Curve Flattening in California, PPE in the ICU, Medication Trials (Lecture 48)
Welcome to another MedCram Covid-19 update. And we are well on our way to a million plus cases confirmed and almost 50,000 deaths worldwide and the large majority of those cases are in the United States at 215,000.
And a large proportion of those are in New York, followed by New Jersey and then California. I wanted to apologize for no video yesterday. It’s been a busy week. I’m back in the Intensive Care Unit. And for the first time this week, I have seen the eyes of the enemy. I am working in the Intensive Care Unit where I’m taking care of Covid-19 patients and it’s completely changed how we do work.
We are very conscious about personal protective equipment. There are negative pressure rooms. We’ve expanded negative pressure rooms. Going into one of these negative pressure rooms is literally like getting ready to go out on a spacewalk.
You have to have an n95 mask, of course, covered up with a surgical mask, and you also have to wear eyewear protection, which is not your typical eyewear protection. It’s goggles so that the virus, if it is in the air, doesn’t get into your eyes. You also have to have a hair cover like a cap or a hat, not to mention that you have to have gloves on and a gown. Usually, you have to have shoe covers as well.
Of course, putting all that stuff on is not so difficult. If you’re clean and you’re outside the room, that’s not the hard part. The hard part is after you’ve gone in the room and done what you’re supposed to do and now you’re about to come out because you’ve got to assume that the virus has landed on every part of your exterior surface.
And so what you have to do is take off all of these things in the right order without contaminating yourself. And putting on the materials called Donning and taking it off is called Doffing and it’s the Doffing part that you can kind of mess up and you have to be careful.
And at each step of the process of taking one thing off first and then the other, you have to make sure that you’re using hand sanitizer on your hands, your gloves at first and then finally down to your hands. And as soon as you are finally done and you’re out of the room, you’ve got to go and wash your hands very carefully and make sure you don’t contaminate yourself.
We now walk around the units with a mask on to make sure that we don’t touch our face. This significantly slows things down, but it’s a necessity and it’s something that we have to live with. And our hospital is resilient and it’s making it work in terms of what we talked about last time and those huge collections of patients that are coming to the hospital but don’t meet the criteria to be admitted.
We talked about the role of hydrotherapy and especially since we looked at those accounts in non peer-reviewed journals back in 1918 and 1919 and some of the things that we could do. I’m actually in touch with an experts in hydrotherapy. And in terms of what the protocols would be based on their experience, I plan on revisiting this in the future, but there’s a lot of other topics that we want to talk about.
So first to this interesting article published in the Washington Post showing some good news: social distancing works. The earlier the better, California and Washington data show. And it goes through very nicely about how the curve that we’re trying to flatten was flattened. This is per 100,000 cases and you can see here from March 13 to March 31 the United States on average in terms of the growth in Seattle can see how this kind of was flattened in comparison to what happened here in New York.
We can see here in Miami that there was a regional order to stay home and there was some flattening, but not as much in the Boston area, certainly not as much. Then San Francisco, there was a flattening of the curve here and you can see that there was two orders: there was restaurants and public events bans and then there was a county order to stay at home in the San Francisco Bay area, of course that spread to just about all of California.
Also some good news is that California Governor Gavin Newsom is feeling more confident that the state can handle what’s coming based on what he‘s seeing with this flattening of the curve.
And as we’ve talked about before here on MedCram, it takes some time. Remember there’s about a five day incubation period median, another seven or eight days before about 20% will need to be hospitalized because of pneumonia shortness of breath, etc. So it’s almost about two weeks before you start to see the effect of that. And we’re sort of getting into that period now about two weeks since we’ve had this thing called social distancing and isolation here in California.
The other thing I wanted to talk to you about is this study post-exposure prophylaxis and treatment for SARS-CoV2. The type of enrollees that would fit the criteria are: number one exposed without symptoms and number two exposed with symptoms. In other words, if you were closely exposed to a person with a confirmed test within four days of enrolling and live in the same household as this person or are a healthcare worker or if you have symptoms and currently diagnosed with confirmed Covid-19 within four days of symptom onset.
This is a way of testing to see whether or not hydroxychloroquine might prevent you from coming down with the virus. And here’s the sheet that you get when you sign up. They can tell you here about what happens with the SARS-CoV1 virus. That was the initial SARS virus and what happens when you increase the chloroquine here. So this is an important trial that you might be able to be involved with, but remember that you’ve got to be involved within four days.
I’ll have a short video today just because it’s a busy week, but we do intend to get into a lot of questions and recommendations and requests that you’ve had.
We look over all of the comments and we try to answer as many of those comments as we can. We’ve had a lot of requests about Kirsten zinc, about hydroxychloroquine, about chloroquine about nutrition, about diets. We’re going to try to get to all of those things in due time.
Until next time. Thanks for joining us.