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Solving the puzzle of treatments, care for coronavirus

Indiana did not have ventilator deaths like New York

By Jackie Harris, Editor, The 411 News

Dr. W. Graham Carlos’ motto, “You win or you learn,” is part of the guidance he relies on to help solve the puzzle of treatments and care for coronavirus patients.

Since COVID-19 is a new disease, there is not a history of how to treat or prevent it. Along with the healthcare field, learning about the disease has also become a required part of the public’s guidance. Painfully, though.

The first reports of the disease came out of China in November 2019. By January, the news was that the virus could not be contained. In the U.S., the death toll from the disease is nearing 60,000. COVID-19 means the coronavirus was identified in 2019.

Dr. Carlos is a Bicentennial Professor, an associate professor of clinical medicine at the Indiana University School of Medicine and the chief of internal medicine and pulmonary critical care at Eskenazi Health in Indianapolis.

In Italy, Dr. Carlos saw how fast the disease spread and how it overwhelmed the nation’s primary healthcare systems. Hospitals in Italy were swamped with patients suffering from life-threatening breathing problems identified as ARDS—acute respiratory distress syndrome. ARDS made treating patients’ other health conditions, such as asthma, obesity, diabetes, high-blood pressure, cancer or heart disease more difficult.

There wasn’t enough medical staff and medical equipment, and most of the patients who died were elderly.

The possibility of becoming another Italy with overwhelmed hospitals sparked stay-at-home orders and quarantines around the globe. Limiting physical contact has proven the most effective way of slowing the spread of COVID-19. In the U.S., schools and churches have been closed. Businesses and operations not considered essential are also closed.

Alarm and fear spread as first, the Seattle area, then the New York metro area, reported staggering increases of COVID-19 infections and deaths, followed by cities big and small.

New York’s health crisis became so dire that in March, Gov. Andrew Cuomo asked for 40,000 ventilators and put out a plea to medical care workers across the nation to come to New York and volunteer in the hospitals.

Later, Gov. Cuomo reported that the death rate among COVID-19 patients on ventilators was 80 percent.

Dr. Carlos saw a different percentage – only 10 percent of COVID-19 patients on ventilators died.

He attributed the differences to preparation. “We did well because we did our best to prepare for treating the disease.”

Ventilators alone do not solve the issue of getting oxygen into the lungs, Dr. Carlos said.

“Most critical is the respiratory therapist who is with the patient all the time, sucking secretions from the lungs, delivering medications and checking on vital levels.”

Physical therapy was an early practice for some COVID-19 patients. Diet made a difference and so did appropriate antibiotics. Staff learned the importance of preventing stress ulcers and blood clots.

“Each ventilator patient is different, there is no one treatment that fits all,” stated Dr. Carlos.

Northwest Indiana received 34 ventilators 10 days ago that went to 17 hospitals.

In an April 28 press release from Gary Mayor Jerome Prince, he introduced nurse practitioner Sharnita Rice as a “hometown hero” who answered Gov. Cuomo’s call for volunteers.

On April 1, Rice, who worked for 12 years as a nurse before becoming a nurse practitioner last year, travelled to a hospital near Manhattan to help with the immense strain of treating patients in a COVID-19 hotspot.

In the three weeks of long days and nights that followed, Rice worked in a medical-surgical unit for noncritical patients and learn- ed about makeshift morgues behind the hospital. Rice saw too many people die from COVID-19.

“I felt like I wanted to help my fellow nurses,” she said. “It was surreal.” Rice was at the New York City hospital long enough to see many desperately ill patients be admitted and released after intense treatment.

Watching those patients go home had Rice and her colleagues cheering.

When she completes her quarantine period, Rice said she plans to return to her work at Methodist Hospital. Dr. Carlos will come to IU Northwest in October—like he’s done for the past several years— to instruct medical students, residents and fellows at the campus medical school.

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