I’m not caring for COVID patients who are still sick with it. I’m a psychiatrist, so my thoughts are unencumbered by actual experience in this area.
This protocol from EVMS contains mostly variations on treatments already very familiar to ICU docs, and I’m sure many institutions are working with protocols similar to this. It’s become clear to anyone paying attention that the severe phenotype of COVID has important differences from other severe viral or other pneumonias. Much will be learned from hard-won experience and rapid information-sharing. There is no time for elaborate controlled trials, though these are being done as best they can. Just like the epidemiologists, critical care docs are operating with a shortage of quality data and having to make the best of it, as there is no “pause” button available.
In my experience and opinion, critical care and pulmonology docs are among the smartest in any hospital. They don’t have time for bullshit or politics, have good instincts, and are in favor of treatments that work, whether or not the evidence or popular opinion is quite there yet (don’t get me wrong, they are among the best at practicing evidence-based medicine). They are used to taking care of the sickest among us, and I am confident that we will see some effective treatment protocols emerge in the coming weeks and months. Too late for many, but critical if this virus hangs around (which seems likely).