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COVID Crisis Post 30: The Nightmare Continues.


Spring has definitely arrived in New York City.


The last couple of days, I have made it a point to get some fresh air in Central Park. Because I have needed it.


I have been wearing a mask and practicing more extreme social distancing since runners and bikers could possibly be spreading virus unknowingly at distances greater than 6 feet.

But let me tell you: the air is FRESH. It smells so clean, the smell of cherry blossoms wafts throughout the air. It is easy to get lost in the beauty and tranquility of the park. But the sobering reality we still deal with cannot be escaped.


Because the stench of death still lingers and is not going away anytime soon.


10,367 - the official death count of New York... CITY. As of last night. And ugh, that's depressing.


An additional 4000 deaths were added due to "probable" COVID-19 deaths that were not initially included in the death toll, both in-hospital and at home. I knew this number was going to increase once the probables were included in the death toll, but still, seeing the numbers in print is still shocking.


Admissions are decreasing across the city, but that does not change the fact that people are continuing to die.


And the sad thing is, we do not know if we are getting better at preventing death or are just getting better at PROLONGING death.


We are seeing some success in transitioning people off the ventilators, though still only a small fraction of all our ICU patients. And we still do not know how successful these transitions will be, nor what the long-term detrimental effects this virus will have on these patients health.


And we also still are not paying the level of attention we need to regarding asymptomatic carriers. What I am about to say is anecdotal so please do not take this as fact.


All patients are being tested for COVID-19 prior to any urgent or emergent procedure (if possible). And MANY are testing positive while being totally asymptomatic. The disease prevalence is likely MUCH higher than we are appreciating, and the risk of spread is still great. We must continue to practice social distancing until we get a better handle of things; the idea of reopening by May 1st is completely asinine.


And even without the concern for opening up businesses too early, admissions may start going up all over the city and country.


Easter services just completed this past weekend, and I believe there is going to be an additional surge of COVID-19 cases as a result. There are still numerous religious organizations, including here in NYC, who continue to congregate in outright defiance of stay-at-home orders. One argument used is the stay-at-home order denies their 1st amendment rights under the Constitution, but again this is where the freedom we are blessed to have also can directly endanger so many lives as well.


Irrespective of what may be coming, we have made changes in regards to how we manage new patients who present with respiratory distress.


One example: we have increased our threshold for intubating patients. This has become more prevalent at a number of hospitals across the city. Early on, if someone was struggling to breathe, the typical response would be to intubate and ventilate to support those patients. But as this disease has progressed, we are now trying everything possible to avoid intubation because we know that once a patient is intubated, their outcomes tend to be poorer. So here is to hoping we can even save one additional life by doing so.


One way to avoid intubation would be finding methods to help improve oxygenation of patients without a ventilator. Currently, many hospitals are using high-flow nasal cannula and 100% nonrebreathing masks to do so. And there has been concern about increasing spread of COVID-19 versus the benefit of using traditional noninvasive ventilation, such as CPAP/BiPAP.


However, the University of Chicago may be providing a model for the rest of the country to follow.


My former medical school classmate Bhakti Patel, a pulmonary critical care doctor at the University of Chicago, has taken the lead in the US utilizing "helmet" noninvasive ventilators that has shown some success in keeping patients off of ventilators. I have mentioned these helmet ventilators to some of my colleagues in New York, and they look extremely promising:


Clearly, anyone who comes out of the University of Michigan is a leader. And best. I have not seen anyone from Ohio State doing anything in particular to aid during this crisis. Not. Shocking.


Our knowledge of the virus continues to change and mutate, which is something we hope the virus itself does not do - at least minimally so. There is so much hope being placed into antibody testing, yet we STILL do not know for sure whether herd immunity can truly be achieved or if the antibody tests on the market EVEN WORK.


The FDA, who initially allowed restrictions to loosen regarding production of antibody tests, have now tightened up those restrictions once again. And the reason for this is because many of these tests may not even be accurate. If these tests create a bunch of false positives or false negatives, then being armed with inaccurate information is even more dangerous than having no knowledge of antibody status.


One study coming out of China (non-peer reviewed, and I take any information coming out of China with a million grains of salt) showed a number of people who were hospitalized with mild symptomatic disease had low-levels or even UNDETECTABLE levels of antibodies against COVID-19:


What does this mean? Who knows. We do not know if this means they could have been possible false positives (those with undetectable levels) or if they just did not mount a sufficient immune response. In addition, if they didn't mount a sufficient immune response, how the heck did they beat the virus in the first place? Does this mean they are at increased risk of reinfection? There are still so many unanswered questions.


A vaccine is still probably our best bet to protect ourselves, but this information, if true, sobers its prospects a bit.


It would be nice to be able to have a moment where COVID-19 does not premeate every facet of my life. I thought the park could be that escape, but it was fleeting. Or maybe, escape could be possible in a dream.


But instead I had a very vivid dream last night where I was infected with COVID-19 but only with mild symptoms, the most severe of which was a temperature of 103.3 - and no, I have NO idea why that number stuck in my head. And I even had a moment WITHIN my dream where I questioned if I had just dreamt I had been infected, but I did, in fact, actually have the disease.


So you can imagine my immense confusion when I woke up this morning.


So yeah, this needs to end. And I look forward to the night when the nightmare of COVID-19 only exists in my memories, and not in reality... assuming that night even exists.


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