With no playbook to follow, doctors in the pandemic's early days reached across oceans and language barriers to advise colleagues trying to save lives in the dark. RacingforaRemedy
They offered “a privileged window into the future,” said Dr. Diego Casali of Cedars-Sinai Medical Center in Los Angeles, who is from northern Italy and was directed to the webinars when he sought advice from a front-line friend about how to prepare.Dr. Jane Muret of the French Society of Anesthesia-Resuscitation also heard by word-of-mouth and, impressed by the breathing-tube lessons, posted a translation when France had only a handful of diagnosed COVID-19 cases.
After decades in practice, ICU chief Dr. Luca Lorini thought he knew how to treat the dangerous kind of respiratory failure -- called ARDS, or acute respiratory distress syndrome -- first thought to be the main threat. The first lessons: The coronavirus wasn’t causing typical ARDS, and patients consequently needed gentler ventilation than normal. They also needed to stay on those ventilators far longer than usual.Then mid-March brought another startling surprise: In a training video for U.S. cardiologists, Chinese doctors warned that the virus causes dangerous blood clots, and not just in the lungs.
“It means at least you’re not shooting in the dark. You’re trying something that from a physiologic standpoint makes sense,” said Osborn, who was living in a camper in her driveway to avoid bringing the virus home to her family after her long ICU shifts. Hospital after hospital struggled with balancing how to get enough air into oxygen-starved coronavirus patients without further damaging fragile lungs.
Italy’s Alessandro Manzoni Hospital set a schedule: Start turning patients onto their bellies at 2 p.m. -- it took more than three hours to work through them all -- and then put them on their backs again at 8 a.m., when fresh nurses arrived. “My general way of doing things is, no one dies alone,” said Osborn, who holds her phone in front of dying patients so loved ones can say goodbye.
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