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“It’s hard for doctors because, with COVID-19, we don’t know if what we are doing is right.”

An N95 mask sitting on a table.
By Alison Kapadia

Brattleboro, VT
United States

This is a new disease. I don’t read a lot of normal press these days but I haven’t noticed a lot of coverage that makes the point that this is a new disease. It’s not same-same as other respiratory diseases. It’s not. (As an emergency doctor), I spend one to two hours per day literally learning about it. All the emergency doctors and hospitalists are doing the same thing — trying to learn as much as we can from China and Italy and New York, so we can learn how to treat this fast.

The tenets of treatment have changed in New York over the last several weeks. Intellectually none of us know if we are doing the right things for COVID-19 patients because we don’t have data yet. So, we don’t know. That is hard. Usually I feel comfortable with any kind of problem like belly pain, chest pain, migraine. I know how to treat these things, and there is data to support what I do, even if it changes over time. It’s hard for doctors because, with COVID-19, we don’t know if what we are doing is right. We feel very responsible.

I am listening to podcasts and reading papers that should not be coming out because the trials have no control groups and the data is terrible. Hydroxychloroquine is a great example. We don’t know if this drug is helpful, neutral, or harmful; we have no idea. And we won’t know unless there are high-quality trials. Worse, we can’t know if people keep giving out hydroxychloroquine because it feels good to do something, even if it’s harmful and has risks. We don’t know what we’re doing but we’re doing our best, and we’re trying to stay up to date with one to two hours of medical education every day. It is hard to physically do that, and it’s even harder to not know what you are doing.

I have thought about what to tell patients to do to care for themselves or family members at home. We are the hospital for the largest free-standing mental health hospital in the United States. They are setting up a whole floor of their retreat for their patients if they test positive for COVID-19 but don’t need to go to the hospital. They can stay at the retreat and get the care they would get at home with a competent caregiver. I coached the nurse practitioner who is running that floor, based on my experience:

  1. COVID-19 gives you high fevers and hallucinations are normal. The fever should improve when you take acetaminophen, but reset your expectation of what that means. The thermometer will read 100 to 104 degrees, not 98 degrees. You won’t hit 98 degrees with COVID-19, even with acetaminophen.
  2. Hydration is important, but don’t over hydrate with IV fluids unless absolutely necessary. Make sure you pee 3 times per day.
  3. It is important that you use your lungs and move around. Take short walks and adjust expectations on what that means based on how you are feeling. Get up and move around every hour or two. Get up!
  4. When you lie down, change positions frequently. The point is to be comfortable. Change every hour on your side, tummy, back, side. The fluid in your lungs can cool and harden. But if you move, the fluid moves around and is less likely to do that.
  5. Try some of the pulmonary exercises that cystic fibrosis patients use. Deep breathing is good.
  6. If you have asthma, use a nebulizer and inhaler if you are wheezing. Just know that the nebulizer will aerosolize the virus (i.e., it will be attached to its tiny, tiny droplets and it can float around longer; any caregiver will be at higher risk). Nebulizers are only helpful if you have asthma — don't use them if you don’t have asthma. Similarly, CPAP machines are fine if you already need that, but may also aerosolize the virus.

    Any underlying conditions should be treated optimally right now. Since I have asthma, I know that when I get a respiratory infection, my asthma will flare, and when I get a cold, I need to use my inhaler before bedtime. I get wheezing and a mild asthma exacerbation that is triggered by the respiratory infection.

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