Coronavirus disease 2019 has posed a significant health care challenge globally, with intensive care unit (ICU) provision being of particular consequence [1]. In the UK, where ICU beds are already lower per head of population than in much of the rest of Europe [2], there has been a requirement to expand the ICU bed capacity rapidly in response. St George's Hospital is a 1000-bedded tertiary care hospital in South West London. From an initial ICU capacity of 60 beds spread over three purpose-built units, ICU beds expanded at peak surge in April 2020 to 83 COVID-19 beds and 13 non-COVID-19 beds (96 in total), involving additional space on two medical wards, a day unit and surgical theatres. Key differences to ICU provision during this time are summarized in Table I, and encompass changes in the environment, staffing and personal protective equipment (PPE), which combined to present a substantial infection control challenge. Patients had long average ICU stays over this period, with multiple central venous catheters (CVCs), and a high proportion of patients requiring additional access for renal replacement therapy.
There are few advances in our knowledge of the epidemiology of atypical pathogens or the effectiveness of antimicrobial therapy--empirical or pathogen specific. However, if molecular testing becomes widely implemented, there will be an increased understanding of the epidemiology and presentation of atypical pneumonia and a shift to more targeted antimicrobial therapy.
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