New York doctors learned valuable lessons during the initial coronavirus outbreak. That knowledge is being passed on to other physicians currently battling the disease in other parts of the country.
MIKAELA WOLF: My name is Mikaela Wolf. I’m a nurse practitioner at North Shore University Hospital, and I am an acute care nurse practitioner.
HUGH CASSIERE: My name is Dr. Hugh Cassiere. I’m the director of critical care services for the Sandra Atlas Bass Heart Hospital on Manhasset, Long Island.
You know, what did we learn? What did I learn? What did the health system learn and my colleagues learn over the last couple months? A lot. If I can go into a time machine and go back to March 14, 2020, so I would tell myself the day before, start using steroids freely, dexamethasone, on all your critically unstable COVID-19 patients.
So there’s two parts to COVID-19. One is the damage that the virus directly does to the body. It causes pneumonia. And then there’s the body’s response to the virus that causes injury, the inflammatory response to the virus. We know now that the body’s response to the virus is doing much more damage than the virus itself.
So how do you control inflammation? Steroids. Steroids have been around for decades. It’s the only therapy that’s been shown to save lives. Everything else we’re going to talk about, it’s more supportive therapy, and they can be helpful.
You know, remdesivir, that’s a little more difficult. It’s, you know, a therapy that was developed for Ebola. Its specific treatment is to stop viral replication. Unfortunately, the studies that have been done on remdesivir have showed that it really just decreases symptoms, and I don’t want to minimize that. I don’t want to minimize that at all. It’s not the blockbuster that we thought it was going to be. It’s more of it helps a little bit. I would recommend remdesivir early, early on in the disease.
Hydroxychloroquine, for some reason, has a political flare to it. I’m not really sure why. This should just be purely science. I’m a science-based physician. Hydroxychloroquine just doesn’t work for patients with severe COVID-19 disease, and that’s just a science fact. So I don’t use or would not recommend hydroxychloroquine for treatment. I wish it did help.
The other thing that we’re learning is there’s a therapy called high-flow nasal oxygen. That’s really our go-to therapy for people who come in who require a high level of oxygen. We shied away from using that early on because there was a fear that using this therapy can aerosolize the virus and infect other people. That’s not the case.
I would say use high-flow nasal oxygen. You’ll probably prevent not everyone from being intubated or being put on ventilators but maybe 10% to 20% of patients, which is a lot.
Unfortunately, there are going to be patients who need ventilators. We’ve learned a lot about what to do for these patients on the ventilators to improve their care. One of them is use blood thinners to prevent blood clots. There’s something about COVID-19. We call it a hypercoagulable state. So when you get infected with this virus, it causes your body to form blood clots, strokes, things called pulmonary embolism. Blood thinners we’ve found are very, very important.
These patients with COVID-19 who develop this type of lung injury called ARDS, you treat it like every other patient who has ARDS. In other words, don’t give a lot of fluid. Sometimes we flip the patients on their belly to improve their oxygen and their ability to ventilate.
MIKAELA WOLF: There was a lot of teamwork involved, which is something that I am going to take away from this and I will relay to anybody else going through this. Teamwork is so important. It takes every– all of the hands you can get, all the support you can get, and you really need to be able to roll with the punches and be able to get back up every single time.
HUGH CASSIERE: I still don’t sleep at night. You know, I still wake up between– anywhere between midnight and 3:00 in the morning. You know, post-traumatic stress disorder is real. Take time to rejuvenate. Take some time for yourself, which is very difficult.
Rely on your colleagues. Rely on your colleagues. Communicate your feelings and what you’re going through with your colleagues. They’re feeling the same things you are, and you can help each other. You can decrease the burden and stress by doing that.
MIKAELA WOLF: Be resilient, and it’s very hard. I’ve been there. I am you. I hear you. I see you. I feel you. Be resilient. There is light at the end of the tunnel.
And rely on your friends, rely on your family, and rely on your community.