COVID-19 Daily: Ground Zero Hospital,
PPE Fights

Ellie Kincaid

March 26, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Here are the coronavirus stories Medscape's editors around the globe think you need to know about today: 

Ground Zero Hospital, Transformed 

In late February, Seattle-area hospitalist David Baker, MD, treated several patients from an assisted living facility who had been admitted with a puzzlingly severe viral pneumonia that wasn't influenza. The call to notify him that two of the patients tested positive for COVID-19 caught him by surprise. Now, Baker and other hospitalist colleagues who helped care for some of the first COVID-19 cases in the US share clinical details about the variety of cases they've seen and what they've learned about how to handle them. "When in doubt, isolate," he said. 

PPE Fights

Despite a severe nationwide shortage of personal protective equipment (PPE), healthcare workers are facing everything from ridicule to firing for taking matters into their own hands. Upper management patrolling hospital halls, telling staff not to wear masks. Memos restricting PPE use and telling workers to reuse masks and gowns. Clinicians shared with Medscape Medical News their stories of clashing with hospital administration over how best to protect themselves and care for patients during the coronavirus pandemic. A hospital administrator told one emergency department physician in Maryland that he was "not setting a good example for other staff members" by wearing a surgical mask on the ward. "I'm angry just talking about this," the doc said.

What's Up With Angiotensin Drugs?

Following reports that angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) may increase susceptibility to COVID-19, doctors have been inundated with calls from panicked patients who want to discontinue treatment. Medscape Medical News reviewed the available evidence and discussed it with several leading cardiovascular experts. The verdict? One expert puts it this way: "There is suggestion of both harm and benefit with regards to COVID-19 and ACE inhibitors/ARBs, but no real clinical data to support these hypotheses…Do not change medication based on no evidence."

Clinician Mental Health

A significant proportion of healthcare workers treating patients exposed to COVID-19 have symptoms of depression, anxiety, and insomnia, according to a survey of more than 1200 healthcare workers in China. "Just as the world has joined efforts to manage COVID-19 infection, it will be critical not to neglect the mental health consequences of the fight against the epidemic," a psychiatrist writes about the implications of the research. 

More Social Distancing Needed

Disease modelers predict that Americans may need to adopt "intermittent social distancing" — periods of normal social interaction interspersed with periods of isolation — for the next year or more to avoid a surge of critically ill COVID-19 patients that could overwhelm hospitals. That's according to an analysis posted to the preprint server MedRxiv this week; postings to MedRxiv have not been peer-reviewed. 

New York vs California

In early March, New York state and California had similar numbers of COVID-19 cases. But as of Tuesday, New York's death toll of 210 was four times higher than California's 51, the San Francisco Chronicle reports. It's unclear why. 

Ellie Kincaid is Medscape's associate managing editor. She has previously written about healthcare for Forbes, the Wall Street Journal, and Nature Medicine.

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