Emergency Room Doctor: Getting Best COVID-19 Treatment Ideas Via WhatsApp
from the don't-stop-believin' dept
The excellent podcast Radiolab has been running some shorter (from its normal fare) "dispatches" from the pandemic that have been quite interesting, but I wanted to take a quick look at one recent such episode that is mostly a discussion between host Jad Abumrad and ER doctor Avir Mitra, who, in a prior life, had interned at Radiolab, in which Mitra plays some of the voice memos he's been recording for himself as he deals with being an ER doctor on the frontlines in a hospital in NYC, where the largest number of COVID-19 cases are happening.
The whole episode is quite interesting, and they get into discussions about how doctors are recognizing that COVID-19 is not acting like other respiratory diseases, and they're finding all sorts of oddities -- like patients who should be passed out due to low blood oxygen levels acting like there's nothing wrong at all:
AVIR MITRA: The biggest thing that struck me is patient comes in, you measure their oxygen level with a pulse ox. And to take a step back, the pulse ox is that little thing you put on your finger with a laser light.
JAD: It shines a laser through your finger and reads the color of your blood. And from that ...
AVIR MITRA: It tells you your oxygen concentration. If normal is, you know, 97 to 100 percent, you know, we're seeing patients that are at 60, 70 percent routinely. Normally, if someone's oxygen saturation is anything close to 70 percent, they're not awake. They're -- they're out of it completely. They're grasping at anything, trying to get oxygen. But these patients we’re seeing routinely that are looking at us, talking to us, they’re wide awake, texting on their phone, and their oxygen saturations are at these super low levels.
JAD: I remember you sent me a text message of somebody who had a -- an oxygen saturation reading of, like, in the 50s and they were on their phone.
AVIR MITRA: Exactly. That one got circulated around because we were all seeing the same thing and it's like you look at someone with a 54, that's a person that you're like, "Okay ma'am, you're gonna be taking a long nap. You know, you're going on a ventilator." And they may be like, "Well, can I just finish posting on Instagram first?" You know, it's just so surreal.
But what struck me about the story -- and which made it worth posting about here -- is that Mitra discusses how he and other doctors are all using WhatsAspp to discuss theories and possible treatments. In a voice memo he recorded, Mitra first discusses how doctors are all communicating and sharing info through WhatsAspp:
AVIR MITRA: April 10, 2020. I've never in my short career seen people spreading information amongst ER doctors and ICU doctors literally by WhatsApp, texting each other images of charts that people have written, kind of really just figuring it out as it goes, which is kind of incredible because in medicine in general, we're very cautious. We'll sit in journal club meetings and debate whether we should give somebody 162 milligrams of aspirin or 325 milligrams of aspirin. We'll -- we'll literally debate that for hours.
JAD: Hmm.
AVIR MITRA: But -- but right now we're just trying different things out almost on a whim.
JAD: So these WhatsApp groups you were telling me about where you're ...
AVIR MITRA: Yeah.
JAD: ... you're exchanging information with doctors in Italy and China.
AVIR MITRA: Yeah. And a lot from Washington also.
JAD: Washington state, right.
AVIR MITRA: Their outbreak started, I don’t know. What was it? A week or two before ours?
And later in the episode, Mitra and others start exploring a completely different approach to treatment, again based on their discussions on WhatsApp:
JAD: One of the things he says that's been puzzling is just the crazy array of symptoms he's seeing in people with COVID. There's the usual cough, fever, breathing issues, but you also have people reporting neurological issues. Some people, including a few folks that I work with, lost their sense of taste and smell for a while. Others are reporting skin issues on their fingers and toes. Migraines.
AVIR MITRA: Trying to understand what's going on and more importantly what to do about it. So one hypothesis that has been kind of floating around, and I've been thinking about and a lot of people have been thinking about is this idea of a coagulopathy.
JAD: He said the idea started again on a WhatsApp group.
AVIR MITRA: I first heard about it from Washington. It may have gone back even to Italy or China, I'm not sure.
JAD: Doctor on one of these groups says, "Hey, I'm seeing these weird lab values in my COVID patients. I'm not sure what it means." Avir and his colleagues start to investigate, and ultimately notice that COVID patients often seem to have very high levels of this one enzyme in their blood. It's an enzyme that's often associated with clotting.
AVIR MITRA: If someone's making clots and breaking down clots and just going through that clotting process. So that kind of brought up this theory of could it be that this virus is somehow inducing little clots all over the body?
JAD: Thousands and thousands of these micro-clots that might be jamming up the highways and preventing the oxygen in the blood from getting where it needs to go.
AVIR MITRA: And it also could potentially explain why we're seeing heart damage, because the blood that’s supposed to go to the heart is getting clotted before it can get there. Same thing with the brain. And as a matter of fact, we see problems with the kidneys. We're seeing problems with every end organ. Maybe it's not a problem with the organ, maybe it's a problem with the blood supply that should be getting to the organ.
As the story makes clear, they don't know any of this for sure, and some of the early tests around this haven't worked out, but it's given them a path to explore, which might have some potential.
There were a few key points that struck me about this. First is that it's yet another example of how the internet has been incredibly useful to doctors on the frontlines. A few weeks back we wrote about how oncologists were getting their best info from Twitter in how to deal with cancer patients with COVID-19, and now we hear about ER doctors on the frontlines using WhatsApp, and getting ideas and real time info from other doctors around the world (some of whom are a little further ahead in making their way through the pandemic).
The second thing that struck me about this was that for the past few years, all we've been hearing about WhatsApp have been stories about people wanting to blame the app for violence in India and elsewhere after groups spread misinformation that may have contributed to physical attacks. This, of course, is the nature of a tool that allows for communication (especially encrypted communications). Some of that communication can be for a good purpose, and some of it may be the ongoing flow of disinformation. And when we're focusing on how to deal with the latter, we should be pretty damn careful that it not cut off the possibility of the former.
The third thing that I found notable about this is how quickly these informal networks seem to have sprung up. There are, already in existence, a bunch of professional organizations and "established" channels of communication to share medical research and ideas... and none of those seem to be as useful or effective in the short term as jumping onto these social media and messaging apps to establish informal networks of experts in a hurry. That's really quite amazing and worth celebrating. For all the complaints and anger over the negative and problematic uses of social media and messaging apps, we shouldn't forget how absolutely vital they've been for many people working hard to actually save lives.
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Filed Under: avir mitra, covid-19, information, information sharing, messaging, radiolab
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Why bother... According to very much official statistics in my country, of those who end up on a ventilator flat out nine out of ten go straight into the grave. Yes, really. Piece of advice from someone who spent his entire adult life very much aware of what it means to not struggle to take a breath: if you end up having problems breathing these days... I hope you had a nice life.
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Why bother... According to very much official statistics in my country, of those who end up on a ventilator flat out nine out of ten go straight into the grave. Yes, really.
The discussion of what may be working here is unrelated to whether or not they go on a ventilator. "Why bother?" seems like a pretty crass response, no?
Meanwhile, doctors continue to experiment and are finding quite useful alternatives: https://www.uchicagomedicine.org/forefront/coronavirus-disease-covid-19/uchicago-medicine-doctors-se e-truly-remarkable-success-using-ventilator-alternatives-to-treat-covid19
That's why we "bother". To learn about what works and how to improve.
Separately, the latest reports say that the survival rate on ventilators is much higher than those 10% numbers initially reported: https://www.npr.org/sections/health-shots/2020/05/15/856768020/new-evidence-suggests-covid-19-patien ts-on-ventilators-usually-survive
But sure. "Why bother?"
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"According to very much official statistics in my country, of those who end up on a ventilator flat out nine out of ten go straight into the grave. "
I'm sure the families of the one out of ten you just said don't need to live are very happy that their doctors are at least willing to try and help them survive.
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This is interesting in another way.
I am not a lawyer or medical doctor but I believe that it is illegal to practice medicine without a license. That a license in each jurisdiction is required and that the internet is composed of thousands of jurisdictions worldwide. If a message can be read in a jurisdiction that that constitutes practicing medicine in that jurisdiction.
If this is true, what a legal minefield for the doctors.
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And what a great example of unintended (or not) bad consequences of bad laws.
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If a message can be read in a jurisdiction that that constitutes practicing medicine in that jurisdiction.
Since when? Providing data (collected in the jurisdiction for which you are qualified) and opinions to anyone in the world is quite literally what the Lancet and New England Journal of Medicine (among many hundreds of others) do every week.
And the same thing is true for lawyers (Harvard Law Review et. al), as well as electricians and plumbers and engineers and architects and police and any other licensed professional you can think of.
The legal term of "practicing" has a definition, and that definition requires much more than "a message was read."
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"If a message can be read in a jurisdiction that that constitutes practicing medicine in that jurisdiction."
Just as if a medical journal is read in a jurisdiction where its writers are not licenced, they can be prosecuted.
Wait, no that doesn't happen and would be absolutely idiotic.
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And now we are all a bit dumber for having read this.
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All social runs into the news problem, in that one use for bad purposes will make headline, while a million uses for normal activities will never be reported on. As a consequence they are painted as bad, because a few bad actors use them, while the rest of their use is largely ignored.
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Exactly. Some people need to remind themselves that when something is "news", it's unusual. They won't report on things that happen all the time because nobody would bother tuning in.
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Would the rest of the system get it right like this guy.
Could it be that communicating through established channels might get someone disciplined or fired? Could it be that exchanging information that others might consider to be proprietary get one sued? Is it possible that some of those professional organizations are entrenched in the 'protect our IP' above all else syndrome? Do the bylaws of those professional organizations prohibit members from aiding and abetting industrial espionage and sharing useful information about the disease progression might be viewed as such?
Maybe the entirety of the health care community should be committed to that part of the Hippocratic Oath where they pledge to 'first do no harm' and come to the realization that a cure and immunization is the goal here, not profit or controlling that which is found to work.
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Re: Would the rest of the system get it right like this guy.
Could it be that Elsevier gets upset at all those papers it will not get to monetize?
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Re: Would the rest of the system get it right like this guy.
That is probably all true, but I think it's more than just IP. It's blame in general. The professional organizations also don't want to get blamed for spreading information that turns out to be false. They won't publish anything until it is sufficiently proven.
The real question, IMO, is do we really want doctors and nurses in times like these to be saying "screw it, we can't waste time, this sounds plausible and I'm willing to take the risk/responsibility myself"? It lets good doctors move quickly to save lives, while bad doctors risk doing more harm due to missing or incorrect information. And there's also the third group that will sit back and wait and follow the "official" procedure even if they know it sucks just so they don't get sued later...
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Re: Would the rest of the system get it right like this guy.
Maybe the entirety of the health care community should be committed to that part of the Hippocratic Oath where they pledge to 'first do no harm' and come to the realization that a cure and immunization is the goal here, not profit or controlling that which is found to work.
This ^^
I'll do you one step further. The vast majority of the health care community is not committed AT ALL to the welfare of those who they treat. I have been told by a head nurse at a very big, important hospital in an important location that the top priority is not patient care but is the bottom line.
As a result of my own personal experience, in my opinion, hospitals treat you as if you are a prisoner, not a patient, which has been corroborated by several other people who I have talked to.
What is particularly a disgrace here in the states is the mental healthcare community. The human mind is incredibly complex and, despite all the research, we are still not even close to grasping its complexities. Despite this, mentally ill people are treated as potential monsters by others, capable of the worst intentions, regardless of one's history or prior record. And it is blatantly obvious that they are treated like profit-generating slaves by the current healthcare system.
In this society most people only pretend to care about others besides their own family members. When everyone was successfully turned against each other, that is when we lost all hope of maintaining a free and democratic society for much longer.
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They aren't even trying to save a single thing about the people involved with this one.
Stupid laws aren't the problem. Terrorists from asia are the problem.
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There can be more than one problem at a time. I'll focus on the one that has evidence for its existence in relation to the pandemic.
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Lolwut?
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""Terrorists from Asia", lolwut?"
He means that he's one of the idiots who's bought into the conspiracy theory that COVID was created in a lab and deliberately released in China to spread and destroy the US economy (it's always specifically the US, the rest of the world never factors into the theory), and he's also dumb enough to believe that nobody anywhere is doing anything about it.
The exactly nature of the theory does vary, but it's always mind-numbingly stupid and illogical, and usually based on misreadings of actual data, not that these guys read the originals anyway.
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Didn't that conspiracy theory originate with the conspiracy theorist in chief, otherwise known as the president?
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Wait ... I thought "The concept of global warming was created by and for the Chinese in order to make U.S. manufacturing non-competitive".
/lol
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I think they called this one extinction rebellion.
They built enough LSD manufacturing hub of it to be concerned that it isn't going to be avoidable at home. In their home country in probably China first, then maybe India as the actual source of the problem.
The "lawful" authorities of their home country and their scientific community fear extinction due to the corrosive nature of that form of supposed "warfare".
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I do not claim to know if it is India or China at all but the PM of india admits it's doing terrorism through india and I have personal knowledge of it being through China
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Well, I can't counter your personal experience obviously, but the people pushing the story in my own experience are the kinds of people who push other, very questionable or outright false conspiracy theories in other areas, so I remain skeptical.
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Terrorists from Asia
Yes, these terrorists, https://www.youtube.com/watch?v=JCS35iIRQkg
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Could the pulse-ox be off by COVID?
I do find it intriguing that the pulse-ox measures such low oxygen values in COVID patients that seem normally active. Did someone verify the blood oxygen levels with a different method, with chemical analysis for example?
If there is a significant difference between chemically and optically/spectrographically obtained measures there could be a quick put your finger in this device check on a COVID signature in the blood of a suspect patient.
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