![]() Still, I prescribe it to some COVID-19 patients, not because I’m convinced it works but because I think it might-and there’s little else we can do. Hydroxychloroquine can interfere with the heart’s electrical circuitry, and has harmful interactions with many commonly used medications. (One widely cited study was the subject of a “statement of concern” issued by the society that publishes the journal in which it appeared the society’s president wrote that the study had failed to meet its basic research standards.) The studies on the question are small and have yielded mixed results, or have been too poorly designed to allow doctors to draw reliable conclusions. But it’s far from clear that the same will happen in human bodies. Traditionally, the drug has been used to treat malaria and inflammatory conditions, such as lupus a recent study found that it can stop the coronavirus from infecting cells in petri dishes. Perhaps the most hyped medication being tried for COVID-19 is hydroxychloroquine. A single incision in the chest should be enough: we need to know exactly how the virus is destroying the lungs. From now on, we’re to ask permission to conduct an autopsy on every patient who dies of COVID-19. We receive an e-mail from our department heads. They want to figure out whether it’s possible to predict-using travel history, smoking status, medications, medical conditions, and other variables-who will need to be intubated and who will be able to go home. Other researchers hope to aggregate data from electronic health records. Many New York hospitals are rapidly introducing clinical trials to investigate which drugs and protocols are most effective some also collect samples-from nasal swabs, blood tests, urine, feces-that might reveal how the virus spreads among people and what it does within bodies. But careful observation today may mean the difference between life and death for other patients, in other states, in the not-so-distant future. It feels odd to be both appalled by the virus and curious about it. Does ibuprofen really make things worse? Should we give steroids or statins, Z-Paks or malaria drugs? How long will patients stay on ventilators, and how many should we expect to come off them alive? We’re exploring different medications and maneuvers, rapidly iterating our protocols in search of an approach that could halt the ruthless progression from infection to intubation. And yet that’s where we find ourselves in my hospital: raising and debating new questions to which the answers are slow in coming. Today, it’s rare to be in such uncharted territory. In the nineteenth century, the medical profession seemed to stumble on a new disease every few years doctors would set about describing its symptoms, detailing its physiology, and proposing possible remedies. The mystery isn’t how the virus presents but how it works. There’s no kidney damage initially the liver looks good blood pressure remains stable. Chest X-rays show a diffuse haziness in both lungs, or, if things are really bad, a complete whiteout. ![]() The body’s inflammatory proteins skyrocket, while its lymphocytes plummet. Then the inability to catch their breath, which triggers the decision to seek medical care. They report fevers, usually high and persistent, lasting for many days. Read The New Yorker’s complete news coverage and analysis of the coronavirus pandemic.īut most COVID-19 patients are textbook, at least at first. The only sign of a urinary-tract infection in an elderly patient might be fatigue. When students arrive in the hospital, senior physicians point out with some glee that patients are rarely textbook. Sweating, chest pain, and unequal blood pressure in the arms: an aortic tear. Fever, vomiting, and right-belly pain: appendicitis. Reading about the signs and symptoms of illness, a student’s task is to create a mental checklist connecting presentation to diagnosis. Why does the virus cripple some lungs and not others? There’s so much we don’t yet know.Īt the beginning of medical school, during the “preclinical” years, students learn about diseases from books, not patients. I can’t work out whether the virus was merciful or merciless in taking them both. His breathing is so labored that he can barely speak, but, between gasps, from behind an oxygen mask, he tells me that he can’t live without her. One evening, we transfer a woman in her eighties to hospice her husband of fifty years joins her the next morning. By the end of the week, she is pacing the room, and he is on the brink of intubation. Now, while her breathing improves each day, his declines. A woman and her husband are admitted to my ward before the coronavirus, they were healthy, enjoying morning walks and evening cocktails.
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