Erica Hayes, 40, has not felt healthy since November 2020 when she first fell ill with covid.

Hayes is too sick to work, so she has spent much of the last four years sitting on her beige couch, often curled up under an electric blanket.

“My blood flow now sucks, so my hands and my feet are freezing. Even if I’m sweating, my toes are cold,” said Hayes, who lives in Western Pennsylvania. She misses feeling well enough to play with her 9-year-old son or attend her 17-year-old son’s baseball games.

Along with claiming the lives of 1.2 million Americans, the covid-19 pandemic has been described as a mass disabling event. Hayes is one of millions of Americans who suffer from long covid. Depending on the patient, the condition can rob someone of energy, scramble the autonomic nervous system, or fog their memory, among many other symptoms.

In addition to the brain fog and chronic fatigue, Hayes’ constellation of symptoms includes frequent hives and migraines. Also, her tongue is constantly swollen and dry.

“I’ve had multiple doctors look at it and tell me they don’t know what’s going on,” Hayes said about her tongue. 

Estimates of prevalence range considerably, depending on how researchers define long covid in a given study, but the Centers for Disease Control and Prevention puts it at 17 million adults.

Despite long covid’s vast reach, the federal government’s investment in researching the disease — to the tune of $1.15 billion as of December — has so far failed to bring any new treatments to market. 

This disappoints and angers the patient community, who say the National Institutes of Health should focus on ways to stop their suffering instead of simply trying to understand why they’re suffering.

“It’s unconscionable that more than four years since this began, we still don’t have one FDA-approved drug,” said Meighan Stone, executive director of the Long COVID Campaign, a patient-led advocacy organization. Stone was among several people with long covid who spoke at a workshop hosted by the NIH in September where patients, clinicians, and researchers discussed their priorities and frustrations around the agency’s approach to long-covid research.

Some doctors and researchers are also critical of the agency’s research initiative, called RECOVER, or Researching COVID to Enhance Recovery. Without clinical trials, physicians specializing in treating long covid must rely on hunches to guide their clinical decisions, said Ziyad Al-Aly, chief of research and development with the VA St Louis Healthcare System.

“What [RECOVER] lacks, really, is clarity of vision and clarity of purpose,” said Al-Aly, saying he agrees that the NIH has had enough time and money to produce more meaningful progress.

Now the NIH is starting to determine how to allocate an additional $662 million of funding for long-covid research, $300 million of which is earmarked for clinical trials. These funds will be allocated over the next four years.

At the end of October, RECOVER issued a request for clinical trial ideas that look at potential therapies, including medications, saying its goal is “to work rapidly, collaboratively, and transparently to advance treatments for Long COVID.”

This turn suggests the NIH has begun to respond to patients. This has stirred cautious optimism among those who say that the agency’s approach to long covid has lacked urgency in the search for effective treatments.

Stone calls this $300 million a down payment. She warns it’s going to take a lot more money to help people like Hayes regain some degree of health.

“There really is a burden to make up this lost time now,” Stone said.

The NIH told KFF Health News and NPR via email that it recognizes the urgency in finding treatments. But to do that, there needs to be an understanding of the biological mechanisms that are making people sick, which is difficult to do with post-infectious conditions.

That’s why it has funded research into how long covid affects lung function, or trying to understand why only some people are afflicted with the condition.

Good Science Takes Time

In December 2020, Congress appropriated $1.15 billion for the NIH to launch RECOVER, raising hopes in the long-covid patient community.

Then-NIH Director Francis Collins explained that RECOVER’s goal was to better understand long covid as a disease and that clinical trials of potential treatments would come later.

According to RECOVER’s website, it has funded eight clinical trials to test the safety and effectiveness of an experimental treatment or intervention. Just one of those trials has published results.

On the other hand, RECOVER has supported more than 200 observational studies, such as research on how long covid affects pulmonary function and on which symptoms are most common. And the initiative has funded more than 40 pathobiology studies, which focus on the basic cellular and molecular mechanisms of long covid.

RECOVER’s website says this research has led to crucial insights on the risk factors for developing long covid and on understanding how the disease interacts with preexisting conditions.

It notes that observational studies are important in helping scientists to design and launch evidence-based clinical trials.

Good science takes time, said Leora Horwitz, the co-principal investigator for the RECOVER-Adult Observational Cohort at New York University. And long covid is an “exceedingly complicated” illness that appears to affect nearly every organ system, she said. 

This makes it more difficult to study than many other diseases. Because long covid harms the body in so many ways, with widely variable symptoms, it’s harder to identify precise targets for treatment.

“I also will remind you that we’re only three, four years into this pandemic for most people,” Horwitz said. “We’ve been spending much more money than this, yearly, for 30, 40 years on other conditions.”

NYU received nearly $470 million of RECOVER funds in 2021, which the institution is using to spearhead the collection of data and biospecimens from up to 40,000 patients. Horwitz said nearly 30,000 are enrolled so far.

This vast repository, Horwitz said, supports ongoing observational research, allowing scientists to understand what is happening biologically to people who don’t recover after an initial infection — and that will help determine which clinical trials for treatments are worth undertaking.

“Simply trying treatments because they are available without any evidence about whether or why they may be effective reduces the likelihood of successful trials and may put patients at risk of harm,” she said.

Delayed Hopes or Incremental Progress?

The NIH told KFF Health News and NPR that patients and caregivers have been central to RECOVER from the beginning, “playing critical roles in designing studies and clinical trials, responding to surveys, serving on governance and publication groups, and guiding the initiative.”

But the consensus from patient advocacy groups is that RECOVER should have done more to prioritize clinical trials from the outset. Patients also say RECOVER leadership ignored their priorities and experiences when determining which studies to fund.

RECOVER has scored some gains, said JD Davids, co-director of Long COVID Justice. This includes findings on differences in long covid between adults and kids.

But Davids said the NIH shouldn’t have named the initiative “RECOVER,” since it wasn’t designed as a streamlined effort to develop treatments.

“The name’s a little cruel and misleading,” he said.

RECOVER’s initial allocation of $1.15 billion probably wasn’t enough to develop a new medication to treat long covid, said Ezekiel J. Emanuel, co-director of the University of Pennsylvania’s Healthcare Transformation Institute.

But, he said,  the results of preliminary clinical trials could have spurred pharmaceutical companies to fund more studies on drug development and test how existing drugs influence a patient’s immune response.

Emanuel is one of the authors of a March 2022 covid roadmap report. He notes that RECOVER’s lack of focus on new treatments was a problem. “Only 15% of the budget is for clinical studies. That is a failure in itself — a failure of having the right priorities,” he told KFF Health News and NPR via email.

And though the NYU biobank has been impactful, Emanuel said there needs to be more focus on how existing drugs influence immune response.

He said some clinical trials that RECOVER has funded are “ridiculous,” because they’ve focused on symptom amelioration, for example to study the benefits of over-the-counter medication to improve sleep. Other studies looked at non-pharmacological interventions, such as exercise and “brain training” to help with cognitive fog.

People with long covid say this type of clinical research contributes to what many describe as the “gaslighting” they experience from doctors, who sometimes blame a patient’s symptoms on anxiety or depression, rather than acknowledging long covid as a real illness with a physiological basis.

“I’m just disgusted,” said long-covid patient Hayes. “You wouldn’t tell somebody with diabetes to breathe through it.”

Chimére L. Sweeney, director and founder of the Black Long Covid Experience, said she’s even taken breaks from seeking treatment after getting fed up with being told that her symptoms were due to her diet or mental health.

“You’re at the whim of somebody who may not even understand the spectrum of long covid,” Sweeney said.

Insurance Battles Over Experimental Treatments

Since there are still no long-covid treatments approved by the Food and Drug Administration, anything a physician prescribes is classified as either experimental — for unproven treatments — or an off-label use of a drug approved for other conditions. This means patients can struggle to get insurance to cover prescriptions.

Michael Brode, medical director for UT Health Austin’s Post-COVID-19 Program — said he writes many appeal letters. And some people pay for their own treatment.

For example, intravenous immunoglobulin therapy, low-dose naltrexone, and hyperbaric oxygen therapy are all promising treatments, he said.

For hyperbaric oxygen, two small, randomized controlled studies show improvements for the chronic fatigue and brain fog that often plague long-covid patients. The theory is that higher oxygen concentration and increased air pressure can help heal tissues that were damaged during a covid infection.

However, the out-of-pocket cost for a series of sessions in a hyperbaric chamber can run as much as $8,000, Brode said.

“Am I going to look a patient in the eye and say, ‘You need to spend that money for an unproven treatment’?” he said. “I don’t want to hype up a treatment that is still experimental. But I also don’t want to hide it.”

There’s a host of pharmaceuticals that have promising off-label uses for long covid, said microbiologist Amy Proal, president and chief scientific officer at the Massachusetts-based PolyBio Research Foundation. For instance, she’s collaborating on a clinical study that repurposes two HIV drugs to treat long covid.

Proal said research on treatments can move forward based on what’s already understood about the disease. For instance, she said that scientists have evidence — partly due to RECOVER research — that some patients continue to harbor small amounts of viral material after a covid infection. She has not received RECOVER funds but is researching antivirals.

But to vet a range of possible treatments for the millions suffering now — and to develop new drugs specifically targeting long covid — clinical trials are needed. And that requires money.

Hayes said she would definitely volunteer for an experimental drug trial. For now, though, “in order to not be absolutely miserable,” she said she focuses on what she can do, like having dinner with her family.

At the same time, Hayes doesn’t want to spend the rest of her life on a beige couch. 

RECOVER’s deadline to submit research proposals for potential long-covid treatments is Feb. 1.

The post Long-Covid Patients Are Frustrated That Federal Research Hasn’t Found New Treatments appeared first on Medika Life.

As a scientist, I question the efficacy of paper surgical masks in preventing the transmission of COVID-19, as my hospital reintroduced a mandate for healthcare providers to wear them.

Although many debate the effectiveness of paper masks, I am more interested in the evidence supporting wearing one rather than the politics surrounding masking.

Mixed Feelings

I remember wearing a paper surgical mask during a particularly busy shift at the hospital last winter.

As I moved from one patient’s room to another, I couldn’t help but notice the discomfort caused by the mask’s straps constantly tugging at my ears.

Despite the inconvenience, I also couldn’t ignore the sense of protection and responsibility that came with wearing it.

I work in cancer medicine, after all.

It’s a strange juxtaposition — the physical discomfort versus the mental reassurance.

Moreover, my patients prefer to see my face.

Moments like these make me reflect on the true effectiveness of these masks and whether they are truly making a difference in preventing the transmission of viruses.

Overview

While we adopted widespread mask use as a public health measure, the evidence supporting their effectiveness remains contested.

Observational studies (and even some randomized controlled trials) suggest a benefit, but there is no high-level, conclusive evidence that masks reduce COVID-19 transmission.

You may be surprised to hear this doctor admit that.

Today, I want to examine a recent study that hails the effectiveness of masking.

The big reveal: We need more rigorous investigations to determine the precise role of paper surgical masks in mitigating the spread of the virus.

A New Study

Atle Freithem and colleagues report the results of a pragmatic randomized control trial in the British Medical Journal:

Personal protective effect of wearing surgical face masks in public spaces.

www.bmj.com.

The take-home message is this:

Wearing a surgical mask for two weeks during the winter of 2023 reduced the spread of self-reported viral illness.

This research proves that paper masks work, right?

Study Details

Purpose: This study aimed to see if wearing a surgical mask in public places like stores, streets, and public transport for two weeks could protect people from getting sick with respiratory infections like colds or the flu.

How the study worked: Researchers randomly divided almost 4,700 adults in Norway into two groups. They told one group of participants to wear surgical masks in public for two weeks while asking the other group not to.

What researchers examined: The scientists were mainly interested in whether people got sick with respiratory infections. They also looked at whether people reported getting COVID-19 or had it confirmed by a doctor.

Important note: The investigators did not tell subjects to wear masks at home or work, only when in public.

Study Results

Here are the study results:

Over the study period, about 9 percent of those who wore masks reported cold or flu-like symptoms, compared to 12 percent of those who didn’t.

This finding suggests that wearing masks might slightly lower your chances of contracting a respiratory infection.

My Take

First, kudos to the researchers for completing a practical, randomized clinical trial evaluating paper mask effectiveness.

We can do randomized clinical trials in the COVID-19 realm.

Second, the study does not prove that paper masks reduce COVID-19 transmission.

Many people believe masks are effective, and this study didn’t use a placebo or fake mask to account for that belief.

The results may reflect that people feel better because they wear a mask rather than a mask that prevents illness.

We Need Studies With Objective Measures

I hope we get a study that uses objective measures of infection.

I wish the authors had used regular virus tests or blood tests checking for COVID-19 antibodies.

And mandated mask wearing for more than a couple of weeks.

The study, as conducted, tells us that people wearing masks reported fewer illnesses, not that they were actually sick less often or felt better overall.

While the study didn’t find a benefit in confirmed COVID-19 cases, it might not have been large enough to detect a small difference.

Bottom Line

This study does not prove masks reduce COVID-19 transmission; the study’s primary endpoint was self-reported illness.

After so much trumpeting of the value of paper masks to reduce COVID-19 contagiousness, we still need high-level evidence to convince me.

Per my hospital’s mandate, I will continue to don my paper mask faithfully in designated places in my workplace.

But am I better off donning a mask year after year for a virus that has diminished in lethality for healthy individuals like me?

If I had a big upcoming event, I would wear an N-95 mask.

Many counterfeit N-95 and K-95 masks are out there, and many don’t fit them properly.

But that is another story.

Do you regularly wear a paper surgical mask? What motivates you to do so?

Effectiveness of Face Mask or Respirator Use.

This report describes face mask or respirator effectiveness in helping protect against COVID-19 infection.

www.cdc.gov.

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In an effort to get ahead of a potential tripledemic this winter of COVID-19, flu, and RSV that could overwhelm hospitals, health officials have re-booted an important program: making COVID test kits free again. Those kits will be available by mail to households starting September 25.

Next comes the hard part: convincing enough people to get the kits and then persuading them to follow quarantine guidelines if they or their family members get sick.

This is not the time to roll out stale messaging delivered by a carousel of health officials trying to convince the public to get the test kits. Americans are weary of being told to keep their guard up against a disease that many view as more of an inconvenience than a threat. If the sales pitch to get the kits is off, health officials may find that the test kits no longer serve as an effective public health tool. Instead, they could become another partisan symbol of perceived government overreach, further impeding people’s freedom to live as they want.

In short, we have a messaging challenge ahead of us, and if we haven’t taken to heart the lessons learned during the worst early days of the pandemic, we’re doomed to repeat mistakes that cost lives.

How can we be more thoughtful about containing COVID and other dangerous diseases? To generate greater public compliance for fighting an endemic disease, communicators must provide a credible and compelling case of the risk of inaction and convince people that ignorance – of not knowing your infection status – is greater than the cost of knowing. These can be very high bars to clear since people have different thresholds for risk and for being informed.

It’s likely we won’t clear those hurdles with the roll-out of the free test kits. Because the perceived risk of COVID-19 infection and severity is low, many people have adopted a “no test, no stress” attitude, especially in light of the potential personal disruption that COVID infection causes. It’s a dangerous direction and one of the reasons why we will continue to see cases spike.

For communicators to overcome the twin challenges of infection risk perception and status aversion, they must use convert communicators – people who are credible to specific audiences and have changed their views to support disease intervention. There is mounting data showing that people who identified as Republicans were far likelier to get infected by COVID and die from the disease than those from left-leaning political parties. Messaging that taps into this research could point to breaking through to these audiences.

Successful public health interventions rely on a strong majority of the population participating in disease mitigation efforts, which means spotlighting conservative voters who see the value of COVID testing and can serve as credible messengers to similarly ideologically inclined individuals. This is where digital storytelling, data visualization and engagement of champions outside of the health sector can be potent measures to build the case for supporting new public health tools.   

It is also important to truly understand the pain points that different audience segments cite as reasons for not wanting to know their infection status and to provide targeted counterpoints. Most people can’t afford to miss work, even with a mild case, and families can be heavily impacted when a parent must choose between going to work or keeping their kids home. In these and other scenarios, the test result becomes the thing people may begin to dread more than the disease itself.

To ensure that people do not feel like they must choose between a host of the least bad options when COVID comes to their home, the government must consider new incentives for reporting positive test results and adhering to public health guidelines. These can range from reinstituting protected sick leave that was available as part of the Families First Coronavirus Response Act (FFCRA) during the pandemic to encouraging more employers to use the tax credits available through the American Recovery Plan Act (ARPA) to reimburse for employee sick leave. Without putting these and other options on the table, people will feel penalized even when they do the right thing.

The post It’s Time to Up Our Messaging Game Ahead of Another Winter with COVID appeared first on Medika Life.

A nurse was killed when she refused to give a patient a cigarette. Of course, the patient had already committed murder, so what did he have to lose? By using a ballpoint pen, a patient stabbed another nurse in the neck.

A psychiatrist on a ward where I worked was also attacked. After I left the office and building, the patient repeatedly hit the small woman psychiatrist with her handbag, which contained a heavy book. The psychiatrist had injuries to her shoulder and neck and went on sick leave for two months. The patient was immediately transferred to another hospital in the state, one for violent patients who had attacked, primarily, physicians.

None of this happened recently, and the violence at the two hospitals where I worked was always treated the same: transfer when an MD was attacked, quiet room for every other attack. The staff felt demeaned and resentful.

“The risk of workplace violence is not distributed evenly across specialty. Data shows that those who work in the emergency department, in geriatrics, or in psychiatry are substantially more likely to experience violence.”

Today, however, the level of violence, primarily at hospitals, is causing a sudden decision for nursing staff to seek other employment or leave the field entirely because of burnout or a lack of safety. Some estimates place the number of nurses leaving by 2027 at around 600,000. The result is that we have inadequate levels of staffing now, and it will get worse. In fact, hospitals are upping their recruitment abroad to supplement the paltry stream from US sources.

The rise in violence against medical professionals has had a substantial influence on the medical community, causing serious difficulties for both patient care and healthcare workers. Stressed and overworked healthcare professionals may degrade the standard of patient care. Also, the fear of violence can make it difficult for healthcare professionals to carry out their jobs properly, which can reduce productivity and increase the risk of patient care errors. In such a situation, what can be done?

How It Is Being Addressed

The media has been providing information on the issue, and both public awareness and education about it are needed. But is that enough? Obviously, an informed public is needed, but what steps are hospitals taking to protect and train their personnel?

According to research, healthcare is the profession where more violence occurs than in any other workplace, and about 654,000 personnel are injured each year. Yes, this is shocking, and I’m willing to play devil’s advocate here after reading what hospitals are proposing by way of decreasing violence in healthcare settings. No, I am not an expert on the matter, but some of the propositions appear to be circling the wagons without addressing some very real issues.

A perusal of the information that is being provided to healthcare personnel boils down to learning to de-escalate potentially violent incidents, educating the public and patients, planning for escape, where to hide, and how to call for help or security personnel. The one factor that is missing is the most distressing of all. The reasons for violence? Patient dissatisfaction, scarcity of mental health facilities, the opioid crisis, the pandemic—the list goes on.

Using a phrase that has become familiar to many of us, “You don’t bring a knife to a gunfight.” How does that apply here? I believe it is apparent that we are not more forcefully addressing the issue of gun availability, but not simply the ready supply of guns in stores.

The type of gun that is being used in almost all of these violent incidents is one meant for war. To more graphically present what these guns do, I have read in the research that the exit wound is the size of an orange, and survival is all but hopeless.

The issues are broader than employee and patient education, where to hide, or hospital protocols. To say that we are handling the question of gun violence in the US would seem to me to be somewhat naive or evasive. It’s a head-in-the-sand gesture when over 200 mass shootings occurred in the first half of 2023. Anyone wishing for more detailed information on gun violence can search the Gun Violence Archive.

Personnel shortages are only one result of the violence we are seeing. The future history books will carry a good deal of bold-faced type to underscore the recklessness we’ve encountered with regard to loss of life and our responses. The question remains: when will it stop?

The post How Can We Address Increasing Violence Against Healthcare Personnel? appeared first on Medika Life.

Yet, a study released today should — once and for all — finally shut the coffin closed on hydroxychloroquine and COVID-19. The study — the Prevention and Treatment of COVID-19 With Hydroxychloroquine (PATCH) Study — was a randomized, double-blind, placebo-controlled clinical trial was conducted at 2 tertiary urban hospitals in Pennsylvania.

They enrolled full-time hospital-based healthcare workers (physicians, nurses, certified nursing assistants, emergency technicians, and respiratory therapists) between April 9, 2020 to July 14, 2020. They planned to enroll 200 subjects.

The trial randomized 132 healthcare workers to take 600 mg of hydroxychloroquine or placebo once a day for 8 weeks, and they tested whether this treatment will prevent infection with SARS CoV-2.

The study found absolutely no difference between the groups (6.3% for hydroxychloroquine vs 6.6% for placebo). In fact, because of futility, the trial was stopped early. This is why they only randomized 132 subjects rather than the planned 200.

This should be the end of hydroxychloroquine for COVID-19.

Now, it is understandable — given the novelty of the disease and the frightening nature of its effects on patients — that clinicians wanted to try anything and everything to treat COVID-19. If there was a treatment that may help, clinicians were using it. That’s how hydroxychloroquine started.

Yet, we need to make sure that any treatment we are administering, especially one with potential significant side effects like hydroxychloroquine, actually works. That’s where randomized trials come in. They are the best way to test whether a treatment actually works.

This study was a very good trial: it was randomized, which means that the subjects were randomly assigned to the two groups. It was double-blind, which means that the investigators and the subjects didn’t know if they received treatment or placebo. And it had a placebo group.

And it showed no effect of hydroxychloroquine.

Indeed, as the study authors rightly note, the study had some important limitations:

Our study was likely established with insufficient power. Given the small sample size, we cannot exclude the possibility of an undetected modest potential prophylactic effect of hydroxychloroquine.

We did not attempt to quantify the frequency of participant exposure or specific timing of exposures.

The cohort largely comprised young healthy HCWs and thus may not be generalizable to other populations with increased risk because of advanced age or additional comorbidities.

Both study hospitals were located in Philadelphia and may not be representative of COVID-19 prevalence and exposure risk in other geographical areas.

We cannot exclude the possibility that a lower or intermittent dose of hydroxychloroquine would be more effective at prevention, although a recent preclinical investigation in a COVID-19 macaque model did not find differences in antiviral activity with varied hydroxychloroquine dosing.

Despite these limitations, I think the study is quite an important contribution to the literature surrounding hydroxychloroquine and COVID-19. There are other ongoing prophylaxis trials, and I’m eagerly awaiting those results as well.

There are some who say that hydroxychloroquine helps zinc work its effect on SARS CoV-2. I looked this up on UpToDate, a clinical resource that I frequently use to keep me apprised on the latest literature, and there is no mention of hydroxychloroquine in combination with zinc. There are other trials around the world being conducted currently testing zinc in a number of combinations. That said, here is what the authors wrote about hydroxychloroquine:

According to a preliminary, unpublished report from a large randomized trial evaluating a number of potential therapies for hospitalized patients with COVID-19, there was no difference in 28-day mortality among 1561 patients who were randomly assigned to receive hydroxychloroquine compared with 3155 patients who received standard care (26.8 versus 25 percent, rate ratio 1.09, 95% CI 0.96–1.23); hydroxychloroquine also did not decrease length of hospital stay. Based on these data, the hydroxychloroquine arm of the trial was closed.

The World Health Organization also terminated the hydroxychloroquine arm of its large SOLIDARITY trial, and the United States National Institutes of Health terminated its trial of hydroxychloroquine in hospitalized patients; each cited a lack of benefit based on preliminary data from the trials.

So, to me, this prophylaxis trial — along with other big studies — should finally put to rest hydroxychloroquine for Covid-19. It simply doesn’t work.

And…if hydroxychloroquine really worked, President Trump would have gotten it. He has received monoclonal antibodies, remdesivir, and other therapies. Hydroxychloroquine was not on the list.

References:

1. RECOVERY trial investigators. No clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19. https://www.recoverytrial.net/news/statement-from-the-chief-investigators-of-the-randomised-evaluation-of-covid-19-therapy-recovery-trial-on-hydroxychloroquine-5-june-2020-no-clinical-benefit-from-use-of-hydroxychloroquine-in-hospitalised-patients-with-covid-19
2. NIH halts clinical trial of hydroxychloroquine https://www.nih.gov/news-events/news-releases/nih-halts-clinical-trial-hydroxychloroquine
3. WHO. “Solidarity” clinical trial for COVID-19 treatments: Update on hydroxychloroquine. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments
4. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial.
   Tang W, Cao Z, Han M, et al. BMJ. 2020;369:m1849. Epub 2020 May 14.
5. Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19. Cavalcanti AB, Zampieri FG, Rosa RG, et al. N Engl J Med. 2020

The post Hydroxychloroquine Does Not Prevent Infection with SARS CoV-2 appeared first on Medika Life.

He became so much worse: he couldn’t breathe. He was restless. He became increasingly agitated.

Then, his heart just stopped. We called a CODE BLUE. We started CPR, and I placed a breathing tube into his lungs. His heart came back, but it was not to last.

I placed him on every medicine I had to try to help his heart beat more forcefully. Nothing was working. When I did an ultrasound of the heart, it was barely beating — even though he was on rocket fuel for the heart. In spite of everything we were doing, we could not save him. He died within hours of coming to the ICU.

It was sad, and I really felt for the family at the bedside. At the same time, I didn’t have the same feeling I had when I took care of a Covid patient who suffered the same fate. I’ve faced death so many times in the ICU. But with Covid it was different, and I’ve figured out why.

Fear.

I didn’t have the fear and dread that I had taking care of Covid patients. You see, I wasn’t scared of catching cardiogenic shock from the patient. I am not scared of catching diabetic ketoacidosis. I am not scared, even, to catch someone’s septic shock, even though it is possible to catch some infections like C. difficile or tuberculosis.

I am scared of catching SARS CoV-2. I am deathly scared of getting Covid and then bringing it home to my family. This disease is so horrific and so new, and we still don’t know what are the long-term effects from this disease. This unknown, this uncertainty, leads to a great amount of fear. And that fear permeates everything when caring for patients who are suffering from Covid-19.

Never before have we had a disease like Covid-19. Sure, we’ve had influenza, and even very bad influenza pandemics like H1N1. We have never had something as bad as Covid-19; something as horrific as Covid-19; something as deadly as Covid-19.

And it’s “transmitted through the air,” as someone famously said recently. It’s so contagious, and that fact adds to the menace of the disease. And when you have dozens of these patients at the same time — all on ventilators, all super sick — the fear and dread can be overwhelming. It was overwhelming.

Yes, we had PPE, and I was and still am extremely grateful for it. The PPE works, too. And we have some treatments now that seem to be effective for Covid. Still, it’s hard to shake the fear, especially when you see firsthand what horror this disease can cause on its victims.

On the one hand, a little bit of fear can be productive. It ensures vigilance: vigilance for hand washing, vigilance for wearing PPE, vigilance for making sure I don’t catch or transit this disease to others.

On the other hand, too much fear can be paralyzing, and I must also be vigilant against letting the very natural fear I have of Covid-19 from taking over. While several thousand of my healthcare colleagues have indeed gotten Covid, and some have even died, the vast majority of us in healthcare have remained safe from this disease. And I thank God for that.

I’ve faced death many times over as a critical care physician, but I’ve never been as affected as I have been with Covid-19. Fear has a lot to do with that. Going forward, I must remain vigilant: vigilant against catching this disease, and also vigilant against letting my fear get the best of me.

The post What is it About Covid That Makes it Worse appeared first on Medika Life.