Daily Archives: Apr 23, 2020

G-Health Enterprises has always strived to transform healthcare by removing barriers created by social determinants of health in underserved communities. With all the news of COVID-19 case and death disparities in minority communities, this mission has become more important than ever. To that end, Dr. Raul Vazquez and his Value Based Payment team are leading the charge with The Community Response Plan.

The Community Action Response Plan is GBUACO’s initiative to unite churches, community based organizations, and medical partners in Western New York for a comprehensive approach to combat the coronavirus and mitigate its effects on the community. To achieve these goals, they will be conducting outreach efforts to provide education and connections with primary care providers, social support, and community resources, launching accessible, multi-site testing centers to test high risk, symptomatic patients, utilizing tele-health and tele-monitoring systems to address the virus and maintain patient health, and creating a voluntary isolation unit within hotels to reduce the burden on hospitals and families for those with mild-to-moderate coronavirus symptoms.

“Coronavirus shed light on social determinants of health which is what we have in many minority communities,” says Dr. Raul Vazquez, President and CEO of G-Health Enterprises. “I have been in practice for the last 30 years and some of this has changed and some of it hasn’t changed, which is sad. If you don’t have food, transportation, an apartment or stability in your life, then you aren’t going to check up on your health.”

Testing is available for high risk patients of Urban Family Practice, all primary care providers in the GBUACO Network, and now to members of the community whose providers are outside of our network, in which case we will send the results your primary provider. If an individual has no primary provider, Urban Family Practice will make the appointment through them to ensure everyone has the option to get tested. Insurance covers COVID-19 tests and for those who do not have insurance and qualify for Medicaid, we can connect you with a GBUAHN outreach enroller who will help with insurance enrollment.

Before visiting our COVID-19 testing locations, please complete a screening by our nurses to determine if you are eligible. You can begin this process by downloading the UFP, GBUAHN or GBUACO apps and filling out the COVID19 surveys or by calling our Nurse Advice Line 716- 604-0504.

Anyone who is interested in becoming a part of the GBUAHN Health Home can inquire about eligibility by calling 716-247-5282 ext. 2128 or completing a referral on the GBAUHN website, gbuahn.org.

Rochester Superintendent Terry Dade said Wednesday that he has inquired with a lawyer about breaking his contract with the Rochester City School District at the end of the academic year in June.

He described his relationship with the Board of Education as strained and said its lack of support for him fueled his decision to leave.

“The way a good district operates is we unify as leaders to identify what the problem is and then to collaboratively come up with solutions, and unfortunately that has not occurred,” Dade said.

Dade became the troubled district’s sixth leader in 10 years in July, having arrived with high expectations from Fairfax County Public Schools in Virginia, where he was an assistant superintendent and led a turnaround effort for some of that system’s worst-performing schoolsHe expressed support for several initiatives in place in Rochester, including a common curriculum, relying more heavily on data to influence decisions, and restorative justice practices, which promote inclusiveness and relationship-building to solve problems. 

But he has spent most of his roughly 10 months on the job attempting to plug budget deficits that stemmed from the district overspending in excess of $27 million last year prior to his arrival.  Consequently, he has laid off scores of teachers, and recently proposed $87 million in budget cuts that include more layoffs and reductions in cherished programs that have met with resistance from the board and the community at large. 

Dade said he has had to shoulder the burden of balancing the budget without the backing of the board.

“The way a good district operates is we unify as leaders to identify what the problem is and then to collaboratively come up with solutions, and unfortunately that has not occurred,” Dade said.

Dade, whose annual salary is $250,000, signed a three-year contract with the board, a body with a reputation for running superintendents out of town. The board was harshly criticized in a 2018 report by a state-appointed education watchdog for micromanaging the district.School Board President Van White did not return a message seeking comment.

Mayor Lovely Warren issued a statement decrying the board, and renewed her call for the state chancellor to step in and take over the district.

“Today, yet again our school board and its enablers are putting their wants, and their salaries, before needs of the children they purport to serve,” Warren said.

“It is a travesty that we would lose another superintendent, especially during the most severe fiscal crisis RCSD has faced,” her statement went on. “Again, rather than deal with a catastrophe of their own creation, the school board has attempted to disgrace and destroy another leader that dare speak the truth.”

News of Dade’s departure followed a severe state comptroller’s audit of the district’s dire fiscal picture released this week that suggested district officials set the stage for financial ruin when they ran roughshod over their own cost projections in preparing the 2018-19 budget.

 

Rochester, NY – Administrators at two Rochester health providers said Tuesday they are opening clinics in areas of the city where many people of color live.

Jordan Health and Trillium Health officials said the clinics aim to give people of color easier access to testing and treatment for COVID-19.

In the latest data from the county public health department, black people were more than half of those being treated for the disease in an intensive care unit despite being less than a quarter of the county’s population.“We need more testing focused on communities of color, so that we can identify and treat those that are sick earlier,” Mayor Lovely Warren said. “The testing being located within the community where people reside is very important.”

The Jordan Health clinic opened Tuesday at Hudson Avenue and Holland Street, north of the Inner Loop. Trillium’s clinic will open next week at Monroe Avenue and South Union Street. Both clinics will be physically separated from the health centers they neighbor, and both will see patients only by appointment.

Jordan and Trillium officials said the clinics offer care on a sliding cost scale.

“No one should avoid care because they’re afraid of getting a bill,” said Dr. Laurie Donohue, Jordan Health’s chief medical officer. “The impact of poverty on health is huge,” Donohue said.

County Public Health Commissioner Dr. Michael Mendoza said earlier this month that early data indicated people of color waited longer to seek treatment for respiratory symptoms than white residents in the county.

On Tuesday, Mendoza said that better access to testing for communities with high proportions of racial and ethnic minorities would identify infections earlier. That would allow patients to be in touch with a doctor sooner and underscore the importance of staying isolated from other people, he said.

Identifying the virus earlier is especially important for people with chronic illnesses, Donohue said.

“We can catch the effects of this virus before they lead to emergent care, ICU care, intubation and ventilator need,” she said.

High blood pressure and diabetes are the two most common underlying conditions in New York state COVID-19 deaths. Black people in Monroe County are four times as likely to be hospitalized for diabetes as white people.

“Communities of color being the most ill patients when it comes to COVID-19 really reflects on the fact that we all need to do more,” said Dr. Robert Biernbaum, Trillium Health’s chief medical officer. “We need to ensure that their needs are going to be met.”

 

‘We are very worried about a surge. If we were to reopen like that, just snap the fingers and reopen, we would have a surge. I guarantee it,’ Mark Poloncarz said

Now that Governor Andrew Cuomo has officially announced reopening will be done on a regional basis, many questions remain, such as: When will it happen, and how?

Erie County Executive Mark Poloncarz said he’s already in conversation with Lt. Governor Kathy Hochul, who’s leading the effort for Western New York.

“As she noted, we will not keep Erie County and Western New York closed any one day more than we need to, but we also won’t open it up any day earlier until it’s right,” Poloncarz said.

Poloncarz explained reopening Western New York likely won’t happen at all once.

“We all wanna get back to business as usual but we have to do it in such a safe manner which will probably mean a rolling opening of the community,” Poloncarz said.

Dr. Thomas Russo, the chief of infectious disease at the University at Buffalo, said the regional approach makes sense.

“We should only reopen when we get our cases down to zero, or as close to zero as possible,” Dr. Russo said, “and have the necessary amount of testing to be able to identify new cases if they arise and public health support to do contact tracing to really minimize a resurgence of new cases.”

Poloncarz stressed, “We are very worried about a surge. If we were to reopen like that, just snap the fingers and reopen, we would have a surge, I guarantee it.”

Even when state government and public health officials deem it appropriate to reopen, preventing further spread of the coronavirus will likely remain a top priority.

Dr. Russo told 2 on Your Side, “I see that when we’re ready to reopen, I see a world with many, many people, and hopefully everyone wearing masks.

“I think that’s gonna be one of the critical public health measures that’s gonna enable us to expand the types of things we’re doing, increasing interactions and minimizing the risks of the resurgence of new cases with the coronavirus.”

When asked what it would take to reopen Western New York, Hochul added, “We need to keep an eye on the numbers, the test-positive cases, the number of hospitalizations or hospital capacity.”Right now in Erie County, we’re still seeing a gradual increase in the number of positive cases, we’ve expanded testing, which is also important. So, I want to see a flattening and a downward trajectory, first of all, so this will be driven by the data, because public health is our number one priority.”

 

    WASHINGTON (AP) — More than 4.4 million laid-off workers applied for U.S. unemployment benefits last week as job cuts escalated across an economy that remains all but shut down, the government said Thursday.

    Roughly 26 million people have now filed for jobless aid in the five weeks since the coronavirus outbreak began forcing millions of employers to close their doors. About one in six American workers have lost their jobs in the past five weeks, by far the worst string of layoffs on record. That’s more than the number of people who live in the 10 largest U.S. cities combined.

    Economists have forecast that the unemployment rate for April could go as high as 20%.

    The enormous magnitude of job cuts has plunged the U.S. economy into the worst economic crisis since the Great Depression of the 1930s. Some economists say the nation’s output could shrink by twice the amount that it did during the Great Recession, which ended in 2009

    26 million lost jobs in last five weeks

    Claims are for temporary financial assistance from state government by individuals who have been laid off

    An urgent question for the unemployed is how quickly the economy may rebound. Most economists expect some employers to start rehiring within a few months, though significant job gains aren’t considered likely until later in the year.

    Few experts foresee a downturn anywhere near as long as the Great Depression. During the Depression, unemployment stayed high for nearly a decade, with the rate remaining in double-digits all the way from 1931 until 1940.

    The painful economic consequences of the virus-related shutdowns have sparked angry protests in several state capitals from crowds insisting that businesses be allowed to reopen. Thursday’s report, showing that the pace of layoffs remains immense, could heighten demands for re-openings.

    Some governors have begun easing restrictions despite warnings from health authorities that it may be too soon to do so without causing new infections. In Georgia, gyms, hair salons and bowling alleys can reopen Friday. Texas has reopened its state parks.

    Yet those scattered re-openings won’t lead to much rehiring, especially if Americans are too wary to leave their homes. Most people say they favor stay-at-home orders, according to a survey by The Associated Press-NORC Center for Public Affairs and believe it won’t be safe to lift social distancing guidelines anytime soon. And there are likely more layoffs to come from many small businesses that have tried but failed to receive loans from a federal aid program.

    The number of people who are receiving unemployment benefits has reached a record 16 million, surpassing a previous high of 12 million set in 2010, just after the 2008-2009 recession ended. This figure reflects people who have managed to navigate the online or telephone application systems in their states, have been approved for benefits and are actually receiving checks.

    Just about every major industry has absorbed sudden and severe layoffs. Economists at the Federal Reserve estimate that hotels and restaurants have shed the most jobs — 4 million since Feb. 15. That is nearly one-third of all the employees in that industry. The layoffs, striking hard at front-line service occupations, have disproportionately hit minority and lower-income workers, who typically have little or no financial cushions.

    Construction has shed more than 9% of its jobs. So has a category that includes retail, shipping and utilities, the Fed estimated. A category that is made up of data processing and online publishing has cut 4.7%.

    Europe’s economies, too, are headed for severe recessions, with surveys of economic activity released Thursday plunging to all-time lows. The downturn is putting up to 59 million jobs at risk, or 26% of all employment in the European Union, according to McKinsey, the consulting firm. That figure includes people who could be laid off outright as well as those who are still on payrolls but might be put on shorter work hours or furloughs. The crisis could double the level of unemployment, which is 6.5% in the 27-country EU.

    Unemployment is also likely to rise in the United Kingdom. Analysts at Capital Economics say the U.K. economy is headed for its biggest quarterly economic contraction in more than a century.

    In some states, many laid-off workers have run into obstacles in trying to file applications for benefits. Among them are millions of freelancers, contractors, gig workers and self-employed people — a category of workers who are now eligible for unemployment benefits for the first time.

    “This has been a really devastating shock for a lot of families and small businesses,” said Aaron Sojourner, a labor economist at the University of Minnesota. “It is beyond their control and no fault of their own.”

    In Florida, applications for unemployment benefits nearly tripled last week to 505,000, the second-highest total behind much-larger California’s 534,000. Florida has had trouble processing many of its applications. Its figure suggests that the state is finally clearing a backlog of filings from jobless workers.

    In Michigan, 17% of the state’s workforce is now receiving unemployment aid, the largest proportion in the country. It is followed by Rhode Island at 15%, Nevada at 13.7% and Georgia at 13.6%.

    When the government issues the April jobs report on May 8, economists expect it to show breathtaking losses. Economists at JPMorgan are predicting a loss of 25 million jobs. That would be nearly triple the total lost during the entire Great Recession period.

    A $2 trillion-plus federal relief package that was signed into law last month made millions of gig workers, contractors and self-employed people newly eligible for unemployment aid. But most states have yet to approve unemployment applications from those workers because they’re still trying to reprogram their systems to do so. As a result, many people who have lost jobs or income aren’t being counted as laid-off because their applications for unemployment aid haven’t been processed.

    Among them is Sasha McVeigh, a musician in Nashville. Having grown up in England with a love of country music, she spent years flying to Nashville to play gigs until she managed to secure a green card and move permanently two years ago. McVeigh had been working steadily until the city shut down music clubs in mid-March.

    Since then, she’s applied for unemployment benefits but so far has received nothing. To make ends meet, she’s applied for some grants available to out-of-work musicians, held some live streaming concerts and pushed her merchandise sales.

    By cutting expenses to a bare minimum, McVeigh said, “I’ve managed to just about keep myself afloat.” But she worries about what will happen over the next few months.

    ___

    AP Writers Travis Loller in Nashville and Pan Pylas in London contributed to this report.

     

      BERLIN (Reuters) – When he was diagnosed with COVID-19, Andre Bergmann knew exactly where he wanted to be treated: the Bethanien hospital lung clinic in Moers, near his home in northwestern Germany

      The clinic is known for its reluctance to put patients with breathing difficulties on mechanical ventilators – the kind that involve tubes down the throat.

      The 48-year-old physician, father of two and aspiring triathlete worried that an invasive ventilator would be harmful. But soon after entering the clinic, Bergmann said, he struggled to breathe even with an oxygen mask, and felt so sick the ventilator seemed inevitable.

      Even so, his doctors never put him on a machine that would breathe for him. A week later, he was well enough to go home.

      Bergmann’s case illustrates a shift on the front lines of the COVID-19 pandemic, as doctors rethink when and how to use mechanical ventilators to treat severe sufferers of the disease – and in some cases whether to use them at all. While initially doctors packed intensive care units with intubated patients, now many are exploring other options.

      Machines to help people breathe have become the major weapon for medics fighting COVID-19, which has so far killed more than 183,000 people. Within weeks of the disease’s global emergence in February, governments around the world raced to build or buy ventilators as most hospitals said they were in critically short supply.

      Germany has ordered 10,000 of them. Engineers from Britain to Uruguay are developing versions based on autos, vacuum cleaners or even windshield-wiper motors. U.S. President Donald Trump’s administration is spending $2.9 billion for nearly 190,000 ventilators. The U.S. government has contracted with automakers such as General Motors Co and Ford Motor Co as well as medical device manufacturers, and full delivery is expected by the end of the year. Trump declared this week that the U.S. was now “the king of ventilators.”

      However, as doctors get a better understanding of what COVID-19 does to the body, many say they have become more sparing with the equipment.

      Reuters interviewed 30 doctors and medical professionals in countries including China, Italy, Spain, Germany and the United States, who have experience of dealing with COVID-19 patients. Nearly all agreed that ventilators are vitally important and have helped save lives. At the same time, many highlighted the risks from using the most invasive types of them – mechanical ventilators – too early or too frequently, or from non-specialists using them without proper training in overwhelmed hospitals.

      Medical procedures have evolved in the pandemic as doctors better understand the disease, including the types of drugs used in treatments. The shift around ventilators has potentially far-reaching implications as countries and companies ramp up production of the devices.

      “BETTER RESULTS”

      Many forms of ventilation use masks to help get oxygen into the lungs. Doctors’ main concern is around mechanical ventilation, which involves putting tubes into patients’ airways to pump air in, a process known as intubation. Patients are heavily sedated, to stop their respiratory muscles from fighting the machine.

      Those with severe oxygen shortages, or hypoxia, have generally been intubated and hooked up to a ventilator for up to two to three weeks, with at best a fifty-fifty chance of surviving, according to doctors interviewed by Reuters and recent medical research. The picture is partial and evolving, but it suggests people with COVID-19 who have been intubated have had, at least in the early stages of the pandemic, a higher rate of death than other patients on ventilators who have conditions such as bacterial pneumonia or collapsed lungs.

      This is not proof that ventilators have hastened death: The link between intubation and death rates needs further study, doctors say.

      In China, 86% of 22 COVID-19 patients didn’t survive invasive ventilation at an intensive care unit in Wuhan, the city where the pandemic began, according to a study published in The Lancet in February. Normally, the paper said, patients with severe breathing problems have a 50% chance of survival. A recent British study found two-thirds of COVID-19 patients put on mechanical ventilators ended up dying anyway, and a New York study found 88% of 320 mechanically ventilated COVID-19 patients had died.

      More recently, none of the eight patients who went on ventilators at the Abu Dhabi hospital had died as of April 9, a doctor there told Reuters. And one ICU doctor at Emory University Hospital in Atlanta said he had had a “good” week when almost half the COVID-19 patients were successfully taken off the ventilator, when he had expected more to die.

      The experiences can vary dramatically. The average time a COVID-19 patient spent on a ventilator at Scripps Health’s five hospitals in California’s San Diego County was just over a week, compared with two weeks at the Hadassah Ein Kerem Medical Center in Jerusalem and three at the Universiti Malaya Medical Centre in the Malaysian capital Kuala Lumpur, medics at the hospitals said.

      In Germany, as patient Bergmann struggled to breathe, he said he was getting too desperate to care.

      “There came a moment when it simply no longer mattered,” he told Reuters. “At one point I was so exhausted that I asked my doctor if I was going to get better. I was saying, if I had no children or partner then it would be easier just to be left in peace.”

      Instead of putting Bergmann on a mechanical ventilator, the clinic gave him morphine and kept him on the oxygen mask. He’s since tested free of the infection, but not fully recovered. The head of the clinic, Thomas Voshaar, a German pulmonologist, has argued strongly against early intubation of COVID-19 patients. Doctors including Voshaar worry about the risk that ventilators will damage patients’ lungs.

      The doctors interviewed by Reuters agreed that mechanical ventilators are crucial life-saving devices, especially in severe cases when patients suddenly deteriorate. This happens to some when their immune systems go into overdrive in what is known as a “cytokine storm” of inflammation that can cause dangerously high blood pressure, lung damage and eventual organ failure.

      The new coronavirus and COVID-19, the disease the virus causes, have been compared to the Spanish flu pandemic of 1918-19, which killed 50 million people worldwide. Now as then, the disease is novel, severe and spreading rapidly, pushing the limits of the public health and medical knowledge required to tackle it.

      When coronavirus cases started surging in Louisiana, doctors at the state’s largest hospital system, Ochsner Health, saw an influx of people with signs of acute respiratory distress syndrome, or ARDS. Patients with ARDS have inflammation in the lungs which can cause them to struggle to breathe and take rapid short breaths.

      “Initially we were intubating fairly quickly on these patients as they began to have more respiratory distress,” said Robert Hart, the hospital system’s chief medical officer. “Over time what we learned is trying not to do that.”

      Instead, Hart’s hospital tried other forms of ventilation using masks or thin nasal tubes, as Voshaar did with his German patient. “We seem to be seeing better results,” Hart said.

      CHANGED LUNGS

      Other doctors painted a similar picture.

      In Wuhan, where the novel coronavirus emerged, doctors at Tongji Hospital at the Huazhong University of Science and Technology said they initially turned quickly to intubation. Li Shusheng, head of the hospital’s intensive care department, said a number of patients did not improve after ventilator treatment.

      “The disease,” he explained, “had changed their lungs beyond our imagination.” His colleague Xu Shuyun, a doctor of respiratory medicine, said the hospital adapted by cutting back on intubation.

      Luciano Gattinoni, a guest professor at the Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen in Germany, and a renowned expert in ventilators, was one of the first to raise questions about how they should be used to treat COVID-19.

      “I realised as soon as I saw the first CT scan … that this had nothing to do with what we had seen and done for the past 40 years,” he told Reuters.

      In a paper published by the American Thoracic Society on March 30, Gattinoni and other Italian doctors wrote that COVID-19 does not lead to “typical” respiratory problems. Patients’ lungs were working better than they would expect for ARDS, they wrote – they were more elastic. So, he said, mechanical ventilation should be given “with a lower pressure than the one we are used to.”

      Ventilating some COVID-19 sufferers as if they were standard patients with ARDS is not appropriate, he told Reuters. “It’s like using a Ferrari to go to the shop next door, you press on the accelerator and you smash the window.”

      The Italians were swiftly followed by Cameron Kyle-Sidell, a New York physician who put out a talk on YouTube saying that by preparing to put patients on ventilators, hospitals in America were treating “the wrong disease.” Ventilation, he feared, would lead to “a tremendous amount of harm to a great number of people in a very short time.” This remains his view, he told Reuters this week.

      When Spain’s outbreak erupted in mid-March, many patients went straight onto ventilators because lung X-rays and other test results “scared us,” said Delia Torres, a physician at the Hospital General Universitario de Alicante. They now focus more on breathing and a patient’s overall condition than just X-rays and tests. And they intubate less. “If the patient can get better without it, then there’s no need,” she said.

      In Germany, lung specialist Voshaar was also concerned. A mechanical ventilator itself can damage the lungs, he says. This means patients stay in intensive care longer, blocking specialist beds and creating a vicious circle in which ever more ventilators are needed.

      Of the 36 acute COVID-19 patients on his ward in mid-April, Voshaar said, one had been intubated – a man with a serious neuro-muscular disorder – and he was the only patient to die. Another 31 had recovered.

      “IRON LUNGS”

      Some doctors cautioned that the impression that the rush to ventilate is harmful may be partly due to the sheer numbers of patients in today’s pandemic.

      People working in intensive care units know that the mortality rate of ARDS patients who are intubated is around 40%, said Thierry Fumeaux, head of an ICU in Nyon, Switzerland, and president of the Swiss Intensive Care Medicine Society. That is high, but may be acceptable in normal times, when there are three or four patients in a unit and one of them doesn’t make it.

      “When you have 20 patients or more, this becomes very evident,” said Fumeaux. “So you have this feeling – and I’ve heard this a lot – that ventilation kills the patient.” That’s not the case, he said. “No, it’s not the ventilation that kills the patient, it’s the lung disease.”

      Mario Riccio, head of anaesthesiology and resuscitation at the Oglio Po hospital near Cremona in Lombardy, Italy’s worst-hit region, says the machines are the only treatment to save a COVID-19 patient in serious condition. “The fact that people who were placed under mechanical ventilation in some cases die does not undermine this statement.”

      Originally nicknamed “iron lungs” when introduced in the 1920s and 1930s, mechanical ventilators are sometimes also called respirators. They use pressure to blow air – or a mixture of gases such as oxygen and air – into the lungs.

      They can be set to exhale it, too, effectively taking over a patient’s entire breathing process when their lungs fail. The aim is to give the body enough time to fight off an infection to be able to breathe independently and recover.

      Some patients need them because they’re losing the strength to breathe, said Yoram Weiss, director of Hadassah Ein Kerem Medical Center in Jerusalem. “It is very important to ventilate them before they collapse.” At his hospital, 24 of 223 people with COVID-19 had been put on ventilators by April 13. Of those, four had died and three had come off the machines.

      AEROSOLS

      Simpler forms of ventilation – face masks for example – are easier to administer. But respirator masks can release micro-droplets known as aerosols which may spread infection. Some doctors said they avoided the masks, at least at first, because of that risk.

      While mechanical ventilators do not produce aerosols, they carry other risks. Intubation requires patients to be heavily sedated so their respiratory muscles fully surrender. The recovery can be lengthy, with a risk of permanent lung damage.

      Now that the initial wave of COVID-19 cases has peaked in many countries, doctors have time to examine other ways of managing the disease and are fine-tuning their approach.

      Voshaar, the German lung specialist, said some doctors were approaching COVID-19 lung problems as they would other forms of pneumonia. In a healthy patient, oxygen saturation – a measure of how much oxygen the haemoglobin in the blood contains – is around 96% of the maximum amount the blood can hold. When doctors check patients and see lower levels, indicating hypoxia, Voshaar said, they can overreact and race to intubate.

      “We lung doctors see this all the time,” Voshaar told Reuters. “We see 80% and still do nothing and let them breathe spontaneously. The patient doesn’t feel great, but he can eat and drink and sit on the side of his bed.”

      He and other doctors think other tests can help before intubation. Voshaar looks at a combination of measures including how fast the patient is breathing and their heart rate. His team are also guided by lung scans.

      “HAPPY HYPOXICS”

      Several doctors in New York said they too had started to consider how to treat patients, known as “happy hypoxics,” who can talk and laugh with no signs of mental cloudiness even though their oxygen might be critically low.

      Rather than rushing to intubate, doctors say they now look for other ways to boost the patients’ oxygen. One method, known as “proning,” is telling or helping patients to roll over and lie on their fronts, said Scott Weingart, head of emergency critical care at Stony Brook University Medical Center on Long Island.

      “If patients are left in one position in bed, they tend to desaturate, they lose the oxygen in their blood,” Weingart said. Lying on the front shifts any fluid in the lungs to the front and frees up the back of the lungs to expand better. “The position changes have radically impressive effects on the patient’s oxygen saturations.”

      Weingart does recommend intubating a communicative patient with low oxygen levels if they start to lose mental clarity, if they experience a cytokine storm or if they start to really struggle to breathe. He feels there are enough ventilators for such patients at his hospital.

      But for happy hypoxics, “I still don’t want these patients on ventilators, because I think it’s hurting them, not helping them.”

      QUALITY, SKILL

      As governments in the United States and elsewhere are scrambling to raise output of ventilators, some doctors worry the fast-built machines may not be up to snuff.

      Doctors in Spain wrote to their local government to complain that ventilators it had bought were designed for use in ambulances, not intensive care units, and some were of poor quality. In the UK, the government has cancelled an order for thousands of units of a simple model because more sophisticated devices are needed.

      More important, many doctors say, is that the additional machines will need highly trained and experienced operators.

      “It’s not just about running out of ventilators, it’s running out of expertise,” said David Hill, a pulmonology and critical care physician in Waterbury, Connecticut, who attends at Waterbury Hospital.

      Long-term ventilation management is complex, but Hill said some U.S. hospitals were trying to bring non-critical care physicians up to speed fast with webinars or even tip sheets. “That is a recipe for bad outcomes.”

      “We intensivists don’t ventilate by protocol,” said Hill. “We may choose initial settings,” he said, “but we adjust those settings. It’s complicated.”

      Escritt reported from Berlin, Aloisi from Milan, Beasley from Los Angeles, Borter from New York and Kelland from London. Additional reporting: Alexander Cornwell in Abu Dhabi, Panu Wongcha-um in Bangkok, Maayan Lubell in Jerusalem, A. Ananthalakshmi and Rozanna Latif in Kuala Lumpur, Kristina Cooke in Los Angeles, Sonya Dowsett in Madrid, Jonathan Allen and Nicholas Brown in New York, John Mair in Sydney, Costas Pitas in London, David Shepardson in Washington DC, Brenda Goh in Wuhan and John Miller in; Zurich. Writing by Andrew RC Marshall and Kate Kelland; Edited by Sara Ledwith and Jason Szep

       

      STAY CONNECTED

      WP2Social Auto Publish Powered By : XYZScripts.com