What ICU doctors have learned about COVID-19

[REWahoo]

Here is a nice summary of some of the lessons doctors treating Covid 19 have learned since they first began to treat it.

Now, ... doctors have a better sense of which medicines and interventions to use or avoid, how the virus affects the body, and how to face their own COVID-19 fears.

https://www.nbcnews.com/health/heal...have-learned-about-covid-19-how-they-n1225801

 

[candrew]

Interesting article. Our eldest son is a nurse practitioner in the ICU at the Phoenix VA hospital. They've found with some of their COVID patients, merely turning them into a prone position (stomach and/or side) can not only delay the need for a ventilator, but in some cases eliminate it altogether.

 

[aiken]

Here is a nice summary of some of the lessons doctors treating Covid 19 have learned since they first began to treat it.



https://www.nbcnews.com/health/heal...have-learned-about-covid-19-how-they-n1225801

Most of the lessons seem to be what didn't work. Not much to be optimistic in terms of success stories.

 

[audreyh1]

I’ve read lots of other things that emergency doctors have learned about treatment that weren’t included in that article such as various supplements and blood thinners, but maybe those techniques kept them out of the ICU.

 

[gerntz]

Most of the lessons seem to be what didn't work. Not much to be optimistic in terms of success stories.

- using high flow oxygen over ventilators seems a big deal.
- using steroids seems a big deal.
- improved sedation methods seems a big deal.

When trying to solve a problem, more experiments fail than succeed, in part because once success is achieved, there is less need to experiment.

 

[aiken]

- using high flow oxygen over ventilators seems a big deal.
- using steroids seems a big deal.
- improved sedation methods seems a big deal.

When trying to solve a problem, more experiments fail than succeed, in part because once success is achieved, there is less need to experiment.

Maybe there are double blind, randomized studies that suggest the above interventions have proved efficacious. The weren't quoted. Maybe there are retrospective studies that would at least suggest correlation. They weren't quoted either.

 

[audreyh1]

Yeah, right, double blind randomized studies during a pandemic in the ICU!

 

[aiken]

Yeah, right, double blind randomized studies during a pandemic in the ICU!

Well, I've seen other anecdotal evidence of efficacy summarily dismissed by people on this board. This article offered zero retrospective evidence...or even specific anecdotal evidence...so how can it be trusted? The science, you know.

 

[MichaelB]

Well, I've seen other anecdotal evidence of efficacy summarily dismissed by people on this board. This article offered zero retrospective evidence...or even specific anecdotal evidence...so how can it be trusted? The science, you know.

Just about everything we know about COVID is observational, not the result of controlled study and peer reviewed scientific research. The article linked in the OP adds to that. In a couple of years we’ll have the studies we need, until then, observation and hypothesis.

 

[Mark1]

I had my annual physical earlier this month and told my Primary Care Doctor I would likely be back via Teledoc to discussed COVID vaccines at a later date. For the time being, he offered me the following link for COVID info. I suspect that at some point in the future they will have discussions on vaccines on the site(?). The site is for doctors and is usually behind a paywall, so some topics might get kind of technical.


https://covid.hippoed.com/#listen

 

[Silver]

Good article.....thanks for posting it.

I worked in health care for 35 years. Although surgery is fairly clear cut (no pun intended), medical intervention is a best guess based on experiential data. Research is an attempt to collect that data in a controlled manner. But it's all just a best guess based on the data you have at the time.

The experiential data gained about the virus by health care professional while working with people infected is very important, and will save lives. As a health care provider, one thing that holds very true....the more often you see it, the better you are at it.

 

[sengsational]

The article seems to be saying that hospitals tried a few things, but they really don't have any effective treatments to offer. Remdesivir helps a little bit if administered very early, but doesn't help at all if administered late, which is when much of it is administered (because they're 'saving' it for the worst patients ). LMW heparin can address the clotting problem to some degree. O2 can help a little bit too, I suppose. They'll probably lose their fear of using steroids as time goes on, but that's just a band-aid. The battle is really won or lost in the earliest stages of the disease, or even before the disease onset (those with high A1C, obesity, diabetic, oxidative stress, have two strikes already).

Just about everything we know about COVID is observational, not the result of controlled study and peer reviewed scientific research. The article linked in the OP adds to that. In a couple of years we’ll have the studies we need, until then, observation and hypothesis.

There was one RCT I saw (NEJM) that started with a group of over 800 people (I think) that had a "high risk exposure" (6 feet or closer for 10 minutes or more without masks or eye protection). Some got hydroxychlorquine others didn't. The results were not statistically significant. The drug didn't help, even though the power of the study was good. But the take-away for me was that both groups had about a 1 in 7 chance of catching the disease from the high risk exposure. That's something like 14% if you go face to face with an infected person, which I found interesting.

 

[gerntz]

Maybe there are double blind, randomized studies that suggest the above interventions have proved efficacious. The weren't quoted. Maybe there are retrospective studies that would at least suggest correlation. They weren't quoted either.

I worked with the info provided.

Do those results stated in the article sound like "Most of the lessons seem to be what didn't work. Not much to be optimistic in terms of success stories." - as they were interpreted to be?