Tag Archives: ICU

ICU Doctor Debunks 6 COVID-19 Myths

Dr. David Chong, an ICU doctor on NYC’s front line shares a few home truths about COVID-19.

It’s Easter Sunday, just after Passover, just after another exhausting 13 hour shift.

I can’t watch the news. I’m too busy and too frustrated by all the misinformation.

Forgive me, but I need to debunk a few viral myths.

Myth #1: COVID-19 is a disease of the old and sick

This cannot be further from the truth. As a critical care physician, I’m caring for the sickest of the sick. I know the data. What little good data there is, I see that 80% of ICU patients are under 65 (in a Wuhan study) or that 40% in ICU were under 60 (in an Italian study). The highest death age group was 60-69. The third highest was 50-59. The most common co-morbid conditions were high blood pressure, diabetes, and obesity.

These are not weird immune-related illnesses, they’re common, and this hits close to home. I’m 53, I have high blood pressure, diabetes and, like millions of Americans, I’m a little obese. Our stats? 60% of our intubated patients are under 65. Most of my ICU patients have never been sick enough to be hospitalized before this. Sure, many who die are old and have other illnesses, but the popular narrative almost says, if you’re not in a nursing home you’re safe. Nothing can be further from the truth. It’s a myth.

Myth number #2: The main concern is a lack of PPE and ventilators

Partially false. Sure, some NYC and UK caregivers have had to use cooking aprons, garbage bags, and other scraps to protect themselves, but many hospitals have all the PPE they need. Luckily, my hospital has been able to keep up with all our PPE needs. But many unanticipated shortages go unreported: COVID test swabs, dialysis machines, and dialysis fluid needed to keep people alive (COVID causes kidney failure), sedative medications, and we need more oxygen, we’re using so much.

But most of all, we need more amazing people. Especially nurses and respiratory therapists, because many are now sick and some have died. Over 100 doctors have died in Italy. Doctors, therapists, pharmacists, students, and others now have a new career as nursing assistants. No-one is a specialist anymore, we are all COVID care providers. Thank you to the many volunteer doctors and nurses from all across the US that have come to NYC to help. Recovery for patients can take weeks to months, so we’ll need your help and sacrifice for a while yet.

Myth #3: Hydroxychoriquine is a “game changer” and it’s safe

This potentially false idea was launched on the back of a very small trial from France. I’ve read the paper and it has major flaws. Three larger and more recent trials were negative but they don’t get press. These “game changer” drugs have dangerous side-effects. A recent trial in Brazil was stopped early for fear that high-dose chloroquine was killing people. Other drugs, however, show promise. Watch this space but no “game changers” yet.

Myth #4: Social distancing is our only option and it’s easy to do

This is also untrue. My home, NYC, is one of the most densely populated cities in the world. Many of my patients are poor and immigrated here. They live in small apartments with large families. Social distancing is impossible for many parts of NYC. And in the US more than 10% of the workforce is unemployed.

Sure, we’re finally flattening the curve, but as a Korean-American, I am proud to say that South Korea did it better and they didn’t shut down their economy. They tested, tested, tested, tracked, and isolated people and provided a mobile app, food, masks, and a thermometer to track their fever. This was done for visitors as well as citizens. The US hasn’t tested widely or efficiently enough. And we need to talk about the painful economic and human impacts of social distancing. Banning all hospital visitors means many terrified patients dying lonely deaths. The loss of human dignity is unimaginable.

Myth #5: We can blame China for the current US pandemic

This is false. Recent research shows that our outbreak in NYC came from Europe. And how helpful are country labels anyway? The 1918 Spanish Flu apparently didn’t originate in Spain, so should we rename it? When it comes to infectious diseases, borders mean nothing in our global economic village, but anti-Asian sentiment has spiked all over the world.

Just read the online hate speech about the “KungFlu” and the “WuhanVirus”. As an Asian American, who is doing as much as I can, this is very distressing.

Andrew Yang wrote, “We need to step up, help our neighbors, donate … and do everything in our power to accelerate the end of this crisis.” This is what my wife and I and so many others are doing. I work 12-15 hours days alongside residents, doctors, nurses, pharmacists, and others. (BTW, many of these heroes are Asian-American.) We’re active in our local church, and my wife has a Facebook group that donates tens of thousands of dollars to food and supplies for front-line workers. Daily, she buys food from struggling restaurants, delivers it to the hospital, and I distribute it in between seeing my patients. This has been our life for months and will be our future for a while.

Does it really matter if the virus is from China, Europe, or Mars? Our response would have been the same: to save as many lives as we can.

Myth number #6: This is all overblown, COVID is just like the Flu

I’m just shocked by this one. The infectivity of COVID 19 is three times that of the flu, and it is 40 times more deadly (Dr. Fauci says “10 times”). On Good Friday in NYC, 783 patients died; that’s one death every 2 minutes. In the US, it was one death every 42 seconds. Brace yourself. This is nothing like the flu. If you don’t believe me, just walk into any emergency room in New York, Detroit, Miami, LA, or New Orleans.

On a final and personal note, I’m blown away by the response of my residents, my colleagues, the people around me, and all NYC hospital staff. Never have I been more proud to be a health care worker and a residency director. I’m impressed by the sacrifice and commitment of all my residents. I’m in awe of their hard work. These are the finest people on earth. I am humbled by their sacrifice and courage to go above and beyond the call of duty. Oddly, it took a pandemic to bring us this level of mass cooperation.

But it’s also frightening.

I have practiced critical care medicine for more than 25 years and never have I been so challenged, saddened, and emotional. Almost every hour of every shift, someone needs intensive care. I’m very used to comforting patients and their families to prepare for death. I used to do this for someone weekly; now it’s hourly. Death has become very common: every shift, every ward, and in every emergency room.

It feels like a bomb went off somewhere and the whole of New York is slowly suffocating.

The 7 PM cheering for health care workers moves me. Previously, at parties, I’d say “I work in an ICU and I ventilate people”. That was a big conversation killer.

Now, I feel like a rock star or a military veteran. Who knows? Maybe one day I’ll get to priority board an airplane. But seriously; this experience will lead to future PTSD, pain, scars, and tears, for me and so many residents and health care workers.

For now, however, we really need your prayers and support.

I hope this demystifies a few things.
Thanks for reading. #columbiamedicine#columbiastrong

Dr. David H. Chong is the Medical Director for all Critical Care Services at NewYork-Presbyterian Hospital/Columbia University Medical Center.

image credit: Dr.Chong
Photo by Max Anderson on Unsplash

A Physician’s Story from the Frontlines

I have been an Emergency Medicine Physician for almost 20 years. I have worked through numerous disasters, and I’m used to the daily grind of heart attacks, gunshots, strokes, flu, traumas, and more. It’s par for the course in my field. Yet nothing has made me feel the way I do about my “job” as this pandemic has—that knot-in-the-pit–of-your-stomach sensation while heading into work, comforted only by the empathetic faces of my colleagues who are going through the same. I am grateful for their presence, knowing they are both literally and figuratively with me, that they understand and accept so profoundly the risks we take each day. I also hope that my friends and family forgive me for my lack of presence during this time—precisely when we need each other most—and that they realize that their words, their encouragement, and their small gestures that come my way daily are the fuel that gets me through each day. This is a story for all of us.

I met my patient, Mr. C., on my first real “pandemic” shift, when what we were seeing that day was what we had been preparing for. He was classic in his presentation, his X-ray findings, his low oxygen levels… we just knew. And he was the nicest man I had met in a long time. Gasping for breath, he kept asking if we needed anything, and that it would all be okay. He told us he was a teacher but that he was learning so much from us, and how much he respected what we were doing. The opposite could not be more true.

We had to decide how long we would try to let him work through this low oxygen state before needing to intubate him. His levels kept falling and despite all our best efforts it was time to put him on the ventilator. He told us he didn’t feel great about this, “but Doc, I trust you and am putting myself in your hands.” That uneasy feeling in my stomach grew even more in that moment. But he, with his teacher’s steady voice, kept me grounded, where I was supposed to be. I saw his eyes looking at me, seeing the kindness in them, even as we pushed the medications to put him to sleep. To say this was an “easy” intubation is an understatement. It was not. He nearly left us a few times during those first minutes, but he kept coming back. We fought hard to keep him with us. The patience and strength of my team that day, truly remarkable.

I handed him over to my friend and colleague, Dr. Ginsburg, and her team in the ICU, and her calming voice reassured me that they had it from here. And then for the next twelve days, I waited and watched his progress, knowing the statistics, and how sick he was when he got to us. They did their magic, and just yesterday my new friend Mr. C was extubated. I decided to go “meet” him again.

Mr C. was in the COVID stepdown unit, recovering, without family. Nobody was allowed to visit him; even worse, his wife had been home alone in isolation for the past fourteen days, too. My heart broke thinking of how that must have been for her. I cautiously went into his room, donned in my PPE, and when he saw me, he stopped for a second. A moment of recognition.

I introduced myself. “I’m Dr. Akbarnia, Mr. C. I was the last person you saw in the ER. You told me you trusted us to get you to this side. Looks like you did just fine.” He started to cry. He said, “I remember your eyes.” And I started to cry. What he didn’t know is that, at that moment, I realized that we do what we do exactly for people like him, for moments like these. His strength, his kindness, his calming words to me meant everything. At that moment, my heart (which had been beating over 100 bpm since this pandemic began) finally slowed down.

I sat down and we talked. I told him that while he is here, we are his family. He will always have a place in my heart. And whether he knows it or not, he will be my silent warrior and guide as I take care of every patient, COVID or not. He will fuel me until the day I hang up my stethoscope.

Dr. Akbarnia has been an ER physician for 20 years.

(Picture and story posted with full permission from patient)