Dr. Marshall's Best Practices to Combat Coronavirus

Welcome to Dr. Roger Marshall's Coronavirus Best Practices Blog

The goal of this blog is to allow healthcare workers on the front lines of the fight against the COVID-19 outbreak. Doctors, nurses, respiratory technicians and others are encouraged to send their thoughts, reactions and reflections to katie.sawyer@mail.house.gov to have them added to this blog. All entries will be kept anonymous, unless otherwise requested. 

March 31

From an Emergency Physician working in Kansas:

How would you like to be a hero and save some lives today? It’s simple, just stay inside your house and watch TV. Do not leave your home unless you absolutely must. And if you do leave, wear a mask and wash your hands religiously.

To put things into perspective, our hospitals here in Kansas are literally developing plans on how best to allocate life-saving ventilators to patients once COVID-19 overwhelms our available resources. I would never have guessed we would need to talk about rationing life-saving care in this day and age, but here we are today. This is us planning for the chaos that is ahead. It truly perplexes me that people are out and about buying flowers and baby tomato plants to plant in their home gardens while we are here diligently preparing for “Armageddon.”

Almost 1,000 people have already died in New York City located here in the United States of America. Already more people have been killed by COVID-19 than the 9/11 attacks. The number of cases is increasing here in Kansas. 

Unless you want the country to stay furloughed, on high alert, and quarantined forever, please do not go out. We must take this “shelter at home” order seriously, otherwise people will continue to die, and our health care system will get further overwhelmed.

I am staying at work for you, so you can stay at home for me. Thank you. 

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From a medical professional in Detroit, Mich., working at the Henry Ford Health Systems: 

850 admitted in isolation; 526 have tested positive for COVID-19; 149 have been admitted pending test. Staff have been putting up to four patients on one ventilator. 

Cumulative COVID-19 stats since March 16: 947 admissions and 356 discharges

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In the news:

Despite not having a positive COVID-19 case in many western Kansas counties, healthcare professionals are preparing. Click HERE for a story on one rural community's preparation efforts: 

March 30

From a medical professional in Detroit, Mich: 

This is not presenting like typical ARDS. The patient’s lungs are VERY compliant, which is opposite of normal ARDS. We are starting a new research protocol to prone our moderate patients on the floor in hopes in will slow the progression. We are also starting PE prophylaxis on moderate patients with a heparin drip because these patients are developing clots and micro-embolus showers.  Their arterial lines, dialysis lines, etc are clotting off at very high rates. We can’t scan them because we don’t have the capability to disinfect radiology rooms fast enough. So hardly anyone is even able to get a CT, ultrasound or even X-ray.   Our research is showing across 5 major trauma 1 centers, this to be the case at each hospital. We are also finding prior to the cytokine storm, consistently markers across a lot of patients are a significant spike in triglycerides...like over 800, and an increase in their neutrophil/lymphocyte ratio. Seems to be the only consistent markers to maybe predict cytokine storm. Once the cytokine storm hits, nothing is working for the patient.  

Many patients are deteriorating very quickly. I’m talking hours. They come in and are on a nasal cannula on the floor and 1-2 hours later are in the ICU on a ventilator. It’s not taking days to get worse.

March 29

Recommended Read by Congressman Marshall: 

How some cities ‘flattened the curve’ during the 1918 flu pandemic
Social distancing isn’t a new idea—it saved thousands of American lives during the last great pandemic. Here's how it worked. https://apple.news/AVcfT9tVgRhGzBWifOL4PJg

From the World Health Organization:

This document provides information about the new codes for COVID-19 and includes clinical coding examples in the context of COVID-19. It includes a reference to the WHO case definitions for surveillance. https://www.who.int/classifications/icd/COVID-19-coding-icd10.pdf?ua=1​ 

From a medical professional in Detroit, Mich: 

739 admitted patients in isolation. 405 patients that have tested positive. 144 admitted pending results. We are turning our outpatient clinic spaces into hospital rooms. As well as converting more floors to ICU’s. We are turning our outpatient clinic spaces into hospital rooms. As well as converting more floors to ICU’s.

March 28

From a medical professional in Detroit, Mich: 

Average ventilator time for those on vents that get better.... 10 days . Takes 10 days on a vent to get over this stuff! 

Over seven days ago we had to split all the ventilators, so now two people per ventilator. Now may have to go to four people pet ventilator

And it gets VERY tricky. You need extra RT staff to manage it. Because everyone’s volumes and peeps are different 

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From Congressman Marshall: 

An NYC doctors explains steps all medical professionals can take to prevent infection and stop the spread: https://youtu.be/WxyH1rkuLaw 

March 27

This was shared with hospital staff in Detroit, Mich., and provide some very useful information from doctors in Wuhan, China. 

https://www.youtube.com/watch?v=9C_enNUJRXw&feature=youtu.be Timestamps are in the video description page - you should be able to click a timestamp on the Youtube page and go straight to the relevant time and section.​

From Congressman Marshall: 

A NYC doctor talks about how hospitals are handling the patient load and the decision process for which patients are placed on ventilators. https://youtu.be/WxyH1rkuLaw 

March 26

Thoughts from Congressman Marshall:

I’ve been following this virus closely since Mid January. On Jan. 24 I first spoke to KDHE and the CDC and asked them to start ramping up testing supplies and PPEs. And since then I’ve spoken to hundreds of doctors, many hospitals and labs, thousands of Kansans, communicated with the CDC and FDA regularly, visited the KDHE lab and have tried to be a strong voice connecting the needs of local health care workers with Washington, D.C.

My favorite data link to follow the epidemiology: https://www.worldometers.info/coronavirus/country/us/

A few lessons learned

For testing: 

  • You can use Chlamydia swabs and Influenza swabs (Non-wood) for Covid 19 Testing
  • You can take the viral medium and split it in half for testing, and this doubles the use of your viral medium. Your lab can do this!
  • Reference labs take 3-4 days for results. I don’t know of any that accept specimens in saline.
  • Some specimens are spilling in shipment. (I'm not sure why lab not “tightening” the lid).
  • Samples must be shipped in coolant.
  • DO not let the lack of testing impact your best clinical judgment.
  • Please share your story!

More later! Rwm

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49 year-old cardiac anesthesiologist has an appendectomy and goes back to work three days later. Losses scheduled vacation to care for #COVID19 THIS! Heart of a physician! I am so proud to call her colleague!! #patientsfirst - Anonymous 

 

 

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