One of my buddies is an MD and has been treating Coronavirus patients for the last 72 hours. He sent out an email sharing his experience. I figure I'd share here.
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Hey everyone,
I thought I would write this to shed some light on my own experience with Coronavirus over the last 72 hours in my ER. Currently I work in White plains and I was supposed to start a new position in their observation unit March 1st ( this is basically a urgent care) within the ER but they asked me if would volunteer for their "COVID" station and without hesitation I agreed.
First of all it has been affecting all ages except people under 17 years old and the sickest patients that I have seen have been females from 20 - 40 years old with no previous medical history.
The contagiousness of a disease is recorded by something called an R value. Currently the R value of coronavirus is a 2 to 4 meaning its on the same wavelength as the FLU. Just because you have been in direct contact with someone or even sleep next to someone does not mean that you are going to acquire it. It is spread through something called droplet meaning that a regular mask will help but you need something called an N - 95 mask which lets smaller particles through for true protection. If you really want pure protection you need a PAPR( powered air purifying respirator) which is something that I wear when evaluating patients
The virulence of the disease has been interesting to me. I have sent home multiple people with just mild cough and body aches. The persons who have been really sick have been presenting more with abdominal pain . Temperature has not really been indicative of COVID 19. Their are 2 main things I am seeing on lab values that are correlating with worse morbidity and that is lymphopenia and elevated liver functions primarily AST and alk phos. ( going back to above probably related to the abdominal pain.)
The course of the disease is also very indolent until day 3 - 5 where a very small amount of patients are presenting with ARDS ( acute respiratory distress syndrome) this is a fancy word for meaning patients lungs are filling up with fluid due to something called interstitial capillary leak. We have intubated a handful of healthy young individuals due to this progression. We have not had any deaths at our hospital yet however we have needed the help of positive airway pressure these are those masks that people wear called BIPAP ( very similar to the CPAP masks that you use for sleep apnea. ) If you continue to need more airway pressure then you have to be intubated and may require something called ECMO ( extra corporal membrane oxygenation : fancy word for a lung machine.) It basically bypasses your lungs and breathes for you. We have had only 1 case over the last weekend requiring this.
Overall in a 72 hour period of seeing coronavirus patients the majority of them are coming in complaining of cough / malaise ( not feeling well). Few have been healthy young adults requiring intubation.
The things we have found out about treating these patients is that NOT giving IV fluids is key ( this is something that goes against every principle about acute care medicine ) . Also some medications that have been helping are antivirals ( ketruda ) something we use for AIDS and also hydroxychloroquine something we use for rheumatological disease like arthritis. Steroids do not seem to help so far from what I have observed.
Overall I have been asked a million questions and I made a small Q and A here :
Can children get it?
I have seen zero people under the age of 17 with coronavirus. I believe this is because the virus likes to attack mature lymphocytes which are not yet competent in children so they are not being affected.
Is the virus only affecting the elderly?
Definitely not. The sickest patients at our hospital have been young healthy women from the ages of 20 - 40
Is there medications to combat this?
no there are none currently that a proven effective however we are using 2 medications which may help. Chloroquine helps to block viral entry into the cells. Keytruda is something called a protease inhibitor used in HIV / AIDS patients to help stop the replication of the virus.
What are the most typical symptoms?
Cough and fever. There have been multiple presentations of the disease so it is hard to diagnose just by physical exam.
Can you get tested for it? and should you get tested for it?
Yes you can get tested for it. I have tested over 50 people the last 3 days and the turnaround time was about 2 days however this will be prolonged with more tests being taken. However testing does not change your overall outcome of the disease. If you are experiencing significant signs of shortness of breath we will admit you to the hospital. If you are experiencing typical flu like symptoms the smartest thing is to remain at home and try and ride it out.
What is the mortality rate?
Its impossible to determine because we cannot accurately say how many people have the disease since most are walking around asymptomatic. However you can calculate the case fatality rate which is 3.4 % from multiple sources I have read
Will hospitals be able to handle this?
yes. for now. My hospital has done a great job of creating negative pressure beds which helps stop the spread of the virus and they have given us the highest level of protective gear. They have moved out as many patients as possible to gear up for this upcoming week.
Is there a vaccine for it?
No. Vaccines take a while for virus'
Is the Quarantine necessary ?
Yes for now. This helps hospitals not be overwhelmed especially if we need ventilators / ECMO machines to help those in real need.
How long is the quarantine?
We are mandating 2 weeks
I have included a great
one page summary of Coronavirus that was forwarded to me from a friend who is currently working at an ICU in Seattle. Overall I believe the government did the right thing of shutting everything down so we could get a hold of this thing and understand its true potential. Only time will tell to see how this virus truly behaves over the next week. I hope this was insightful for those who have been worried. As of right now I am not that concerned about it but this may change... I have only been dealing with this disease for 72 hours.
Stay safe everyone I hope this helps from my own personal experience. Feel free to share this with friends if it helps put them at ease. Also if anyone has any questions feel free to ask
xxx xxxxxx MD
Every health care professional who is on the front lines of this thing deserve a ton of respect and applause. Stay safe everyone.