Amid the chaos of the pandemic's early days, doctors who faced the first coronavirus onslaught reached across oceans and language barriers to advise colleagues trying to save lives in the dark.
With no playbook to follow and no time to wait for research, YouTube videos describing autopsy findings and X-rays swapped on Twitter and WhatsApp spontaneously filled the gap.
When Stephen Donelson arrived at the University of Texas Southwestern Medical Center in mid-March, Dr. Kristina Goff was among those who turned to what she called "the stories out of other places that were hit before."
Donelson's family hadn't left the house for two weeks after covid-19 started spreading in Texas, hoping to protect Donelson, an organ transplant recipient. Yet one night, his wife found him barely breathing, his skin turning blue, and called 911.
[CORONAVIRUS: Click here for our complete coverage arkansasonline.com/coronavirus]
In the overflowing hospitals in New York or Italy, Goff thinks Donelson wouldn't even have qualified for a then-precious ventilator. But in Dallas, "we pretty much threw everything we could at him," she said.
STEEP LEARNING CURVE
Like doctors everywhere, Goff was at the beginning of a huge learning curve.
"It's a tsunami. Something that if you don't experience it directly, you can't understand," Italian Dr. Pier Giorgio Villani said in the first of a series of webinars organized to alert other intensive care units what to expect -- just two weeks after Italy's first hospitalized patient arrived in his ICU, and 10 days before Donelson fell ill in Texas.
The video sessions, organized by an Italian association of ICUs, GiViTI, and the nonprofit Mario Negri Institute and later posted on YouTube, constitute an oral history of Italy's outbreak, narrated by the first doctors in Europe to fight the coronavirus.
Italian friends spread the word to doctors abroad, and translations began for colleagues in Spain, France, Russia and the U.S., all bracing their own ICUs for a flood of patients.
They offered "a privileged window into the future," said Dr. Diego Casali of Cedars-Sinai Medical Center in Los Angeles, who was directed to the webinars when he sought advice from an Italian front-line friend about how to prepare.
Every tidbit about the newest baffling symptom, every trick to try, served as clues as the virus bore down on the next city, the next country. By the time Donelson arrived, Goff's hospital was adjusting ventilator care based on that early advice.
But while grateful for the global swirl of information, Goff also struggled to make sense of conflicting experiences. "You have no idea how to interpret what went right or what went wrong," she said, "or was it just the native course of the disease?"
CONFUSING TIME
Doctors in Italy were confused: Reports from China were suggesting a death rate of about 3% among those infected. But for the first 18 days, only dead people left the ICU at Bergamo's Pope John XXIII Hospital. While the toll eventually dropped, 30% of the hospital's initial 510 covid-19 patients died.
After decades in practice, ICU chief Dr. Luca Lorini thought he knew how to treat the dangerous kind of respiratory failure -- called ARDS, or acute respiratory distress syndrome -- first thought to be the main threat.
"Every night, I would go home and I had the doubt that I had gotten something wrong," Lorini said. "Try to imagine: I am all alone, and I can't compare it with France because the virus wasn't there, or Spain or the U.K. or America, or with anyone who is closer to me than China."
By February, China had filed only a limited number of medical journal reports on how patients were faring. Lorini's hospital tried to fill the gap by dividing patients into small groups to receive different forms of supportive care and comparing them -- not a scientific study, but some real-time information to share.
The first lessons: The coronavirus wasn't causing typical ARDS, and patients consequently needed gentler ventilation than normal, for longer than usual.
Mid-March brought a startling surprise: In a training video for U.S. cardiologists, Chinese doctors warned that the virus causes dangerous blood clots, and not just in the lungs. They urged American doctors to use blood thinners protectively in the severely ill.
"We're learning as we go," said Dr. Tiffany Osborn, a critical care physician at Washington University School of Medicine in St. Louis. "You could talk to me in two weeks, and I might be telling you something that's really different."
A NEW SKILL
When Donelson arrived in the Dallas hospital, "we had very little hope for him," Goff said. He was battling against the ventilator's artificial breaths, so Goff sedated him to let the machine do all the work.
Hospital after hospital had struggled with balancing how to get enough air into oxygen-starved coronavirus patients without further damaging fragile lungs. One procedure that helped is proning -- turning patients from their backs to their stomachs in a prone position to take pressure off the lungs.
Donelson stayed on his belly about 16 hours a day early on, as his doctors watched his oxygen levels improve.
Hospitals that specialize in treating ARDS knew how to prone before covid-19 hit. For many others, it was a brand-new skill.
"We've never had to prone anyone here before the pandemic, but now it's like second nature," said Kevin Cole, a respiratory therapist at Maryland's Fort Washington Medical Center.
Even now, Goff is humbled at how difficult it remains to predict who will live and who will die. She can't explain why Donelson, who went home after a 90-day ordeal, was ultimately one of the lucky ones.
Information for this article was contributed by Nathan Ellgren of The Associated Press.
FILE - In this Monday, March 16, 2020 file photo, a doctor watches a coronavirus patient under treatment in the intensive care unit of the Brescia hospital, Italy. Amid the chaos of the pandemics early days, doctors who faced the first COVID-19 onslaught reached across oceans and language barriers in an unprecedented effort to advise colleagues trying to save lives. (AP Photo/Luca Bruno)
Stephen Donelson, left, smiles as he walks up his driveway to his home accompanied by his wife, Terri, in Midlothian, Texas on Friday, June 19, 2020, after his 90-day stay in the Zale Hospital on the UT Southwestern Campus. Donelsons family hadnt left the house in two weeks after COVID-19 started spreading in Texas,hoping to shield the organ transplant recipient. Yetone night, his wife found him barely breathing, his skin turning blue,and called 911. (AP Photo/Tony Gutierrez)
COVID-19 patient Stephen Donelson is applauded by family and health care professionals as he departs the Zale Hospital on the UT Southwestern Campus in Dallas, Friday, June 19, 2020. During his three-month hospital stay, Donelson spent 17 days on a ventilator. When it was removed, he was too weak to even sit without support and the breathing tube had taken away his ability to swallow. (AP Photo/Tony Gutierrez)
FILE - In this Thursday, March 12, 2020 file photo, medical staff in work at one of the emergency structures that were set up to ease procedures at the Brescia hospital, northern Italy. Amid the chaos of the pandemics early days, doctors who faced the first coronavirus onslaught reached across oceans and language barriers in an unprecedented effort to advise colleagues trying to save lives. (AP Photo/Luca Bruno)
Terri Donelson and her husband, Stephen, right, are greeted by friends, family and neighbors after his arrival at his home in Midlothian, Texas on Friday, June 19, 2020. A trick doctors around the world shared with each other: Flip COVID-19 patients over from their backs to their stomach. Its called proning and it takes pressure off the lungs, which lie closer to the back. Donelson stayed on his belly about 16 hours a day early on, as his doctors watched his oxygen levels improve. (AP Photo/Tony Gutierrez)
Terri Donelson, left, and her husband, Stephen, walk up their driveway to see friends and family awaiting him at his home in Midlothian, Texas on Friday, June 19, 2020, after his 90-day stay in the Zale Hospital on the UT Southwestern Campus. Donelsons family hadnt left the house in two weeks after COVID-19 started spreading in Texas,hoping to shield the organ transplant recipient. Yetone night, his wife found him barely breathing, his skin turning blue,and called 911. (AP Photo/Tony Gutierrez)
The rest is here:
Treating of virus work in progress - Arkansas Online
- Progress Lighting - Home - December 22nd, 2016 [December 22nd, 2016]
- Home - Progress Lighting Outlet - Authorized Progress Dealer - January 13th, 2017 [January 13th, 2017]
- What does progress mean? - Definitions.net - January 13th, 2017 [January 13th, 2017]
- Progress Fire Company Harrisburg, PA - January 13th, 2017 [January 13th, 2017]
- Homepage Center for American Progress - January 13th, 2017 [January 13th, 2017]
- Progress being made on possible grocery store co-op in Winston-Salem - myfox8.com - February 7th, 2017 [February 7th, 2017]
- Nioh Review-in-Progress: FromSoftware's Formula Evolved - Shacknews - February 7th, 2017 [February 7th, 2017]
- Deutsche Bundesbank Cites Progress With Blockchain-Based Settlement - CryptoCoinsNews - February 7th, 2017 [February 7th, 2017]
- IMF: Greece's debts are still unsustainable despite progress - The Seattle Times - February 7th, 2017 [February 7th, 2017]
- Think Progress Editor Mocks Audi for Equal Pay Super Bowl Ad - Breitbart News - February 7th, 2017 [February 7th, 2017]
- Progress apparent on defense - Pittsburgh Steelers - Steelers.com - February 7th, 2017 [February 7th, 2017]
- IMF: Greece's Debts are Still Unsustainable, Despite Progress - Voice of America - February 7th, 2017 [February 7th, 2017]
- Can US disrupter-in-chief trigger some progress? - Jerusalem Post Israel News - February 7th, 2017 [February 7th, 2017]
- The Cost of Progress - Slate Magazine - February 7th, 2017 [February 7th, 2017]
- Cavaliers' pitching rotation a work in progress | Cavalier Insider ... - The Daily Progress - February 8th, 2017 [February 8th, 2017]
- High schoolers create 'zines for progress' with WolfsonianFIU - FIU News - February 8th, 2017 [February 8th, 2017]
- Cries of 'dictator' show Pope Francis is making progress - Crux: Covering all things Catholic - February 8th, 2017 [February 8th, 2017]
- Officials: City is making progress in effort to address opioid crisis - The Union Leader - February 8th, 2017 [February 8th, 2017]
- IN OUR VIEW: Work Ready in Progress for Carter - The Independent - February 8th, 2017 [February 8th, 2017]
- BP's Earnings Keep Showing Progress, Even if the Headline Results Don't Say So - Motley Fool - February 8th, 2017 [February 8th, 2017]
- Women's Progress in the Boardroom Took a Hit in 2016 - Inc.com - February 9th, 2017 [February 9th, 2017]
- Blight Elimination Progress, Uplifting - MyWabashValley - February 9th, 2017 [February 9th, 2017]
- Rauner 'heartened' by progress in Springfield - Bloomington Pantagraph - February 9th, 2017 [February 9th, 2017]
- David Johnson showed off the insane progress he's making in rehab from his knee injury - USA TODAY - February 9th, 2017 [February 9th, 2017]
- Through the looking glass: Tower view showcases progress on Amazon's unique biospheres - GeekWire - February 9th, 2017 [February 9th, 2017]
- Britney Spears Says Niece Maddie Is 'Making Progress' After ATV Accident: 'Let's All Keep Praying' - PEOPLE.com - February 9th, 2017 [February 9th, 2017]
- Progress on vet's Mustang to be unveiled - Indianapolis Star - February 9th, 2017 [February 9th, 2017]
- Evgeni Malkin making 'progress,' could return Saturday in Arizona - Pittsburgh Post-Gazette - February 9th, 2017 [February 9th, 2017]
- Forecasters See Slow Progress in Labor-Market Measures Favored by Trump Administration - Wall Street Journal - February 9th, 2017 [February 9th, 2017]
- 'Paper boys' were the lifeblood of The Daily Progress - The Daily Progress - February 10th, 2017 [February 10th, 2017]
- Cliffs Natural Resources Is Showing a Lot of Progress on Its Return to Profitability - Motley Fool - February 10th, 2017 [February 10th, 2017]
- ATA says states' telemedicine progress a mixed bag ... - FierceHealthcare - February 10th, 2017 [February 10th, 2017]
- Seltzer's Notebook | Colangelo Encouraged by Sixers' Progress - Sixers.com - February 10th, 2017 [February 10th, 2017]
- The Trump administration can't entirely roll back progress on climate change here's why - Washington Post - February 10th, 2017 [February 10th, 2017]
- Colts position review: OL showed legit progress, but work remains - Indianapolis Star - February 10th, 2017 [February 10th, 2017]
- Egyptian Economy Making Slow, Tentative Progress - Voice of America - February 10th, 2017 [February 10th, 2017]
- ATA: States show mixed progress with telemedicine | Healthcare Dive - Healthcare Dive - February 11th, 2017 [February 11th, 2017]
- Louisville City notes: McCabe making progress - The Courier-Journal - February 11th, 2017 [February 11th, 2017]
- Jeremy Lin: Progress but no timetable - NetsDaily - February 11th, 2017 [February 11th, 2017]
- Marginal progress for Turkish-backed forces in north Syria - LA Daily News - February 11th, 2017 [February 11th, 2017]
- Jimmy Cheek: UT chancellor appreciative of hard work, progress on journey - Knoxville News Sentinel - February 12th, 2017 [February 12th, 2017]
- Syria Regional Crisis 2016 Emergency Appeal - Progress Report - Reliefweb - February 12th, 2017 [February 12th, 2017]
- CWLP officials: Bailout repayment would set back progress - The State Journal-Register - February 12th, 2017 [February 12th, 2017]
- Pistons' Johnson making halting but definite progress - The Detroit News - February 12th, 2017 [February 12th, 2017]
- Clairton works: Real progress is coming to the former steel town - Pittsburgh Post-Gazette - February 12th, 2017 [February 12th, 2017]
- The Democrats' Strategy: Hindering Progress For Partisan Politics - Daily Caller - February 13th, 2017 [February 13th, 2017]
- The surprising progress stoppers on the Dallas Cowboys defensive line - Cowboys Wire - February 13th, 2017 [February 13th, 2017]
- Gender Progress in Ballet - Huffington Post - February 13th, 2017 [February 13th, 2017]
- Foyt pleased with progress, regrets lack of time - Motorsport.com, Edition: Global - February 13th, 2017 [February 13th, 2017]
- Progress Made, but Threat Lingers at California's Oroville Dam - Wall Street Journal - February 13th, 2017 [February 13th, 2017]
- Adele, Beyonc, and the Grammys' Fear of Progress - The Atlantic - February 13th, 2017 [February 13th, 2017]
- North Korea Claims Progress on Long-Range Goal With Missile Test - New York Times - February 13th, 2017 [February 13th, 2017]
- How Travel Bans Can Impede America's Progress - Forbes - Forbes - February 13th, 2017 [February 13th, 2017]
- Jeff Sessions' appointment threatens decades of civil rights progress - The Hill (blog) - February 14th, 2017 [February 14th, 2017]
- Ionis Earns $75M Milestone from Bayer for Progress of Antisense Drug Program - Genetic Engineering & Biotechnology News (press release) - February 14th, 2017 [February 14th, 2017]
- Guilford Schools annual report shows mixed results on progress - Greensboro News & Record (blog) - February 14th, 2017 [February 14th, 2017]
- Sniper Elite 4 review in progress - PC Gamer - February 14th, 2017 [February 14th, 2017]
- For Honor Review In Progress - GameSpot - February 14th, 2017 [February 14th, 2017]
- China's military progress challenges Western dominance, says IISS - Deutsche Welle - February 15th, 2017 [February 15th, 2017]
- PFW in Progress Recap 2/14: Patriots Offseason Outlook | New ... - Patriots.com - February 15th, 2017 [February 15th, 2017]
- Daily Progress, chamber establish regional business Hall of Fame - The Daily Progress - February 15th, 2017 [February 15th, 2017]
- Huntsville-based Progress Bank to acquire Birmingham's First Partners Bank - Birmingham Business Journal - February 15th, 2017 [February 15th, 2017]
- City, UF sign partnership for progress - Gainesville Sun - February 15th, 2017 [February 15th, 2017]
- California officials lift evacuation order for 200000 threatened by damaged dam - CBS News - February 15th, 2017 [February 15th, 2017]
- 5G progress at Ericsson could help enterprises work worldwide - Computerworld - February 16th, 2017 [February 16th, 2017]
- Officials making 'great progress' on California dam repairs, remind residents to stay vigilant - Fox News - February 16th, 2017 [February 16th, 2017]
- Halo Wars 2 Review in Progress - IGN - February 16th, 2017 [February 16th, 2017]
- CUGNON: Forward progress - Yale Daily News (blog) - February 16th, 2017 [February 16th, 2017]
- F-35 Program Makes Significant, Solid Progress, Official Says - Department of Defense - February 16th, 2017 [February 16th, 2017]
- Lenovo's data center ambitions remain work in progress following Q3 results - ZDNet - February 16th, 2017 [February 16th, 2017]
- PFW in Progress Recap 2/16: Free Agency and Potential Patriots - Patriots.com - February 16th, 2017 [February 16th, 2017]
- S&P 500: 'Blow-off' Phase in Progress - DailyFX - February 16th, 2017 [February 16th, 2017]
- Combine invites are another sign of progress at Michigan - Big Ten ... - ESPN (blog) - February 16th, 2017 [February 16th, 2017]
- Halo Wars 2 review in progress - PC Gamer - February 17th, 2017 [February 17th, 2017]
- 'Hero' film produced just for Charlottesville featured the mayor, The Daily Progress - The Daily Progress - February 17th, 2017 [February 17th, 2017]
- Republicans' health care overhaul still a work in progress - Press Herald - February 17th, 2017 [February 17th, 2017]
- Trump Boasts Of 'Incredible Progress' In 4 Weeks Of Presidency - NPR - February 17th, 2017 [February 17th, 2017]
- Donald Trump touts promise progress at press conference - PolitiFact - February 17th, 2017 [February 17th, 2017]
- Mild winter helping crews make significant progress on East End Connector - WRAL.com - February 18th, 2017 [February 18th, 2017]
- Committee updates Legislature on precinct consolidation progress - Chicago Tribune - February 18th, 2017 [February 18th, 2017]