Dr. Mike Hansen works as a pulmonary medicine and internal medicine specialist, and in a recent YouTube video he shared some of the common trends and insights that he has noticed while working with ICU patients over the last several months during the coronavirus pandemic.
"The most common symptoms that I'm seeing are fever, cough, shortness of breath, and muscle aches. I haven't seen many patients with other symptoms we often hear about, such as loss of taste and smell, nausea, or diarrhea."
Low Vitamin D Levels
"A lot of COVID patients who require hospitalization do have low vitamin D levels," he says, but is quick to add that correlation does not equal causation. "Does that mean we should give every hospitalized COVID patient big doses of vitamin D when they hit the door? Maybe."
The virus is highly contagious
This might sound obvious, but even in the highly controlled ICU environment with its rigorous safety protocols, people can still contract COVID. Hansen recalls having a patient who was in the ICU for completely unrelated reasons, who then began to experience difficulty breathing, and showed inflammation in the lungs. They tested positive for COVID, but it is unclear how exactly they got the virus in the ICU. "It speaks to just how contagious the virus really is," he says.
It's lonely for patients
Because of the strict no visitors policy in hospitals, Hansen has seen firsthand that it has been incredibly difficult for patients and family members alike during the pandemic. "As if dying isn't bad enough, some of them are dying alone, which is obviously horrible," he says.
"We're giving remdesivir, convalescent plasma, dexamethasone, and even therapeutic doses of blood thinners," he says. "I can't say one way or another if they're making a difference. If they are making a difference, it's not obvious. That's why we always need scientific studies in the form of randomized control trials to really know if a treatment is working or not."
Hansen describes testing as something of a "guessing game" at this point. He cite the example of one patient who tested positive for COVID on two separate occasions, three weeks apart. "It could be that the PCR test is picking up the inactivated viral RNA, and these remnants are causing the test to be positive, even though it's possible he's no longer spreading the virus."
"A lot of my COVID patients are obese or morbidly obese," says Hansen. "And a lot of people who are obese have sleep apnea, or obesity hyperventilation syndrome, where they can't breathe out as much carbon dioxide as they should."
"The question is, how low are we willing to let someone's oxygen levels go, before we decide on putting a breathing tube in? The decision becomes easier when someone is in respiratory distress. Once the patient is intubated, the settings on the ventilator have to be tailored to that patient. And while this is true of intubated patients in general, this is even more so with COVID due to the varying ability of their lung disease; some patients might have more inflammation, or more blood clots. There are so many factors... it's not one size fits all."
As both an ICU doctor and a pulmonary medicine specialist, Hansen is able to follow patients in their recovery. In the cases of some patients, there is permanent damage to their lung function, but he adds that in other cases, that damage does slowly heal over time.
The virus is unpredictable
"Who gets sick, the variety of symptoms, the variation in severity of disease, the variability of timing where someone can be fine and then suddenly require a breathing tube, how some people get more inflammation while others get more clots, how some people recover quicker than others, how some people have it but test negative... we're all still learning about this virus," says Hansen.
He adds that a vaccine alone is no guarantee against the virus, as we still don't know how long the antibodies are protective, and while some medical trials look promising, the best thing we can all do right now is to continue social distancing and using masks.
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