Initially, physicians were placing patients on a mechanical ventilator to aid their breathing; Over time, they learned to position patients on their stomachs and provide supplemental oxygen oxygen through less invasive means and postpone ventilation or avoid it altogether if possible.
By mid-June, clinical trials in England had shown that treatment with the cheapest steroid drug, dexamethasone, reduced the mortality of patients on the ventilator by a third, and by one-fifth in patients receiving supplemental oxygen. But the initial recommendations from China and Italy were “not to use steroids altogether, even though many of us thought it would make sense to use them,” said Dr. Geeta Lisker, a critical care physician at Northwell Health. “I think it’s making a big difference. But when we launched this in March, data and recommendations from China and Italy were saying, ‘Don’t use it, steroids are bad.’
Even doctors did not know at first that the new virus could cause fatal blood clots in Covid-19 disease. Now patients are put on thinner blood early in treatment when needed.
But another problem in the spring was that hospitals in hard-hit areas like New York City were overflowing. Doctors who had not worked in critical treatment for many years were trained to care for critically ill patients, nurses were short staff, and equipment was scarce. “There was an intense tidal wave that surpassed the health care system,” said Dr. Lisker. “You had critical care units run by doctors who hadn’t had serious treatment in 10 years or so.”
He added, “There is no question that whether you were alive or dead in April, some of it had to do with what unit you landed in.”
Indeed, she said, “the whole idea of squeezing the curve was to avoid overstating the health care system.”
Medical experts are worried that a surge in cases across the country could reverse or reverse this benefit. The number of Kovid patients admitted to the hospital has increased by 40 percent in the last month, and now more than 41,000 patients are hospitalized in the United States. Idaho, Utah and Kansas City, Mo. In hospital administrators have warned that they are already close to capacity. Some have turned to ambulances, and others have gotten out of bed and are planning ration care, saying they may be forced to relocate patients to facilities in other states.