COVID-19 Daily: HCQ Hospital Protocols, ED Physician Death

What your doctor is reading on Medscape.com:

APRIL 28, 2020 — Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today: 

Hospitals Update Hydroxychloroquine Protocols 

Across the country, hospitals are incorporating Friday’s warning from the US Food and Drug Administration about the risks of prescribing hydroxychloroquine and chloroquine for COVID-19 patients into their treatment protocols. For some hospitals, the message affirmed the cautious approach they were already taking.

Michigan Medicine, for example, stopped using hydroxychloroquine and azithromycin (both separately and in combination) about a month ago, an infectious diseases specialist there said. “When we reviewed the data that was available in more detail, we realized that it was essentially uninterpretable,” he said. As of Monday, the only patients receiving this drug at Michigan Medicine are those enrolled in a randomized, placebo-controlled clinical trial.

New York Emergency Physician Death

Lorna M. Breen, MD, had been immersed in treating COVID-19 patients as medical director of a Manhattan emergency department, and had contracted and recovered from the disease herself. On Sunday, Breen, 49, died by suicide, the New York Times reported. “She’s a casualty just as much as anyone else who has died,” her father told the Times .

During the COVID-19 pandemic, physicians can talk to a psychiatrist by calling the Physician Support Line, a free mental health hotline exclusively for doctors, at 1-888-409-0141. The National Suicide Prevention Lifeline is a free, 24/7 confidential service that can provide people in suicidal crisis or emotional distress, or those around them, with support, information, and local resources. Its number is 1-800-273-TALK (8255).

Immigrant Physicians Fighting COVID-19 Worry About Visas

Visa restrictions often block the ability of immigrant physicians to meet COVID-19 surges across the country, the chief clinical officer for an integrated healthcare system in the southern United States said on a press call. 

“This pandemic is a war with an invisible enemy, and immigrant physicians have been absolutely critical to providing quality care, especially on the front lines — but current visa restrictions have limited the ability to deploy these physicians in communities with the greatest need,” he said.

Nationwide, over one in five physicians are immigrants, according to data from the National Immigration Forum, but that figure is greater than one in three in New York, New Jersey, and California, three states hard hit by COVID-19 cases. 

Guidance on Diabetes and COVID-19

An international panel of diabetes experts has published practical recommendations for managing diabetes in patients with COVID-19 both in and out of hospitals. Diabetes is generally a major risk factor for the development of severe pneumonia and sepsis due to viral infections, and data from several sources suggest the risk for death from COVID-19 is up to 50% higher in people with diabetes than in those without.

Curbside Consult

A pulmonologist in Germany shared his early successes with an alternative approach to ventilation for COVID-19 patients on Medscape’s Consult platform: “COVID-19 is not [acute respiratory distress syndrome (ARDS)],” he said. “And it does need a different strategy of ventilation.”

But many physicians are wary of abandoning decades of research-backed practices for this new approach. “Regardless of whether COVID-19 behaves like ARDS or not, we as physicians have been thinking about judicious use of mechanical ventilation for several decades,” one pulmonologist and critical care specialist said. “I don’t think we should stray away from some principles of mechanical ventilation.”  

Interpretation of COVID-19 Guidelines for Children 

A physician from Sichuan University and West China Second University Hospital discusses interpretation of COVID-19 guidelines for children in a Medscape reference video. According to the video, transmission of COVID-19 to children often occurs through parents and caregivers.

In Memoriam

As front-line healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. More than 500 throughout the world have died. 

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form.