COVID-19 Daily: Post-Vent Mortality,
Troponin for Triage

Ellie Kincaid

April 13, 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: 

Post-Ventilator Mortality

In a report on nearly 4000 COVID-19 patients from the UK who were admitted to intensive care units (ICUs), two thirds of the subset who required mechanical ventilation died, as did one fifth of the subset who required basic respiratory support. For comparison, the report shows that of ICU patients with viral pneumonia who required mechanical ventilation from 2017 to 2019, slightly more than one third died. 

But the picture isn't clear yet. "We can't say if COVID-19 disease is killing ventilated people at a higher rate or whether it's just that more people are on ventilators because of it," one expert told Medscape Medical News.  

Is Cardiac Troponin Useful for Triage? 

Cardiac troponins by high-sensitivity assays (hs-cTn) should be considered "an ally and a crucial diagnostic and prognostic aid" during the COVID-19 pandemic, and may inform the triage of patients to critical care, UK cardiologists advise in a recently published viewpoint. 

However, whether troponin truly adds something beyond information already available at the bedside has not yet been conclusively proven, another expert cautioned. 

Antibody Tests to Leave Quarantine?

Blood tests for antibodies to SARS-CoV-2 have been proposed as a way to allow those with immunity to the virus to safely return to work. But more scientific research is still needed before antibody tests could be used this way. 

"We don't know which antibody response neutralizes the virus," Joseph Vinetz, MD, a professor of infectious diseases at Yale University, told WebMD Health News . "Once you have an antibody test, you have to study people with antibody responses for their risk for getting a new infection."

Report From Georgia on Different Vent Strategies 

As more COVID-19 patients arrive in ICUs, it's becoming increasingly clear that a one-size-fits-all ventilator strategy is not going to work, an Atlanta, Georgia clinical nurse specialist in critical care said in a Medscape commentary. She shared her institution's experience and how they are treating patients.

"In COVID-19 patients who may quickly develop profound hypoxia, we don't want to apply protocols blindly and assume that a failure to respond is the result of the patient," she said. "Instead, when our protocol methodology has failed, we need to step back and ask if we are using the wrong strategy for this patient's phenotype." 

On Clinicians' Spiritual Health 

"Rather than risk professional embarrassment, the spiritual needs of healthcare professionals are often suppressed and left at loose ends," a board-certified chaplain writes in Medscape

Attending to the spiritual well-being of clinicians is in line with calls to support them with wellness initiatives, Elizabeth Berger, MS, APBCC, writes, and she reminds clinicians that hospital chaplains can help them as well as their patients: "Just like the way chaplains formulate, relay, and execute spiritual care plans for patients and families, we can also help clinicians and healthcare leaders strategize and plan for their own spiritual self-care and that of their teams." 

How They Did It: Setting Up a PUI Unit

Healthcare workers have had to get creative to repurpose facilities for their particular needs during the COVID-19 pandemic. Physicians from Wake Forest School of Medicine in Winston-Salem, North Carolina described for MDedge how they converted a hospital medical-surgical unit into a Person Under Investigation (PUI) unit for patients suspected of COVID-19.

#FireFauci Trends

The hashtag #FireFauci had been used in tweets more than 120,000 times as of Monday afternoon, after President Donald Trump on Sunday evening retweeted a conservative politician's critique on a television interview by Anthony Fauci, MD, head of the National Institute of Allergy and Infectious Diseases. 

"President Trump is not firing Dr. Fauci," White House spokesman Hogan Gidley later said in a statement, Reuters reported. "Dr. Fauci has been and remains a trusted advisor to President Trump." 

The hashtag #SaveFauci began trending early Monday afternoon. 

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk of infection. Hundreds 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

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

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube, and follow Ellie Kincaid on Twitter @ellie_kincaid.

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