COVID 19 Update From Italy
By: Donald V. Watkins
Copyrighted and Published on March 22, 2020
Below is the latest COVID 19 update from a front-line anesthesiologist/critical care doctor working in Milan, Italy. As of Sunday, Italy has experienced 5,476 COVID 19-related deaths. Milan is the most adversely affected city in Italy. This COVID 19 information is being circulated with ER doctor groups in America. Here are the highlights from this doctor's report:
1. Hospital wards are being converted to "COVID wards" to better treat patients. The situation at this doctor's hospital is dramatic. They have created four new intensive care units to treat intubated patients. All patients in ICU are on CPAP machines from 8 to 12 hours a day.
2. ER and ICU doctors have noticed that patients 40-years-old or less are developing very bad pneumonia. The best treatment results come when COVID 19 patients are placed face down on their stomach while breathing with CPAP machines and/or mechanical ventilators. Each patient on a mechanical ventilator is ventilated for 18 hours a day. Mechanical ventilation is essential for all COVID 19 patients.
3. The typical COVID 19 patient arrives in the Emergency Room with mild dyspnea (i.e., labored breathing), coughing, and fever. "They need rapid intubation (i.e., a tube placed into the trachea for ventilation), or they will die from acute respiratory distress."
4. Of the COVID 19 patients hospitalized, 80-85% of the critical patients are men, including 30-year-olds with no linkage to smoking/vaping or other co-morbidities (i.e., potentially fatal diseases or underlying medical conditions).
5. Milan's "911" Emergency Services cannot take care of all respiratory patients. As such, infected individuals are dying in their homes with no medical care. Hospitals are treating only "young" COVID 19 patients (i.e., individuals less than 60-years-old) with "light" co-morbidities.
6. Active cancer patients are the most difficult to treat. The mortality rate for cancer patients is 3-6%. Additionally, patients taking ACE inhibitors and ARBs have the worse outcomes.
7. Intubated patients do not improve quickly. ICUs are filled with ventilated 40-year-old patients and they don't seem to be improving.
8. Italian hospitals have promulgated a "vademecum" (i.e., handbook or guide that is kept constantly at hand for consultations) for the benefit of ER and ICU doctors, nurses, and respiratory therapists. [DonaldWatkins.com will acquire an Italian vademecum, translate it into English, and post it on this website for the benefit of America healthcare providers and our readers.]
9. The coronavirus is mutating and doctors have not found a cure or vaccine for it. Giapreza (or angiotensin II), a biochemical protein whose presence in the bloodstream promotes aldostererone secretion and tends to raise blood pressure, seemed to improve vital signs and outcomes in about 50 cases. The doctors are also using choroquine, tocilizumab, antiretrovirals, and anakina, but no steroids at all.
10. Italian doctors who are treating COVID 19 patients wear a single-use cap, a single-use coat, shoe covers, double gloves and goggles or face shields with a N100 mask. Even with this personal protective equipment, a 36-year-old female anesthesiologist in Milan is now intubated and mechanically ventilated in ICU.
America was 3 months late in properly responding to the COVID 19 healthcare crisis. Like Italy, America thought COVID 19 would be "nothing more than the common flu." ICUs in Italy are now full of COVID 19 patients.
Conditions in American hospitals are expected to mirror the COVID 19 patient numbers, treatment protocols, and morbidity rates experienced in Italy. Because of America's population size and lack of a nationwide COVID testing program, the number of COVID-related deaths in America is expected to vastly exceed those reported for Italy.