keeping our loved ones close in new ways

As a new week begins, let me give you a glimpse into how things stood at the end of last week at my hospital in Kansas City.  We continue to have an average of 25-30 COVID-19 positive patients in the hospital and roughly half of those are in the ICU - mostly intubated. There also continues to be 25-30 patients who have been tested and are referred to as PUI - persons under investigation.  We have had deaths and have also had people who have been able to be liberated from the ventilator and discharged.

Overall, in the metro area, the number of patients admitted to the hospital who are COVID-19 postive continues to slowly increase.  It's too early to know where we are on the curve. There is no evidence that it has flattened. In our facility we are prepared for a "mild to moderate" surge. We are ok on amount of PPE but continue to be very judicious with use.  An area of greater concern is the potential for/likely shortage of medications required to keep patients sedated and comfortable while on breathing machines.  

There are still no FDA approved medications for COVID-19 though we continue to use hydrochoroquine and azithromycin following specific protocols. The use of convalescent serum is also being investigated.  

There remains much that is unknown about this illness. Patients are staying on ventilators for weeks instead of days. Generally when someone is on a ventilator for longer than 10-14 days a tracheostomy is done to prevent further damage to the vocal chords and allow for longer term weaning from the vent. We are not doing tracheostomy's right now because surgery on a COVID-19 patient poses significant risk for transmission of disease.  In addition, once a patient gets a trach they have significant ongoing aerosolization of secretions, and this creates a constant high risk for transmission of the virus.  We have seen patients who seem to be getting better precipitously take a turn for the worse, and some patients we thought would not survive, suddenly improve.

We are treading water, trying to be realistic and prepare families for potential deaths, while also understanding their need to hold on to the potential for a miracle. 

What we do know is that it still makes the most sense to continue our current state of social distancing, being vigilant to avoid transmission, washing hands, working from home if we can, reaching out to others virtually, keeping our loved ones close in new ways. 

Comments

[Christine]

Appreciate all your hard work and all the dedicated folk like you in the medical and supporting groups. Also thank you for keeping us updated.

[Susan]

Thank you for your work. We're social (physically distancing) and trying to keep others safe. We appreciate all those who have to put themselves in the path in order to help those who get the virus and those who feed and deliver goods to those of us sheltering in place. Thanks so much for the update too.

[Emie]

Thank you for the information. I like hearing from medical professionals because their motives are clear.. offer the BEST care available. Listening to the experts gives me comfort because they use facts and science. Period.
I truly appreciate your blog... it's a fine mix of medical info with beautiful, calming pictures and comforting words. Well done and thanks from the bottom of my heart. I look forward to our "visits" every day.

[Chris oliveira]

I was happy to see that the court upheld your Governor’s decision.

[Maureen]

Thanks so much for this information. You paint a very clear picture.

[Vicki in Michigan]

Thank you for all you are doing, including sharing info from the front lines.

Much appreciated!

[carol]

Thanks to each of you for YOUR thoughts and thanks. Emie - I enjoy our visits too!

[Kari Elledge]

Thank you so much for sharing this information. I appreciate the work that you are doing and am grateful that you have taken the time to share with us. I have been following your posts for quiet sometime and love your perspective of the world around you. I find your delivery of the COVID-19 information to be stern (i.e. realistic and not sugarcoated) but comforting (i.e. calm and hopeful).