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Even as the Covid-19 outbreak has already overwhelmed some U.S. hospitals, in many cities anxious physicians feel more like coastal dwellers who learn that a tsunami has formed miles offshore: It hasn’t hit them yet, they know it’s going to, and they are desperate for information about how to survive it.

Now, fed up with what they see as inadequate and confusing directives from public health authorities, many physicians are trying to get on-the-ground advice directly from colleagues in countries that were the first to be hit by the coronavirus pandemic.

Hospitals in Baltimore, including those affiliated with the Johns Hopkins University School of Medicine, are coping, so far. Maryland’s case count rose from 190 on Saturday to 244 on Sunday to 288 by Monday night, however, mirroring where New York and other states were two weeks ago before Covid-19 began inundating their hospitals.

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At Hopkins, physicians had been scanning scientific papers for clues to potential therapies and the use of protective equipment, said infectious disease physician Annie Antar, whose usual focus is HIV: “But our faculty had a lot of questions, so I thought, physicians in China dealt with this successfully.”

Early last week, she asked Weiwei Dai, a postdoctoral fellow in her lab who had graduated from medical school in China, for help. Hey, Antar said, can you connect me with any of your colleagues in China who had experience with Covid-19?

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“All of my medical school classmates are clinicians in China now,” Dai said. “I quickly thought of people” who could help Hopkins understand what was coming and how to cope with it.

It came together within hours: They would have a Zoom meeting on Thursday, led by physician Jian’an Wang, president of the Second Affiliated Hospital of Zhejiang University School of Medicine in Hangzhou. It had sent 123 nurses, 42 physicians, and six other staffers to run an ICU in Wuhan, about 500 miles away, soon after the city was locked down in January. Although the number of new cases there and in surrounding Hubei province has dropped to the single digits (and, on some days, zero), many of the Zhejiang staff are still there.

“When facing a global crisis, sharing of medical and scientific information is invaluable if we are to save lives and halt the pandemic as quickly as possible,” said physician Paul Auwaerter, director of Hopkins’ division of infectious diseases.

A U.S. physician not involved in the Hopkins effort said that more and more of her colleagues are reaching out to those on the front lines in China, South Korea, and Italy for advice, especially as their doubts about guidance from U.S. authorities grow. The U.S. Centers for Disease Control and Prevention originally told physicians, nurses, and others caring for Covid-19 patients to use N95 masks, for instance, but earlier this month changed that to ordinary surgical masks for most needs.

Missouri nurse Rainee Sinroll was one of many U.S. health care workers who answered a STAT survey about their Covid-19 experience. This is “unlike any other outbreak I’ve ever been involved with. Absolutely NO training and info to staff that will be involved.”

The Zhejiang hospital was an obvious place for the Hopkins physicians to seek expert advice. Not only is it top-ranked in China for pulmonary medicine, intensive care, and other specialties, but it has more than 300 international trainees, most from the U.S. and Canada.

We want to work together with you to help fight Covid-19, Wang told the Americans as the hourlong meeting began. Their first question: If you were in our position, at the very beginning of the outbreak, what are the most important things to know?

The Zhejiang contingent took over one makeshift ICU in Wuhan on Feb. 14, plus one ward for Covid-19 patients in an existing hospital. They had 72 ICU patients, 55% older than 65, yet only nine of the ICU patients died; 17% required intubation in order to breathe, a procedure that risks making virus particles not only airborne but also aerosolized — meaning they can remain suspended in the air for some time.

The Hopkins doctors were keen to hear how their counterparts cured 35 intensive-care patients completely and brought the status of another 28 to only mild disease. With no surefire Covid-19 therapy and a blizzard of conflicting information on what existing drugs might work, Antar said, “one of our main questions was about their experience with off-label use” repurposing existing drugs approved for other illnesses to use in the fight against Covid-19.

That experience has involved everything but the kitchen sink, though informed as much as possible by science. Several antivirals, including the HIV drugs lopinavir and ritonavir, did not accelerate recovery or reduce mortality, ICU physician Xiao Lu said. Some immune system regulators — including alpha interferon, anti-IL-6 monoclonal antibodies such as tocilizumab, and immunoglobulin — showed hints of efficacy in some critical cases.

Some patients received the malaria drug chloroquine, which President Trump has touted and which is being tested in a World Health Organization-supported clinical trial, but the Zhejiang team did not have rigorous data on its effects. They tried tocilizumab, too, a drug that has enough potential that on Monday, Genentech announced that it had received U.S. Food and Drug Administration approval for a clinical trial in Covid-19 patients with severe pneumonia; the rheumatoid arthritis drug, which goes by the brand name Actemra, might quell the out-of-control immune reaction that has killed many Covid-19 patients.

“All of us want to practice evidence-based medicine,” Antar said. “But the timeline for this might not allow us to wait for that.”

The right equipment helped. The Zhejiang team brought oxygen supply systems, monitors, ultrasounds, ventilators, and protective equipment from Hangzhou.

Who should be hospitalized, the Hopkins physicians asked? Suspected cases can be isolated and observed in their homes, they were told, as doctors in overwhelmed Italy are also telling U.S. doctors. Mild and moderate cases can be treated in mobile units, away from other patients; coronavirus spread within hospitals has been disastrous in Italy. Severe and critical cases in China get hospitalized, but at a dedicated facility, to reduce spread from Covid-19 patient to hospital worker to non-Covid-19 patient.

How do we know when a patient can be discharged, Antar and her colleagues asked? After a normal body temperature lasting three days, minimal respiratory symptoms, two negative tests for the virus more than 24 hours apart, improvements seen in lung imaging, and no serious underlying conditions, especially for older patients.

The Hopkins teams was impressed with China’s scrupulous measures to minimize viral transmission, “especially among health care workers,” Auwaerter said. “Such measures have successfully slowed the epidemic in China.” In contrast, failing to do so has fueled the disastrous spread of Covid-19 in Italy, physicians at a hospital in the country’s hard-hit north warned over the weekend.

The Wuhan hospitals “had a whole committee on PPE [personal protective equipment] adherence,” Antar said. “People would check if others were using it correctly. They’d work only four hours at a time so they wouldn’t become fatigued” and inadvertently dislodge goggles or other protection. “And they also had a committee to support the families of health care providers, including taking care of elderly parents and taking their children to school” in areas where those remained open.

Thousands of health care workers in China have become infected, though most of those cases occurred before stringent PPE practices kicked in. None of the Zhejiang contingent was infected.

As a result of the meeting, Hopkins’ infectious disease staff asked administrators to develop a plan, now, to set up, manage, and staff isolation units, Antar said, “pushing for measures that closely match what was done in China.”

While the Hopkins team is designing an evidence-based response, their Zhejiang colleagues ended the meeting Thursday by praying for the Americans.

  • Thank you so much to all of our healthcare professionals in the US and all over the world, and an extra big thank you to those in China helping us prepare for this virus.
    (Our apologies for the uneducated people who make arrogant remarks in reguards to where or how this happened, that does not matter. It could have started anywhere. I try and pitty those stupid enough to assume they are somehow immune to a threat they cannot see an so not understand, but the truth is right there and yet they continue to be selfish in their ways.)

    Many of us have been praying and routing for the health care workers and everyone in China to fight off this virus. So happy to hear you are winning! My heart breaks for those who have lost loved ones. We also pray for Italy and all other places that are being affected.

    We all need eachother, we need eachothers experience, we need eachothers empathy and kindness, we need eachothers help, now more than ever especially the knowledge of those who have been in the middle of the war developing treatments and learning how to defeat the virus.

    We can be proud of our countries and heritage and still respect and care for eachother. Becasue in the end, a virus doesn’t stop at boarders, it attacks us as its human hosts, and as the human race, all together as one, we fight back, we fight alone, then we fail alone, we fight together and we will win.

    • Well spoken Marie, if you or your loved ones are not affected by this virus, you have to be thankful to God but that doesn’t mean you shouldn’t be of help to the people suffering all over the world.
      Currently I got a news that the out break of the virus has reached Africa and is now affecting people living in Nigeria. This is what we should come out to know how to control this bad situation. I have volunteered to fight this with all my life. Chat me up on [email protected] let’s talk privately to know how to be of help to the world. Please don’t be selfish.

    • I would like to counter your statement that “ this could have started anywhere”. It ordinated from bats and where giant open air food markets and the consumption of bush meat and any strange food is allowed to pile upon other living and dead animals. Just look up Chinese open air markets and research how many people I’m the world eat bat soup! I fail to believe that is ANYWHERE.

  • China to Ease Coronavirus Lockdown on Hubei 2 Months After Imposing It. Lockdown has helped China to control Coronavirus in the areas where it spread.
    India to go into complete lockdown for 21 days: PM Modi.Rs 15,000 Crores allotted for the Coronavirus control.
    The entire Nation welcomes it Prime Ministerji. With Strict Social Distance this Coronavirus can be controlled. The example of Italy shows that People took it light and even after so much havoc,still people are moving in some places freely. Unlike other Pandemics Coronavirus is Exponential.

    CORONAVIRUS – SOCIAL DISTANCE MEASURES

    From the perspective of epidemiology, the basic goal behind social distancing is to decrease the basic reproduction number, Ro, which is the average number of secondary infected individuals generated from one primary infected individual in a population where all individuals are equally susceptible to a disease. In a basic model of social distancing, where a proportion f of the population engages in social distancing to decrease their interpersonal contacts to a fraction a of their normal contacts, the new effective reproduction number R is given by:

    R = [ 1 – ( 1-a2 )f | Ro ]
    For example, 25% of the population reducing their social contacts to 50% of their normal level gives an effective reproduction number about 81% of the basic reproduction number. A seemingly small reduction has a profound effect in delaying the exponential growth and spread of a disease.
    Our ,Entire nation observed Janata Curfew voluntarily following PM’s appeal to check spread of Corona virus

    The entire country observed Janata Curfew today(22nd March) following Prime Minister Narendra Modi’s appeal for people to voluntarily stay indoors to check the spread of Corona virus. In his address to the nation on 19th March of this month, he urged public to avoid stepping out of their homes.
    Prime Minister said the steps we take now will help in the times to come. People’s restraint and determination will defeat the epidemic. At 5 pm on 22nd instant everybody came out openly clapped to thank Doctors and others who helped to check the spread of the coronavirus.
    Though the Union Government and different State Governments are taking effective steps to check Coronavirus,the huge funds required can be supplemented by Public donations including from Industrialists,Film Industry,Officials,Doctors and general public. I suggested to our Prime Minister to appeal towards this end. As it will have more impact having come from Prime Minister.
    Dr.A.Jagadeesh Nellore(AP),India

  • I work in science. Looking over publications I found that there was research going on about how to safely reuse N95 masks that is very promising. This article, published based on Air Force research work should be circulating to hospitals. It offers 3 simple, safe and effective methods to sterilize masks based on H1N1. A quick look at research on SARS coronavirus indicates it responds similarly to all these decontamination methods, so they should work for SARS-CoV-2 as well!

    Heimbuch, Brian K., et al. “A pandemic influenza preparedness study: use of energetic methods to decontaminate filtering facepiece respirators contaminated with H1N1 aerosols and droplets.” American journal of infection control 39.1 (2011): e1-e9.

  • You are sadly correct Sarah…
    Unfortunately the leaders in China have demonstrated over and over they are not honest or credible partners even in critical matters like this.

    One need only look at their response to SARS, looking the other way while colistin continues to be used in pork feed creating resistant E coli that is untreatable, or it’s well-documented program of forced organ harvesting often without anesthesia. Let’s not forget the initial whistleblowers we’re silenced and disappeared. China’s Communist Party posthumously reprimanded dr.li for calling the world’s attention to the outbreak in Wuhan

  • This is really commendable as 4 hours of PPE is enough for anyone to undergo some trauma in this sort of epidemic response – emotional , physical and social as well. The resilient network is good. I believe the ambulance drivers were trained. Basic SOPS were formulated when we were out there in West AFrica during the last Ebola outbreak in 2014 -2016 and now I was fortunate to be a part of EVD preparedness and response . This article clearly shows how a turbulant phase was tackled by the exceptional colleagues who asked and seeked continuously in order to care better , treat better and regain confidence at the end. The challenge was accepted , the doctors pooled their experience and this probably will help them survive much better for delivering the very best that they had once aspired for . Kudos to all of these medics

    • This is nothing but the truth. All hand must be on deck, in order to find solutions on how to eradicate this out break of virus that has shot down the world economy.

  • That is not a good idea. They are liar and hid information to the world. Now, they think themselve as savers to help other counties. Wake up people!

    • Also, I would like to add additional information. No one can access the correct data from China government. China government reports their data officially on the official website. Other countries only report those data on their website. Without transparent, why do we trust them?

    • That doesn’t mean that the individuals are not trustworthy human beings, because they are.

      You comment is racist and irrelevant to the article. Yes there is a need to help the Chinese citizens if they want us to help to handle their government. How about Trumps lies and what about his trying to buy Vaccine rights strictly to be used or distributed by our government? Governments can suck, but they are not always a reflection of the general population. But that’s not the issue are discussing.

      You are adding to a different problem. Not helping anything at all. Do you really think you know more about infectious viruses, how they affect the human body, and the best treatments and procedures than the Doctors at John Hopkins?

      Please people, the health care community is doing everything in their power DESPITE our governments failing them and us! Please give them the respect they deserve and earned and let them do their jobs!

      Thank you to all them. That’s all you should be saying.

    • I think I this situation now, no one is to be trusted. All we have to be looking for is how to get a solution to this out break of coronavirus that is spreading all over the world. Your opinion and mine can go a long way to help in this situation.

    • Agreed. But I will probably get called “ racist” too ;when someone whom you don’t trust or withholds information is called out, it has nothing to do with race.(in that case I would be racist against my kids lol)

    • Marie, the question is not about race but whether the number of people that were reported as recovered, really were. There have been activists who through social engineering gained estimates of what the true death toll in Wuhan reached last month. It was conservatively 4 times the total death toll reported by the whole country of China. People in China are forced to say things they do not believe everyday. It certainly would be better to take the data and recommendations from some other country.

  • Fantastic there is clinician to clinician communications.
    China has much to answer for regarding mid November until late January. In the meantime it’s heartening to see the best of our profession transcend the politics

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