Clinical Associate Professor of Medicine, PCOM; and Physician, Critical Care Medicine, Internal Medicine, Sleep Medicine, and Pulmonary Medicine, ChristianaCare’s Christiana Hospital, Newark, Delaware
“I’m managing chronic lung disease patients with telephone and video virtual visits
while also managing patients in the ICU. We want to keep our chronic patients out
of the hospital to cut down on risks. We’ve had telemedicine capability for some time,
but nationally there was slow adaptation due to lack of support from insurers. That’s
changed on a dime. We can now talk to them and help them with the isolation they feel.
Vital signs can be an issue, but many have pulse oximeters while others can take their
own blood pressures. We can’t do OMM over the phone, but you can guide patients how
to do it themselves. … In the ICU, I see patients with COVID-19 pneumonia that have
multiple areas of their lungs that are inflamed and filling in with infectious fluid
that doesn’t allow for gases to be exchanged. You can’t take it out with a diuretic.
What’s making these patients so sick is their immune system ramping up into what we
call an acute cytokine storm, causing damage to the lungs and other organs. We use
steroids to curb the storm. While we’ve told people to avoid steroids before becoming
infected because it could lower your resistance, once you have COVID, and your system
is overly ramped up, steroids can play an important role. … We’ve made in-roads with
COVID patients by doing awake proning, which improves areas of the lungs that can
perform oxygen exchange. We also use high-flow nasal cannulas which have prevented
some patients from intubation. Wall oxygen can go up to 15 liters a minute. We have
devices that amplify the oxygen flow up to 50 liters a minute. Patients with the large
nasal canula can talk and eat, plus they are not aerosolizing the virus, which protects
health care workers. … Personally, I use social media to reach more people with evidence-based
messages about the coronavirus. I post weekly on my Facebook page—Dom Val—without
hype and politics, in a straight-forward manner. I discuss what we might expect in
the coming weeks, pointing to CDC or other predictive models. I talk about the importance—and
rationale—for social distancing and wearing masks in public. One post had 1,300 shares—all
the way to Australia and Poland. I finish each post with a positive message about
America’s response and my belief that our resilience will bring us through to the
end. I want to help as many people as I can. What better time to do it?”
As told to David McKay Wilson
April 22, 2020
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