For clinicians combating the disease, caused by a new pathogen that was unknown before it emerged in Wuhan, China, late last year, the learning curve has been steep. Doctors shared information and gleaned insights from a barrage of studies shared with unprecedented speed, but there were also missteps. At first, the focus was on the illness’ effects on the lungs; understanding the deleterious impact on other organs came later.
Early on, physicians were placing patients on mechanical ventilators to assist with their breathing; over time they learned to position patients on their stomachs and provide them with supplemental oxygen through less invasive means, and postpone ventilation or avoid it altogether if possible.
By mid-June, clinical trials in England had proven that treatment with a cheap steroid drug, dexamethasone, reduced deaths of patients on ventilators by one-third, and death in patients getting supplemental oxygen by one-fifth. But the early recommendations from China and Italy were “to absolutely not use steroids, even though a lot of us thought it made sense to use them,” said Dr. Gita Lisker, a critical care physician at Northwell Health. “I think it’s making a big difference. But when we started with this in March, the data and recommendations from China and Italy were saying, ‘Do not use them, steroids are bad.’”
Doctors also weren’t aware at first that the Covid-19 illness caused by the new virus caused life-threatening blood clots. Now patients are put on blood thinners early on in treatment when necessary.
But the other problem in the spring was that hospitals in hard-hit areas like New York City were overwhelmed. Doctors who hadn’t worked in critical care for many years were being drafted to care for seriously ill patients, nurses were short-staffed, and equipment was in short supply. “There was a sheer overwhelming tidal wave that overtook the health care system,” Dr. Lisker said. “You had critical care units run by doctors who hadn’t done critical care in 10 years, or even ever.”
She added, “There is no question that whether you lived or died in April, some of it had to do with what unit you landed in.”
Indeed, she said, “The whole idea of flattening the curve was to avoid overwhelming the health care system.”