COVID-19 Daily: Ventilator Protocols Questioned, Physician Rights

Alicia Gallegos

April 05, 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: 

Does COVID-19 Require Different Ventilator Protocols?

As New York health officials race to secure ventilators, some physicians are starting to ask whether it's time to change the way this equipment is used in patients with COVID-19. 

Cameron Kyle-Sidell, MD, a critical care physician working in New York City, has been sounding the alarm on Twitter, urging healthcare professionals to consider that COVID-19 acts less like typical acute respiratory distress syndrome (ARDS) and more like high-altitude pulmonary edema (HAPE). The bottom line, Kyle-Sidell said, is that the current use of ventilators may be causing lung injury in COVID-19 patients and that it may be time to consider lung-protective strategies that utilize lower pressure settings. 

Kyle-Sidell is not the only one raising questions about the use of the ARDS paradigm in COVID-19 patients. In a letter to the editor published in the American Journal of Respiratory and Critical Care Medicine on March 30, Luciano Gattinoni, MD, of the Medical University of Göttingen in Germany, and colleagues noted that COVID-19 patients in intensive care units in northern Italy had an atypical ARDS presentation, namely well-preserved lung gas volume and severe hypoxemia. Gattinoni and colleagues suggest in the letter that instead of high positive end-expiratory pressure (PEEP), physicians should consider the lowest possible PEEP and gentle ventilation.

Medical Societies Voice Support of Physician Rights 

The Council of Medical Specialty Societies (CMSS) has some sharp words for hospitals that are restricting safety supplies and silencing their healthcare workers. 

In a statement, CMSS — which represents more than 800,000 physicians across 45 specialties — reminded institutions of their responsibility to protect employees and asserted that workers should not face retribution for expressing their concerns. The pointed sentiments follow growing reports that healthcare workers are being reprimanded or terminated for speaking out about the lack of personal protective equipment (PPE). Workers in other cases have been disciplined or fired for wearing PPE brought from home.

"We wanted to say this publicly so that our members know it's really critical they have this chance to share what they believe endangers their own safety as well as the safety of their patients," CMSS CEO Helen Burstin, MD, told Medscape Medical News.

New Questions on Neurologic Symptoms 

Recently, the first presumptive case of encephalitis linked with COVID-19 was reported in a 58-year-old woman in Detroit. Now, neurologists around the United States are calling out a range of neurologic symptoms linked to the disease, from ataxia to stroke.  

So far, these reports are anecdotal or based on observational data, and the majority of patients with COVID-19 do not present with neurologic symptoms. It's also still unclear if the neurologic symptoms that are being observed are caused by COVID-19. 

Robert Stevens, MD, of the Johns Hopkins School of Medicine in Baltimore, Maryland, told Medscape Medical News that knowledge of neurologic symptoms in COVID-19 is "purely descriptive" at this point, which is why he is working to set up a data registry that will track these outcomes in COVID-19 patients. 

Mother-Newborn Separations Not Supported by Evidence

The CDC recommendation to separate mothers with confirmed or suspected COVID-19 from their infants after birth is not supported by evidence and could cause lasting harm, according to some experts. Newborns need to breast-feed frequently to establish breast-feeding habits and to benefit from everything it has to offer, one physician said.

"We know for a fact that when babies are artificially fed the risks for hospitalization [and] for severe infections such as pneumonias and meningitis are much higher," said Anne Eglash, MD, clinical professor at the University of Wisconsin School of Medicine and Public Health and cofounder of the Academy of Breastfeeding Medicine.

More recent recommendations from the World Health Organization say it is safe to feed a newborn expressed milk from a mother with COVID-19. WHO's recommendations also allow "more close, intimate contact" because it recognizes that it may be feasible to separate a newborn from its mother in an environment such as a hospital, but that once the infant goes home, he or she will likely be exposed.

Coronavirus Aerosolized Through Conversation

Whether COVID-19 is aerosolized through talking or exhalation has been a lingering question since the virus took hold. An expert committee has now concluded that the answer is yes. 

The findings come from a rapid expert consultation by the National Academies Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats. However, it's not yet certain if the viral particles are viable or emitted in strong enough doses to cause infection. 

Committee chair Harvey Fineberg, MD, PhD, shares what to make of the findings and provides guidance for healthcare workers on best protection practices. 

AHA Develops COVID-19 Registry 

The American Heart Association (AHA) is launching a new registry that will collect cardiovascular-focused data on COVID-19 patients.

AHA officials said the goal of the registry will be to shed light on the impact of COVID-19 on cardiac conditions and ultimately help inform care and improve outcomes. The registry will include information on serial cardiac biomarkers, clinical data, laboratory results, medications, and clinical outcomes.  

UK Prime Minister Johnson Hospitalized

The United Kingdom's Prime Minister, Boris Johnson, has been admitted to the hospital for tests, according to a statement from his office. "This is a precautionary step," because the prime minister continues to have persistent COVID-19 symptoms after testing positive for the virus 10 days ago, the statement says.

In Memoriam

Medscape has published a memorial list to commemorate healthcare workers who have died of COVID-19. 

We will continue updating this list as needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form

Alicia Gallegos is a Medscape and MDedge reporter who writes about health law and healthcare policy. She has previously written for American Medical News, ACP Internist, and the Association of American Medical Colleges. 

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube, and follow Alicia Gallegos on Twitter.  Here's how to send Medscape a story tip.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.