Different Experiences in ICU Flow through Optimization in COVID-19: Academic U.S. Center/Community Hospital U.S. Center/Academic Center in East Africa

In response to the Sars-CoV-2 pandemic in 2019, hospitals globally were affected by a rapid influx of infected patients. Many of these patients were critically ill and deteriorating. Acute respiratory failure was a distinct characteristic of the infection, often causing rapid decompensation. Patients required prolonged stay in hospitals and utilization of critical care services, which quickly depleted. Hospitals struggled due to a lack of time for preparedness and limited resources. Novel methods and restructuring occurred at all levels in the health care systems to make the best use of available supplies and increase efficiency. Importance was given to controlling the infection, increasing hospital and ICU bed availability, and increasing primary and support staffing. Major changes were seen in the utilization of ventilators and oxygen support devices which were critical to the respiratory failure observed in massive numbers. Contact and airborne isolation had a major impact on patients and families due to deviation from routine levels of support and interaction. Research on patient treatment, outcomes, and vaccinations made rapid progress. This chapter describes the adaptations, considerations, and rapid transformation that helped different types of hospitals cope with the pandemic.