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Treating Serious COVID-19 Cases. Does the Coronavirus Cause Lasting Damage?

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by Peter Wark for The Conversation

As the number of COVID-19 cases around the world continues to climb, hospitals are under increased pressure to provide emergency care for the most severely ill patients. What does this involve, and how does the coronavirus damage the respiratory system?

The virus first invades our bodies by attaching to a protein called ACE2 on cells in the mouth, nose and airways. For the first week of infection, symptoms are relatively mild, with sore throat, cough and fever. Some people, particularly children, may carry the virus with few if any symptoms at all.

But this early stage also seems to be the time at which people are most infectious to others.

The Wuhan data

As the place where the pandemic originated, the Chinese city of Wuhan has yielded the biggest and most useful set of cases from which we can analyse the disease’s typical progression.

From days four to nine after infection, the symptoms worsen, with increasing breathlessness and cough. In those ill enough to be admitted to hospital, more than half require assistance with oxygen, usually in a standard hospital ward. Some patients suffer worsening breathing difficulties that necessitate admission to an intensive care unit (ICU), typically eight to fifteen days after the illness began.

What happens in ICU?

In ICU, various treatments can support these more serious breathing problems. This includes high-flow humidified oxygen, delivered via a nasal mask. The oxygen is warmed and its humidity artificially increased so as to avoid uncomfortable dryness. It is gently pumped into the lungs at a comfortable rate that still allows the patient to speak and eat.

If breathing worsens further, the patient is then intubated. This involves inserting a tube through the mouth and into the windpipe, through which oxygen is delivered via a ventilator. Intubated patients need to be sedated (kept asleep) until their lungs recover enough to work without assistance.

In the most severe cases, where the lungs fail and it is not possible to deliver enough oxygen by ventilator, patients are given extracorporeal membrane oxygenation, which effectively outsources the work normally done by the heart and lungs to an external machine. Blood is carried from the body, and carbon dioxide removed and oxygen added, before it returns to the patient’s circulation. This is the most advanced form of life support, but also carries the highest risks and the longest recovery times.

An analysis of adult COVID-19 patients treated at two Wuhan hospitals found that 50 of the 191 cases studied required ICU treatment.

Of these 50 ICU patients, 41 received high-flow humidified oxygen, 33 were intubated, and 3 received extracorporeal membrane oxygenation.

Only 8 of the 41 patients treated with high-flow oxygen survived, and just one of the intubated patients. Overall, 11 of the 50 ICU patients survived. But those who did recover seemed to do so reasonably rapidly: 75% were discharged within 25 days.

Data from outside China is more limited, but offers more grounds for optimism. A review of 18 hospitalised patients in Singapore found that six needed oxygen support with oxygen, but just two were admitted to ICU and only one was intubated, and this patient was able to go home a mere six days after coming off respiratory support.

From Washington state in the US, among 21 cases admitted to the ICU, 17 were admitted to ICU within 24 hours of hospital admission and 15 required intubation. Besides their respiratory distress, seven developed heart damage, four suffered kidney failure, and three liver damage. As of March 17, 11 of the patients had died, two had left the ICU, and eight still needed ventilation.

Does the disease cause long-term symptoms?

At this stage there is no data on the long-term effects of COVID-19. But we can look at the after-effects of other acute viral respiratory diseases such as influenza, SARS and Middle East respiratory syndrome (MERS).

In these diseases, collectively called acute respiratory distress syndromes (ARDS), the fragile small airways and air sacs become damaged by inflammation, can become blocked by fluid and blood, and are replaced by scar tissue as they heal. This can stiffen the lungs – at first from fluid and then from scar tissue – impairing their ability to transfer oxygen and making breathing more laboured. In SARS and MERS this damage appears to occur as the virus is being destroyed by the immune response.

How long does it take to recover from ARDS? One survey of 396 German patients found that 50% were hospitalized for 48 days or longer during the year following their original recovery. A smaller review of 37 ICU survivors of pandemic influenza in 2009, found that roughly half still complained of severe breathlessness on exertion but, more promisingly, 83% had returned to work.

At this stage our best course of action is to focus on slowing the coronavirus’s spread and protecting the most vulnerable. The death rate from COVID-19 is worse in countries where health services have become overwhelmed. Our best bet is to maximize our resources by minimizing the number of people who suffer severe symptoms.


Peter Wark is Conjoint Professor, School of Medicine and Public Health, at the University of Newcastle.

The Conversation publishes knowledge-based journalism that is responsible, ethical and supported by evidence from academics and researchers in order to inform public debate with facts, clarity and insight into society’s biggest problems.

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Health

County Hospitals Receive 300 iPads for Patients to See Family

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LOS ANGELES – 300 iPads have been donated to Los Angeles County hospitals to facilitate patient-family communication during the COVID-19 pandemic. The gift is through a partnership with the Annenberg Foundation, Brilliant Corners, and the Los Angeles County Center for Strategic Partnerships.

“The engagement of loved ones during hospitalization has been shown to improve clinical outcomes,” said DHS Director, Dr. Christina Ghaly. “Clinical staff identified a role for virtual visiting through technology in order to facilitate this family involvement. The generous donations by the Annenberg Foundation and MobileDemand will help support this critical element of our patients’ care.” 

Due to the COVID-19 pandemic, patient visitation by family and loved ones is limited at facilities in order to prevent exposure and the spread of disease. While there are some exceptions, such as the birth of a child or death of a patient, visitation is not permitted for the vast majority of patients and not allowed at all for COVID-19 patients. 

The donation provides 300 iPads to ensure patients and their families are able to connect, despite restrictions in access to the hospital. A second donation, by MobileDemand, provides rugged, protective healthcare iPad cases to protect against damage and loss. The rugged case also has an adjustable easel attached, providing effortless viewing for patients who are too weak to hold a tablet. Additionally, it frees health care staff from having to hold the device for patients.

“This is a wonderful example of how philanthropic organizations, nonprofits, government, and businesses can collaborate and meet an immediate need in our community,” said Wallis Annenberg, Chairman, President and CEO of the Annenberg Foundation. “Being able to offer an opportunity for comfort and connection to those suffering and to alleviate some of the stress from our frontline caregivers is of utmost importance.”

While social distancing has been successful in flattening the curve of the COVID-19 surge in Los Angeles County, it is anticipated that it will continue for several months. With this gift, physicians and nurses will be able to place an iPad in the room of COVID and other critically-ill patients for the duration of the admission and reduce potential exposure and use of personal protective equipment going in and out of the room. Having a stationary iPad helps relieve medical staff who would otherwise have to hold the phone for a patient or search for the person’s personal phone. It also will allow patients who do not have a personal mobile device to communicate and “visit” with their family.

The Los Angeles County Department of Health Services (DHS) is the second largest municipal health system in the nation. Through its integrated system of 26 health centers and four hospitals – LAC+USC Medical Center, Harbor-UCLA Medical Center, Olive View-UCLA Medical Center, and Rancho Los Amigos National Rehabilitation Center – and expanded network of community partner clinics, DHS annually provides direct care for 600,000 unique patients, employs over 22,000 staff, and has an annual budget of over $6 billion.

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Processions to Cedars Will Salute Healthcare Workers on National Nurses Day

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The coronavirus (COVID-19) outbreak is putting a strain on essential workers such as first responders and healthcare workers who are on the frontlines in the effort to care for coronavirus patients so the City of West Hollywood is setting out to recognize them in a special way on May 6.

National Nurses Day is a day of recognition to celebrate and honor the contributions that nurses have made and continue to make in our communities and throughout the nation. National Nurses Day is celebrated annually on May 6, which marks the beginning of National Nurses Week, a week-long celebration to raise awareness of the value of nursing and educate the public on the role nurses play in meeting the healthcare needs of Americans. National Nurses Week concludes on May 12, the birthday of Florence Nightingale, or as she was more commonly known, “The Lady of the Lamp” and founder of modern nursing.

The West Hollywood Sheriff’s Station of the Los Angeles County Sheriff’s Department is coordinating two motorcades to honor healthcare workers on Wednesday, May 6, 2020, which is nationally recognized as National Nurses Day. The processions will begin at 9:45 a.m. and at 7:15 p.m. on Santa Monica Boulevard at La Cienega Boulevard and the motorcades will head west and then travel southbound on N. San Vicente Boulevard passing multiple medical center locations in West Hollywood en route to a destination outside the emergency room entrance of Cedars-Sinai Medical Center on Gracie Allen Drive. First responders will briefly stop, exit their vehicles and applaud healthcare workers while wearing face coverings and practicing appropriate social distancing.

“Our nurses and healthcare workers are nothing short of heroes,” said City of West Hollywood Mayor Pro Tempore Lindsey P. Horvath. “The coronavirus pandemic has reminded us just how critical their work is to our everyday health and safety. This National Nurses Day means so much more to all of us — the City of West Hollywood and our LA County Sheriff’s West Hollywood Station and LA County Fire Stations; the City of Beverly Hills and Beverly Hills Police and Fire; the City of Los Angeles and LAPD and LAFD; the California Highway Patrol, and more — and we will honor these heroes in a special way for the care that they provide, which often goes unseen and unrecognized, in carrying us through this crisis.”

“As the worldwide response to the novel coronavirus (COVID-19) continues, the critical importance of nurses in our society has been brought sharply into focus,” said City of West Hollywood Councilmember John Heilman. “More often than not, when a coronavirus patient ends up in a hospital, it is the nurses at the frontlines who are responsible for their care and treatment, putting themselves at risk in the process. We can’t say ‘thank you’ strongly enough.”

The City of West Hollywood encourages residents and community members to participate during this day of celebration while still adhering to LA County Safer At Home Orders and social distancing requirements. Suggested forms of participation include amplifying posts on social media channels, making yard or window signs and banners, participating in a coordinated daily applause or shout out for nurses and healthcare workers, and donating to organizations that are addressing the emerging needs of nurses and healthcare workers during the coronavirus (COVID-19) health pandemic.

According to the American Nursing Association, nursing is the nation’s largest healthcare profession, with more than four million registered nurses in the United States. Registered nurses comprise one of the largest segments of the U.S. workforce and are the primary providers of hospital patient care, delivering most of the nation’s long-term care. In nursing, where workers are on the front lines of patient interactions, women make up more than 85 percent of the workforce. This year, with the onset of coronavirus, nurses have stepped up and shown the incredible impact they have on our healthcare system. It is more important than ever that we recognize National Nurses Day and celebrate the significance of nurses every day.

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Texas & California Wet Markets Show Full Extent of Vile Conditions

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Texas & California Wet Markets Show Full Extent of Vile Conditions

(TMZ) — It’s becoming more clear by the day that wet markets are NOT just a China problem — it’s an American problem too … just take a look at these latest clips from Texas and California.

TMZ has gotten a hold of even more graphic videos of two different live animal shops in TX and CA — where people pick out the animal, have it slaughtered on the spot and then sold to them right then and there — and you see the mixed-in livestock runs the gamut.

There are pigs in pens, goats and sheep hoarded together … and, of course, as we’ve seen in New York and elsewhere — chicken and rabbits cooped up in cages — all in the same area within earshot of each other, and all getting butchered.

Ya got pigs hanging from hooks out in the open, chicken beaks, feathers and guts all over the floor and in an exposed trash can — this while customers (including kids) come in and browse the freezer for whatever cuts of meat they want. It’s downright dirty and gross.

As we’ve been told by the experts, these one-stop-shop slaughterhouses/storefronts can be breeding grounds for disease — including new viruses, like COVID-19, which supposedly got started at a wet market in China.

We already know of lawmakers in Cali and New York working to get these things shut down, but it’s pretty apparent there needs to be federal legislation rolled out to address this. Can’t call the kettle black when we’re swimming in the freakin’ pot.

Tune in to TMZ on TV weekdays Monday through Friday (check syndicated/local listings)

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