The critical care unit, popularly known as the intensive care unit (ICU), is a section of a hospital where special medical equipment and services are provided for patients who are seriously ill. Patients in the ICU are usually suffering from severe and or life threatening conditions and requires continuous and constant care, monitoring of haemodynamic status and adjusting monitoring devices where necessary.

Covid-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While most people will be asymptomatic or with mild to moderate symptoms, others may experience severe disease and consequently ICU admission and treatment. The respiratory compromise lends these patients on mechanical ventilators or life support machines, in a medically induced coma with indwelling treatment and monitoring devices. Additionally, about one in every six patients will have life threatening complications that may be caused by a condition known as cytokine release syndrome or a cytokine storm. Once these cytokines are released into the bloodstream they can kill the tissues and organs including the heart, lungs and kidneys, which may then complicate the treatment in ICU, reducing the chances of recovery and prolong the length of ICU stay.

Nursing a patient in ICU is one of the most stressful yet rewarding experiences. It is difficult to step foot in an ICU without feeling the pain and suffering held within its walls. It is very hard to suppress existential questions in such proximity to death. Despite encountering, the 12 hour long shifts with delayed lunch and sometimes no coffee breaks, constantly beeping devices and alarms. 

So far, Namibia only has one patient who is diagnosed with Covid-19 in the ICU. To reduce their exposure risk, nurses try to combine patient care tasks to minimize the number of times they must enter the room. They have to don and doff PPE carefully, following a specific protocol, to avoid contaminating themselves or their PPE during the process. Adding to the burden of care is the discomfort of spending hours at a time in an isolation room in full PPE: one or more gowns or coveralls, head coverings, masks, goggles, gloves, shoe covers, and face shields. It’s hard to hear, and unbearably hot. Family members are not allowed to visit this patient, so they depend on updates from the ICU staff. Although we are trained to have an outer facade of calm, working in ICU during this pandemic seems difficult. Currently there are enough ventilators and structures in place but if the pandemic is not contained, ICUs may not have the capacity to handle the crisis. We hope that there are enough qualified staff to work, train and serve the nation when push comes to shove.

 The worst nightmare is having insufficient workforce, supplies, medication and equipment to meet the patient’s needs. In addition to the Covid-19 patients, we will have our typical ICU patients with pneumonia, those that came from long and complicated surgeries, MVA polytrauma patients to care for.  Whether or not that will come to fruition is tough to predict. Regrettably, intensive care is a specialty used to these decisions. We often only have seconds to do things. We have to think on our feet and work around the clock anyway. 

We appreciate that everyone who works in a hospital is a mom, dad, daughter, brother or son. We try to give everything to saving lives, work and care, but equally we are thinking about the logistics of our personal lives, our safety from this deadly virus and our elderly relatives. As the fight against Covid-19 wages on, we as specialized healthcare workers are ready to take on the fight on the frontline to promote and safeguard the wellbeing of our patients, their families and the community at large. Furthermore, it is a collective responsibility of every Namibian to take standard precautions and prevention measures put in place to curb the spread of coronavirus and avoid covid-19 related ICU admissions and deaths.

*Edith Hamukwaya is an ICU registered nurse specialist, who is currently a lecturer and researcher at the University of Namibia.