Thread by @vineet_chopra

There’s a lot of doom and gloom out there when it comes to #CoVID19.

It’s true / it’s a bad disease.

But we discharged three people home this week after short hospital stays. All felt great at discharge.

I’ll count that as a win.

Following up on @leorahorwitzmd great views on clinical care, here is what we have seen caring for #COVID19 @umichmedicine

1\ Our hospitalists have now cared for over 100 #COVID19 critically and non-critically ill patients.

2\ There appear to be 2 phenotypes of disease:
A) Those with mild-mod hypoxia, need 02 and improve slowly over time.

B) Those with rapidly escalating 02 needs proceeding quickly to intubation.

Presentation doesn’t depend on age, health. This dz doesn’t discriminate.

Clinical symptoms vary but high grade, hectic, oscillating fevers are common.

Cough and shortness of breath also up there.

GI symptoms much less frequent but def exist.

Hypoxia and rapid 02 needs are hallmarks of the dz. CXR with periph hazy GGOs key.

The lung injury from #coronavirus leads to high 02 requirements, even in clinically stable patients.

This is a single organ dz for the most part.

Not uncommon to see young, healthy people with no med probs end up on the vent.

This last part is scary. Hard to predict course.

Sky high d dimers and #VTE appears common. I wonder how many cardiac arrests (mostly PEA/Asystole) were actually PE rather than myocarditis.

We have started to pharmacologically prophylax critically ill patients given this observation.

Have not seen a lot of myocarditis; but some pts do develop worsening cardiac dysfunction days after extubation. Almost all of these have been patients with pre existing structural or ischemic heart dz.

During recovery, pts continue to have a high PEEP requirement. Lung compliance doesn’t seem to be affected much during illness, but the need for prolonged positive pressure is peculiar.

Take them off PEEP too early, and Sats drop precipitously.

Toci and other IL6 blockers really seem to work - if you give it early enough in the dz. Peri intubation is too late.

We follow biomarkers and 02 needs when making this decision. Also talk to #ID and #IDPharm who are our besties.

FYI - we are a trial site for Sarilumab.

Really have not seen any clinical benefit from hydroxychloroquine. Rather have seen a lot of GI ADRs and LFT bumps coming out of it.

Not sure this has as much of a role in disease care TBH.

There is profound physical weakness during recovery. Those that get better need help with basic ADLs.

Yes, even a 30 yr old needs assist to get up and go to the bathroom.

Early PT and ambulation is key.

Finally, I have never seen a dz that needs so many of us to come together to deliver care.

#COVID19 care needs MDs, RNs, resp therapists, APPs, pharmacists, PT, Social workers, sub specialties and palliative care.

It takes a village to fight - fortunate to have one @UMich.