By ETHAN WEISS, MD
We have seen and heard about the classic symptoms of
COVID-19 at UCSF Medical Center, where I work as a cardiologist. Patients keep
coming in with pulmonary distress, pneumonia, and ultimately, Acute Respiratory
Distress Syndrome (ARDS) – the life-and-death situation that requires
However, I’m beginning to learn about other symptoms that some
doctors are noticing. There are numerous reports of other complications, especially
in advanced disease.
One of the most interesting involves disruption of the blood’s coagulation system. New anecdotal reports have described clotting in test tubes and lines, derangements of clinical clotting assays, pulmonary emboli, large clots in the heart, as well as microvascular thrombosis.
Elevation in D-Dimer, (a biomarker of coagulation system activation) has been associated with dramatically increased risk of death from COVID-19. This has led some to speculate that empiric treatment with anticoagulants might improve outcomes in these critically ill patients. Indeed, there was this recent publication of a retrospective analysis of anticoagulation with heparin or low molecular weight heparin showing an association with improved outcomes in COVID-19 patients in China.
By HOWARD LUKS MD, JOEL TOPF MD, FACP, ETHAN WEISS MD, CARRIE DIULUS MD, NANCY YEN SHIPLEY MD, ERIC LEVI MBBS, FRACS, BRYAN VARTABEDIAN MD
“EVERYTHING WE DO BEFORE A PANDEMIC WILL SEEM ALARMIST. EVERYTHING WE DO AFTER WILL SEEM INADEQUATE”—Michael Leavitt
Last updated 3/18/2020.
Why are we writing this?
The COVID-19 pandemic has reached a point where containment is no longer possible. The COVID-19 threat is real, and rapidly getting worse. Many of you are very nervous, some are unsure of the validity of the information you are reading. As physician leaders, we felt it was important to craft a resource you can rely on as being scientifically accurate and one which contains as much actionable information and guidance as possible.
Accurate, actionable information during an epidemic can save lives. Physicians are on the front line of this epidemic. Not only are we treating the sick, but we are also cringing at the misinformation spread through both traditional broadcast and social media. Evidence matters. Unfortunately, evidence is often slow, methodical, and boring and has a tough time against clicky headlines and exaggeration. We believe that an accurate representation of the current COVID-19 pandemic followed by a set of actionable steps you, your loved ones, politicians and local officials can utilize is of paramount importance and ultimately could save tens of thousands of lives.
COVID-19 isn’t just the flu?
COVID-19 has been described by some as “just a cold”, or just like the common flu. COVID-19 is not the common flu. COVID-19 is an order of magnitude worse than the flu. The fatality rate is approximately 10 times worse than the flu.
The flu spreads from September through April in the US, and June through August in the Southern Hemisphere. Yes, it does cause severe illness in many, but it does so over a longer time course. Time is a variable that is working against us during this COVID-19 outbreak. COVID-19 victims will be presenting to a hospital in need of critical care at a rate that is far higher than occurs with the flu.
In addition, these patients will be requiring hospital treatment over the course of a few weeks rather than the 3-4 months of a typical flu season. The healthcare system in the USA is not ready to handle tens of thousands or hundreds of thousands of people over a short time frame. In Italy, the healthcare system buckled under the strain and the healthcare teams are now forced to make horrible life and death decisions.