I don’t usually rant on social media. However, after a week of service in the ICU, I’d like to get a few things off my chest. #COVID19 (1/10)
1) This is a horrible, relentless, nasty disease in its severe form. If the patient is obese and/or has renal failure, the prognosis is extremely grim. They are NOT dying from comorbidities. They are dying from COVID -19. #COVID19 (2/10)
2) When I say relentless; most patients make some improvements initially (days 4-6), but decompensate with a 2nd cytokine storm (as many have described). It is this 2nd decompensation that is deadly and that we need to prevent.
jhltonline.org/article/S1053-…
3) We are forced to share dialysis circuits given the high percentage of renal failure (these people had normal kidneys before!) Why isn’t there more press for this fact? We need more machines to manage our patients effectively. @NYTHealth @WSJhealth #COVID19 (4/10)
4) This IS ARDS full stop. While certain pts may be phenotypically different and benefit from lower PEEP, others de recruit quickly. Different phenotypes should be treated as such. We are seeing more atypical presentations than usual because the volume is tremendous. (5/10)
5) My interest is in thrombosis and there is a definite hypercoagulable state associated with this illness. Anticoagulation is all over the place at different centers, but there is no randomized data yet to guide any of it (working on it) #COVID19
onlinelibrary.wiley.com/doi/abs/10.111…
6) Every single ICU patient (barring QTc issues) got hydroxychloroquine and it doesn’t seem to have helped. Maybe it helps for prophylaxis or in mild disease, but doesn’t appear to do anything once in ICU. It is NOT a pancea and should not be given indiscriminately. (7/10)
7) Listen to people who have been studying viruses and ARDS before all this began and will continue to investigate/clinically deal with it long after we have all moved on #COVID19 #DrFauci @PulmCrit @CDCgov @nycHealthy @ishlt @ColumbiaCCM (8/10)
8) Be skeptical, but armchair conspiracy theories without any viable solutions are extremely disheartening. We are all in this together, help us generate the data that will answer those questions you are skeptical about and more importantly help our patients #COVID19 (9/10)
9) The rapid dissemination of materials, protocols, data is truly impressive. I feel like every intellect is pointed at one problem. Further, the support from people inside and outside of the hospital is truly overwhelming and much appreciated #COVID19 @nyphospital (10/10)
I have only glimpsed what this disease can do, so hats off to the leadership for their transparency and stewardship over the last 6 weeks. It is remarkable to witness the level of dedication of each individual trying to make a difference. @nyphospital @ColumbiaMed
I alluded to it but felt remiss that I didn’t specifically mention that the nurses, residents, and fellows are truly superstars working tirelessly under less than ideal conditions #NYPHeroes
