Critical care and pandemic preparedness and response

Abstract

Critical care was established partially in response to a polio epidemic in the 1950s. In the intervening 70 yr, several epidemics and pandemics have placed critical care and allied services under extreme pressure. Pandemics cause wholesale changes to accepted standards of practice, require reallocation and retargeting of resources and goals of care. In addition to clinical acumen, mounting an effective critical care response to a pandemic requires local, national, and international coordination in a diverse array of fields from research collaboration and governance to organisation of critical care networks and applied biomedical ethics in the eventuality of triage situations. This review provides an introduction to an array of topics that pertain to different states of pandemic acuity: interpandemic preparedness, alert, surge activity, recovery and relapse through the literature and experience of recent pandemics including COVID-19, H1N1, Ebola, and SARS.

Keywords: COVID-19; critical care; epidemic; influenza; pandemic; preparedness; surge.

Fig 1

Timeline of some notable pandemics and epidemics since 1918. AIDS, acquired immunodeficiency syndrome; HIV, human immunodeficiency virus.

Fig 2

Timeline of acuity with corresponding CRITCON pandemic stage.

Fig 3

Research planning schematic.

Fig 4

Intensive Care Society: CRITCON PANDEMIC Capacity management tiers.

Fig 5

Ways in which pandemics cause deviation from normal critical care practices. ECLS, extracorporeal life support; PPE, personal protective equipment.