COVID-19 headlines for geriatricians 30/3/20

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Latest COVID-19 headlines

Multiple patients should not placed on single ventilator

The Society of Critical Care Medicine (SCCM), American Association for Respiratory Care (AARC), American Society of Anesthesiologists (ASA), Anesthesia Patient Safety Foundation (APSF), American Association of Critical-Care Nurses (AACN), and American College of Chest Physicians (CHEST) have issued a consensus statement on the concept of placing multiple patients on a single mechanical ventilator.

They advise clinicians that sharing mechanical ventilators should not be attempted because it cannot be done safely with current equipment. The physiology of patients with COVID-19-onset acute respiratory distress syndrome (ARDS) is complex. Even in ideal circumstances, ventilating a single patient with ARDS and nonhomogenous lung disease is difficult and is associated with a 40%-60% mortality rate.

Attempting to ventilate multiple patients with COVID-19, given the issues described here, could lead to poor outcomes and high mortality rates for all patients cohorted. In accordance with the exceedingly difficult, but not uncommon, triage decisions often made in medical crises, it is better to purpose the ventilator to the patient most likely to benefit than fail to prevent, or even cause, the demise of multiple patients.

COVID-19 linked to cardiac injury 

COVID-19 can have fatal consequences for people with underlying cardiovascular disease and cause cardiac injury even in patients without underlying heart conditions, according to a review published in JAMA Cardiology.

Experts have known that viral illnesses such as COVID-19 can cause respiratory infections that may lead to lung damage and even death in severe cases. Less is known about the effects on the cardiovascular system.

“It is likely that even in the absence of previous heart disease, the heart muscle can be affected by coronavirus disease,” said Mohammad Madjid, MD, MS, the study’s lead author and an assistant professor of cardiology at McGovern Medical School at UTHealth. “Overall, injury to heart muscle can happen in any patient with or without heart disease, but the risk is higher in those who already have heart disease.”

Which medications are safe to use in COVID-19 patients?

A recent study has found that there is no evidence for or against the use of non-steroidal anti-inflammatory drugs such as ibuprofen for patients with COVID-19.

The study, led by researchers at King’s College London, also found other types of drugs, such as TNF blockers and JAK inhibitors safe to use. Some 89 existing studies on other coronavirus strains such as MERS and SARS, as well as the limited literature on COVID-19, were analysed to find out if certain pain medications, steroids, and other drugs used in people already suffering from diseases should be avoided if they catch COVID-19.

Dr Mieke Van Hemelrijck, a cancer epidemiologist and an author on the paper, said “This pandemic has led to challenging decision-making about the treatment of COVID-19 patients who were already critically unwell. In parallel, doctors across multiple specialties are making clinical decisions about the appropriate continuation of treatments for patients with chronic illnesses requiring immune suppressive medication.”

Treatment decisions based on age are ‘morally wrong’

A group of organisations and individuals dedicated to supporting older people have joined together to urge the UK government to not endorse treatment decisions based on age during the COVID-19 pandemic.

In a joint statement, they said that the media are reporting that governments across the world are developing ethical guidelines and decision tools to help their doctors to prioritise patients for hospital admission and treatment.

This difficult work is designed to ensure that the incredibly tough decisions about who gets what treatment at this time of crisis are made as fairly and effectively as possible by their doctors, who if these guidelines and decision tools are needed will be working in very stressful and challenging situations.