Blog | Monday, April 20, 2020

3 observations from my week working on a COVID-19 floor


I've spent the last week working on the coronavirus unit of a Boston-area hospital, treating almost exclusively COVID-19 patients. I wanted to share with you three observations I've made, that you may not have read about or seen on the news.

1. Gastrointestinal symptoms
Away from the respiratory symptoms of dry cough, shortness of breath, and sore throat, GI symptoms are extremely common, often bad enough to cause dehydration and acute renal failure. Beware of these.

2. Oxygen
Literally every day a hospitalized patient remains on nasal cannula oxygen is good news. If you have a loved one in hospital, know this. Each day that passes with them staying only on nasal oxygen means they are not crashing, and the body is fighting the virus hard. The oxygen requirements should eventually come down. Different hospitals have different protocols, but ours is 6 liters of oxygen before requiring intensive care unit and consideration of intubation and a ventilator. There's some evidence coming out (and many ICU specialists I've spoken to about this), that we may not want to be too aggressive with ventilating COVID-19 patients. Watch this space.

3. Men affected much worse
After now spending a few weeks seeing COVID-19 patients in hospital, it is blatantly obvious to me that this sex discrepancy is independent of comorbidities and lifestyle factors, especially in younger patients. I've lost count of the number of times I've called the wife at home to update her on husband's condition—and she also has coronavirus, but is only suffering with a sore throat!

Whether this is genetics, chromosomes—or we are simply witnessing millions of years of evolutionary biology in action—which will, for obvious reasons, want to favor the survival of females when an animal species is faced with an imminent threat to its survival—we cannot say for sure.

Two other quick things to note: A LOT of patients have got better and we've successfully discharged them from hospital, which should be very reassuring to everyone! We have also started giving a 5-day course of hydroxychloroquine and azithromycin combination to almost every hospitalized patient. Research on this is still pending, jury's out—but we are giving it a go.

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site, where this post first appeared.