Working in the Virus’ Shadow: SARS-CoV-2, 7 July, 2020, 1400 Hrs

I am sweating. It has been a while since I last posted on this topic. Not because I have been ignoring SARS-CoV-2, rather because being in the hospital – in the ICU – caring for COVID19 and other patients, has been about all I can do. Still, listening to health experts – Tony Fauci, Laurie Garrett, and others – it is as clear as can be where we are and where we are going.

Regarding cases, in the United States, as of today, there are 2.9 million cases; 130,000 of our fellow humans have died. The US makes up about 4% of the world’s population, and worldwide there are about 11.7 million cases and 540,000 deaths. The obvious implication is that our country, once a beacon for the world in science and medicine, with 4% of the world’s population, accounts for 25% of worldwide cases and deaths.

Florida – where I practice – Arizona, and Texas are in serious trouble with significantly increasing cases; it just so happens that Trumpian sycophant Governors rule those States. According to the Johns Hopkins University Corona Virus Project, on 6 July the 7-day average of new cases was 8,587 in Florida; the same day, the Arizona average was 3,844 and Texas 6,991 new cases. Several days ago, on 2 July, Florida announced something more than 10,000 new cases in a single day. Ten thousand cases in one day; how great are we? China, Japan, Korea, Vietnam, Thailand, Malaysia, Indonesia, Philippines, Australia, and the entire European Union – with a combined population of 2.6 billion people – are averaging 6,760 cases per day; fewer than Florida.

There is no way to describe this except as an unmitigated, unshirted disaster. Trump’s incompetence, lack of attention, inadequate appointees, and thuggishness are all responsible for this. Every case, every death rests on the shoulders of Trump and his administration.

Who would’a thunk it? Put an incompetent, fascist in power and guess what happens? Well, you needn’t guess. If you have eyes, you can see.

The National Institute of Allergy and Infectious Diseases’ Director, Anthony Fauci suggests that we will see 100,000 cases per day soon, if current trends continue. If true, and if mortality stays at about 5%, we will lose 5,000 brothers, sisters, friends, parents, and grandparents every day. EVERY. DAY.

Indeed, how great are we? I will state unequivocally: Not great at all.

What about prevention? It appears that the shortage in personal protective equipment (PPE) in many hospitals is better. At the several institutions at which I have clinical privileges, there is adequate PPE for health workers in the Intensive Care Units (ICUs). Yet, in many institutions (Robinson-Jacobs, AP), shortages persist and equipment intended for single use is being re-used, likely unsafely.  Deborah Burger, president of National Nurses United, as well as the leadership of the American Medical Association, note that there are still shortages that require a “…coordinated national strategy to buy and allocate gear”. There have been some 600 of us – health care workers: nurses, physicians, dieticians, social workers, environmental service workers, and so forth – who have lost our lives in the process of caring for COVID19 patients. Still, even though this has been an ongoing problem since January – February, shortages persist. The country that is the self-designated “Leader of the World” cannot perform the most basic function of a government: To protect its people from disease. Indeed, some of the contracts let by the Trump Administration for PPE have gone to grifters who produce and deliver nothing but junk. One cannot read about this without cringing, bursting into tears: What happened to our country? As new cases skyrocket in our country, we will see more and more health care workers walk away from their jobs out of fear that they will become ill due to lack of PPE. Who can blame them? What about THEIR families and loved ones? All of us who do this work recognize we are at increased risk. We only ask to be given the proper tools to do the job. Our Federal Government has failed us. Our State Governments continue to struggle. This was all unnecessary, resulting from incompetent and petulant leadership.

Then, there are those who refuse to wear masks. The reasons are many: Masks are “unmanly”; masks “make me re-breathe carbon dioxide”; mask get in the way of “God’s beautiful breathing apparatus”. All nonsense; idiotic. These benighted souls are αμάθησ, as we say in Greek. Lost in their ignorance.

What about treatment?  There is no specific therapy: Hydroxychloroquine, azithromycin, oral bleach, bright lights in the rectum, all therapies pushed by the Grifter-in-Chief, range between useless and dangerous. While we await a functional vaccine, there are non-specific treatments that help. Dexamethasone, a potent steroid, given for 10 days seems to blunt the mortality of the virus. Convalescent plasma – pooled from patient who had COVID19 and survived – helps, as does tocilizumab, an immune suppressing agent that prevents “cytokine storm”. This is a syndrome in which the body’s immune system is on “full throttle” resulting in multiple organ failure and sometimes death; tocilizumab blunts this response. There is, additionally, remdesivir, an anti-viral agent developed with US tax dollars and then handed over to Gilead Pharmaceuticals who charge $500 per bottle; each patient needs between 4 and 5 bottles of the drug. It may shorten the duration of the illness; may.

Who says (corporate) socialism doesn’t work?

And, as if all of this is not enough, today Trump announced the initiation of a one-year period to pull the United States out of the World Health Organization, an organization we helped found. An organization I know well and one that does a very good, if sometimes limited by statute, job. One of my most brilliant research fellows worked there developing treatment criteria during the 2014 Ebola Epidemic; it is a fine organization.

The care provided in our ICUs and intermediate care units for COVID19 patients is very good. Even though our health system is an organizational and financial disaster, American Health Care Workers are excellent. We will care for you as well as we know how no matter where you are from and what you believe. We do it not because we are heroes – we are not – but because it is our honor and privilege to do so. You are our raison d’être.

I opened this piece stating that I was sweating. I didn’t mean it as metaphor. Three days ago a man I was caring for deteriorated rapidly in the ICU. He had tested negative for SARS-CoV-2 when he was admitted. The nurses and I did all we could to save him, and save him we did. In order to do this, we had to place an endotracheal tube, a central line, an arterial line; all procedures that required being very close to him. As he had tested negative, we only wore surgical masks and eye protection. Yesterday I was informed that re-testing was positive for SARS-CoV-2. There is a chance that several of us will become positive, although – obviously – I hope this isn’t the case. Testing for us tomorrow!

It is my strongest preference not to become sick and die from the SARS-CoV-2 virus infection; there are too many books to write and too much work to do to try to make our world more just.

And I certainly don’t want to get sick and die because a con-man grifter-thug mismanaged a pandemic so severely that a country belonging to the world’s most economically advanced became, in a period of four years, a failed state.

About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the approximately 10 years until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director and Co-Chairman of Critical Care Medicine in PA; this ended in 2017. He served as a Physician in the Surgical Group with Médecins sans Frontières (MSF, Doctors without Borders) through 2018 and is presently an intensivist in Florida, struggling through the SARS-CoV-2 crisis. While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". Follow on Twitter @ajlayon
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