Hello, I am an anesthesiologist, ICU physician, and have a PhD in Pharmacology (my graduate studies included work on viral transmission). I work in a large hospital system in a Northeastern city that is about to be overwhelmed by the coronavirus crisis. Many of you may have heard about "flattening the curve" - I am here to answer your questions about why this goal is so critical as we prepare for what may be the worst public health disaster this country has ever seen.

Please be sure to check out https://www.cdc.gov/coronavirus/2019-ncov/index.html often for the latest news and recommendations as there are many new developments daily.

Please also check out https://coronavirus.jhu.edu/ as it is a great resource as well.

AMA!

Comments: 2820 • Responses: 88  • Date: 

silvermistmiyu1252 karma

Hi! Thank you for being available for AMA. This might be different question than what you’ve intended, but I just need someone else’s opinion as I’m being shut down by my hospital and program.... I’m a resident physician in a NY program. Many of my co-residents are ill with covid like symptoms or in quarantine. We are not being tested because we don’t meet the hospitalization criteria. We are asked to work after being afebrile for 24 hours. We have not geolocalized our ICU for covid patients yet so they are in all the icus with potential exposure to other patients and staff. I’m not sure what the best way to go is, but I don’t think we are doing the best job for our people and our patients. What do you think? What is your ideal scenario? What can we do better?do you think surgical masks are enough for health care providers given healthy Chinese doctors ( in the 20s) have died from this while wearing Hazmat suits?

drdrintensivistmdphd1042 karma

It certainly sounds like not ideal circumstances. I would keep advancing your concerns up the administrative ladder.

We have isolated an entire floor in our main hospital (ICU and floor beds) for coronavirus and have dedicated specific ORs for them if they need surgery. We are reserving our N95 and PAPRs only for confirmed Covid-19 cases, because otherwise we will run out. (Apparently Columbia University has run out of masks because they used them all up in the first 4 days due to huge volumes of suspected Covid-19 patients).

I would certainly be persistent with your concerns until changes are made. Good luck, and stay safe - hand hygiene with soap and water is still your best defense.

crazyornotcrazy940 karma

How long should we keep the social distancing going to flatten the curve enough? In the Netherlands all measures are until April 6th for now. This seems like a really short time to me. I see organisers planning new events for April and May already (concerts, festivals etc).

drdrintensivistmdphd1388 karma

I think those dates will be extended as this crisis unfolds and the true costs and burden emerge.

eggyolk13930 karma

Should I request to leave work if I am in a non-essential support role? I just don't know why my employer is not moving towards work from home

Edit: Now they are giving teams free lunch tomorrow and Friday. Salad, wraps and fruit. Healthy, but sounds like a great way to cause more contamination. Is it just me, or is this nuts?

drdrintensivistmdphd712 karma

Yes.

drdrintensivistmdphd827 karma

Hi folks, I've answered a bunch and need to take a break. I'll try and be back in a bit. Thank you for your questions, and please, please, please, STAY THE FUCK HOME!

littletoyboat761 karma

Do you have any good news? We could all use some cheering up right now.

drdrintensivistmdphd4198 karma

There are a lot of smart people working on cures around the globe. We need to support them - now and after this crisis passes - with funding. Maybe coronavirus will be a lesson, for humanity in general, and the U.S. in particular, that the war on science and medicine has contributed to the extent of this pandemic. Support candidates who believe in science - whether it's in regards to the coronavirus or climate change - and vote out people who defund the sciences, education, etc.

peaheezy572 karma

Bit of an unusual question here.

I’m a private practice Neurosurgery physician assistant at a large hospital in NJ. Our MICU is full, the SICU is starting to add vented covid or suspected covid patients, the medical step down is now full of non-covid ICU patients and the orthopedic nurses are being pulled to medical step down beds that are being created from other units. It’s only been 10 days since our first case...

My team is not hospital employed but we are close with the Surgical ICU team and have at least some experience managing critical patients. We all feel like if the medicine teams call for help we should do our best to answer but none of us us much experience with vents, vasopressors or ARDS at this point. I’ve been perusing my old copy of The ICU Book but I’m at last coming to my question, any resources you recommend to get someone up to speed as quickly as possible to at least help medical teams in dealing with critical Covid cases? Speaking with some critical care friends/residents they do not have enough staff and will need help pretty soon. Meanwhile our service is quiet because elective surgery is cancelled.

drdrintensivistmdphd611 karma

First of all, you are awesome. Thank you for stepping up and helping us out.

At this point, there is little time to learn the basics of critical care and what I would focus on is learning as much about Covid-19 specific treatments as you can. There is "A Seattle Intensivist's One-pager on COVID-19" that a lot of us are using as a reference. This is probably a good place to start. Message me if you can't find it on google.

Again, thank you and your colleagues so much!

bertiebarnes539 karma

I work in a grocery store produce department and am really scared. Is there anything you think I can do besides washing my hands? My company says no masks and no gloves.

drdrintensivistmdphd739 karma

Social distancing. Stay about 6 feet away from everyone else and keep practicing good hand hygiene.

Irish_Redneck07485 karma

I'm in Texas and I've noticed the lack of police on the highways. DPS, Local, County, and even the constables are scarce, which is uncommon. Many areas are shutdown, including toll roads, and schools, but I'm still going to work everyday. Should I be doing something different? Why is nobody worried about the fact that nothing else is being done? What's a plan of action to take??

drdrintensivistmdphd556 karma

If you are at a job that can be done at home, you should urge your employer to let you work from home. Otherwise do everything you can to limit your interactions with other people.

peedubb329 karma

I’m still trying to understand, what makes this novel coronavirus so much more serious and dangerous than other diseases we’ve seen such as ebola, h1n1, etc such that it warrants the response we’re seeing from the government and medical communities which is unlike anything I’ve seen in my lifetime?

drdrintensivistmdphd953 karma

It's more infective and more lethal. Its prodromal (before you see symptoms) period is very long (14 days or longer). It can stay viable on surfaces for up to 3 days. It can linger, alive, in the air, for up to hours. It was completely dismissed by the upper echelons of this government and certain segments of the media for weeks.

For these reasons, this virus is much more deadly that the other diseases you listed.

Edit: it is also very lethal.

common_cactus290 karma

Assuming that social distancing and staying home work to stop disease spread, when does it become safe for people to start living their lives again? Wouldn’t the spread start back over (assuming no treatment or vaccine)?

drdrintensivistmdphd390 karma

I don't think we know yet. I am guessing this new way of life may persist for months.

nopal_blanco286 karma

Realistically, how long will it take to see results from the measures we are taking?

Do you think we are doing enough to limit social interactions and flatten the curve?

How long will this social distancing need to last? I have a fear that people will not adhere to it for longer than 2 months, putting us all back in this very spot.

drdrintensivistmdphd339 karma

Months. No. Months. and I agree.

Jbradsen284 karma

Flattening the curve seems like an AWESOME plan. Unfortunately, many Americans will lose their healthcare coverage if they don’t work. Not to mention they don’t have 2-3 weeks of paid leave, sick or PTO-wise. Then there’s the problem of few Americans having more than $500 in savings so how will they feed their families?

I’m a healthcare worker in the medical lab so I do agree with the idea of flattening the curve and staying home for the greater good. Sadly, for many, it’s just not realistic. Most Americans will consider their jobs to be ESSENTIAL.

drdrintensivistmdphd557 karma

Well, this problem has been a long time coming and exposes how weak we are as a country, especially on the health care front. Most people in this country have been one healthcare disaster away from bankruptcy for years. Now, we have millions of people who will experience health care disasters all at the same time. Access to medical care and paid sick leave are two components of American society that are tremendously lagging compared to actual advanced countries.

So yeah, we will all pay the price now for a crappy system that forces people to work because they don't have access to healthcare other than through their jobs, and because they don't have paid sick leave. This is the system we built, and now we are paying the consequences.

Shadowslipping247 karma

If you can without it directly doxxing your work. How many ICU beds at the moment? How many filled with non Covid-19 patients, How many Covid-19?

drdrintensivistmdphd382 karma

Our larger hospitals in the area are about full now - which is frightening because this is just beginning. The next step will be to utilize the smaller community hospital ICUs, which almost never see patients of this acuity. All the hospitals are in emergency contingencies and at "surge" capacity - ORs, floor beds, preop/postop areas, will all be used to treat the incoming flood of patients.

We have a few Covid-19 patients in the various ICUs in our system, many are suspected, but again, due to a shortage of tests, we don't know.

ben_abuyah246 karma

Do reinfections occur frequently, and how does that affect flattening the curve?

drdrintensivistmdphd512 karma

We are still learning about reinfection, and though it appears rare, there are documented cases of reinfection being lethal. With respect to reinfection and flattening the curve, the message remains the same: stay the F home and practice social distancing.

mander2431209 karma

My primary care physicians office just closed. What are your thoughts on this? Appropriate or do you think PCPs are still needed to help prevent ER overload?

drdrintensivistmdphd202 karma

A good question. I honestly haven't thought about this enough to render an opinion.

NetSage183 karma

When do you think governments will stop under reacting? Medical experts have been pretty clear social distancing isn't enough at this point yet we still allow non-essential businesses run where hundreds or even if thousands of people gather.

drdrintensivistmdphd631 karma

I believe that over the last 10-20 years, there has been a robust anti-science movement in many countries, including the U.S., that has become entrenched in the upper echelons of government. I think the response to this crisis has been paralyzed by these officials' lack of understanding of the importance of science and medicine. The poor responses by governments won't change until people change their governments.

Luna920164 karma

I’d say worst public health emergency in the world, not just the US. I work in healthcare too, at an ER, and it’s been quite the process the last couple weeks. Now starting to implement a drive through program so pts don’t have to enter the building. I definitely know that flattening the curve matters and feel that most people are waking up. There are still many that simply don’t understand it though, saying things like “flu killed x many of people”, “people die from cancer and no one cares about that”, “we only have X number of cases here in X.” What do you say to these people to explain? And what do you think the impact of the college students on the Florida beaches will be after the governor said he won’t close beaches statewide? I would personally think that will work against the efforts of everyone else socially distancing when those students all head back home.

drdrintensivistmdphd314 karma

Unfortunately, some people are unreachable and intolerant of common sense and medical advice. I am not sure how to convince those people of the threat they pose to themselves, their loved ones, friends, and neighbors, and other countrymen and women. All of these people who ignore recommendations of social distancing - those who go to pubs and beaches - are, in my view, complicit in the spread of this disease.

FrozenJakalope163 karma

Given that this appears to be transmitted by droplets, are vape clouds an infection vector? This occurred to me as I walked through someone's candyfloss-flavoured cloud earlier today

drdrintensivistmdphd233 karma

Very interesting point. I would assume yes. There is also some anecdotal evidence that vapers are at higher risk of severe infection require ICU support.

somebitch27 karma

Does anyone have any sources for this that I can show my husband?

SerialTurd136 karma

The discussions are to stay indoors and minimize any crowd exposure for the next few weeks to help flatten the curve but what happens after that? Do we say ok, back to normal but keep social distancing? That seems like it would just cause another spike in cases.

Are we realistically looking at shutting ourselves in for the next few months?

drdrintensivistmdphd163 karma

I think it will be months. We won't have a clear picture until testing catches up with the number of cases.

aaronthenia134 karma

My wife is immunosuppressed due to a kidney transplant (glomerulonephritis) but has no underlying medical conditions besides that. I know that she is more susceptible to being sick because of her immunosuppressants but I also know that COVID-19 is being treated with immunosuppressants in several places so does that also possibly lower her mortality risk? Sorry, just being hopeful and thank you for doing what you do.

drdrintensivistmdphd250 karma

I would say she is at high risk of contracting the disease and unfortunately definitely not a lower mortality risk. We are not using immunosuppressants as a treatment as far as I know (would love to see your sources). The Chinese use steroids, a type of immunosuppressant, for treatment, but that's likely because their standard of care for treating Acute Respiratory Distress Syndrome (ARDS) utilizes steroids. ARDS is what most of the patients with severe Covid-19 infection experience. In the U.S. generally we do not treat ARDS with steroids unless under particular circumstances. Use of steroids in ARDS is associated with increased superimposed infections, especially fungal infections.

I am sorry you and your wife are subjected to this virus scare on top of everything else you've already been dealing with. Stay away from everyone you can, practice good hand hygiene, and keep up to date on what's going on in your community with regards to the disease. I wish the best for you both - keep fighting.

Pctardis126 karma

Is there anything surprising about the imperial college study that has seemingly upended the previous laissez-faire attitudes of the UK and the U.S?

https://www.cnn.com/2020/03/17/health/coronavirus-uk-model-study/index.html

drdrintensivistmdphd159 karma

What surprised me was that these numbers did not come out earlier.

nthlmkmnrg122 karma

I’ve heard that we may need to have significant social distancing (including closure of restaurants, no gatherings of more than a few people, etc.) for as much as 18 months. Is that true?

drdrintensivistmdphd194 karma

It may be that long. But I'm thinking more like 6 months. We don't really know yet.

RealAmerik121 karma

If keeping everyone home for a determined period of time helps flatten the curve, is there a risk in a significant uptick once people go back out into their communities? Will there be a secondary spike in cases?

drdrintensivistmdphd197 karma

We expect a second spike after the initial. Probably sometime in the fall, if I had to postulate.

neoXwave118 karma

Here in India which is densely populated and a large demographic variance in society,there is clear lack of social distancing and general hygiene how do you think the effects of a community transmission would be when comparing to what has been happening elsewhere.

Community transmission is not yet major still though that may be cause of under testing and also unlike china that can enforce orders rapidly we also lack in that aspect

what are your thoughts on the situation here in india?

drdrintensivistmdphd208 karma

My parents actually just returned to the U.S. from India yesterday. I would say actually that the response there - both by the government and the people - seems to be (from my parents' accounts) more serious than our government and people have taken the threat, especially initially. The densely packed cities of India do pose a serious threat though and it seems to me almost impossible to practice adequate social distancing there. Like you, I believe that undertesting is the reason we have not seen a huge number of infected in India. I am worried...

dhoopwhoop113 karma

As a regular person I’m trying to do my part and staying the fuck home. Is there anything else we can do to support the frontline healthcare workers such as yourself?

Thank you for doing this AMA and for producing such concise, digestible replies. You and fellow healthcare workers are true heroes during this crazy time.

drdrintensivistmdphd104 karma

Thanks for your kind words.

Spread the word about social distancing to everyone you know. Convince them about how important this is. If they care about themselves, their family, friends, fellow citizens and humans, they need to stay the F home and practice social distancing.

DirtyProjector106 karma

More and more articles are coming out saying it will be 18 months at least before we’re in the clear. Do you agree with this assessment? Even if we “flatten the curve” over the next 28 days, we still don’t have enough immunity to have this go away, which means it keeps coming back until we have a vaccine, which may or may not work, and will take 18 months at least to produce. So is this our life now?

Also, what do you think about the news going around about cures for coronavirus, such as Dr David Paterson in Australia and Didier Raoult in Marseille? I’ve seen everything from using Kaletra to Faripiravir to Raoult suggesting using Hydroxychloroquine with a z pak. The thing is, the US doesn’t have a lot of these drugs stockpiled and chloroquine is pretty toxic, and it will take 3 months to get clinical trial results so we’ll still be in the throes of it for some time.

drdrintensivistmdphd152 karma

This is our new normal, yes. For months, at least, I believe.

These "cures" are still anecdotal, without robust numbers and trials to prove their efficacy. As you say, these drugs are not readily available either. Our institution is to be starting trials with chloroquine so we will see how effective that will be.

royhobbsj7104 karma

Do you believe all hospitals should be postponing elective procedures at this point, given the growth of test positive cases?

VorpalPlayer138 karma

They already are. My hospital is not performing surgery of any kind on anyone over 60. I am home with a crippled hand that they refused to fix. A friend was scheduled for cancer surgery, and it was cancelled. We don’t have any cases in the area, either.

drdrintensivistmdphd201 karma

Absolutely yes, for 2 main reasons: bringing patients to the hospital for elective surgery puts them at risk for contracting the disease from the hospital setting and puts other patients and hospital staff at risk if the elective patient is bringing the virus in; and hospital staff should be focused on preparing for the upcoming onslaught of patients - that includes training, simulations, etc - so performing elective cases should not be a priority.

Most places I know that are continuing to perform elective cases are doing it purely for the monetary reasons, not for the health of those elective patients.

cicatriz197 karma

If most of us are going to get it eventually anyway, why not just have a massive WW2 style manufacturing of ventilators and public health facilities? Probably a short term quarantine strategy needed but then let herd immunity happen. Stretching this out over a year or more may not even work. Is it worth a trillion dollars to (hopefully) flatten the curve? We’re only on this earth so long.

drdrintensivistmdphd107 karma

Yes! We need something exactly like that. Will the private sector answer the call? Or will the federal government need to step up?

LurkerResearching94 karma

Do we for sure know if it is airborne or just droplet?

drdrintensivistmdphd171 karma

Right now we are operating under the idea that this coronavirus is transmitted via droplets, and thus all our personal protective equipment is tailored to preventing droplet transmissions. However, there is some evidence that there may be airborne transmissions so our PPEs may change accordingly.

battlesong92 karma

What can the average person staying at home do to help beyond social distancing?

drdrintensivistmdphd171 karma

Encourage others to stay the F home. Make sure every single one of your family members and friends know how serious this is.

biznizexecwat88 karma

Why do I have nurses in my family/see nurses & health care professionals - that seem to disregard all the available information?

Is it "trying to ignore the obvious" for some strange attempt to bolster self confidence? Or do they think that by not taking a hard line stance with family and contradicting their delicate sensibilities - these relationships will be lost/is more important?

How are you handling this?

drdrintensivistmdphd118 karma

I have experienced that as well.

I really don't know how to reach these people. They obviously have the intelligence but they don't have the curiosity or temperament to be proven wrong. All I can think of is to keep repeating the facts - and the fact that they are not only putting themselves at risk by ignoring recommendations, but they are also putting everyone they care about at risk as well.

quaquero81 karma

If we manage to “flatten the curve” and most hospitals are thus able to handle severe cases, does that not mean that people will continue to get ill over many months, albeit at a lower rate? At what rate of new cases can we consider the epidemic under control?

drdrintensivistmdphd108 karma

Correct. I think when we hit a peak of new infections we can say we at least have a handle on things. We will not know that until people are adequately tested, which is still not the case here in the U.S.

YOUR_ROYAL_MAJESTY80 karma

If flattening curve means we stay home longer and how long? Would we stay home?

drdrintensivistmdphd109 karma

I don't think there's a way to give a number on that. My guess would be months. It would have to be at least until we peak in the number of cases, which we don't know, since we still do not have enough tests.

joeboyib73 karma

How does contraction of the virus by a pregnant woman impact the development of the fetus or labor and delivery?

drdrintensivistmdphd101 karma

So far we haven't seen that. Most sources say there is a higher risk of severe illness in pregnant women, but I do not believe that has been confirmed. There was a recent article about 4 women in China, infected with coronavirus, who gave birth to healthy non-infected babies. Unfortunately, there still isn't much good data out yet about this.

It can be hard to practice social distancing because of the frequent appointments necessary for prenatal care - for all those prenatal visits and everything, you probably would want L to wear a mask while out and about.

TalkingBackAgain71 karma

Doc, give it to us straight, given the fact that the US has done nothing to stop the spread of the virus, that there are not nearly enough ICU beds to serve all those who are going to need it and that we don’t have enough ventilators, people to work them and equipment to service all the cases that are going to be presenting at the hospital, how fucked are we?

/I am not remotely making fun of this situation. I might be in that ICU ward fighting for my life.

drdrintensivistmdphd134 karma

Frankly, we are very fucked.

reallegume70 karma

PhD pharmacology here as well. Am I off base in being a bit skeptical of people saying that vaccines are the only long term play (e.g. Imperial college study). Chloroquine and Remdesivir look pretty promising. Couldn’t we use these prophylactically for at risk patients?

Also, thank you for doing an amazing job at this AMA!

drdrintensivistmdphd70 karma

Chloroquine and Remdesivir will treat the disease, but will not confer immunity, which will be required to keep the virus under control long-term. Unlikely they would be good choices as a prophylactic because they are not benign drugs.

Good luck with grad school! It's a grind...

Circleofbones63 karma

As a person with asthma, how worried should I be if I contract the virus? Since I have asthma, is it automatic death?

drdrintensivistmdphd103 karma

You are at higher risk. It is not automatic death. If you have daily, long acting inhalers use them as prescribed. Use your rescue inhaler liberally. Wash your hands, don’t touch your face, stay the fuck home.

PM_Me_Thick_Thighs_61 karma

So by social distancing, does it mean to distance yourself from places like resturants? Me and my girlfriend live apart and I would like to still see her every now and then.

drdrintensivistmdphd95 karma

Any place where there are other people, so sadly yes.

Maybe a picnic or something?

AstridDragon41 karma

But what about going to each other's places? In particular I have no washer and dryer at home, so my options are laundromat or partners place, who lives alone as do I. Visits ok?

drdrintensivistmdphd43 karma

Should be ok.

lars2x59 karma

Hi! I am from the netherlands and we currently have the approach to limit social activity. We are however not in ‘lockdown’ since our icus are still able to handle the load. Ive read many times online that this ‘herd immunity’ theory is stupid and that we are doing it all wrong. However, from my limited understanding i dont know why this would be so wrong. As long as our icus are able to handle the load this is the right response since the virus has to go ‘through’ the whole population before this is over correct? Why do you say that we should just all stay inside. Wouldnt this be counter productive since the moment we all go back outside the virus will come back?

Also, since this virus is supposed to be spread via ‘liquid particles’, how does a healthy person without any symptoms (no coughing, runny nose etc) infect others. If you are not coughing you cannot spread it right? Thanks!

drdrintensivistmdphd69 karma

Well, the thought is that a vaccine would emerge in time to help give immunity without having to get the actual disease. Remember that herd immunity doesn't require infection with the actual, live virus.

If you wipe your nose on your sleeve, then your sleeve on a surface, and someone else comes and touches that surface, the 'liquid particles' can be transferred that way. This is why hand hygiene is probably the most important part of preventing spread of the virus.

Spookyredd53 karma

I've read that there have been no cases of children showing symptoms. But, could they be carriers instead and infect others?

drdrintensivistmdphd164 karma

They are absolutely carriers, in fact, they have been found to have very high viral loads. So while they can appear perfectly healthy, they could be spewing virus everywhere. They seem not to bear the severe effects of the disease possibly because of lower levels of ACE2 receptors in their lungs and also because of a more robust T-cell driven initial response to the disease.

teremyth50 karma

You say about to be overwhelmed, How many pts on ventilators d/t corona in your unit?

How many total icu beds is your hospital?

Do areas without community spread need to practice social distancing prior to confirmed community spread?

Can infected drs and nurses safely treat confirmed corona patients?

drdrintensivistmdphd67 karma

We don't have enough tests so we don't know the number of actual Covid-19 positive cases in our ICUs. We have at least 5 or so confirmed, with several unconfirmed. Our main hospital has about 100 ICU beds. Many of our community hospitals are already full with non-Covid19 patients.

I think we should assume there is spread in all communities, so by default everywhere should be practicing social distancing.

Our policy on this is changing but I believe right now confirmed Covid nurses and doctors are being sent home, for at least 4 days (previously 14 days) or until symptoms subside. When they are well again, they can return to work but must wear PPE when interacting with patients and masks at all times.

possiblycrazy7947 karma

My son has been in ICU for 2 months for a million post op complications & has ultimately ended up needing a tracheostomy indefinitely. In the past few weeks, he has been spiking fevers with +secretions & all cultures are coming back with nothing. He has been on contact precautions the entire time for MRSA, but after awhile, most ppl only wore gloves for ppe, unless there was a sterile procedure going on. ID has gotten involved, & does not think that he needs to be tested for covid. Do you think this is a wise decision? (We are in AZ).

drdrintensivistmdphd68 karma

Unfortunately I cannot comment on specific cases because I do not have the details. It may be worth talking to a couple different members of the ID team to see if they have different thoughts on whether a test for Covid is warranted.

I am sorry about your son and I hope you and your family are managing OK during these tough times. Hang in there.

Cravenmorebeer47 karma

I am an Anesthesiology resident in Texas. At this point should is wearing an n95 mask for all intubations?

drdrintensivistmdphd79 karma

We are not. Only for confirmed coronavirus cases. The reason is that we have a mask shortage - if we use them for suspected cases, we will not have enough for test-confirmed Covid-19 cases.

We are using standard surgical masks with face shield, and double gloves, and throwing everything (outer glove, blade, handle, oral airway, etc) away into a nearby trashcan immediately.

Dentite2146 karma

I am a dentist and we are now shut down for 3 weeks. Most states are advising dentists to shut down for 2-3 weeks. My big concern is aerosolizing the virus. Though PPEs are mostly effective, I do fear the awesome from the virus will stay airborne longer similar to if the virus actually becomes airborne. Even with perfect cleaning, what is the best way to approach this for patient safety and the safety of staff? This virus will be here for a long time and I know we will unknowingly encounter the virus at an increasing rate when we reopen. Any other thoughts about minimizing risk here?

drdrintensivistmdphd51 karma

Excellent question. My sister in law is a dentist and dentists and dental hygienists are most at risk for exposure and infection (more than anesthesiologists and EMTs, for example, according to the NYT). I don’t know if three weeks is long enough. N95s should be sufficient - if they are properly fitted. Tell patients to stay home if they are at all ill. Wipe and clean everything. Wash hands. Not sure there is much else you can do.

Fortunedd43 karma

Hi, I work in an amazon facility in a city that has a 30 day lock down for non-essential businesses.

It seems like nobody cares about the health of the workforce, they are hiring more people cramming more bodies into warehouses that already have hundreds of employees.

It feels like it is just begging for a massive outbreak, like it is the hotspot. And Amazon employees will be the ones spreading the virus.

What can we do? There’s so many reports throughout my facility and others of people getting sick. Some say people are testing positive. Who knows! Inside the warehouses is an absolute madhouse right now. Yet nothing is being done. Everyone just expects their packages.

drdrintensivistmdphd70 karma

Amazon doesn't care about you or your fellow workers. Generally I don't think any companies (including hospitals) care about their workers. They care about their bottom line. This won't change until they are made to, by government regulations.

I don't know that there's much you can do, unfortunately, other than the basic precautions (washing hands, don't touch face, keep distance if you can).

drdrintensivistmdphd43 karma

The virus itself has devastating pathophysiological effects, so it’s not just the infectivity - it’s lethal and severe as well.

_Shahnawaz40 karma

Realistically, around how many more months can this pandemic continue till?

drdrintensivistmdphd64 karma

I'd say into the fall at least.

stonewashedpotatoes38 karma

What are your thoughts on patients continuing with wellness visits (vaccination schedules, follow-ups, yearly exams, etc)? Should this be postponed to reduce the spread of COVID-19?

drdrintensivistmdphd67 karma

I am still thinking about this. Vaccines should be administered, I think, but other non-urgent visits like physicals etc should be delayed. This bring up a very important point - the "maintenance" health cares that are going to be ignored over the next several months - physicals, check-ups, cancer surveillance like imaging and colonoscopies, elective surgeries like joint replacements - are going to continue to pile up and when they will be restarted there will be a huge backlog. Not to mention that people's health will suffer by not getting this "routine" care.

waterloograd38 karma

If we get sick, what should we be looking out for in terms of catching serious cases early? If I get sick I don't want to take up a nurse's or doctor's time and risk infecting them just to tell me to go home and rest. But I also don't want to stay at home when I need help.

Thank you for doing what you are doing. Stay healthy and take care of yourself!

drdrintensivistmdphd44 karma

Cough, fever, shortness of breath should spur you to seek medical care.

Thank you for your kind words.

55iamonte36 karma

Do we have numbers on recovery of t1 or t2 diabetics?

drdrintensivistmdphd64 karma

I have not seen them, but it appears they may be at increased risk due to increased infectivity and viral load burden due to increased expression of the ACE2 receptor on pneumocytes, which is the receptor the virus uses to enter the cells in our lungs.

ed_edd_eddy_fu28 karma

Best treatment choice ATM?

drdrintensivistmdphd71 karma

Supportive care. There is increasing evidence that anti-malarials (chloroquine and derivatives) and antivirals (remdesivir) may have a role in treatment, but for now we are just trying to support failing organs.

curious_cutlet27 karma

What to do if one of my roommate is down with it? We share kitchen and stuff

drdrintensivistmdphd72 karma

Have they been tested positive? Your roommate needs to stay in their room, and you need to clean any surface they may have touched. You should stay 6 feet away from the at all times. Wash your hands frequently. If you are able to get an N95 mask, wear it. Unfortunately, if they have true Covid-19, you may also have it already.

italianredditor23 karma

What do you think is the correct way to prevent contagion in hospital wards?

My unit in Italy is still admitting new patients for elective surgery (mostly abdominal, cancer patients, etc.) and not testing the patients that come in unless they show symptoms.

Also patients aren't required to use masks and the staff is given one surgical mask a day and plenty of gloves as protection. No glasses or visors. No masks with filters.

They only tested the whole staff when the head nurse figured she had been infected, took the test and turned out to be positive. They all suspiciously came out negative (about 40 people tested).

I feel like this is being mishandled on several levels but I'm not sure, could you provide some insight on the matter?

drdrintensivistmdphd45 karma

I am very surprised they are doing elective surgeries. We have stopped those.

Eye protection seems mandatory to me.

We have designated floors for Covid patients. And designated ORs.

Honestly, though, I should be asking you for advice, you have seen more than we have.

emdabbs23 karma

Do you think Americans need Medicare for All? I am worried about medical bills through all of this. Thanks

drdrintensivistmdphd53 karma

I support M4A. This disaster has exposed many of the core health care problems in this country, especially access to care. I worry about the medical bills for my patients too. ICU stays will bankrupt most normal people.

beepybeetle20 karma

do you think china’s heavy-handed approach contributed significantly to their recent slowdowns of virus transmission and if so, would it change how governments might respond to the next pandemic?

drdrintensivistmdphd76 karma

Yes, but remember that their heavy-handed approach (like the U.S's) to suppress information about the initial stages of spread of Covid likely contributed to its explosive dissemination in the first place. So the effectiveness of authoritarian governments to tamp down pandemics is a double edged sword.

I think many governments were caught flat-footed in their response - authoritarian or otherwise. Certainly our government and its propaganda outlet contributed to the outbreak and now they are trying to recover using heavy-handed approaches.

Bombuss20 karma

What physically happens to the patients who need to be intubated/ICU'd? I know the details of intubation and care, but what are the symptoms that the covid-patient goes through causing a need for intubation?

Do the lungs collapse, does the nervous system malfunction, are they overheated due to fever, etc?

drdrintensivistmdphd33 karma

Great question, thank you.

Essentially most of these patients get ARDS (clarification - most of the patients that are in the ICU with covid-related illness) - acute respiratory distress syndrome - in which there is massive inflammation of lung tissue in response to the virus, which ends up "flooding" the lungs (pulmonary edema), and making it hard to get blood from the lungs to the heart (pulmonary hypertension). This inflammation leads to scarring, and the alveoli (air sacs that exchange gases) are involved, making oxygenation difficult. This usually requires intubation to provide high concentration of oxygen at (usually) higher pressures. Overinflating the lung or providing too much pressure with each breath can, at this point, cause irreversible damage.

For those that survive the pulmonary ordeal (younger patients, it seems), there is a cardiac phase, in which the virus causes weakness of the heart, so that it can't properly distribute blood to the body (the heart may pump only 10% of the blood within it versus 60% normally). This heart failure can be lethal as it may cause decreased delivery of oxygen to the heart itself (leading to heart attacks), or other organs, like the kidneys (kidney failure requiring short- or long-term dialysis) or strokes from poor perfusion of the brain.

burnshimself18 karma

How do we come out of this? Seems like social distancing is only stemming the spread of the infection, but as soon as people start going out more frequently / let their guard down infections will begin spreading more rapidly. Is there a way to return to normal life? Social distancing has resulted in millions of lost jobs and lost wages - feels like we can only sustain that for so long before everyone starts to feel really acute pain.

drdrintensivistmdphd44 karma

There will probably be a second peak. This will likely continue for months. I will leave it up to economists and labor and business experts to figure out how to fix all those monetary issues.

LadiesHomeCompanion18 karma

If the biggest bottleneck in treating everyone will be caused by the number of available respirators, has there been any word or news releases from manufacturers about throwing production and distribution into overdrive?

drdrintensivistmdphd33 karma

Very good question. I wish our president offered some leadership and had a "send a man to the moon" type challenge to manufacturers to help us out a bit.

lle-ell17 karma

Is there any data on how younger people with underlying diseases handle this illness? I've only seen mortality by age for the whole population. E.g. are children with cancer as likely to die from this as old people with cancer?

drdrintensivistmdphd24 karma

Most children have done ok. The fatality rate is very very low (under age of 9 years 0.002%). But that doesn't mean they can't get sick or die. But they are known to be carriers and potent distributors of the virus.

MattsyKun17 karma

What good news is there? My anxiety already can't take much more of this. I've essentially lost one of my jobs because all events are canceled, and will be canceled for almost half a year? I'm already staying home (I quit my job before all this started because I have another one lined up) but with the incubation period so long, what do you suggest to help the mind alongside the body?

(asides from washing hands yadda yadda)

drdrintensivistmdphd23 karma

I'm sorry I don't have much good news.

I am trying meditation.

postedByDan16 karma

Is the R0 significantly higher than posted? I wonder because in every place it pops up, immediate steps are taken to contain it by the time we get 200 or so infections. How do we know this number is accurate?

drdrintensivistmdphd42 karma

I think it's impossible to determine that accurately right now because we are not testing everyone who should be tested.

celtic188816 karma

Thank you for this

Any real updates on the NSAID v acetaminophen rumors on treating symptoms and fever?

drdrintensivistmdphd29 karma

Latest I have seen is to avoid ibuprofen and other NSAIDs.

HorseLove1915 karma

Is there a brief message that you would like to be seen by the masses? If you could say anything that everyone in this thread would then share with everyone they know, what would it be?

drdrintensivistmdphd48 karma

STAY THE FUCK HOME.

nevertricked14 karma

  1. How will you intubate safely?

  2. What have you heard about the implications of finding the virus in CSF? There was a case study out of China where pts readmitted, 45% of ICU pts had LP which tested positive for Covid19.

  3. Strong work!

  4. Is this a new normal for the next 18 or so months until a viable vaccine is approved? Should we come to terms with the prospect of having a flu season AND a SARS-Covid season indefinitely?

  5. What about antibody therapies which give passive immunity in the meantime? Could those be implemented to buy us time until vaccines are a go?

drdrintensivistmdphd19 karma

  1. We have the appropriate PPE on, we throw everything away immediately after use. We use indirect imaging like glidescopes or Mcgraths to increase the distance between our faces and patient airway. If you want details, we have some guidelines I can share if you message me.
  2. I do not know much about Covid in CSF.
  3. Thank you
  4. I saw some recent knows about antibodies for conferring passive immunity, but I don't know how far away from clinical trials that is.

frackstarbuck13 karma

Do you think there needs to be more messaging talking about the need to disinfect our personal technology along with washing our hands?

drdrintensivistmdphd20 karma

Very good point. We need to wiping down our disgusting phones frequently. My wife is always getting on my case about that.

soulsista1212 karma

Would a tracking app help people by showing who they came in contact with who was later diagnosed with Coronavirus?

For example, I go to the grocery store on 3/1 and the bank on 3/3. I start getting symptoms and get a positive diagnosis on 3/8. Health care professionals activate a “positive” covid-19 thing on my phone. It then alerts anyone who came within X number of feet of me that they may have been exposed. Could we utilize modern technology in such a way?

drdrintensivistmdphd19 karma

Israel I believe has such a system. It's a good idea. But will need to contend with our rights as citizens to privacy, however.

viktorlarsson10 karma

Hello!

I have two questions.

  1. I am a type 1 diabetic, but in overall good health. I rarely get sick and consider myself fit and able. In what way does covid-19 put me in a risk group?

  2. My daugther is six years old and ususally meet my parents every week. They have a great relationship. If the strategy of social distansing is to continue for several months, I'm afraid of all the love and interaction they would miss from not being together. Would it be over reacting to not let them see each other?

drdrintensivistmdphd12 karma

  1. Diabetics are known to be a high risk group. This is because the virus enters pneumocytes (cells in the lung) via a receptor called ACE2, and these are upregulated in diabetics. These means there are more "portals" so to speak, for viral entry. Diabetics are more likely to suffer severe disease as a result. Wash your hands, don't touch your face, and stay the F home.
  2. I don't think it would be overreacting. You can explain to your daughter that the only reason she can't be close to them is to protect her grandparents from getting ill. What about skype, facetime, etc?

eire1889 karma

Why will the social isolation last for months? Do we know how long the virus can survive both in a host and on surfaces?

I live in a populated area so I can’t even go outside without meeting people (no full lockdown here yet). I’m getting serious cabin fever.

drdrintensivistmdphd19 karma

Virus can infect someone and that person can be asymptomatic for 14 days or more. It can stay on surfaces up to 72 hours (especially plastic) and can linger in the air for up to 3 hours.

I'm sorry. This is the new normal, sadly.

Azmordean8 karma

I keep seeing people say "we may have to do this for 12-18 months until there is a vaccine." I see that as fearmongering and not remotely realistic. It seems to me more than 2-3mo of near lockdown would completely collapse the global economy, and might well be a situation of "the cure is worse than the disease." Isn't the purpose of these measures to be relatively speaking short term, and blunt the peak of the curve, to allow the health system to gear up, and hopefully get a lot more testing, which would then allow more targeted measures? I also point to Korea and China, both of which are on the downslope and it has only been 2ish months. Appreciate any thoughts from an expert -- I just feel like all the talk of "years" makes people become despondent and have an attitude of "F it, it's not possible to live like this forever," which is very unhelpful.

drdrintensivistmdphd8 karma

I think 18 months may be a bit of a stretch. I think we can get over the peak by June. The problem will never be truly solved until the vaccine is developed, which may take a year.

And complete collapse of the global economy is our own doing - we knew this was coming and we didn't prepare properly.

joeboyib8 karma

A recent Wired article "Is the Split Over Covid-19 Really About Politics?" talked about how Democrats and Republicans are seeing this pandemic differently. If this is true would we expect to see worse patient outcomes red states? If so, why wouldn't Republican's want to protect their constituents?

drdrintensivistmdphd34 karma

I don't know if we will see worse outcomes in red states because they tend to be more spread out and rural so they may have a de facto social distancing built into their situation. But it does alarm me that there is a whole party in this country that at first denied this was a problem in the first place and spread misinformation about the virus via its cable news channel.

getreadytolose6 karma

Other than overloading hospitals, why wouldn't herd immunity be the most plausible course of action? The virus isn't going to just pack up and leave. As soon as we get back to life, we're back to square one. This is certainly no way to live, nor is it going to end all human life on earth. At what point does the potential from crime for individuals that live pay check to pay check outweigh our elderly populace? As soon as people can't eat it will get far uglier than this virus. All of this is the presumption of no vaccine in the near future.

drdrintensivistmdphd8 karma

Yes, but herd immunity doesn't require active infection of live virus that can kill people. The hope is that by "flattening the curve" we are buying time for treatments and eventually vaccines to be developed.

BuffaloMtn6 karma

Is there any estimate for the number of people that have it but don't have any symptoms?

drdrintensivistmdphd13 karma

I have seen many numbers out there - in the tens of thousands - increasing day by day.

keilwerth3 karma

Based on the data we have (e.g. the virus affecting the elderly and those with underlying conditions, ~80% of cases in China having not been detected, ~80% of those infected not requiring serious medical intervention, etc.) and having an appreciation that we're fighting a war on multiple fronts (medical, economic, etc.) shouldn't the best course of action be to quarantine all those in the at-risk category and allow all others to return to work, school?

drdrintensivistmdphd9 karma

No.

chung2k61 karma

I understand the importance of flattening the curve for now, but what's your stance on preparing for annually recurring c19-variant infections ?

Is it realistic to having a small personal ventilator at home and a prescription of whatever drug that's found to be best at combating c19 in the future?

drdrintensivistmdphd2 karma

We need to properly fund the organizations that can help in these situations. Perhaps Dr. Trump's elimination the pandemic response team was a horrible idea. Perhaps defunding the CDC was a horrible idea. Perhaps the war on science and medicine that one party has waged for the last 20 years has been a horrible idea.

To prepare for what you correctly note is coming, we need to believe in science again and properly fund the organizations that bring us scientific advances - colleges and universities, the NIH, the CDC, etc. - while also encouraging the private sector.

No. Vents are not simple to use. You need to be intubated to be on a vent. Whatever drug is found to be best at combating c19 will likely have some significant side effects so, again, no.

duhon00apierres1 karma

Hello. I have travel plans in May that involve several flights. Should I cancel my plans?

drdrintensivistmdphd2 karma

Yes.

GodzillaLongdrill0 karma

My partner Brewster and I were arguing about whether the coronavirus can be transmitted through sexual contact. As the virus is transmitted through droplets, if my partner gets infected couldn’t he infect me if some of his sexual fluids are shot into my mouth or anus? Or what if I become infected… Would I be able to transmit the virus to Brewster through my anal sexual juices?

drdrintensivistmdphd6 karma

Hi Brewster, I do not believe that Covid-19 can be transmitted via anal sexual juices, but I will do some research and get back to you.

GodzillaLongdrill-14 karma

Earlier in this thread you said that Donald Trump was handling this situation better than you could’ve possibly imagined and that we as a nation would be best served in electing him for at least 1 to 2 more terms in office. Don’t you think we should have diversity of thought at the top?

drdrintensivistmdphd13 karma

Dr. Trump has sabotaged the response to this pandemic from the start. His minions at Fox News have contributed to the deaths of many with their denials and misinformation about the virus.