Covid Virus Challenges of Sub Clinical Infections

The New England Journal of Medicine (NEJM) reported a letter to the editor today (April 6, 2020) from scientists in South Korea describing the challenges of dealing with early infection in patients who do not show symptoms.

Remember that South Korea started testing patients very early and tracking patients they tested. The first confirmed case of Corona Covid-19 was on January 20, 2020.  They started testing people who had traveled and by Feb 10 there were 28 cases of laboratory confirmed Covid Virus ranging in age from 21 to 73.  Only twenty of the patients developed early symptoms and only 8 of the 20 started with a fever.  Some patients reported severe sore throat and some had only a mild cough.

They were able to track all of these patients who had recently traveled and see how they transmitted the virus.  Patient 3, who had no symptoms, transmitted the virus infection to Patient 6, who in turn transmitted it to patients, 10,11 and 21. Patient 12 contracted the virus during a stay…

Will Telemedicine Be The New Normal

The technology for telemedicine (video visits with your doctor) has been around for decades. Sutter Health was the first hospital system in the West to install the electronic ICU (eICU) where critical care physicians and nurses could do remote video monitoring of all patients in ICU beds and jump on problems before they became serious (drop in blood pressure, restless patients, changes on oxygen, or other critical markers).  We have wearable technology for patients to transmit their blood glucose levels, EKGs and even sonograms but despite the technology and hype, none of this has been adopted on a wide scale.

So why has it taken so long for patients and doctors to adopt this technology and use it every day instead of relying on last century visits to the doctors office?  Why does a patient in a rural community need to drive for hours and wait months to see a specialist in a big city?

The Corona Covid-19 Virus will revolutionize telemedicine and I don't see us ever going back.


Ventilators and Corona Covid-19

We are hearing about the need for ventilators during this Corona Covid-19 surge time so thought I’d explain how ventilators work in this crisis and why there is such a demand. It’s important to remember that the Covid-19 virus has no treatment. When a patient is admitted to the hospital we provide supportive care. That means we help the patient stay alive long enough for their own immune system to mount a defense and eradicate the virus.

Supportive care is provided by intense nursing with IV fluids, oxygen, anti-fever drugs, blood pressure support, anti-blood clot drugs and close monitoring for decompensation. Covid patients decompensate (get worse) very quickly and can develop a condition called ARDS (acute respiratory distress syndrome). This is a life-threatening pneumonia where fluid leaks into the lungs and does not allow the alveoli (pulmonary cells) to exchange air.

When patients go downhill and their blood oxygen saturation (O2 sat) falls, they will need mechanical ventilatio…

PPE Is A Massive Problem

I was shocked to receive an email from a friend today with a story that sent chills down my spine.
Everyone knows there has been a shortage of PPE (personal protective equipment) that puts health providers at risk of contracting the contagious Corona Covid-19 virus.  Yesterday (April 2) at the White House briefing it was reported that 200,000 N-95 masks were sent to New York and millions of masks and other PPE will be sent across the nation.   When I received this email, I realized that response is totally inadequate.  The doctor referred to in this email is being kept completely anonymous because he fears his position as a resident would be impacted if the hospital or identifying information were known.

Considering the recent firing of U.S Navy Captain Crozier after he asked for help for his stricken men, this doctor is not being paranoid to want anonymity.

Read this plea and then ask yourself if we are doing enough.

"Dear Toni,
My brother is on the front line in _____________…

Covid Test Negative? Not So Fast

Now that we are expanding testing for Corona Covid-19 Virus, many patients are confused when they feel sick but get a negative test result.  They have all the signs of Covid infection with fever, cough and malaise but the test came back negative.  The Washington Post reported on a woman who was hospitalized with presumed Covid pneumonia but her test was repeatedly negative.  What is going on?
Every clinical test we use in science and medicine has a sensitivity and a specificity.  This tells us how good the test is in diagnosing who has the disease (true positive) and how many people with the disease we missed (false negative).  Doctors know that tests with high sensitivity are pretty good at giving us accurate results for Covid-19 to show us the patients who have the virus. 
With the Covid Virus we have many many tests that are being used and each of them, depending upon how they are testing and how they were developed in the Petri dish, have different values.  None of these tests we…

Life In The Hot Zone

This Cartoon was created by Alex Thomas, MD for the Annals of Internal Medicine.  It shows what many physicians are experiencing as the CDC and hospital organizations change the protocols on a daily basis to deal with the Corona Covid-19 Virus pandemic.  Doctors feel like they are human fodder.  (click on the image to see it larger)

Hydroxychloroquine and Covid-19

Thanks to a shout out by President Trump that Hydroxychloroquine would be a "game changer", this drug is all over TV and web as the possible treatment for Corona Covid-19.  Because this virus HAS NO KNOWN TREATMENT,  the FDA is fast-tracking pharmaceuticals and vaccines.  There are at least 22 known studies ongoing to test the effectiveness in humans and Corona Covid-19.  Here's what we know (today, March 28, 2020) about Hydroxychloroquine:

As a drug used to treat rheumatoid arthritis and lupus, Hydroxychloroquine works in a complex manner on cells and proteins to down regulate the immune response.It is also used to treat uncomplicated plasmodium malaria but is not effective against all malaria strains.The brand name for rheumatology use is Plaquenil and it can be found in the urine three months after taking.  It has a very long half life.The Journal of Antimicrobial Agents reported astudy of 26 patients receiving Hydroxychloroquine. Six patients were lost to follow up, …