Another day, another….
First, a shoutout to my team, Julie Traupman, Enrique Unson, M.D., Kathy Chao, Daniel Maddock and Ramon Trinidad. The people of Essex County owe you a big, big thanks. The administration of St. Barnabas owes you a bigger thanks, but don’t hold your breath. I am proud and amazed how these women and men, who work in small private practice responded. The bell tolled and they answered it. I am very, very impressed. Not many people are going to willing put themselves into harm’s way for a paycheck. Each could have easily cut and run. Each, instead, worked harder than they have before in their lives. I am proud and grateful for your contributions and help.
Regarding COVID in the history of modern Medicine, never has one infectious disease hit so quickly and so consistently. The Spanish Flu pandemic may be the closest comparator, but we didn’t have labs, X-rays, medications, etc.
In 1981, when I was a senior in high school, my father came home one night and at dinner (we ALWAYS ate dinner together) told us about GRIDS, which stood for Gay-Related Immunodeficiency Syndrome. My Dad went on to explain to my Mom, me, Annie, who was 15 and Marshall who 11, that the NY docs were seeing gay men with a certain type of weakened immunodeficiency. Soon, the docs realized that this syndrome was seen in other groups, especially IV drugs users and hemophiliac boys. The name of the syndrome was changed to AIDS or Acquired Immunodeficiency Syndrome. AIDS then steadily spread, but its pace was nowhere near the pace of COVID. Further, AIDS led to several unusual infections. No one came to the hospital with AIDS; they came because their immune system made them susceptible to certain infections that no one else was susceptible to.
COVID-19 is different, very different. Obviously, COVID is easier to catch. Anyone can catch it. But not anyone gets very sick from it. The more pts we see, the more obvious it is that this severe COVID disease is a complication or secondary to Diabetes. My team and I have seen 101 COVID pts in less than 4 weeks. We are not sure we know how to diagnose and treat anything else anymore.
We had 14 new consults today. 13 of the 14 new pts had elevated blood sugars. 10/14 are known diabetics (3 others probably have diabetes and don’t know it; the one pt who doesn’t have DM weighs 286 lbs.). In other words, none of those 14 pts has normal sugar metabolism.
My team and I are so adept and used to diagnosing COVID pts when can do it their vital signs, labs and chest X-ray most every case. The pattern is so similar and so different from any other disease. Of course, we now know that diabetic pts are at much higher risk for COVID, so that helps.
We have seen 101 COVID pts. 25 of them have required intubation and mechanical ventilation. Of these 25, 23 pts have diabetes and the other 2 have prediabetes. The association of severe COVID and diabetes is unbelievable, remarkable and unquestionable. All around the hospital, everyone knows it. The sicker pts have diabetes that is harder to control. Yet, none of the US medical literati talk about diabetes as an issue.
Accordingly, we have seen better improvement in COVID pts, when their diabetes was tightly controlled. This makes sense and fits with the observation that severe COVID disease is seen almost exclusively in diabetics with poorly controlled sugars. I am encouraging, based on the anecdotal evidence, for the hospitalists and intensivists to try tighter control in their COVID pts who are very ill or getting worse.
A woman came in a few days ago with out of control diabetes and she had COVID. But because she had really high blood sugars, the intensivists treated her with an intravenous insulin drip and tight control of her sugars. She, although still very sick, has improved substantially more than others, who were as sick but not treated with insulin intravenous drip.
The data on treatment continue to grow. Since we treat every pt, I wasn’t looking for effect of treatment. But if a pt gets half-way through HCQ/azithro therapy, his/her chances of needing to be put on a ventilator are extremely small. I can think of no other explanation for this observation than HCQ/azithro combo is working.
Dave Dobesh continues to crank out reading the EKGs and is now reaching out to a colleague for help, since there is so much work. Dave continues to tell me that unless you're not critically ill and not on another drug which causes those EKG changes, you really don’t see them. We, however, are continuing to collect data and obtaining EKGs often on all pts on HCQ/azithro.
Taking Testing to the Streets –
It’s time to stop waiting for sick COVID pts to come to the ER. It’s time to go out there, test everyone and treat the COVID ones. Friends are volunteering to start outreach testing. We are just starting to organize and raise money. If interested in participating, please email me at ssmith1824@gmai.com.
If interested in donating to the effort, please visit www.smithcenternj.org.
My wife and I founded the SC or Smith Center over 10 years ago. The focus of the SC is on inner-city pts with HIV and other infections. However, we can use the SC to collect donations to support this effort. Those that know my wife and me, know that we don’t get any sort of benefit or remuneration from the SC.
The time is NOW to actively fight back against this disease. I have never seen so many people hope a drug doesn’t save lives. Those people…I have no words for those people. If you all want to believe that HCQ doesn’t work and that HCQ is toxic, please stay away… forever.
For those that believe Science overrules rhetoric and falsehood, that politics has nothing to do with fighting a deadly pandemic, then please join the fight.
If anyone wants facts and data on the safety, efficacy and availability of HCQ, please let me know.