What ICU doctors have learned about COVID-19 — and how they’re prepared for a 2nd wave


The World Health Organization had just declared COVID-19 a pandemic when intensive care units in the United States started to see an influx of severely ill patients. It was mid-March, and though coronavirus cases had been mounting in countries including China, South Korea and Italy, in the U.S. there was still a dearth of knowledge about how the virus spread, how it affected patients, and what type of threat it posed to the doctors treating them.

Within three months, critical care physicians across the country received a crash course on a disease that didn’t exist in the U.S. before this year, and are more prepared in the event of a second wave of the illness. Now, in June, doctors have a better sense of which medicines and interventions to use or avoid, how the virus affects the body, and how to face their own COVID-19 fears.

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In the beginning, “everyone had the concern of getting infected,” Dr. Francis Castiller, medical director of critical care at UNC REX Hospital in Raleigh, North Carolina, said. The new disease was spreading rapidly, before many ICUs were able to prepare for the surge or protect their staff appropriately.

Dr. Josh Denson, a pulmonary medicine and critical care physician in New Orleans, said he diagnosed the first critically ill COVID-19 patient in Louisiana. But the hospital did not yet have strict protocols for quarantining patients.

“They hadn’t isolated this patient appropriately, so my team members and I were exposed,” said Denson, who works at Tulane Medical Center but was at a different hospital when he was exposed to the virus. “We had real concerns about whether we were going to get this or not.”

He never got sick, and has since tested negative for COVID-19 antibodies.

But it was those fears, in part, that affected how critically ill patients were cared for in the beginning of the outbreak in the U.S.

COVID-19 notoriously wreaks havoc on the lungs, leaving severely ill patients struggling to breathe. As cases started emerging in the U.S., doctors looked to their colleagues in Italy, who were already in the middle of a huge influx of extremely sick patients.

For patients with severe breathing problems, the Italian doctors were using a type of therapy called high flow nasal oxygen, a much less invasive approach than putting a patient on a mechanical ventilator. Patients can get 100 percent oxygen through the nose without having to have a breathing tube put in place.

But an unusually high number of health care personnel in Italy — 20 percent, according to an editorial in The Lancet medical journal — were becoming infected with the coronavirus. They blamed the high flow nasal oxygen, figuring the treatment was aerosolizing the virus, spreading it to doctors and nurses.