Have we flattened the curve? Hospitals are not (yet) being overwhelmed

Please Read: https://twitter.com/scott_mintzer/status/1239290389963714562

I’ve been in touch with an intensivist at a Seattle hospital with one of the highest numbers of COVID-19 admissions in the US.

They’ve been too exhausted to post much themselves, so I am conveying some of what I’ve been told, which is… eye-opening. To say the least. /1

The Seattle situation isn’t quite at Lombardy levels yet… but it’s getting there.

First of all regarding the clinicians. None are sleeping more than a couple hrs a night. Everyone is utterly exhausted. My colleague has seen so many people die as to have become totally numb. /2

It’s also nearing Status Lombardosus with regard to resources. They haven’t run out of ventilators (yet), but every single ICU bed in Seattle metro is full. And the onslaught shows no signs of stopping. They’ve run out of other things as well. /3

My colleague saw a patient who had a half-full syringe left attached to her IV line. The syringe had an antibiotic. First thought was that this was some gross nursing error.

It turned out not to be a mistake at all, but rather an accomodation to dire circumstances. /4

It was a drug that was supposed to be infused over hours. But there were no IV pumps available. So the nurse had given some of it, left the syringe attached, and planned to come by to give more a little later, and then finish it.

Here in the wealthiest country in the world. /5

They are also at the point of having to ration some kinds of care. For the most severely ill patients, there’s a machine called ECMO — extracorporeal membrane oxygenation — which is basically like an external lung that oxygenates blood when the patient’s lungs won’t work. /6

Seattle has 12 machines, which is less than what’s needed. So a central committee there is deciding: you can’t go on ECMO if you're >40 yrs old, if you have another organ system failing, or… incredibly… if your BMI is>25. Turns out these are all major poor prognostic signs. /7

(Note: that doesn’t mean that anybody with a BMI >25 is in trouble if they get COVID. Just that if you’re critically ill from it, that is apparently a poor prognostic marker. Not sure anybody has a clear idea why.) /8

Meanwhile the combo of exhausted health care workers & no open ICU beds has made a very hazardous health situation for the entire region. If you have a stroke, a heart attack, etc., it will be hard to get the best care. There are patients in ERs for hours waiting for ICU beds. /9

My colleague told me something else remarkable: COVID patients are not dying of lung disease.

This seems to be a very distinct syndrome, and in severe cases the pneumonia leads to ARDS, a condition in which the lungs leak fluid & the patient can’t breathe w/out a ventilator. /10

But apparently the ARDS is not too severe, and they can manage people through that part of it.

Instead, after several days, the virus suddenly attacks the heart, causing it to precipitously fail. The myocarditis phase is savage and kills people within a day or two. /11

My colleague has seen a number of cases in which multiple family members were in the hospital and critically ill. Maybe this means there’s some genetic predisposition, but it’s probably too soon to say. /12

And then there’s the fear that comes with an epidemic. Apparently people shopping wearing the hospital’s logo on their clothing have been asked to leave the store. And some who work in the hospital have been asked to move out of their apartment buildings for a few months. /13

Restaurants have refused food delivery, with some of them refusing to even leave the food on the ground outside. The hospital had to send the medics to go pick it up. One doc’s housekeeper refused to come clean for her. /14

In short, this is a nightmare, teetering on the precipice of even worse destruction. The goal of every American city should be to avoid becoming the next Seattle.

Everyone needs to understand not just how bad this could get, but HOW BAD THIS ALREADY IS in one major US city. /15x

P.S. This isn’t my first hand info.

Obviously the colleague who told me this has no reason to make stuff up. But on basic journalistic principles I would welcome anyone who can corroborate this picture.

/r/CoronavirusWA Thread