This article by Nicole Wetsman at The Verge recounts how physicians have learned to treat COVID-19 the hard way. All of the methods described in the article have been mentioned here at one time or another but they’re all collected in a single place in the article which is handy.
I’m afraid that providers will continue to learn how to treat patients with COVID-19 for the foreseeable future.
While I am generally down on social media, in this case people were in contact with each other very early on passing on everything they thought could possibly help. While the political ideologues argued about hydroxychloroquine docs were just going ahead and using it. Most found it didnt help and stopped. Some found that it did and continued using it. We will need RCTs to know if it actually helps. Things like proning and steroids were more clear cut. They worked so people kept using them. At this point I think we are kind of stuck until someone comes up with therapies or a vaccine.
Of note, one of my staff has underway her own study of the long term effects of Covid. Went over some details of it this morning with her and looks pretty good. Several med students are helping with the grunt work. A lot of pts discharged from the hospital are going home and staying on O2 at home. Will be interesting to see how many, if any, are permanently on O2 and how long they need it on average.
(For those who actually read the article the picture showing 6 people turning a pt is pretty accurate, though you sometimes need more people. A lot of our pts in general are morbidly obese and a bit worse for Covid pts. If you prone an intubated pt and botch it they will probably die so you need to do it right. Very personnel intensive.)
Steve
For every article poo-pooing hydro an article can be produced showing effectiveness. Especially if early and in conjunction. Same with masks. In the absence of definitive clinical evidence and conclusion cost benefit should prevail. I will continue to use a mask in public whether foolish or not………………because for me its costless, and soothes the sensibilities of the populace.
Steve makes a point about the pic that should not be missed. Morbidly obese. Well, yeah. Its been clear from earliest days that this was a disease of “the vulnerable.” Various flavors. I know it sounds crude, but it simply is not the responsibility of the masses to shut down the world for the tiny minority. Especially the self destructive. It simply isn’t. That equation doesn’t work.
And to down grade it from morality to practicality – those holding that view (like protected bureaucrat Fauci) simply have no chance. No chance. NFC. People are people. They will not comply. So stop pissing in the wind and develop a workable strategy.
The percentage of Americans that are obese is 42.4%, severe obese at 9.2%.
It isn’t a tiny minority — it is darn close to a majority.
“For every article poo-pooing hydro an article can be produced showing effectiveness.”
Not true. The studies showing positive effects get a lot more coverage but the large majority of studies show no effect. A minority show negative effects. Maybe if you include the tiny “studies” with 40 or 50 patients and they altered the data you can come close. It is still possible it has some effect if given very early so that in hospitals that admit pts even when not very sick you are seeing some effect, but even there if you are admitting not very sick people you expect them to get better. You need a prospective RCT. (I do read medical journals as opposed to Breitbart so my sources are biased.)
“Same with masks.”
Wrong again. (What a surprise.) The majority of the literature shows that they work and has been reinforced with recent lab experiments. Of those in the past that claimed they didnt work a lot of those were due to compliance. Kind of like saying food doesnt work if you don’t eat.
OT- Hope you read Tabarrok’s piece on pooled testing. The math has always been good on this so I don’t understand why this isn’t further along. Once again the FDA is interfering with something we should have been doing weeks ago. We need better leadership.
https://marginalrevolution.com/marginalrevolution/2020/07/pooled-testing-is-super-beneficial.html
Steve