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What your doctor is reading on Medscape.com:
APRIL 24, 2020 — Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today:
Doctor Support Hotline
In late March, a Philadelphia-area psychiatrist launched the Physician Support Line, a free mental health hotline exclusively for doctors. Her goal: To create a resource through which psychiatrists would be available to provide frontline physicians with some emotional personal protective equipment.
Doctors often feel they can’t share their fears, even with family members, in part because of societal pressures to act like heroes on the front lines of what has been framed as a war, the psychiatrist told Medscape Medical News . Through the hotline, psychiatrists give doctors permission to feel what they are feeling, and that can help motivate them to go back to work.
“They don’t want to look like cowards, because that’s the opposite of a hero,” she said. “Saying it to another doctor feels much better because we get it, and we normalize that for them. It’s normal to feel that way.”
Mortality in Large New York Case Series
In a study describing the largest cohort of hospitalized patients with COVID-19 in the United States thus far, the mortality rate was 21% among the 2634 patients whose outcomes (death or discharge) were known at study end. Of the 320 patients who received mechanicalventilation and whose outcomes were known, 88% died.
The full study includes 5700 patients who were hospitalized with confirmed COVID-19 in the New York area from March 1 through April 4. The most common comorbidities among all 5700 patients were hypertension (57%), obesity (41%), and diabetes (34%). As has been seen in other patient series, male sex and increasing age were associated with a higher risk for death
“We’ve been seeing since March 8 that the severity of patients has lessened dramatically, and they are coming in later in the disease,” said one of the paper’s authors. “Many things are changing, we hope for the better.”
FDA Drug Safety Communication on Hydroxychloroquine and Chloroquine
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The US Food and Drug Administration (FDA) issued a drug safety communication Friday cautioning against the use of hydroxychloroquine or chloroquine for COVID-19 outside of hospitals or a clinical trial due to the risk for heart rhythm problems. The communication reiterates information about the drugs’ risks published with the agency’s original Emergency Use Authorization in late March.
In the new safety communication, the FDA said it is aware of reports of “serious heart rhythm problems” in COVID-19 patients treated with hydroxychloroquine or chloroquine, often in combination with azithromycin and other QT-prolonging medicines, and of increased use of these medicines through outpatient prescriptions.
A Role for Home Pulse Oximetry?
Intervening earlier in the disease course of COVID-19 could prevent patients from needing intensive care, and widespread use of pulse oximeters could help guide such intervention, argues one emergency medicine physician who spent 10 days working at a New York City hospital during the surge. He proposed this theory in a New York Times opinion piece and expanded on it in an interview with Medscape Medical News.
Experts who weighed in on the theory raised concerns. “I would suspect that the majority of patients who deteriorate with COVID-19 are deteriorating due to progression of their viral disease and systemic inflammatory response rather than silent hypoxemia causing them to increase their respiration and induce lung injury,” said one. “While I think some pulse oximetry for patients with a known diagnosis of SARS-CoV-2 makes sense, I don’t support half the country buying these devices now, on a ‘just in case’ basis,” said another.
Emerging Data Suggest Higher COVID-19 Prevalence
Data from early antibody testing studies in the United States — such as in New York State — suggest COVID-19 may be more widespread than official numbers from diagnostic testing indicate, and survey data from Medscape and WebMD mirror this trend.
Of more than 1400 US physicians who participated in a Medscape reader poll, 80% said they think the proportion of people infected with COVID-19 is “generally higher than what has been reported.” A WebMD reader poll of more than 6300 people found that 10% of the respondents suspected they had COVID-19 during the past 30 days, yet only 7% of that group said they received diagnostic testing.
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COVID-19 in Children
Relatively few cases of COVID-19 have been seen in children, and most cases in children are mild. In China, only about 2.4% of cases occurred in patients under 19 years of age; similar trends have been observed in the United States. A Medscape reference article sums up what physicians know so far.
In Memoriam
As front-line healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. More than 500 throughout the world have died.
Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form.
