My experience perfectly matched published reports. Procal universally low. Ferritin, CRP, d-dimer elevated. Lymphopenia prominent. Patchy infiltrates on CXR. Diarrhea common. So, I want to share some other things I haven’t seen talked about as much.— Leora Horwitz (@leorahorwitzmd) March 31, 2020
2nd, the fevers did not seem particularly related to outcome. In fact most of my ICU transfers did not have persistent fever. They did, however, make patients miserable.— Leora Horwitz (@leorahorwitzmd) March 31, 2020
4th I did have a bunch of mild troponin elevations, but mostly demand ischemia. No EKGs c/w myocarditis. Suspect too late a complication for me to see.— Leora Horwitz (@leorahorwitzmd) March 31, 2020
6th, I found CRP and ferritin often to move in opposite directions (usually CRP ↘️while ferritin still ↗️; CRP leading indicator?). This was confusing. Moreover, I had patients with ferritin >3,000 who did well and others with <800 who struggled. So, not universally helpful.— Leora Horwitz (@leorahorwitzmd) March 31, 2020
8th I kept underestimating their exertional hypoxia. Learned my lesson when I transferred one pt to lower acuity floor and he had a syncopal event getting from wheelchair to new bed. Walked all patients with pulse ox prior to d/c.— Leora Horwitz (@leorahorwitzmd) March 31, 2020
10th Our standard protocol right now is azithro/hydroxychloroquine/zinc but I have little faith in efficacy. For the patients I really worried about (fast O2 requirement rise, high inflammatory markers) I gave tocilizumab off label. Clinical trial of sarilumab starting this week.— Leora Horwitz (@leorahorwitzmd) March 31, 2020
12th Most of my patients didn’t eat anything. Partly lack of taste/smell, partly misery with fever, partly hypoxia with exertion, partly lack of visitors/staff in room to encourage and help. Several asked me for soft diet to reduce effort of chewing. Must attend to nutrition.— Leora Horwitz (@leorahorwitzmd) March 31, 2020
13th Lastly, one of the biggest concerns for non-critically ill patients was persistent painful cough. Most had paroxysmal dry, wheezy coughing spasms, often precipitating desaturations. Tried cough syrup, albuterol MDI with spacer (avoiding nebs), codeine, with little effect.— Leora Horwitz (@leorahorwitzmd) March 31, 2020
