Saturday, March 28, 2020

One Doctor's Clinical Perspective

From Vox Populi:
I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know. Clinical course is predictable. 2-11 days after exposure (day 5 on average) flu-like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue. Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma. 
Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours. 81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical. Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. 
Somehow this ***** has told all other disease processes to get out of town. China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails. (Read more.)

From RealClearPolitics:
Please for the reassurance of people around the world, to wake up this morning and look at people talking about creating DNR situations, Do Not Resuscitate situations for patients, there is no situation in the United States right now that warrants that kind of discussion. You can be thinking about it in the hospital. Certainly, hospitals talk about this on a daily basis, but to say that to the American people and make the implication that when they need a hospital bed it's not going to be there or a ventilator, it's not going to be there, we don't have evidence of that.

It's our job collectively to assure the American people, it's our job to make sure that doesn't happen. You can see the cases are concentrated in highly urban areas and there are other parts of the states that have lots of ventilators and other parts of New York state that don't have any infected. We can meet the needs by being responsive.

There is no model right now -- no reality on the ground where we can see that 60% to 70% of Americans are going to get infected in the next eight to 12 weeks. I want to be clear about that. We are adapting to the reality on the ground and looking at the models of how they can inform but learning from South Korea and Italy and from Spain and I know you will look up my numbers. (Read more.)
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