Friday Session II: AAP Ask the Experts
Reviewed by Debnath Chatterjee, MD, FAAP
Associate Professor of Anesthesiology,
Children’s Hospital Colorado, Aurora, CO
Diversion of Resources During COVID-19 Pandemic: A Front-Line COVID Perspective.
Frank H Kern, MD, FCCP, from Zucker/Northwell School of Medicine and Cohen Children’s Medical Center, presented an American perspective of the front-line response to the COVID-19 pandemic. He started with a historical perspective of the similarities and what we learned from the 1918 Spanish flu (Figure 1).
While the mode of transmission was similar, mortality rates with COVID-19 were much higher in the elderly population. Dr. Kern described the massive influx of patients with COVID-19 in March 2020 and how several New York hospitals were rapidly overwhelmed (Figures 2 and 3).
There was a massive mobilization and redeployment of physicians who served as hospitalists, intensivists, and ER physicians. ICU management protocols prioritized early intubation and ARDS ventilation strategies. Anesthesiologists led hospital-wide intubation teams, and more than 90% of the intubations were for COVID-19 patients. However, he noted that most patients did not have the classic ARDS picture and were not responsive to PEEP. COVID-19 patients who needed CPR had poor outcomes.
Dr. Kern highlighted several drugs that were repurposed, including hydroxychloroquine (anti-malarial), high-dose Vitamin C, dexamethasone, remdevisir (anti-viral), and tocilizumab (IL-6 inhibitor) (Figure 4).
Non-targeted anti-inflammatory therapies that showed benefit included dexamethasone in sicker patients and the early use of convalescent plasma and monoclonal antibodies. Numerous observational studies showed that Vitamin D deficiency increased the risk of mortality. Dr. Kern concluded by praising the hospital systems for a tremendous response to a new disease and emphasized the need for future planning.
- Beigel JH, et a. Remdesivir for the treatment of COVID-19- Final report. N Engl J Med. 2020; 383(19): 1813-26.
- Recovery Collaborative Group, Horby P, et al. Dexamethasone in hospitalized patients with COVID-19. N Engl J Med. 2021; 384(8): 693-704.
- Radujkovic A, et al. Vitamin D deficiency and outcome of COVID-19 patients. Nutrients. 2020; 12(9): 2757.