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Boris Johnson responds to treatment and remains stable in intensive care

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Via Financial Times

Boris Johnson is “responding to treatment” and remains “clinically stable” in intensive care, a spokesperson for the UK prime minister said on Wednesday.

Mr Johnson is in “good spirits” during his treatment for persistent coronavirus symptoms at St Thomas’ Hospital in London, Downing Street said. He is receiving “standard oxygen treatment and breathing without any other assistance”.

While Mr Johnson continues to receive treatment, the latest figures for the UK showed that 7,097 patients had died in hospital after testing positive for coronavirus in the UK as of 5pm on Tuesday, up by 938 from 6,159 the day before — its biggest daily increase so far.

The prime minister has been in hospital since Sunday evening and was moved to intensive care on Monday as his condition worsened. He has not been diagnosed with pneumonia, nor has he been put on a ventilator.

His spokesperson declined to say whether symptoms of a high temperature and cough had subsided, or whether the PM had taken trial drugs to combat coronavirus.

Mr Johnson is “not working” at present but “has the ability to contact those he needs to”, Number 10 said. In his absence, foreign secretary Dominic Raab is deputising where necessary. Mr Johnson will “continue to follow the advice of his medical team” on what he can do.

As he embarked on his third day in intensive care, doctors warned of a long recovery ahead. Alison Pittard, the dean of the Faculty of Intensive Care Medicine and a practising intensive care doctor at Leeds General Infirmary warned that a full recovery from intensive care treatment can often take 12 to 18 months.

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However, patients could be expected to return to work long before making a “full” recovery that sees them able to endure exactly the same workloads and exercise regimes that they had usually maintained before going into intensive care.

She confirmed that a patient who had spent seven days in intensive care could “on average” expect to return to work within seven weeks, but that in some patients it might be half that time. 

That said, defining “recovery” was important, and that full recovery — where a patient is back to their normal life — takes much longer. Dr Pittard warned that Mr Johnson could experience a “dip” in morale after his initial recovery was complete.

“I’ll see patients in my clinic six months after discharge from ICU, and when they were first sent home, they have had quite a rapid improvement in their physical state, measurable on a daily basis,” she explained.

“This encourages you to get better, but then at about six months that recovery plateaus and it’s more difficult to see that improvement, and patients get a bit low at this point.”

Making hard predictions for Covid-19 patients was impossible, she added, given how little data were available about patients recuperating from severe bouts of the disease.

“People are behaving very, very differently when they have Covid-19,” she said. “Some need a bit of oxygen, and are fine. Others deteriorate very rapidly and we can’t predict who will deteriorate and go on a ventilator.”

Early data from the Intensive Care National Audit & Research Centre have shown that only 32.7 per cent of ICU patients given invasive ventilation leave the unit alive, compared to 83.8 per cent of those, like Mr Johnson, who receive ‘basic’ ventilation.

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On the negative side, Covid-19 is causing patients to experience greater complications, including blood clotting and kidney problems, than for patients who go into intensive care as a result of viral pneumonia caused by standard flu.

“The chances are, if you have Covid-19 compared to a flu virus, you are going to stay in ICU longer than with a normal flu virus, and chances are it will take you longer to recover,” Dr Pittard added.

“What has become apparent over time is that the way that the body responds to this virus is different from the way it responds to a normal flu virus.

“So we are seeing abnormalities in clotting systems, and clots in blood vessels that supply the lungs, and that’s why we think patients have such depleted oxygen levels, and this isn’t something that we normally see.”

Other recovery variables include the psychological impact on patients, Dr Pittard said, with some patients suffering a form of post-traumatic stress disorder (PTSD) as a result of their experience on an intensive care ward.

Editor’s note

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“There is a big psychological element to having been critically ill. Some get a PTSD-type picture, and this group of patients get home and just because they have been involved in unusual situation need special support,” she explained.

But she concluded that Mr Johnson’s stressful job would not necessarily impede his recovery.

“Stress is relative. I am an intensive care consultant and people often say ‘I couldn’t do your job’, but for me it is what I’m trained to do. I don’t find it stressful. For some people that ‘stressful job’ can actually be their comfort zone.”

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