The number of people hospitalized with Covid-19 in the U.S. and its territories reached a record high of 73,014 on Monday. With the virus spreading in swaths of the U.S., including less-populated areas with fewer and more remote hospitals, some doctors fear emergency rooms and intensive-care facilities will soon become overwhelmed again.
This summer, as the number of Covid-19 cases rose in Sunbelt states, Jeffrey Bander at Mount Sinai Health System in New York fielded calls from colleagues in Arizona. The cardiologist helped treat patients during New York’s first coronavirus surge in March and April, and he has since published research on plasma therapy for Covid-19 and the virus’s impact on the heart. “If they come in a trickle it’s easier,” he said of the ability to treat patients. “If they come in waves it’s harder.”
To get a better sense of whether and how emerging treatments are working, public-health officials, hospitals and doctors are monitoring how much patient hospital stays are shortening as treatment options expand.
A crucial difference in hospital treatment has stemmed from a better understanding of how to approach respiratory problems caused by the virus. Instead of rushing to put patients with low oxygen saturation on ventilators, which brings its own risks, doctors now know that people with low oxygen levels can remain that way longer than previously thought, Dr. Bankhead-Kendall said. For the most critically ill who do require ventilation, hospitals are expanding the use of technology to monitor those patients.
Doctors said that much remains unknown and that treatments continue to evolve. Researchers are still learning about the systemwide effects of Covid-19, including blood clotting, fatigue, cognitive issues and kidney damage. The disease is still proving to take a harsh toll on some previously healthy people who become infected, and comorbidities common in many Americans including diabetes and asthma are complicating outcomes.
Ben Daxon, a critical-care physician at Mayo Clinic in Rochester, Minn., arrived in New York to volunteer in April with almost no experience caring for Covid-19 patients.
Notes written by a patient who was on breathing support.
PHOTO: BEN DAXONDuring his first shift in New York, when protective gear was scarce, he donned a scuba mask with a viral filter held in place by a part made on a 3-D printer.
Doctors in New York at the time debated when to try untested therapies, he said. Patients might benefit, but they might also be harmed. “I was in the middle,” Dr. Daxon said. He was surprised to find one patient on an uncommon mode of breathing support known as airway pressure release ventilation. Existing evidence suggests some benefit from it, but there isn’t a lot of evidence, said Dr. Daxon, who found that the doctors in New York were managing the patient’s breathing well.
One evening, as the patient struggled to breathe, Dr. Daxon gave him paper to write on. He scrawled the word “scared.” The physician sat with him, telling him stories. “The air is good now,” wrote the patient.
Dr. Daxon returned after a week to Minnesota, one of the Midwestern states now seeing hospitalizations rising. He said he would like to see the ventilation mode studied further, but he is now focused on well-researched therapies. Studies have shown, for example, the importance of carefully managing ventilator settings. “If we do those things well, then we’re going to do well by our patients,” he said.
—Melanie Evans contributed to this article.
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