The New York Times

The New York Times 14 Apr 2020

Doctors Face Troubling Question: Are They Treating Coronavirus Correctly?


Doctors say the coronavirus is challenging core tenets of medicine, leading some to abandon long-established ventilator protocols for certain patients. But other doctors warn this could be dangerous.

Stuart Ramsay visits a hospital in Naples that is employing advanced technology to protect healthcare workers from the #coronavirus.

No staff members have been infected thanks to gas masks, waterproof suits and strict barriers between areas.

Scientists are also working hard to find out whether people are immune to COVID-19 once they've already had it.

In the age of COVID-19, hospitals could face a worst-case scenario that forces doctors to decide who to treat if life-saving supplies are limited. Among those most vulnerable are patients with pre-existing conditions who may be excluded from care.
One reason the deadly coronavirus has spread so quickly is due to the lack of prior knowledge about the disease and how it spreads. In the absence of facts, many conspiracy theories popped up to explain the world's current chaotic state of affairs. Some of these conspiracies are downright strange - and they're having weird real-world effects. Just ask the owner of the 5G cell tower in the Netherlands that an extremist set on fire because they believed it was spreading COVID-19 via radio waves.
One serious and unintended consequence of the coronavirus is the severe toll it's taking on mental health. In the U.S., 1 in 5 adults suffer the effects of mental illness each year, but less than half receive treatment. The President and CEO of Mental Health America, Paul Gionfriddo, joins Stephanie Ruhle to discuss how the virus is causing more depression and anxiety across this country and potentially fueling a mental health crisis. Aired on 5/13/2020.

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“This disease has challenged everything
that we believed was right six weeks ago.”
“It’s different than anything we’ve seen before,
and maybe the way we’ve taken care of things
is not the right way of doing it.”
“There is a lively and healthy debate,
that I think is a good debate, about what the right thing
to do here is.”
“I’m concerned that if we continue on the path
that we’re on, that hundreds of thousands of lives
and lungs may be at risk.”
“It’s actually kind of vital that we not
deviate from those treatment protocols
because we know that they reduce mortality.”
“Low oxygen levels.”
“They will tire out within a few hours.
So what’s your next step?”
“Before Covid-19, I would recommend putting you
on a breathing machine.”
“I would have rushed to intubate.”
“Because that was probably the right thing to do.”
“I know when to put in a breathing tube.
I’ve worked long enough, and I’ve worked enough places
with enough people.
But in this disease, it is extremely confusing, you know,
it just doesn’t make sense.
Listen, I stocked up for the apocalypse, like most people.
Now, I just can’t believe that I ever
thought that I’d somehow be home
to make all my frozen food.
On a normal day in an I.C.U., you have very sick patients.
Patients will — are dying, but this is just different.
It’s just — you have a disease we don’t understand
that is very deadly with patients that are scared
and staff that are scared, and on top of that,
it does not appear that we have a good treatment
strategy other than a ventilator.
And we don’t — we’re not sure when to put a breathing tube in.
The crux of it is, we don’t want to put a breathing tube
into someone who doesn’t need it
knowing that there’s a 70 percent chance they’ll die,
and then we don’t want to not put it into someone
who would need it too late.
When you go to the E.R., and there’s like
40 people that need oxygen, and they all
look terrible, but they can all talk to you.”
“And no apparent distress whatsoever.”
“And then you get them on a monitor, and you look up,
and you see this oxygen saturation
of 45 percent or 50 percent.”
“And telling myself this is impossible.
This is not possible.
How can this be?”
“It’s just not compatible with life
to have an oxygen saturation that low.”
“You know, this is strange.
It’s out of a horror movie.”
“I’ve been unable to sleep because I'm trying
to wrap my head around it.
This goes against anything I’ve ever believed.”
“The paradigm of ARDS is not matching with the patients
that I’m seeing, so it’s like trying
to fit a square peg into a round hole.”
“The core of the core of the core — it is just,
what disease are we treating?
And are we treating something that is naturally ARDS,
or are we not?”
“We protect the lung against what we do to the lung.
Protect it from what?
From what we do in mechanical ventilation.”
“So what he is saying is that we just have to be gentle.
People will need a ventilator, and those that do
need as high oxygen as possible, as little pressure
as possible, in order to buy time until this demon
virus stops.”
“These patients have ARDS.
I think the editorial has both been misinterpreted,
and I think people have misunderstood
that it’s just that.
It’s an editorial.
It’s not a study and it’s not a trial.
I don’t doubt that people have seen
some cases with some terrifyingly low oxygen numbers.
On average, they’re as sick as prior cohorts with ARDS.”
“I just think it’s important to say that it’s not
a settled question.
Every hospital in the world is probably
solving its problems slightly differently.”
“We’re using an early intubation strategy here,
and of our first 66 patients, already a third of them
have been extubated.
I’m arguing for evidence-based medicine, which is something
that we all purported to agree with before this outbreak hit.
We have large, randomized, controlled trials.
The patients in those trials had
met the same diagnostic criteria
that our current patients meet.
We should apply the results of the trials.”
“Today, we do not rush to intubate.
Intubate shouldn’t — has become the last resort,
and the protocol once they’re intubated
has changed drastically.”
“So within the last two weeks, I mean,
what has been unacceptable has become very acceptable.
Some of these patients don’t need to be intubated.
You watch them carefully.
You make sure their oxygenation is adequate,
and they can recover.”
“I am not saying we don’t need ventilators,
but perhaps we need to think about how we’re using them.
Somebody, and preferably people
that are not taking care of patients every day,
needs to look at the disease and figure out
how we can treat it better.”
“The truth will come out eventually.
In the meantime, the question is: What do we
do until that happens?
And yes, I’m nervous.
I’m scared everyday when I go into work,
but I’m just trying to do the best I can.”

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