severe illness. Over time, however, this global consensus started to change.
According to data from epidemiological teams at the Centers for Disease Control
and Prevention in the United States, people under the age of 30 accounted for
more than 20% of COVID-19 cases over the summer of 2020. This trend was
subsequently validated, as reported in a study from Brazil by Kurtz et al.
published in this issue of Intensive Care Medicine…
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