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Taking care of an ICU patient with COVID-19 at Maimonides Hospital in Brooklyn.    Washington Post photo. 4/15/20

Paul Goldfinger, MD, FACC

Ocean Grove.  April 15, 2020.

 

Washington Post April 15, 2020:    Covid-19 kills by inflaming and clogging the tiny air sacs in the lungs, choking off the body’s oxygen supply until it causes organ failure. But doctors are seeing that the virus may be causing heart inflammation, acute kidney disease, neurological malfunction, blood clots, intestinal damage and liver problems.

As we have pointed out, this epidemic is, from a medical point of view, creating more questions than answers even as new questions tumble out of ICU’s and research labs all over the world.  The earliest observation was that the virus attacks and damages the small lung air spaces causing oxygen lack around the body and leading to the need for ventilator care.

But so many have been dying despite the ICU and ventilator approach, that other ideas are being considered.  American physicians have been obtaining a great deal of information from researchers in Wuhan, China and from their own, in the trenches, observations.

It is now becoming clear that the virus attacks other organ systems directly including the kidneys resulting in renal failure and need for dialysis.

Liver damage causes liver failure, and the virus attacks the linings of the intestinal tract as well.

In some patients, the immune system reacts by spewing out damaging substances called cytokines, resulting in “cytokine storms.”

And other issues include neurologic damages, heart injury,  and blood clots in the legs which can cause pulmonary embolism.

So it seems that the coronavirus infections can overwhelm most of the body’s systems and overwhelm the ability of healthcare workers to save patients from death or lingering and nonredeemable complications.

I can imagine the scenes in ICU’s all over the world, where patients tumble downhill with one problem on top of another, after another, after…. I can imagine the stress on the doctors, nurses and other medical personnel who try to plug holes in the dyke, but then other leaks pop open.  I can picture the horror that they experience as they lose one patient after another.

And I can imagine the terror in the hearts and souls of patients and their families.

It must be like a tsunami hitting a peaceful island of tranquility and then tearing it apart in no time.

It’s hard to believe that this disaster will completely subside for some time.  The search is on for all sorts of ways to stem the tide. And all of us who are outside looking in and getting frightened for ourselves and our families can only do what we are told and asking everyone else to do the same.

 

JUDY KUHN  ;”Dividing Day” from Adam Guettel’s The Light in the Piazza
“Beautiful is what you are,
Only somehow wearing a frightening disguise.
I can see the winter in your eyes, now, telling me:

“Thank you, We’re done here, Not much to say.

We are together but I have had Dividing Day.”

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Coronavirus workers in Madrid respond to cheers from apartment dwellers. Internet photo.

 

By Paul Goldfinger, MD.

Hydroxychloroquine is an antimalarial drug which has been around for many years.  A long while ago it was suspected that the drug would work against killer viruses, and it has been looked at for that purpose as far back as 40 years ago.  Recent laboratory trials have produced discouraging results.  There are concerns about cardiac toxicity, but, in general, it has been safe, and the chances of a major cardiac rhythm disturbance are quite small.  Its approved uses include lupus, rheumatoid arthritis, and malaria.

It got into the news recently when some French doctors gave it to a small number of patients with Coronavirus, and some of them seemed to respond favorably.  Even though there are no scientific trials to prove the benefit in patients, doctors all over the world have been trying it along with an antibiotic, azithromycin.

The general attitude of doctors working in the trenches to combat the horrible COVID-19 disease has been “let’s try it, because our patients are dying.”  They have been giving the drugs “off label” and with the knowledge of patients and families. The usual routine is to give it early in the illness for a matter of days. There are many anecdotes describing  beneficial  results, but nothing has been proven, and some doctors refuse to use an unproven treatment.

Meanwhile the NIH and other academic institutions here and around the world have initiated controlled studies.

The President has jumped on the band wagon touting these drugs, and huge numbers of pills are being manufactured and distributed with the approval of the FDA.  This drug has not been officially approved by the FDA for this purpose, but doctors have the green light to try it.

Here are some quotes from a variety of solid sources, news and medical:

“Drug companies across the world have begun donating tens of millions of doses of hydroxychloroquine to the United States, and the President said on April 4 that 29 million doses had been added to the National Strategic Stockpile, a cache of medical supplies maintained by the government to respond to emergencies.”

“Studies of hydroxychloroquine in the past  have found that it failed to prevent or treat influenza and other viral illnesses.”

“Recent reports from doctors in China and France have said that hydroxychloroquine, sometimes combined with the antibiotic azithromycin, seemed to help patients.   Many hospitals around the world  are giving it to patients even though there  is no proven treatment, and they hope it will help.” Others are trying it as a preventive for exposed people.

” A nationwide clinical trial began on April 2 in the US. It is to enroll 510 patients at 44 medical centers.  Last month, the Food and Drug Administration issued an emergency use authorization, allowing health care providers to use the medicine for this  illness, even though the drug has not been approved as a specific treatment for COVID-19.”

American College of Cardiology:     “Hydroxychloroquine and azithromycin all prolong QT interval on the ECG, raising concerns about the risk of arrhythmic death from individual or concurrent use of these medications. We strongly encourage enrollment of patients in clinical research protocols, whenever available. All clinical use that occurs outside of a research setting should incorporate anticipated benefits balanced against risks.”

Currently, there is hope for benefit from hydroxychloroquine, yet there is little evidence. That is likely to rapidly change, given many pending clinical studies in the U.S.,  and some of those should produce results fairly quickly.

“Dr. Anthony Fauci continues to hold the same line as the rest of the medical community—cautious optimism.”

“Dr  Fauci, the country’s top infectious disease doctor, has repeatedly warned  that there is no conclusive evidence to support using the drug.  Asked whether it should be considered a treatment for Covid-19, he said on 24 March: “The answer is no.”

I heard him respond to a question at a press conference  as to whether he would take the drug if he had  Coronavirus, and he said, “Only if I could be part of a clinical trial.”

Would I take it if I were very ill with Corona, the answer is “yes.”

 

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