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It is been a week since my last post on the coronavirus situation. At least here in my corner of Northeastern Pennsylvania, things are still relatively mellow. We have had a fairly rapid uptick in diagnosed COVID 19 cases in my state and my county. Currently, at our hospital, there are only two patients that are known to be positive. Happily, both are doing well. Elsewhere in the community, sadly, 2 patients have died.
I think there is a struggle in hospitals to maintain “social distancing” during the workday. Medical care, obviously, revolves around individual patients, and health caregivers tend to work in close proximity. I myself can breeze in and out of a patient’s room on my rounds, but the nurses and therapists have to be in and out for the whole shift. I cannot convey the dedication this requires.
Though I’ve seen some patients in isolation, to my knowledge I’ve seen no one that is tested positive for the virus. I’m sure that won’t last.
There has been a lot of talk about putting multiple patients on one mechanical ventilator. This concept got a lot more traction than I ever would’ve considered. Somebody has even been touting a 3D printed adapter to enable this.
Those of us who know something about this topic would roll our eyes when it was mentioned. This is because it is wildly impractical. Happily, I read today that the Society of Critical Care Medicine, among other organizations, has put the kibosh to this.
The fact that this was discussed, should be a clue that there is a lot of nonsense out there about this virus. Some of this is amplified by social media, and by the press who are desperate to “out scoop” one another.
Meanwhile, I continue to teach my fellow caregivers how to mechanically ventilate patients with the respiratory physiology seen in coronavirus patients. Physicians in particular in this day and age, are very uncomfortable providing services to patients for problems even slightly out of their skill set. This is not always a bad thing. For many of these practitioners, mechanical ventilation is way outside their current comfort zone. Most of the physicians that I instruct are not far from my age, and thus at increased risk of complications from coronavirus infection. Nonetheless, I see a grim determination among my colleagues, and a genuine interest absorbing what I am attempting to convey. If push comes to shove, I think these fine people will respond to the best of their abilities.
There continues to be a steady dribble of positive information on the topic of potential treatments including hydroxychloroquine/azithromycin, and remdesivir. The sad truth is that in the midst of the outbreak, there will never be adequate data obtained at a level traditionally required by the medical community to prove or disprove the efficacy of these treatments.
Also being discussed is the concept of harvesting antibodies from the convalescent serum of recovered patients. This is somewhat of an age-old concept rendered obsolete historically by vaccines and antimicrobial therapy. I wonder why I don’t hear more efforts in that direction as I suspect it would work. Despite the gloom and doom, the survival rate for this coronavirus is still pretty high. There will be plenty of recovered patients to provide antibodies for those at risk.
I do hope that enough of the hydroxychloroquine/azithromycin stores are freed up, that they can be used on patients early in their course. I fear that the current concept of reserving the drugs for patients in the ICU, and in the throes of the systemic immune response syndrome (which is pretty much what kills these patients) will be too late for this viral suppression therapy to be effective.
As it stands now in Northeastern Pennsylvania, we wait. We read about our fellow caregivers, in New York and elsewhere where the virus is rampant and we pray for them. We shall see what comes.
Hopefully, we will be up to the challenge.