COVID-19 Changes Medical Practice, Maybe Forever

Rounding in the ICU for 2 weeks taught me that a new risk calculus has emerged in the COVID-19 era.

I’m writing this after spending two weeks on the renal ICU service here at Yale in Connecticut. We are in the upswing of our COVID-19 surge.

I want to talk a bit about what I’ve learned and experienced in these two weeks, with the caveat that there is significant selection bias. Patients with COVID who end up needing renal on board are generally not doing very well — we’ve really been struggling to provide the best care possible.

So — some thoughts and observations. Obviously, due to privacy concerns I can’t give you specific patient information.

• In two weeks, we had many deaths and one successful extubation. These patients take a LONG time to heal and prolonged ventilation, at least in those with renal failure, is the rule not the exception. By the way since I know people will ask, all of these patients received hydroxychloroquine — it is part of Yale’s, publicly accessible COVID-19 treatment algorithm.
• Most of the patients had pre-existing conditions, but typically they weren’t severe — these were definitely NOT people who might have died anyway. We’re talking a pre-existing condition of a BMI…