Becker's Hospital Review

40 CMO / CARE DELIVERY 10 things we've learned about COVID-19 so far By Richard Fogel, MD, Chief Clinical Officer, Clinical & Network Services, Ascension C OVID-19 has impacted nearly every aspect of our lives. As we continue to find safe and creative ways to navigate our new reality with this virus, it's worthwhile to reflect on what we've learned along the way. Here are 10 observations about COVID-19 that immediately come to mind: 1. e virus doesn't care who you are. A virus is a piece of genet- ic material (in this case RNA) surrounded by a protein capsule. If you breathe in enough particles of the virus, you're going to get COVID-19. It's that simple. Anyone can get it. 2. Testing isn't 100 percent. Medical testing isn't perfect and can some- times lead to a false sense of security. ere are false negatives (you have COVID but test negative) and false positives (you don't have COVID but test positive). In general, rapid tests have higher false negative rates. If you think someone might have COVID and a rapid test is negative, testing should be repeated with a more sensitive test. 3. Respiratory spread is the most common way for COVID to be transmitted. e virus is spread through the air. An infected person breathes it out; you breathe it in. e closer you are to someone who is infected (whether or not they have symptoms), the more likely you are to become infected. e better the ventilation and airflow around you, the less likely you are to become infected. Close proximity indoors means higher risk; being socially distanced outdoors lowers the risk. 4. Masks work. Because the virus is predominantly spread through the air, masks can help to both protect you from inhaling the virus and also protect other people if you have the virus. Some masks are better than others. Properly fitted N95 masks offer optimal protection and have the best filtration. Surgical facemasks or medical ear-loop masks are also very good, but don't offer the same protection as an N95 mask. Cloth masks are not as good as medical masks, but still offer some protection. On another note, unless you wear the mask over your nose and mouth, it probably doesn't help very much. As al- ways, be certain to practice good hand-washing habits and stay home if you are sick. 5. COVID-19 has many symptoms: some typical, some atypical. Most patients with COVID present with either a fever, cough or shortness of breath. However, many also have other symptoms in- cluding headache, fatigue, gastrointestinal complaints, rashes and more. In children, there can be an inflammatory syndrome that re- sembles Kawasaki disease. It's important to be alert for these other symptoms. Too oen the diagnosis of COVID has been delayed be- cause the symptoms weren't typical. Of importance, the sudden loss of taste or smell in an otherwise healthy person is very concerning for the diagnosis of COVID. 6. Some people have symptoms for many months aer infection. We call these cases "long haulers" and the cause is not completely understood. Most commonly, these individuals get over their acute symptoms but are le with disabling fatigue, marked exercise intol- erance, and oen a sense of heart racing with minimal activity. Some researchers think that the virus causes inflammation in the part of the nervous system that controls heart rate, blood pressure and tempera- ture. Patients with such cases seem to be increasing in number and will likely further grow as the pandemic continues. It's important to note that despite the presence of these "long haul" symptoms, people like this are not infectious. 7. We've made a lot of progress on therapies. It's hard to believe, but we've only known about COVID-19 for several months. Howev- er, in that short time medical researchers have identified treatments that work to limit the disease or shorten its duration (remdesivir, dexamethasone), treatments that probably work (monoclonal an- tibodies) and treatments that likely show minimal or no benefit (hydroxychloroquine). Medical researchers have a lot of experience conducting studies to determine which treatments are most likely to be beneficial. Listen to the scientists who are doing good peer-re- viewed research. Be wary of those who promote cures without good science supporting them. 8. e mortality rate from COVID-19 in October is a lot lower than it was in March and April. We've learned a lot about this disease over the past several months. In addition to the therapies described above, we've also learned a great deal about the critical care of patients with COVID-19. We've learned how to best use oxygen, how to best position patients for maximal ventilation ("proning"), when and how to use mechanical ventilators. We've begun to understand how the virus affects the heart and other organs. We've found that the virus increases blood clotting and are doing research to understand when and how to use blood thinners. In the Ascension system alone, which serves 4 million unique lives annually, we've seen a 50% reduction in hospital mortality over the past six months – remarkable progress in such a short period of time. 9. COVID-19 isn't going away any time soon. e pandemic will end when we have "herd immunity" to the virus. is will happen when either enough people have become infected and develop im- munity, or when enough people are treated with an effective and safe vaccine. Unfortunately, it looks like that according to our best infor- mation only 10 percent of the population has reportedly had the virus to date and is immune for an undetermined amount of time. We've got many more months to go. 10. We still have a lot to learn. e good news is we're learning more all the time. n Roper St. Francis Healthcare names 1st physician CEO By Kelly Gooch R oper St. Francis Healthcare in Charleston, S.C., has named Jeffrey DiLisi, MD, president and CEO, effective Dec. 7. Dr. DiLisi will be the first physician at the helm of Roper St. Francis, the faith-based health system said in a news release. Most recently, Dr. DiLisi was senior vice president and CMO of Virginia Hospital Center in Arlington. Roper St. Francis is a partnership between the Medical Society of South Carolina in Charleston and Cincinna- ti-based Bon Secours Mercy Health. n

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