Movie reference day

It’s been one strange trip. I am not sure how to describe what the past 10 days have been like. I really thought it was like a month. My team and I saw over 70 COVID pts and over 100 pts total. To do our part (and then some), I had my whole team go to Barnabas every day. We were seeing the bulk of COVID pts, I even volunteered to cover Barnabas Chief of ID’s pts so he could concentrate on administrative issues. And even having all 6 of us there, we were swamped.

A few mornings ago, I was leaving for the hospital and my wife said Goodbye or Goodluck, my sons and nephews were floating around the house with little to do. They had nothing to do and I didn’t have enough time in the day. That, and at age 56, I no longer feel completely immune to all things infectious. JWI is just the exception.

So, there I was with a band of brothers, going to war and most people weren’t. I felt like a pilot in the Battle of Britain; those few docs, nurses, techs, who went in, we put ourselves in harms way and work until we drop. Hopefully, I am like Michael Caine’s character and not the guy who didn’t know up from down. https://www.youtube.com/watch?v=mVQt7cHZm_4

The fear factor amongst healthcare workers (HCWs) grew as the PPE which you all now the meaning of, supply dried up. On one unit, the nurses had to use trash bags. I forgot to ask if the bags were used or not.

The N95’s dried up pretty quick and people started using them. I am not sure that is the best approach for a disease spread by small droplets. We were told to re-use an N95 and cover it with a surgical mask. Wearing and removing 2 masks and in different order and trying to keep the underneath NP5 mask clear…I was pretty sure I was making things worse for myself. After a couple of days of that nonsense, I stopped using N95s. BTW, the Univ of Washington doesn’t use N95s and they have actually studied this process. I really hope Univ of Wash is correct.

As you may have heard, especially from CNN, there is or was some controversy about using hydroxychloroquine for treatment of COVID. Pres. Trump made that statement after a French group reported that HCQ plus a Z-pak got rid of virus very quickly. The study was small, but the differences were so great that the p-value was extremely low. But these were virologic results, not clinical ones. With those virologic data, we started using this combination right away. From my anecdotal experience, I think it works and it works a lot better if you get to the pt earlier. But the French group used 10 days of HCQ and Barnabas used 5 days. Since there were no clinical data then, one couldn’t argue about the lower dose. Last Friday, the same French group released virologic AND clinical data in an uncontrolled study. Compared to historic controls, meaning data from other, recent trials, HCQ 200 mg three times per day for 10 days plus a Z-pak resulted in much, much better pt outcomes. THIS drug combo works. It appears to work very well, especially if it gets to the pt early. The problem with the combo is that HCQ and azithro can affect the heart rhythm, so the EKG has to be watched carefully on both drugs and that’s tough to with outpts.

We are making real progress on this disease. I think the naysayers have never seen a COVID pt and wouldn’t ever go in a pt’s room. But we are seeing improvements in many pts.

Diabetes – Like “Plastics” in “The Graduate” Diabetes is the word.

Essentially severe COVID disease is a new complication of diabetes. Most of our pts are diabetic or pre-diabetic. We have diagnosed several pts with diabetes they didn’t know they. Along with diabetes, we see obese people getting sick. Neither obesity nor diabetes should do this. But maybe there is a clue to a pathway to stop this virus.

Finally, HCQ is used daily in Lupus pts who do very well on it. HCQ is being studied in family members of COVID pts. If HCQ works in prophylaxis, then it will be easy to end this thing. We just give it to a bunch of people and break this thing.

I haven’t had time to read about the COVID antibody assays. If they truly differentiate antibodies against this virus from antibodies against other coronaviruses, they will be a tremendous help in getting people back to work. We can use people who have antibodies against COVID as the first line in treating pts or anywhere. They can’t get infected again.

That kind of test will also help in vaccine development and understanding immunity against this virus.

But again, DIABETES…just one word.

https://www.youtube.com/watch?v=Dug-G9xVdVs

I hope to see you all soon at a social gathering.

SMS