Categories
Epidemiology

(Age + BMI) x Hemoglobin A1C = COVID Mortality Risk

OK, not really. This title is not a scientifically-proven equation and so don’t quote me on it. But it does underscore the observations that there are both powerful modifiable risk factors and non-modifiable risk factors for death due to COVID-19. We started anecdotally noticing this in our ICU in the spring as the COVID-19 outbreak […]

Categories
Epidemiology

The Effect Of Age On COVID-19 Mortality Rates

Last week, I was asked if it would be OK if 20 family members visited one of my patients who is in his 80’s over the holiday weekend. My reflexive response was “Don’t come!” but it raised the question of what is the probability of dying should this patient get infected by COVID-19 and how […]

Categories
Intensive Care Unit

The Management Of Respiratory Failure In COVID-19 Patients

Every hospital in the United States is bracing for a potential deluge of patents with COVID-19 infection and many of these patients will require admission to our country’s intensive care units. There are not enough critical care physicians to manage all of these patients so it may be necessary for doctors and nurses who do […]

Categories
Life In The Hospital

Why COVID-19 Has Made Me More Efficient

A funny thing happened last month… I realized that I’ve been feeling a lot more rested in the past 6 months. So I asked myself the 5 “whys” to sequentially drill down on the question: Why #1? Because I was getting to bed earlier Why #2? Because I wasn’t doing as much work at home […]

Categories
Epidemiology

You Are Safer From COVID-19 In The ICU Than In The Grocery Store

This summer, COVID-19 numbers keep going up. Five months ago, we thought COVID-19 would behave like other respiratory viruses: have peak incidence in the winter and then drop off in the summer. But that has not happened. Across the United States, there is a second surge in new infections and southern states that seemed to […]

Categories
Outpatient Practice

Is It Safe To Go To Your Doctor’s Office During The COVID Outbreak?

In March 2020, outpatient medicine as we previously knew it changed, perhaps forever. The COVID-19 outbreak was accelerating in the United States and by the beginning of June, it would kill more than 100,000 Americans. People self-isolated in their homes, businesses shut down, and hospitals prohibited visitors. Patients were scared to go to their doctor’s […]

Categories
Epidemiology

When It Comes To COVID-19, Are We Testing The Right Thing?

During this COVID-19 outbreak, I have the dual roles of overseeing our hospital’s response to the pandemic and also of rounding in our ICU and taking care of COVID patients first-hand. One of issues that I struggle with in both of these roles is how accurate is our testing? Currently, we have 3 ways that […]

Categories
Intensive Care Unit

The Pandemic Of Dogma Within The Pandemic Of COVID-19

Our generation of physicians prides itself on the practice of evidence-based medicine. Ideally, this means making medical decisions based on peer-reviewed clinical studies and randomized, controlled clinical trials. It means getting away from the “this-is-the-way-you-do-it-because-this-is-the-way-we’ve-always-done-it” approach to medicine to ensure that patients get the best known treatment for any given medical condition. But what happens […]

Categories
Epidemiology

Imagining Life After COVID-19

It is mid-April and physicians and hospitals are already planning on how and when to re-institute normal operations, like flowers poking through snow after a cold winter. But it is pretty clear that the normal operations of the future will not be like the normal operations of the past. I’m using this post to speculate […]

Categories
Emergency Department Inpatient Practice Intensive Care Unit

With COVID-19, Hope For The Best But Prepare For The Worst

In August 2004, my family was vacationing on the North Carolina Outer Banks. I had been following Tropical Storm Alex as it came north from the Caribbean toward the island that we were staying on. On August 3rd, it was looking like the storm was going to head out over the Atlantic the next afternoon […]