Some intensive care units in various hospitals throughout this county have designated units for COVID-19 patients. As an intensive care doctor, I’ve been seeing a lot of COVID-19 patients in our designated COVID ICU. It’s one thing to read about COVID in the medical literature, but to be actually seeing real patients with this disease is another experience altogether. There are a lot of things I’ve learned, but for this video, I’ll focus on the top 10 that stand out to me.
So, starting at the bottom with number 10, is, signs/symptoms. The most common symptoms that I’m seeing are fever, cough, shortness of breaths, and body/muscle aches. I haven’t seen many patients with the other symptoms we often hear about, such as loss of taste and smell, or nausea, and diarrhea. I have not seen any rashes related to COVID, probably because I only see adult patients. I will say that even though confusion and delirium is very common in the ICU in general, there does seem to be more of that with COVID.
A lot of COVID-19 patients who require hospitalization have low levels of vitamin D. And this is consistent with what we are seeing in a lot of recent studies that have been coming out. But of course, correlation doesn’t necessarily mean causation, so does it just so happen that a lot of patients who have moderate or severe COVID, happen to have low vitamin D levels? Maybe, maybe not. And does that mean that we should give every hospitalized patient with COVID big doses of vitamin D when they hit the door? Maybe. And does that mean people, in general, should supplement with vitamin D? And what is the ideal level of vitamin D for the population, especially when it comes to COVID-19? Should we be targeting the current general recommendation for everyone, irrespective of COVID, with a goal of 20 ng/ml? or should we aim for higher, like 30, or perhaps 40? No one knows for sure the answers to these questions. But there are studies being done on this. And as we speak there are 3 RCT for vitamin D and COVID.
This virus is VERY contagious. One of my patients was in the hospital for unrelated reasons. She actually had sepsis due to infarcted gut, meaning part of her intestine was not getting enough blood flow. It was severe enough to the point that some of the tissue in her intestine had died. When this happens, the bacteria that live in the intestine can then invade the walls of the intestine, and get into the bloodstream. This is bad news because these bacteria can then spread throughout the body, and this is known as sepsis. Besides antibiotics, this treated with surgery, where the dead gut tissue is removed, meaning part of the intestine is taken out. And this is what happened to her. And she got better. But after she initially got better, she started having more difficulty with her breathing. Her oxygen levels were dropping, despite us giving her more and more oxygen. So we got a CXR, and later a CT scan of the chest, which showed bilateral infiltrates, meaning areas of inflammation in both lungs. And this is the pattern we typically see with COVID pneumonia, where it tends to go to the periphery of the lungs and also more so at the bottom of the lungs.
Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
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