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In This Week’s Podcast
For the week ending April 3, 2020 John Mandrola, MD comments on the following news [and features] stories.
COVID-19
When I recorded last week, there were 85,000 cases in the United States; today there are nearly a quarter of a million cases—a three-fold increase in 7 days. Now, you might say that is due to an increase in testing. I do not think so, because of the deaths.
A week ago, US deaths totaled 1200, today there are nearly 6100—a five-fold increase in just 7 days. If this five-fold increase continues, we will be at 30,000 deaths next Friday. After that... you get the picture.
Heroes
Our hospital now has dedicated COVID units. You feel a sense of reverence on these units. Those who work entire shifts on these units bear the brunt of the risk. Before COVID these were regular docs, nurses and respiratory therapists; people I saw every day.
From now on, the people who faced the highest risks at a time when we don’t understand exactly how this virus is transmitted have earned extra respect. I will remember who they are; I hope administrators and leaders in each hospital system also remember these people. Kudos to Medscape for keeping a Memoriam for healthcare workers who have courageously died in the line of duty.
Spreading the Virus
My understanding of the data out this week and previous weeks is that this virus is everywhere. For instance, we already have cases of patients being admitted for something else and then testing positive. That means, before they were put into isolation, they were spreading virus everywhere.
What’s more, studies now show the virus is in the air, on the air ducts of patients’ rooms, on keyboards, mice, and possibly even the packages coming from Amazon. And even if we avoid infection in the next month during the surge, can we avoid it for a year or more?
But there is a large treasure in recovery from this infection: immunity. Once immune, you are free to return to normal.
Are the anecdotes of younger healthier-appearing clinicians getting seriously ill and dying from this virus a real phenomenon or a result of media coverage? Most of my smart friends think the risk of more serious illness in healthcare workers is real. But then the question is why? Plausible causal reasons for this could be a higher dose of virus at the time of infection, another cause could be repeated exposures. Another could be that sicker patients shed virus more readily. This makes proper personal protective equipment a vital issue, as this surely reduces the risk of big exposures.
Betrayals
In his editorial, Eric Topol concludes, “The handling of the COVID-19 pandemic in the United States will go down as the worst public health disaster in the history of the country.... Perhaps what we in the medical community will remember most is how our country betrayed us at the moment when our efforts were needed most.”
But COVID-19 also has given us an infusion of leadership from clinicians. At my institution, there are groups of doctors that are leading COVID policy decisions. It was necessary. While administrators know numbers, clinicians know how to care for the ill.
Intolerance of Ideas
COVID19 has amplified the already present and utterly destructive phenomenon of intolerance of ideas. Science cannot function properly in this setting. This week the intolerance surrounds the controversy of mask-wearing and I was struck by the public debate about the benefits of public use of masks.
In many Asian cities and countries, mask wearing in public is viewed as fulfilling a moral contract for public safety. This is not so in North America. But many public intellectuals here think that we should adopt an Asian way. Some of their arguments are strong, others weak. The problem I noticed is the vitriol when some make an argument or point out the weaknesses of public masks; they are difficult to use properly, they may distract from other important measures, etc.
A second area of intolerance is of those who discuss the harms of our interventions. While this is a major pathogen, one that demands our attention, you cannot deny that our interventions are causing direct harm to millions of people right now. Ten million Americans have lost their jobs. The problem is especially acute here because so many of these millions get their health insurance through employment.
A Bit on Cardiology
The virtual ACC and the ISCHEMIA trial were published this week. Medscape has excellent coverage. But in this time of grieving, it seems irreverent to discuss these issues.
There is much to learn in how COVID-19 affects the heart. Drs Marc Dewck and Nick Mills in Edinburgh, Scotland asked me to mention a 2-minute survey on transthoracic echo images in affected patients. This is a joint effort of the ESC and EACV imaging.
© 2020 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Apr 3, 2020 This Week in Cardiology Podcast - Medscape - Apr 03, 2020.
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