Lecciones desde el epicentro occidental de la pandemia: la experiencia de Montefiore Health System en el manejo de pacientes infectados con COVID19 en la ciudad de Nueva York
[Lecciones desde el epicentro occidental de la pandemia: la experiencia de Montefiore Health System en el manejo de pacientes infectados con COVID19 en la ciudad de Nueva York]Roberto Christian Cerrud-Rodriguez1, Gerardo Victoria2, Julio Sandoval3, Cesar Cuero4, Fernando Alfaro4, Mario J Garcia1
1. División de Cardiología, Montefiore Health System/Albert Einstein College of Medicine Ciudad de Nueva York Estados Unidos; 2. Hospital Santo Tomás Ministerio de Salud Ciudad de Panamá República de Panamá; 3. Comité Asesor del Ministerio de Salud en asuntos relacionados a la pandemia de COVID-19 República de Panamá; 4. Caja de Seguro Social Ciudad de Panamá República de Panamá;
Resumen
[Lessons learned from the pandemic’s Western epicenter: the experience of Montefiore Health System in the management of patients infected with COVID19 in New York City]
ResumenMontefiore Health System, red de hospitales universitarios afiliados al Albert Einstein College of Medicine, ha sido uno de los principales frentes de batalla contra el COVID-19 en la ciudad de Nueva York, epicentro occidental de la pandemia. Con múltiples campus localizados principalmente en el Bronx, donde la tasa de infección por COVID-19 es de 2,048/100,000 habitantes, ha tenido que enfrentar la pandemia desde sus inicios. La experiencia acumulada a lo largo de estos meses es invaluable, aunque desafortunadamente gran parte de ella ha sido adquirida en base a ensayo y error, dada la novedad de este virus y la ausencia de guías de manejo basadas en la evidencia. Nuestra experiencia es también relevante ya que el 35% de nuestra población es de raza Hispana. En las siguientes páginas repasamos aquello que sabemos sobre los inicios del SARS-CoV-2, las tesis más aceptadas acerca de su fisiopatología, su curso clínico, el manejo inicial una vez el paciente es admitido a nuestra institución con el diagnóstico de COVID-19. También exponemos nuestras experiencias en el manejo terapéutico de las complicaciones multiorgánicas que provoca esta entidad.
Abstract
Montefiore Health System, a network of university hospitals affiliated with the Albert Einstein College of Medicine, has been one of the main fronts in the battle against COVID-19 in New York City, western epicenter of the pandemic. With multiple campuses located mainly in The Bronx, where the rate of infection is of 2,048/100,000 inhabitants, it had to fight the pandemic since its very beginning. The experience gained during these past months is invaluable, although unfortunately most of it had to be learned by trial and error, given the novelty of this coronavirus and the complete lack of evidence-based guidelines. Our experience is particularly relevant given that 35% of our patient population is of Hispanic heritage. In the next few pages, we’ll go over what we currently know about the beginnings of SARS-CoV-2, the currently accepted hypothesis about its pathogenesis, its clinical course, and its initial management once a COVID+ patient is admitted to our institution. We also share our experiences with the clinical management of the multiorgan complications caused by this disease.
Abstract
[Lessons learned from the pandemic’s Western epicenter: the experience of Montefiore Health System in the management of patients infected with COVID19 in New York City]
ResumenMontefiore Health System, red de hospitales universitarios afiliados al Albert Einstein College of Medicine, ha sido uno de los principales frentes de batalla contra el COVID-19 en la ciudad de Nueva York, epicentro occidental de la pandemia. Con múltiples campus localizados principalmente en el Bronx, donde la tasa de infección por COVID-19 es de 2,048/100,000 habitantes, ha tenido que enfrentar la pandemia desde sus inicios. La experiencia acumulada a lo largo de estos meses es invaluable, aunque desafortunadamente gran parte de ella ha sido adquirida en base a ensayo y error, dada la novedad de este virus y la ausencia de guías de manejo basadas en la evidencia. Nuestra experiencia es también relevante ya que el 35% de nuestra población es de raza Hispana. En las siguientes páginas repasamos aquello que sabemos sobre los inicios del SARS-CoV-2, las tesis más aceptadas acerca de su fisiopatología, su curso clínico, el manejo inicial una vez el paciente es admitido a nuestra institución con el diagnóstico de COVID-19. También exponemos nuestras experiencias en el manejo terapéutico de las complicaciones multiorgánicas que provoca esta entidad.
Abstract
Montefiore Health System, a network of university hospitals affiliated with the Albert Einstein College of Medicine, has been one of the main fronts in the battle against COVID-19 in New York City, western epicenter of the pandemic. With multiple campuses located mainly in The Bronx, where the rate of infection is of 2,048/100,000 inhabitants, it had to fight the pandemic since its very beginning. The experience gained during these past months is invaluable, although unfortunately most of it had to be learned by trial and error, given the novelty of this coronavirus and the complete lack of evidence-based guidelines. Our experience is particularly relevant given that 35% of our patient population is of Hispanic heritage. In the next few pages, we’ll go over what we currently know about the beginnings of SARS-CoV-2, the currently accepted hypothesis about its pathogenesis, its clinical course, and its initial management once a COVID+ patient is admitted to our institution. We also share our experiences with the clinical management of the multiorgan complications caused by this disease.
Citas
[1] Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3.
[2] Silver AC, D. China is tightening its grip on coronavirus research 2020 [cited 2020 April 21]. Available from: https://www.nature.com/articles/d41586-020-01108-y.
[3] Walls AC, Park YJ, Tortorici MA, Wall A, McGuire AT, Veesler D. Structure, Function, and Antigenicity of the SARS-CoV-2 Spike Glycoprotein. Cell. 2020;181(2):281-92.e6.
[4] Ciceri F, Beretta L, Scandroglio AM, Colombo S, Landoni G, Ruggeri A, et al. Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis. Crit Care Resusc. 2020.
[5] Li H, Liu L, Zhang D, Xu J, Dai H, Tang N, et al. SARS-CoV-2 and viral sepsis: observations and hypotheses. Lancet. 2020.
[6] Dolhnikoff M, Duarte-Neto AN, de Almeida Monteiro RA, Ferraz da Silva LF, Pierre de Oliveira E, Nascimento Saldiva PH, et al. Pathological evidence of pulmonary thrombotic phenomena in severe COVID-19. J Thromb Haemost. 2020.
[7] Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020.
[8] Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. Jama. 2020.
[9] Xie J, Tong Z, Guan X, Du B, Qiu H. Clinical Characteristics of Patients Who Died of Coronavirus Disease 2019 in China. JAMA Network Open. 2020;3(4):e205619-e.
[10] Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199-207.
[11] Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.
[12] Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020.
[13] van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564-7.
[14] Alhazzani W, Moller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020.
[15] Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020.
[16] Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020.
[17] Magagnoli J, Narendran S, Pereira F, Cummings T, Hardin JW, Sutton SS, et al. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. medRxiv. 2020:2020.04.16.20065920.
[18] Principi N, Esposito S. Chloroquine or hydroxychloroquine for prophylaxis of COVID-19. Lancet Infect Dis. 2020.
[19] Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the Treatment of Covid-19 - Preliminary Report. N Engl J Med. 2020.
[20] Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301-8.
[21] Beun R, Kusadasi N, Sikma M, Westerink J, Huisman A. Thromboembolic events and apparent heparin resistance in patients infected with SARS-CoV-2. Int J Lab Hematol. 2020.
[22] Barrett CD, Moore HB, Yaffe MB, Moore EE. ISTH interim guidance on recognition and management of coagulopathy in COVID‐19: A Comment. Journal of Thrombosis and Haemostasis. 2020.
[23] Castagna F, Cerrud‐Rodriguez R, Villela MA, Bortnick AE. SARS‐COV ‐2 infection presenting as ST‐elevation myocardial infarction. Catheterization and Cardiovascular Interventions. 2020.
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