Initial Clinical Impressions of the Critical Care of COVID-19 Patients in Seattle, New York City, and Chicago

Abstract

Since the first recognition of a cluster of novel respiratory viral infections in China in late December 2019, intensivists in the United States have watched with growing concern as infections with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus―now named coronavirus disease of 2019 (COVID-19)―have spread to hospitals in the United States. Because COVID-19 is extremely transmissible and can progress to a severe form of respiratory failure, the potential to overwhelm available critical care resources is high and critical care management of COVID-19 patients has been thrust into the spotlight. COVID-19 arrived in the United States in January and, as anticipated, has dramatically increased the usage of critical care resources. Three of the hardest-hit cities have been Seattle, New York City, and Chicago with a combined total of over 14,000 cases as of March 23, 2020. In this special article, we describe initial clinical impressions of critical care of COVID-19 in these areas, with attention to clinical presentation, laboratory values, organ system effects, treatment strategies, and resource management. We highlight clinical observations that align with or differ from already published reports. These impressions represent only the early empiric experience of the authors and are not intended to serve as recommendations or guidelines for practice, but rather as a starting point for intensivists preparing to address COVID-19 when it arrives in their community.

Management of Coronavirus Disease 2019 Intubation Teams

“…7 The structure and availability of the teams may have contributed to these initially reported favorable outcomes by allowing rapid access to intubation performed by attending anesthesiologists. 7,8 Emory's initial intensive care unit intubation rate of 76% compares similarly to initial reports from Seattle (75%) 9 and Chicago (86%). 10 Additionally, the team structure, availability of PPE, and strict checklist adherence led to low incidence of infection among members of the intubating team.…”

Factors Associated With Intubation and Prolonged Intubation in Hospitalized Patients With COVID‐19

“…1,2 Severe disease is notable for hypoxic respiratory failure requiring prolonged supportive care oftentimes involving intubation and invasive mechanical ventilation. 3,4 In the United States, the rapid transmission of the virus, which can also be spread by asymptomatic individuals, has led to a sharp increase in infections in a short period, straining the health care system. Of significant national concern is the limited supply of mechanical ventilators and the number needed to adequately satisfy the demand from the US population.…”

Hepatic Predictors of Mortality in Severe Acute Respiratory Syndrome Coronavirus 2: Role of Initial Aspartate Aminotransferase/Alanine Aminotransferase and Preexisting Cirrhosis

“…The pandemic has caused 472,885 deaths globally and over 100,000 deaths in the United States as of June 23, 2020 (3) New York City, especially the Bronx and Queens boroughs, has been particularly impacted by this virus (4). COVID-19 manifestations include fever, cough, and diarrhea (1,2,(5)(6)(7)(8)(9)(10). Patients with immune suppression and chronic disease such as hypertension, diabetes, and obesity are at higher risk of mortality (2,(8)(9)(10).…”