As a specialist in maternal-fetal medicine at UAB Hospital, Dr. Akila Subramaniam some of the most complicated pregnancies in Alabama and parts of the surrounding four states. She has never seen anything like it.
The 1,157-bed hospital has already admitted 39 pregnant women with COVID-19 so far this month. Ten of them are in the intensive care unit and seven are on ventilators due to the disease. In a typical week, Subramaniam told The Daily Beast that the number of pregnant women at the ICU would be one or two.
As of this week, there were no more ICU beds available in Alabama for patients, pregnant or not. The state health department has asked the federal government for staff and other resources, and Gov. Kay Ivey has reinstated a state of emergency. Yet more than half of the state’s population is unvaccinated.
Dr. Subramaniam told The Daily Beast about what it is like to care for pregnant patients under these conditions. Her interview is edited and condensed for the sake of clarity.
“As doctors, we talk about who is a white cloud and who is a black cloud – which means that some people tend to have worse luck in terms of how things roll and some people never look to have complicated patients in their service. I tend to be more on the darker side of things, for whatever reason. And I’ve never had so many [patients] on the ICU at once. ”
“We did not have very large increases left in the summer of 2020 – not like other people saw during the winter of 2020, the beginning of 2021. We wanted an occasional patient in the unit, maybe one, maybe two, but we never saw this number…. That kind of shift in this new wave, which is mostly attributed to the Delta variant. If you look at what [we saw in] March to June it was a manageable level of things. And so began in late July, when we began to see an increase in cases and how much serious illness we see. ”
“Our share of people doing okay and surviving is really pretty good, considering our numbers and resources and all that stuff. But that’s not good enough, because we do not have any ICU beds. I just heard today that they kept trying to get someone flown here from [Florida] handle. They could not get her here and she died because there is no bed to bring her to. It would not happen in a normal given state. ”
“It’s a little more challenging where we ultimately have to deal with two patients as opposed to one, and what we do for one can hurt the other … The majority of patients want everything to be done for the child, but it’s really hard when you know that some of the things that have been done for the baby are really putting the mother’s life in danger. ”
“It’s really hard to talk to a patient who’s in high flow, nasal cannula, struggling to breathe and asking them, ‘Well, what do you want us to do when they put this tube down your throat? ? Do you want us to do a C-section to potentially save your baby? It could end up hurting you, you might die … Are we focusing on you? Do we focus on the baby? ‘”
“Often these women are intubated. So we get consent, either before they have the tube put in their throat, or from a partner, or we do it going forward with two doctors. I can not imagine how scary it must be to suddenly wake up and know that you had a baby and you had no understanding of what it was like. It sounds scary, but it’s what’s happening. ”
“Even for us who are used to seeing maybe 30 patients in one day, and now see 30 plus 10 at the ICU, it is a challenge. It’s mentally taxing, it’s physically taxing. When you see 40 patients in one day, you are not giving each patient the same amount of time as if you saw 30 or 20. You just are not. Women continue to work, women continue to have supplies, and all of this continues to happen. We are really facing a lack of resources and we are doing fine and we are doing it, but there is a breaking point. ”
“If you were to talk about how pregnant women are, we should talk about vaccinated pregnant women, and then we should talk about unvaccinated pregnant women differently … What we see, at least in our [patients] that’s in our ICU and in [patients] there are on our work floors that need extra oxygen, they are unvaccinated. We do not have a single patient [in the ICU] who have completed the vaccination series. ”
“All I can say is get vaccinated … I’m not saying you can not get COVID, I’m not saying you can not give your friends COVID, but hopefully it will keep you away from an ICU. “
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